Ethics and Practice of Knowledge Integrity in Communicating Health and Medical Research.

• Date: 22 March 2023
• Author: Mogull, Scott A.

Introduction

In medicine and science, intellectual property (or "knowledge") consists of the research design, data, and insights presented by researchers in published journal articles (American Psychological Association, 2020). Such forms of intellectual property in open science, which is a social model of community and information sharing, assigns credit to the authors of the first published account of novel information (Latour & Woolgar, 1986; Katz & Linvill, 2018; Mogull, 2018a; Kapczynski, 2017; Davidoff et al., 2001). Through the lens of science communication ethics, intellectual property in scientific and medical research has been examined during the production and publishing stages through authorship and credit (Latour & Woolgar, 1986; Mogull & Katz, 2012; Katz & Linvill, 2018; Garfield, 1980). Such authorship and credit models are commonly emphasized by professional organizations such as the American Psychological Association (2020), International Committee of Medical Journal Editors (2019), and National Academy of Sciences (2009).

Despite guidance from scientific and medical associations, the actual practice of citing findings from the research literature operates in the space of writer ethos lacking institutional oversight. Notably, such practice is guided by community norms that reflect one's own research quality, subject knowledge, professional ethics, and communication intent. Thus, citing knowledge is one example of the responsibility and accountability that are underpinnings of a writer's individual agency (Lynch, 2020). Specifically, citation practice helps construct a writer's ethos through traceable and permanent record, revealing one's knowledge of and commitment to a medical discourse community. Notably, both improper attribution to the original researchers as well as misrepresentation of the rhetorical intent of published research have increasingly come into focus as a teaching or training issue, which is part of a wider gap in the communication training of medical researchers (Derish et al., 2007). For example, in the latest review of knowledge integrity in the medical literature, nearly 15% of "facts" cited from previous studies were determined inaccurate or false, with nearly two-thirds of these quotations categorized as "major" content errors in which writers significantly mischaracterized the original research or misled their readers (Mogull, 2017). Based on the nature of the misquoted claims, scholars theorize that some writers may not be reading the full text of journal articles and therefore do not encounter the original authors' main point or conclusion (Simkin & Roychowdhury, 2005, 2007; Gavras, 2002), do not understand the information presented in the original article (Jergas & Baethge, 2015; Hartree, 1976), are intentionally misleading their audience to fit their own narrative (Greenberg, 2009; Eklund, 1995; Yankauer, 1990; Nigel Gilbert, 1977, Ingelfinger, 1976), or may misuse references to increase personal metrics of evaluation (George & Robbins, 1994; Hansen & Mclntire, 1994). This relatively stable rate of 15% of falsely cited or communicated claims has permeated the medical literature for decades and has created networks of misinformation with important implications for influencing future research (Greenberg, 2009; Simkin & Roychowdhury, 2005, 2007; Ingelfinger, 1976).

Recently, a group of twenty authors of medical journal articles--apparently concerned by misquoting or mischaracterization of their own work--categorized and quantified the "factual" errors of statements by other writers who cited their work and published articles in the medical literature. Of 7,438 cited statements this group analyzed, 688 (or 9.2% of) statements were determined by the authors of the original research to be inaccurate or inappropriately cited (Pavlovic et al., 2021). As summarized in Table 1, many of the errors were interpreted by these researchers as rhetorical misuse or lack of understanding of their original research. In reflection, this group of authors emphasized that "citation inaccuracies undermine the integrity of the scientific literature and can have serious consequences, however, good citation practices are rarely taught" (Pavlovic et al., 2021, p. 679).

Although each of these issues in Table 1 evokes concern for the field of RHM, a first step for RHM students, instructors, and practitioners is to establish a framework for systematically searching information in the medical literature that conserves the message and maintains RHM knowledge integrity. Such practice is consistent with the calls for an ethics of praxis in RHM (Meloncon, Molloy, & Scott, 2020) with implications extending beyond the medical literature to also provide patients with more accurate life-altering information, ensure the validity of public health campaigns, establish credible foundations for research funding, and promote research-informed public policy action. In this pedagogical practice article, RHM knowledge integrity is explored in the context of preparing RHM students and practitioners to be careful curators of information from the medical literature with transferrable skills beyond the academy. More directly, the goal of this article is to provide a systematic framework for searching and citing key "facts" from the medical literature to locate "a needle in a haystack. "

Framework for Conserving RHM Knowledge Integrity while Searching and Citing the Medical Literature

The goal of this framework is to combine database automation and human agency to locate relevant research findings from the medical literature and to guide writers in the practice of conserving the rhetorical intent of the original authors. Importantly, this framework attempts to guide individuals to conserve RHM knowledge integrity and help construct the ethos of writers in the field. In this four-phase approach presented below, students and practitioners are guided through: (1) identifying an appropriate database of curated research as an empowered professional, (2) purposefully developing a strategy of keywords and filters for optimizing database searches, (3) locating and citing researchers' claims (or findings) from journal articles to conserve their voice, and (4) managing a personal library of research literature with a content management strategy that integrates time-savings and quality measures.

For instructors, this framework (covering approximately one week of instruction) may be incorporated into an existing research paper assignment or may be assigned as a short, standalone literature search unit focusing on theory and practice of finding and conserving the integrity of claims from the medical literature. Furthermore, this framework may be conducted individually by students or in small groups, with student work being analyzed at the end of the assignment. Alternatively, this framework may be optimally delivered as an instructor-guided series of discussions and activities as a class explores and reflects on each step in the process. As outlined in the framework and discussion below, this approach integrates practice and theory that emphasizes human agency.

Phase 1: Identifying an Appropriate Database of Curated Research

Identifying the database is a pivotal decision that is often taught to students from an institutional view rather than as transferrable skills to empower individuals with access to research literature beyond the institution. Specifically, undergraduate writing classes are often taught that the institutional library is the locus of information within an academic institution, which masks the actual information repository as a resource accessible outside of an intuition. To prepare students for professional careers in RHM with access to the literature outside the academy, students need exposure to and training with the disciplinary databases as resources of curated knowledge. These professionally curated databases provide a critical layer of access and quality control that are masked by broad searches of multiple academic databases merged through an institutional library interface and available outside of an institution.

Situating database selection from a practitioner's perspective reframes the database decision as a writer's agency rather than accepting the situated, institutional role as a student accepting an institutional narrative. Upon graduation, such a student accepting this lack of agency would also lack the necessary skill and, importantly, access to research the RHM literature through publicly and professionally accessible databases. Thus, we should reframe the training and selection of databases as professionally curated indexes of peer reviewed journals and teach students the names, experiences, and purposeful decisions that underly the records being searched. Furthermore, we should prepare students to access these databases outside of the institution (when possible) and position the academic library as one possible conduit for obtaining access to a specific, desired database and access to journal subscriptions.

Procedurally, the key to a successful database search of the literature is to have the research question, objective, or hypothesis drive the process. Professionally, this is first applied to identify the academic field of research that informs the database selection as the field's accepted, curated repository of disciplinary content. For the RHM literature, two of the most relevant databases are PubMed/MEDLINE (https://pubmed.ncbi.nlm.nih.gov) that is curated and managed by the U.S. National Library of Medicine, and APA Psylnfo (typically available through intuitional libraries) that is curated and managed by the American Psychological Association. Notably, each of these professional databases has disciplinary experts that evaluate and select journals for quality metrics. Notably, these curators filter "predatory" journals from "legitimate" ones, which is as an increasing concern for...