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Publish & Perish Publish & Perish Research on research and researchers Joeri K. Tijdink Publish & Perish Research on research and researchers colofon ISBN: 978-90-825123-4-2 ©Joeri Tijdink, 2016 opmaak: proefschrift-aio.nl druk: dpp.nl VRIJE UNIVERSITEIT Publish & Perish Research on research and researchers ACADEMISCH PROEFSCHRIFT ter verkrijging van de graad Doctor aan de Vrije Universiteit Amsterdam, op gezag van de rector magnificus prof.dr. V. Subramaniam, in het openbaar te verdedigen ten overstaan van de promotiecommissie van de Faculteit der Geneeskunde op donderdag 30 juni 2016 om 9.45 uur in de aula van de universiteit, De Boelelaan 1105 door Joeri Kees Tijdink geboren te Tiel promotoren: prof.dr. Y.M. Smulders prof.dr. L.M. Bouter CONTENT Chapter 1 General Introduction 7 Chapter 2 The assessment of publication pressure in medical science: validity and reliability of a Publication Pressure Questionnaire (PPQ) 19 Chapter 3 Emotional exhaustion and burnout among medical professors: a nationwide survey 39 Chapter 4 Publication pressure and burnout among Dutch medical professors: a nationwide survey 61 Chapter 5 Publication Pressure and Scientific Misconduct in Medical Scientists 81 Chapter 6 Medical scientists’ view on publication culture. Results from 12 focus groups among Dutch medical researchers 97 Chapter 7 How does industry funding disclosure influence psychiatrists? A randomized trial among Dutch psychiatrists 121 Chapter 8 Machiavellianism is associated with research misbehavior in Dutch biomedical scientists 137 Chapter 9 Publiphilia Impactfactorius: a new psychiatric syndrome among biomedical scientists? 159 Chapter 10 General Discussion 181 Chapter 11 English Summary 205 Appendix 211 1 6 Chapter 1 1 General Introduction What is this thesis about? Why should we care? Publication culture; some historical background Why do we publish? Competition The biomedical scientist Unresolved issues Thesis objective Outline of this thesis 7 What is this thesis about? This thesis deals with organizational, cultural and personal factors involved in the execution of biomedical research. More specifically, the prime goal of this thesis is to describe publication culture and to unravel different factors related to biomedical science and scientists that might influence the publication process. I focus on factors related to the scientist him- or herself; perceived publication pressure, burnout symptoms in scientists, self-reported research misbehavior, biases in interpreting scientific information, and personality traits. This has brought me to the title of this thesis. Publish OR Perish has always been and still is a well-known adagium by academic leaders (1;2). Due to the results of this thesis, I have slightly changed this saying; our results point out that you can publish your results and still perish in present culture due to publication pressure and emotional exhaustion. Why should we care? Publishing scientific articles is the core business of academic researchers. Together, Dutch scientists deliver more than 30.000 peer reviewed papers each year. (3) Due to heavy workload and other stressful aspects of scientists’ professional life, the numerous steps towards answering a research question are susceptible to bias and intentional and unintentional errors. This can jeopardize the validity and the credibility of the scientific enterprise. Furthermore, most scientists rely on earlier evidence collected by others to design their experiments and line of reasoning. If this foundation is invalid, new knowledge is prone to corruption by the biases of the past. Biomedical sciences in particular have a vulnerable position, as they provide results that may directly influence patients’ health. So, yes, we should care. Publication culture; some historical background To accurately understand current publication culture, we should look at the history of the process of biomedical science. Although the first scientific manuscripts date back from 400 BCE (Hippocrates) and the first ‘peer reviewed 8 General Introduction process’ is described in a book called Ethics of the Physician (900 AD) (4), the 1 present form of publishing scientific articles through peer review as standard for defining scientific quality is fairly ‘new’. It was around 1940 that JAMA started using experts (‘peers’) to review scientific articles (5). With the expansion of information technology and the Internet, publishing scientific results is currently transforming rapidly. The number of publications has increased dramatically in the last decade and every day new, digital open access scientific journals pop up (6). This has made scientific publishing a fast, streamlined, enterprise, partly driven by financial incentives. Why do we publish? On the one hand, publishing