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Fake research can be harmful to your health – a new study offers a tool for rooting it out

A new screening tool to help study reviewers identify what’s fake or shoddy in research may be on the horizon. And everyday people can apply some of…



Although most medical research is reliable, studies that are flawed or fake can lead to patients undergoing treatments that might cause harm. skynesher/E+ via Getty Images

If you are suffering with chronic pain, diabetes, heart problems or any other condition, you want to be confident that your doctor will offer you an effective treatment. You certainly don’t want to waste time or money on something that won’t work, or take something that could do you harm.

The best source of information to guide treatment is medical research. But how do you know when that information is reliable and evidence-based? And how can you tell the difference between shoddy research findings and those that have merit?

There’s a long journey to the publication of research findings. Scientists design experiments and studies to investigate questions about treatment or prevention, and follow certain scientific principles and standards. Then the finding is submitted for publication in a research journal. Editors and other people in the researchers’ field, called peer-reviewers, make suggestions to improve the research. When the study is deemed acceptable, it is published as a research journal article.

But a lot can go wrong on this long journey that could make a research journal article unreliable. And peer review is not designed to catch fake or misleading data. Unreliable scientific studies can be hard to spot – whether by reviewers or the general public – but by asking the right questions, it can be done.

While most research has been conducted according to rigorous standards, studies with fake or fatally flawed findings are sometimes published in the scientific literature. It is hard to get an exact estimate of the number of fraudulent studies because the scientific publication process catches some of them before they are published. One study of 526 patient trials in anesthesiology found that 8% had fake data and 26% were critically flawed.

As a professor in medicine and public health, I have been studying bias in the design, conduct and publication of scientific research for 30 years. I’ve been developing ways to prevent and detect research integrity problems so the best possible evidence can be synthesized and used for decisions about health. Sleuthing out data that cannot be trusted, whether this is due to intentional fraud or just bad research practices, is key to using the most reliable evidence for decisions.

Systematic reviews help suss out weak studies

The most reliable evidence of all comes when researchers pull the results of several studies together in what is known as a systematic review. Researchers who conduct systematic reviews identify, evaluate and summarize all studies on a particular topic. They not only sift through and combine results on perhaps tens of thousands of patients, but can use an extra filter to catch potentially fraudulent studies and ensure they do not feed into recommendations. This means that the more rigorous studies have the most weight in a systematic review and bad studies are excluded based on strict inclusion and exclusion criteria that are applied by the reviewers.

Systematic reviews explained.

To better understand how systematic reviewers and other researchers can identify unreliable studies, my research team interviewed a group of 30 international experts from 12 countries. They explained to us that a shoddy study can be hard to detect because, as one expert explained, it is “designed to pass muster on first glance.”

As our recently published study reports, some studies look like their data has been massaged, some studies are not as well designed as they claim to be, and some may even be completely fabricated.

Our study provides some important ideas about how to spot medical research that is deeply flawed or fake and should not be trusted.

The experts we interviewed suggested some key questions that reviewers should ask about a study: For instance, did it have ethics approval? Was the clinical trial registered? Do the results seem plausible? Was the study funded by an independent source and not the company whose product is being tested?

If the answers to any of these questions is no, then further investigation of the study is needed.

In particular, my colleagues and I found that it’s possible for researchers who review and synthesize evidence to create a checklist of warning signs. These signs don’t categorically prove that research is fraudulent, but they do show researchers as well as the general public which studies need to be looked at more carefully. We used these warning signs to create a screening tool – a set of questions to ask about how a study is done and reported – that provide clues about whether a study is real or not.

Signs include important information that’s missing, like details of ethical approval or where the study was carried out, and data that seems too good to be true. One example might be if the number of patients in a study exceeds the number of people with the disease in the whole country.

Spotting flimsy research

It’s important to note that our new study does not mean all research can’t be trusted.

The COVID-19 pandemic offers examples of how systematic review ultimately filtered out fake research that had been published in the medical literature and disseminated by the media. Early in the pandemic, when the pace of medical research was accelerating, robust and well-run patient trials – and the systematic reviews that followed – helped the public learn which interventions work well and which were not supported by science.

For example, ivermectin, an antiparasitic drug that is typically used in veterinary medicine and that was promoted by some without evidence as a treatment for COVID-19, was widely embraced in some parts of the world. However, after ruling out fake or flawed studies, a systematic review of research on ivermectin found that it had “no beneficial effects for people with COVID-19.”

On the other hand, a systematic review of corticosteroid drugs like dexamethasone found that the drugs help prevent death when used as a treatment for COVID-19.

There are efforts underway across the globe to ensure that the highest standards of medical research are upheld. Research funders are asking scientists to publish all of their data so it can be fully scrutinized, and medical journals that publish new studies are beginning to screen for suspect data. But everyone involved in research funding, production and publication should be aware that fake data and studies are out there.

The screening tool proposed in our new research is designed for systematic reviewers of scientific studies, so a certain level of expertise is needed to apply it. However, using some of the questions from the tool, both researchers and the general public can be better equipped to read about the latest research with an informed and critical eye.

