🤌💰 Meet the Medical Mafia: Paper Mills Exposed

👋 Happy Friday. Okay. So I was going to wait until your birthday. But you’re just so wonderful, I couldn’t wait. I’ve been saving up… I got you a gift. I got you some med news 🎂 🥳.

I know, I know. I shouldn’t have. But here you go 😊 

Here’s what we got:

• 💰 Meet The Medical Mafia: Paper Mills Exposed

•  🎭️ To AI, or not to AI - That Is The Question

• #TheMoreYouKnow: Other Top Stories of The Week

If you want to read any previous editions of The Handover, you can on our website.

RESEARCH UPDATE
Meet The Medical Mafia: Paper Mills Exposed

Are you aware of what's been going on? Crime is on the rise. 

I’m not talking about moped theft, murder, or even unpaid TV licences. Something more insidious…. Colleagues in your MDT might even be complicit.

Because beneath the academic journal lurks a festering criminal underground. A whole cartel of “paper mills” (the academic mafia) quietly polluting research with fake studies that slip into print, only to be retracted and shredded in PubPeer comments later.

Whispers about the medical mob have been circulating like the boogeyman. Rumours, mostly. Until now. 

A paper published in the Proceedings of the National Academy of Sciences has exposed the truth, unpacking just how rife fake academia really is.

But first, how do these mills actually work?

You’re a resident doctor. The job is already hard enough. But now, if you want any real shot at a job in your desired speciality, you’ve got to “enrich” your portfolio too.

So you play the game of academia, trying your best to get published. But grovelling and kissing up gets tiring. Surely there must be an easier way? 

You’re approached by a shady man, in a shadier trenchcoat, with shady sunglasses to boot. He claims he can make your academic woes fade away. You’ll get published. All he’ll need is your name, institution, and a $500-$2000 payment.

You give him what he wants.

In his lair, he has an army of ghostwriters who:

1. Invent a study (fake data, made-up participants, fictional lab results)

2. Recycle old graphs/images from unrelated real studies

3. Insert citations to other clients’ papers, so everyone in the network boosts their citation. 

After the paper is cooked, they must infiltrate the journals. The mills pay off editors to traffic their research. They wave the paper through without real scrutiny.

And just like that, your name’s on a totally-not-bogus paper.
No one’s the wiser.

Enter Richardson et al. These researchers dug deep into PLOS ONE, a megajournal with open metadata. What they found was a web of suspicious editors and dodgy papers.

The findings are quite disturbing:

• They found 32,786 unique suspected paper mill articles

• The flagged editors handled 1.3% of total papers published, but were responsible for 30.2% of the papers retracted articles - one editor in particular put out 79 papers with 49 being retracted. 

• Image duplication: 2,213 articles were flagged for having duplicated images – a clear indicator of research misconduct. Worryingly, only 34% had been retracted.

• Beyond PLOS ONE, the same suspicious editor behaviour was spotted across 10 journals published by Hindawi – a publisher that had to close down after being overrun by paper mill spam.

• The team uncovered outfits like ARDA — a publication broker offering "journal placements" for $250 to $500. The authors note ARDA pushes for “problematic” articles to be published on behalf of their clients. 

So, we know the fraud’s real. We know it’s organised. And we know it’s accelerating. But the question is what are institutions going to do about it?

Publishing fraud has alarming consequences on the quality of scientific research and healthcare as a whole. Without drastic action, much more snake oil will end up in systematic reviews.

That said…If you know a paper mill runner, send them my way 👀 If you can’t beat ’em… join ’em.

RESEARCH UPDATE
🎭 To AI, or not to AI - that is the question

To all my budding surgeons: how cosy have you gotten with GPT lately? Is it honing your scalpel skills… or just letting you coast on autopilot while you daydream about how good that viral Creed TikTok edit was. 

This week, two fresh studies landed with very different takes on AI in medical procedures. 

So, is AI in the operating theatre a force for good… or just a force for incompetence?

First up, a randomised controlled trial in JAMA Surgery from McGill University. They’ve built a fancy AI surgical teaching system called Intelligent Continuous Expertise Monitoring System (ICEMS).

Here’s how it works:

• You practice surgery in VR.

• The system measures everything from bleeding risk to healthy tissue injury risk to how aggressively you’re holding your bipolar forceps.

• It spits out a surgical score from −1.00 (novice) to 1.00 (expert), comparing you against an established pro.

• It instructs your practice giving you real time feedback. 

87 students trained with either:

1. AI-only feedback, 

2. AI read aloud by a human

3. Personalised AI-informed human coaching.

The key finding of this trial is that group 3 was the best. Achieving much higher scores across trials and the realistic task than group 1 and 2.

Unfortunately, this trial did not have an intervention group that was human instruction alone. So we don't know if AI + Human > Human alone. 

But, all in all, we can see AI is a pretty good teacher, or rather, teaching assistant.

On the other hand we have this study out of The Lancet Gastroenterology. 

Since late 2021, four Polish endoscopy centres have been part of the ACCEPT trial, a real-world programme where AI systems assist in spotting polyps during colonoscopy. 

The researchers wanted to know: if doctors get used to having AI spot polyps for them, does their own detection ability drop when the AI isn’t there?

They reviewed 1,442 colonoscopies before and after AI systems were rolled out across four endoscopy centres in the ACCEPT trial.

The research found:

• Polyp detection in non-AI procedures dropped by 6% after regular AI exposure.

• Adenoma detection rate(the gold-standard measure of colonoscopy quality) fell from 28.4% to 22.4%.

• Experience didn’t protect: The decline occurred regardless of the endoscopist’s years of experience or specialty.

So, what do we make of this?

These two studies are like the “angel and devil on your shoulder” when it comes to AI in healthcare. If there is one thing in common, human factors remain critical.

In teaching, AI remains fine. In clinical practice, the line is a bit more grey.

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QUICK BITS: OTHER NEWS

• No Strikes in August - Thats right, no strikes this month. Negotations between BMA and Streeting are on going and are apparently productive. BMA resident doctor lead tells LBC radio, it’s a “step in the write direction”. But that doesn't mean that strike button can’t be pressed in the future. Watch this space.

• Virtual Reality for Schizophrenia CBT? - So you see and hear things in the real world that aren’t really there? We’ve got a solution. Put on the Meta Quest 3 or Apple Vision Pro so you can see and hear things in the virtual world as well. Hopefully that’ll even things out. But in all seriousness, a brand-new randomised controlled trial has tested VR‑guided therapy for paranoia in schizophrenia. Turns out, virtual reality isn't better than gold‑standard CBT—but it’s just as effective and way more immersive.

• Cancel The Leng Review, Say PA Union - Not their exact words, but it was their sentiment. The United Medical Associate Professionals (UMAPs) are seeking a high court injunction to put a stop to the recommendation made by the Leng review actually going through. This is peculiar, considering the review opened up opportunities for PA’s, like career progression and more clinical responsibility. At the cost of a name change and reporting to doctors. Seems like a decent trade off. Each to their own I suppose.

• IVF Startup Claims to Predict Embryos IQ - In a bid to secure the title for Worst Start Ups for Humanity Award, Herasight — an IVF start up — claims it can screen for several genetic traits including IQ. Prospective parents will be able to pick from a list like it’s a genetic pick-and-mix: schizophrenia, melanoma… and, of course, “my kid’s chances of Quant Finance.” The company has its sceptics as it whether this is actually possible. All the same, screening for IQ is banned here in the UK. This is really an American problem(classic Americans).

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