Medical Journals Have a Fake News Problem

Srinubabu Gedela was 24 in 2006 and studying for his doctorate at Andhra University in Visakhapatnam, on the east coast of India, when he faced firsthand what he’d later view as a scourge plaguing scientists in the developing world. Since the 17th century, medical journals have been the portal through which researchers gain insight into the latest discoveries and best practices from colleagues continents away. But subscriptions to the top publications can cost thousands of dollars a year. As Gedela tells it, he was trying to break new ground on diabetes, and Andhra’s research library was woefully understocked. Gedela comes from Allena, a village of roughly 2,000 people. He was raised there in a mud-walled, sugar-cane-roofed shack by farming parents. How were budding scientists like him supposed to advance, he wondered, without the tools afforded to their more privileged counterparts in the West?

To solve his immediate problem, Gedela paid 250 rupees (about $4) each month for an overnight bus to visit research institutions in Hyderabad, about 400 miles away. The beat-up vehicles lacked air conditioning and bathrooms and jostled over cracked roads baking in 95F heat. More than 12 hours later, Gedela would arrive and pore over the latest issues of publications such as Talanta: The International Journal of Pure and Applied Analytical Chemistry.

By this time, a new model of publishing had begun upending the business of scholarly communication. Traditional journals make money by charging subscription fees. Open-access journals often flip this model by charging the authors fees, then offering articles to readers for free.

Before Gedela was granted his Ph.D., he’d already begun setting aside his laboratory studies to devote himself to promoting open access. He bought a domain name for 200 rupees, recruited a few colleagues in Hyderabad and Visakhapatnam to make a website, and began building his company. He named it Omics Online Publishing, after a suffix applied to fields of study in biology. (It was later changed to Omics International.) In April 2008 he posted the first article for the Journal of Proteomics & Bioinformatics.

Omics has since grown into an internet publishing powerhouse with, as Gedela says, a mission to “free scientific knowledge from all barriers,” claiming 1,000 open-access journal titles that post 50,000 articles annually in fields including medicine, technology, and engineering. It’s also built a robust conference division that will hold about 3,000 events worldwide this year.

Gedela, now 35, is stocky and just over 5 feet tall. The dark hair framing his round face has begun to gray at the temples. On a morning in late April, he sits behind a wooden desk in Hitec City, a buzzing technology and pharmaceutical hub of high-rise office parks a 45-minute drive from Hyderabad’s Old City. In strained English, he recounts drawing inspiration to start Omics from his late grandfather, whose portrait looks down from a nearby shelf full of trophies, framed news clippings, and elephant statues. “ ‘Never cheat others’—that was his slogan,” he says. “Giving knowledge to someone is always good.”

This beneficent vision, however, stands in stark contrast to the U.S. government’s and many academics’ perception of Gedela’s business. In a 2016 lawsuit, the Federal Trade Commission denounced Omics as a predatory publisher duping professionals to make quick profits. Professors and researchers have identified Gedela as the progenitor of a fraudulent empire that’s eroding public trust in scientific inquiry. He denies it all, continuing to extend his global reach from Hyderabad. And he’s received help from an unexpected source: the pharmaceutical industry, which regularly publishes in the company’s journals and attends its conferences, bringing Omics both credibility and the funds to grow.

There’s some truth in Gedela’s tale of arriving at the gates of knowledge only to find them shut. Scholarly publishing is a lucrative industry for the dominant players. RELX Group’s Elsevier unit, which has about 2,500 journals, including Cell and the Lancet, made more than £2 billion ($2.6 billion) in 2016, while John Wiley & Sons’ journals subdivision, which publishes Cancer, among others, earned $853,000 in the fiscal year ended in April 2017. Their business model allows for operating margins of about 30 percent: They procure free content based on government or privately funded research, get academics to peer-review the papers for free, and sell it back to university libraries and other institutions at high prices. In the early 2000s, scientists and scholars started the open-access movement hoping to challenge what they saw as an exploitative system that priced out many who could benefit from a rush of global research. They would use the internet to distribute the same high-quality papers to more people at lower cost. Depending on whom you ask, the movement either mostly succeeded or helped create a chaotic stew of content into which unscrupulous entrepreneurs could blend.

