Abstract
Doctors working in a university hospital anywhere in the world usually need publications to help win promotion. China, however, has gone one step further. Now clinicians working in a county hospital owned by the government must also get published to get promoted, although this can be in a local journal. To make matters worse, in some hospitals, the rules even apply to nurses.
You can understand how these policies create a huge demand for publication. Buying and selling research papers is an open secret. Clinicians often get calls and are pursued by emails to buy articles to get promoted. It is easy to find websites that will buy you a publication in a target journal. Last year, two identical papers were published almost simultaneously in different international journals but they were from two different groups of Chinese clinicians.1,2 Early last year, Tumor Biology retracted 107 articles, all from China, because of issues related to fake peer review. 3 Research misconduct is not confined to Chinese doctors, of course. Recently, The Lancet retracted two papers published six years ago by Macchiarini and his colleagues about a revolutionary new technique for tracheobronchial transplantation. 4 These cases are just the tip of the iceberg. 5
In China, a clinician’s job title depends largely on their publications and not on their clinical experience. The skill of treating patients is being less valued than the ability to write papers. Hence, doctors try hard to get papers published, especially in high-impact journals, to enhance their reputation, which is important in relation to their license to practise.
Patients often travel a long way to a university hospital, and they choose a doctor according to the doctor’s title. They believe a professor of medicine is a greater authority, but they do not understand that in some cases, doctors with grand reputations are not as good as doctors with fewer publications.
When hospitals are evaluated by governmental or non-governmental agencies, publications are one of the major factors in the assessment. Inevitably, higher-ranked hospitals are more attractive for patients, and publication therefore is now an important part of workload counted by hospitals.
University doctors, of course, are busy with their clinical work. A senior doctor will see about 50 patients in a morning outpatient clinic. Junior doctors are occupied with clinical duties on wards. Where is the time for research and publications? Is it any wonder that career pressures mean that doctors find ways to abuse the system and become involved in scientific fraud and misconduct?
Nonetheless, scientific fraud and misconduct are unacceptable and China has no mechanism to take action against individuals. In other countries, professional bodies decide on a case-by-case basis, and someone who commits fraud may lose their license to practise. 6 A university might take action too. 7 This is not the case in China. Nobody’s medical license has been annulled because of scientific misconduct. Integrity is a fundamental part of a doctor’s life and it is hard to believe that someone who commits scientific fraud will always be honest with their patients. Regulatory authorities and universities in China have developed some policies to deal with scientific misconduct, such as delayed promotion for some years when fraud is confirmed, but more stringent policies are needed to stop the wide spread misconduct. Further, we also must recognise the damage being done by rewarding doctors and hospitals on the basis of their publication records.