gives researchers the opportunity to present the results of their studies, compare findings with the body of evidence in the field, and convey a personal line of reasoning to the scientific community. Scientists are part of the knowledge circle; adding valid information to the existing body of knowledge that will bring the research field at issue to the next level. Furthermore, publications are career cornerstones. Without publishing scientific work, nobody will recognize you as a scientist or expert. Publications are essential for an academic career, particularly if they are published in high-impact journals. Finally, it is rewarding to present your results to the scientific community; you receive recognition and status. The tacit reward system was formed earlier in the 20th century, following a period in which education, research and public’s interest were assessed in an informal manner, and scientific work was prioritized by policy makers and scholars (7). This reward system was replaced by a more ‘measurable’ and individual-oriented reward system in the eighties of the 20th century. This change in allocating of funds and rewards has provoked a more ‘market-like’ competition among scientists (8). Competition has also changed the evaluation process; productivity in terms of publications and citations is nowadays the dominant pillars of the assessment of individuals and organizations (9). One of the consequences is that individual 9 productivity and aggregate output have increased enormously in the past decades. However, if a reward system is not functioning properly, it can backfire. Behavioral research has shown us that one-sided reward systems cause problems (10); some people will mainly focus on the measurable parameters and pay less attention to content. Competition Competition is often seen as a salutary driving force for the scientific enterprise; it creates an atmosphere of high performance and can stimulate researchers to improve their rating and the rating of their institute. Many believe that these beneficial consequences dominate over the negative effects; people get the best out of themselves by competing with others and push scientific fields to their limits to be the first to report a discovery (7). Competition provides incentives to individuals to excel. Another perceived advantage of competition is that rivalries can provide a counterweight to confirmation bias – the tendency to favor evidence that supports dominant beliefs. Scientists will be eager to disprove, surpass or scoop discoveries made by rivals. Science has thus adopted a type of ‘tournament structure’, with a steep drop off in reward terms for those who don’t come in first: the winner takes all (11). Competition is clearly essential in individual sports, pushing yourself to your (physical) limit. But is this also be the case for science? To what extent should science provoke and reward individual glory? Or should science be a team sport, with collaboration and cooperation as its fundamental values and where scientific performance is rated by team results rather than by individual indicators? Several well-known scientists within different disciplines have discussed and criticized contemporary publishing culture (‘publish or perish’) (1;8;12-14). As mentioned earlier, myopic rewarding of scientific output ignores other important academic duties of a scientist such as education, mentoring and collaboration. 10 General Introduction The holy grail for scientists of today’s competition is publishing in high impact 1 journals. (2) It will further ones career and foster individual status and prestige. This will be easiest for confirmatory results, or at least results that confirm mainstream thinking, and indeed these positive results are not only more frequently published, the negative ones are increasingly disregarded and less likely to be published. The result of this is referred to as ‘publication bias’. Factors such as publication pressure and publication bias may compromise objectivity and integrity of research, as they drive scientists towards production of easily publishable results at all costs. (15) To quote Ioannidis (author of the classical paper ‘why most research findings are false’ {Ioannidis, 2005 562 /id}) ‘competition and conflicts of interest distort too many medical findings’ {Ioannidis, 2011 528 /id} Furthermore, a ‘winner takes all competition’ may provoke fraud or other research misbehavior (18). It can lead to sabotage of competitors’work, biased peer review and engagement in other Questionable Research Practices (QRP) or more severe research misbehavior like data fabrication (19). A relationship between level of competition and research misbehavior has indeed been suggested in earlier research. (20) An essential aspect of
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