Jeffrey Beall, a librarian at the University of Colorado at Denver, has, somewhat by accident, found himself at the center of the controversy. Many of the early scientist-driven, open-access publishers, such as Public Library of Science, have maintained quality controls similar to those of their traditional counterparts. But when Beall was pursuing tenure in 2008, he noticed a mounting barrage of error-laden emails from open-access journals he’d never heard of. These companies would seemingly publish anything, with little to no peer review, and were opaque about their ownership and fees. Writing about them on his personal blog, he was the first to use the now widely accepted term “predatory” for the suspect publishers as he compiled a blacklist of bad titles. Over six years, the list exploded from 18 publishers to 1,155.

A 2015 study in the journal BMC Medicine estimated revenue generated by the open-access predator market at $74 million, compared with $244 million for reputable open-access journals and the $10.5 billion that traditional journals make from global subscriptions. Beall thinks at least 25 percent of open-access journals can be classified as predatory. Their ranks continue to grow, because it’s so easy to start one: “You don’t need any investment, you don’t need any overhead, all you need is a website,” he says. “We could set one up today.” Message boards and blogs are littered with complaints about their exploiting academics in the grip of “publish or perish” pressure. (Close title names is one standard trick: Preventive Medicine, founded in 1972, is published by Elsevier; the Journal of Preventive Medicine is published by Insight Medical Publishing, which is owned by Omics.) Universities and research institutions issue warnings to would-be authors to stay away, lest they ruin their credibility, and have banned the journals as qualifications for promotions.

Beall’s list provided guidance to the scholarly community on where not to publish. It also drew criticism from people who felt unfairly maligned, such as Gedela, who threatened Beall in 2013 with a $1 billion lawsuit, calling the blog a “deliberate attempt to defame” Omics. Gedela never followed through. But Beall says he shuttered his blog “under pressure” from his university in January, a claim the institution disputes. In any case, it still exists in internet archives. There’s also the Directory of Open Access Journals—a list, launched by Lund University in Sweden, of 9,500 journals that adhere to high standards and peer review. Its editor-in-chief, Tom Olijhoek, says there were some Omics titles on the list until 2011, when all were removed: Potential authors complained about being spammed, seeing their titles plagiarized, and the lack of peer review.

In response to the rapid proliferation of sketchy journals, academics around the world have performed a series of stings. In 2014, Peter Vamplew, a computer scientist from Australia, submitted a 10-page paper consisting solely of the words “Get me off your f—ing mailing list” repeated more than 800 times. The International Journal of Advanced Computer Technology, deemed predatory by Beall, accepted it and requested a publishing fee of $150. Last year, Christoph Bartneck, a professor at New Zealand’s University of Canterbury, submitted to an Omics conference a nonsensical paper he’d written using the autocomplete function on his iPhone. Opening sentence: “Atomic Physics and I shall not have the same problem with a separate section for a very long long way.” Accepted within three hours, the piece was only slightly more absurd than articles that have popped up in Omics titles that weren’t part of a sting, such as one by an author claiming to have deciphered a code proving the existence of aliens. Gedela says Bartneck’s paper slipped through because it was submitted so close to the conference’s deadline.

Not everything published in predatory journals is junk. But the mixing of bad science with good reduces the value and credibility of all output, says Rick Anderson, associate dean for collections and scholarly communication at the University of Utah’s library. He describes a sting study about dark chocolate’s purported benefits for weight loss that was published by another journal on Beall’s list, International Archives of Medicine, and picked up by mainstream news outlets. “What if it was about the measles vaccine?” Anderson asks. While Omics has hardly cornered the market, Beall calls it “a global parasite” and “the worst of the worst.”

Omics and Gedela first got into trouble with the U.S. government in 2011. The National Institutes of Health, a division of the U.S. Department of Health and Human Services banned Omic’s journals from indexing in PubMed Central, one of the world’s primary databases for medical research, given “serious concerns” about its practices. In 2013, HHS accused Omics of trademark infringement and using the names of employees at the NIH and PubMed Central “in an erroneous and/or misleading manner.”

For instance, Amina Woods of the NIH was listed as the editor-in-chief of Omics’s Biology and Medicine. Bloomberg Businessweek contacted her at the NIH—she heads the structural biology unit in Baltimore—and she said she’d never agreed to take the position. “I’ve been trying to get the journal to remove this information from their website for years,” she said. When Bloomberg Businessweek asked Gedela why Woods was still listed as the editor, he claimed he wasn’t aware of the situation. Within a day, her name and accompanying photo were gone.

In August 2016, in U.S. District Court in Nevada, the FTC raised the stakes, accusing Omics and Gedela of violating the FTC Act by engaging in “deceptive academic publishing practices.” The agency calls Omics’s peer-review processes a “sham,” whereby manuscripts get approved within days of submission instead of the weeks or months it takes at more credible venues. It alleges that Omics claims distinguished experts as editorial board members and as speakers at its conferences without their consent; fails to disclose publishing fees ranging from hundreds to thousands of dollars until after articles are accepted; cites phony impact factors (a measure of prestige indicating how often a journal’s articles get cited elsewhere); and maintains that journals are indexed in PubMed when they aren’t. It says Gedela “appears to be the driving force behind Defendants’ deceptive practices.”

The FTC has asked for a preliminary injunction and is seeking unspecified monetary reimbursement for academics who claim to have been duped into publishing. The suit is the FTC’s first against a so-called predatory publisher, says Malini Mithal, acting associate director in the agency’s Bureau of Consumer Protection. The agency says a preliminary review of bank records shows researchers spent at least $26.6 million on publication and conference registration fees from 2009 to 2015.

In legal filings, Omics dismisses the FTC’s allegations as “fake news” that relied on Beall’s “fake news blog.” It calls the agency’s decision to go after Omics “highly arbitrary,” saying hundreds of publishers accept articles “without doing proper review” while it does “initial review.” It accuses the FTC of having “a clear intention of attacking open access publishing” as a whole, while supporting the traditional subscription-based industry “who collects lot of amounts [sic] from the scientific community and does a huge business.” It also claims “paid editors” have defamed Omics on its Wikipedia page.

A trial date has yet to be set. “This case is very important in terms of signaling to the industry that these practices are illegal and we’ll take action when we see behavior like this,” Mithal says. A win for the agency, she says, would show that “there might be different models of academic publishing out there, but whatever model you use, you have to abide by basic consumer protection principles.”

In Hyderabad, where Omics’s headquarters are spread over 250,000 square feet in two buildings, Gedela is convinced of a win. “The FTC is following the fake news,” he says. He exudes nervous energy as he walks the halls, rarely making eye contact with employees and cutting off conversations abruptly. For years he’s promoted a postdoctoral study he did at Stanford to boost his credibility. The school confirms he held a position for five months, an unusually short time, in 2009, a year after starting Omics. Gedela is cagey when asked about the details, saying he left early to return to India to build his company. But when he hooks his laptop up to a large TV screen in his office to show emails proving the dates of his Stanford sojourn, he accidentally projects an adviser’s email threatening to terminate his contract after saying he took vastly more vacation than allowed. When questioned, he brushes the discrepancy off.

According to financial documents filed with the Indian government, Omics’s fiscal 2016 revenue was $11.6 million and profit about $1.2 million. If the FTC prevails, Gedela says, his company will cease operations in the U.S., losing about 20 percent of its revenue. But that’s an outcome, he says sternly, he isn’t expecting: “Always, truth wins in the end.”

The online journals featured on the Omics home page are rife with grammar glitches and low-resolution headshots. Despite such obvious red flags, Bloomberg Businessweek found that researchers at major pharmaceutical companies, including AstraZeneca, Bristol-Myers Squibb, Gilead Sciences, and Merck, submit to Omics journals and participate in their conferences. Pfizer, the biggest U.S. drugmaker, has published at least 23 articles since 2011, including two since the FTC’s lawsuit.

It’s unclear whether drugmakers are purposely ignoring what they know of Omics’s reputation or are genuinely confused amid the profusion of noncredible journals—none were willing to discuss their involvement in any depth. Whereas academics publish to maintain their careers, pharma companies want to communicate with doctors. Top-tier publications such as the New England Journal of Medicine and the Lancet guarantee eyeballs and influence. Outlets with lower standards, though, such as Omics’s, provide a venue for companies to publish studies that aren’t sufficiently groundbreaking for the lead journals, or those they’d prefer not be subject to rigorous vetting—either to get them out sooner or to avoid scrutiny.

A Pfizer paper on the financial burden of chronic lower-back pain published in 2014 in Omics’s Journal of Pain & Relief suggests the pharmaceutical company may have had an interest in skipping the traditional journals’ review processes. Based on a survey of just 106 people it concluded that direct and indirect costs of severe back pain ranged from $11,800 to $25,051 per patient annually. Such figures could be used to justify a medication’s price to patients and their health plans. The New England Journal of Medicine, for example, will rarely publish cost studies, because they’re notoriously unreliable. “It’s very easy to just drive the results to a conclusion that you want,” says John Ioannidis, a professor of medicine, biomedical data science, and statistics at Stanford. The Pfizer paper was “not very transparent, so it’s hard to see if their calculations are accurate.”

Pfizer wouldn’t respond to study-specific questions and declined interview requests. “Our priority is to publish Pfizer-sponsored clinical research in a transparent, accurate, and fair manner,” spokesman Steven Danehy wrote in an email. “We are concerned by the allegations brought forward by the FTC and await the outcome of the investigation.”

AstraZeneca Plc, the second-biggest drugmaker in the U.S., has published at least five articles in Omics journals since 2011, including one in Internal Medicine: Open Access on a drug developed with Bristol-Myers Squibb Co. called Farxiga that regulates blood sugar levels. The study found that Farxiga offered superior weight control compared with other diabetes regimens. These results—though perhaps valid—weren’t vetted by the U.S. Food and Drug Administration, so it’s not a claim that can be made on the label or in advertisements. Still, doctors who come across this study might assume that it was rigorously peer-reviewed and be influenced to prescribe Farxiga over a competitor. The journal’s editors didn’t respond to requests to specify who, if anyone, had reviewed it. When contacted by Bloomberg Businessweek, spokeswoman Abigail Bozarth said AstraZeneca has asked staff to no longer publish in “identified predatory journals,” yet declined to say when that policy change was made.

Jeffrey Curtis, a physician and professor at the University of Alabama at Birmingham, worked on a rheumatoid arthritis study with Bristol-Myers that was published in an Omics journal within two weeks of submission. Companies “are often in more of a hurry and are willing to accept lower-tier journals,” Curtis says. “They want a citation. They want someone to be able to reference it and have it be official.”

Bristol-Myers spokeswoman Sarah Koenig says the drugmaker publishes all clinical trial results of “significant medical importance” in “peer-reviewed journals,” but she wouldn’t respond to questions about how the company decides which journals to publish in.

The marketing website for Descovy, Gilead Sciences Inc.’s HIV drug, cites an Omics-published study finding that a key ingredient in Descovy showed up at the same levels in patients’ blood as another already-approved drug. The trial data are, in fact, sound—they passed muster with the FDA when Gilead submitted them as part of the drug’s application. So why did the company choose Omics instead of a more prestigious venue? Spokesman Ryan McKeel says Gilead picked the publication because it was “a specialized journal with an open-access format, allowing clinicians and researchers easy access to the information.” He adds that this type of study is straightforward and well-defined. “Consequently, peer review is less of a factor than in other scientific publications.”

Critics disagree with this rationale. Without adequate peer review to ensure quality control, “anything can get published, and you can’t believe anything you read,” says Rita Redberg, a cardiologist at the University of California at San Francisco Medical Center and an editor at JAMA Internal Medicine. “People can get harmed because we depend on what we read in medical journals to drive patient care.”

Drugmakers have fueled Omics’s rise by also sponsoring and attending conferences, which Gedela says generate 60 percent of Omics’s revenue. In a meeting room at the company, photographs taken at conferences, beginning in 2010, show the names of Novartis, Axis Clinicals, and Agilent Technologies as sponsors on screens behind speakers. Drugmaker employees often lead workshops at the events, as Andrew Flick, a senior scientist in Pfizer’s global research and development department, did at Omics’s International Green Chemistry Conference in Las Vegas last year (after the FTC filed its complaint). Other recent speakers include researchers from Novartis, Merck, Eli Lilly, and GlaxoSmithKline. “So almost all the major pharma companies” have worked with Omics, Gedela says. Agilent, Axis, and Merck didn’t respond to requests for comment. Eli Lilly declined to discuss its involvement with the conferences. Novartis spokesman Eric Althoff declined to comment specifically on Omics, saying his company reviews quality of agenda and “legitimacy of the organization” when conferences seek its sponsorship. GlaxoSmithKline spokeswoman Mary Anne Rhyne says the company allows authors to pick their own journals, though in-house experts suggest reputable publications when asked. Omics conferences “were not on our radar as problematic,” she says, adding: “It’s not always easy to spot questionable outlets. Staff training in this area is ongoing.”

As the workday starts in Hyderabad, hundreds of employees stream into Omics’s seventh-floor office in Hitec City’s Raheja Mindspace IT Park. Prachi Tyagi cheerfully takes her seat among rows of chest-high cubicles and switches on her desktop computer. She’s 22. Omics recruited her last year as assistant managing editor overseeing the International Journal of Clinical Rheumatology and the Journal of Clinical & Experimental Pharmacology, her first job after graduating with a bachelor’s in biotechnology. For the next nine hours, she’ll run manuscripts through plagiarism-detection software, communicate with authors and editors, and update her journals’ websites and social media feeds. She earns bonus pay for exceeding quotas on the number of manuscripts that get submitted and published monthly and gets docked if she falls short.

One of Tyagi’s most important tasks is soliciting manuscripts. “Sending emails is a must daily,” she says. She scours Google and university websites for the addresses of academics and researchers. The signature on her correspondence with a U.S. reporter says she’s based in the Los Angeles suburb of Westlake Village. For years, researchers have noted emails purporting to come from Nevada and England, where Omics has nothing more than mailboxes. Researchers on the receiving end of all those emails sent by Tyagi and an army of her fellow workers have a word for them: spam. But Tyagi is thrilled to have this job. “Omics is a good company with a good reputation,” she says.

Omics employs roughly 2,000 people—more than two-thirds are women—and offers subsidized food and free transportation, a Hyderabadi version of San Francisco’s Google buses, without the controversy. Among the employees are one of Gedela’s brothers, who owns a small stake, and Gedela’s wife, Anita, who was appointed director last year but stays at home to care for their 3-year-old daughter. Acquisitions of established journal companies such as Canada’s Pulsus Group Inc. and Andrew John Publishing Inc. have helped the company grow.

As managing director and majority owner, the boy from the tiny village of Allena now drives a black Range Rover and pays himself a $280,000 salary. From the windows of Omics’s offices, next to Novartis, Facebook, and Wells Fargo outposts, you can see the red-tiled roof of Gedela’s house. He lives alongside wealthy expats in a planned community of three-story, Mediterranean-style villas in generic developer beige. But for one subtle nod to regional architecture, the arched white-rimmed entryways, the houses could just as easily be in an American exurb. Gedela owns a private school for 3,500 students, has donated money to build canals and a Hindu temple, and recently delved into venture capital and film production.

Local newspaper articles laud Gedela, and business and science associations give him awards. Hitec City’s special economic zone grants him generous tax breaks, and the government is handing him heavily subsidized land on which to build new headquarters. Gedela defends Omics’s quality control and disavows the idea that he’s motivated by profit. “I started the business to help the scientific community,” he says. “We’ve never made a mistake.” —With Ari Altstedter