Lisa Bero is Senior Editor, Research Integrity for Cochrane, an international non-profit organization that publishes systematic reviews.

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Spread & Containment

What’s next for ancient DNA studies after Nobel Prize honors groundbreaking field of paleogenomics

Thousands of ancient genomes have been sequenced to date. A Nobel Prize highlights tremendous opportunities for aDNA, as well as challenges related to…




Researchers need to be careful not to contaminate ancient samples with their own DNA. Caia Image via Getty Images

For the first time, a Nobel Prize recognized the field of anthropology, the study of humanity. Svante Pääbo, a pioneer in the study of ancient DNA, or aDNA, was awarded the 2022 prize in physiology or medicine for his breathtaking achievements sequencing DNA extracted from ancient skeletal remains and reconstructing early humans’ genomes – that is, all the genetic information contained in one organism.

His accomplishment was once only the stuff of Jurassic Park-style science fiction. But Pääbo and many colleagues, working in large multidisciplinary teams, pieced together the genomes of our distant cousins, the famous Neanderthals and the more elusive Denisovans, whose existence was not even known until their DNA was sequenced from a tiny pinky bone of a child buried in a cave in Siberia. Thanks to interbreeding with and among these early humans, their genetic traces live on in many of us today, shaping our bodies and our disease vulnerabilities – for example, to COVID-19.

The world has learned a startling amount about our human origins in the last dozen years since Pääbo and teammates’ groundbreaking discoveries. And the field of paleogenomics has rapidly expanded. Scientists have now sequenced mammoths that lived a million years ago. Ancient DNA has addressed questions ranging from the origins of the first Americans to the domestication of horses and dogs, the spread of livestock herding and our bodies’ adaptations – or lack thereof – to drinking milk. Ancient DNA can even shed light on social questions of marriage, kinship and mobility. Researchers can now sequence DNA not only from the remains of ancient humans, animals and plants, but even from their traces left in cave dirt.

Alongside this growth in research, people have been grappling with concerns about the speed with which skeletal collections around the world have been sampled for aDNA, leading to broader conversations about how research should be done. Who should conduct it? Who may benefit from or be harmed by it, and who gives consent? And how can the field become more equitable? As an archaeologist who partners with geneticists to study ancient African history, I see both challenges and opportunities ahead.

Building a better discipline

One positive sign: Interdisciplinary researchers are working to establish basic common guidelines for research design and conduct.

In North America, scholars have worked to address inequities by designing programs that train future generations of Indigenous geneticists. These are now expanding to other historically underrepresented communities in the world. In museums, best practices for sampling are being put into place. They aim to minimize destruction to ancestral remains, while gleaning the most new information possible.

But there is a long way to go to develop and enforce community consultation, ethical sampling and data sharing policies, especially in more resource-constrained parts of the world. The divide between the developing world and rich industrialized nations is especially stark when looking at where ancient DNA labs, funding and research publications are concentrated. It leaves fewer opportunities for scholars from parts of Asia, Africa and the Americas to be trained in the field and lead research.

The field faces structural challenges, such as the relative lack of funding for archaeology and cultural heritage protection in lower income countries, worsened by a long history of extractive research practices and looming climate change and site destruction. These issues strengthen the regional bias in paleogenomics, which helps explain why some parts of the world – such as Europe – are so well-studied, while Africa – the cradle of humankind and the most genetically diverse continent – is relatively understudied, with shortfalls in archaeology, genomics and ancient DNA.

Making public education a priority

How paleogenomic findings are interpreted and communicated to the public raises other concerns. Consumers are regularly bombarded with advertisements for personal ancestry testing, implying that genetics and identity are synonymous. But lived experiences and decades of scholarship show that biological ancestry and socially defined identities do not map so easily onto one another.

I’d argue that scholars studying aDNA have a responsibility to work with educational institutions, like schools and museums, to communicate the meaning of their research to the public. This is particularly important because people with political agendas – even elected officialstry to manipulate findings.

For example, white supremacists have erroneously equated lactose tolerance with whiteness. It’s a falsehood that would be laughable to many livestock herders from Africa, one of the multiple centers of origin for genetic traits enabling people to digest milk.

The 2010 excavation in the East Gallery of Denisova Cave, where the ancient hominin species known as the Denisovans was discovered. Bence Viola. Dept. of Anthropology, University of Toronto, CC BY-ND

Leaning in at the interdisciplinary table

Finally, there’s a discussion to be had about how specialists in different disciplines should work together.

Ancient DNA research has grown rapidly, sometimes without sufficient conversations happening beyond the genetics labs. This oversight has provoked a backlash from archaeologists, anthropologists, historians and linguists. Their disciplines have generated decades or even centuries of research that shape ancient DNA interpretations, and their labor makes paleogenomic studies possible.

As an archaeologist, I see the aDNA “revolution” as usefully disrupting our practice. It prompts the archaeological community to reevaluate where ancestral skeletal collections come from and should rest. It challenges us to publish archaeological data that is sometimes only revealed for the first time in the supplements of paleogenomics papers. It urges us to grab a seat at the table and help drive projects from their inception. We can design research grounded in archaeological knowledge, and may have longer-term and stronger ties to museums and to local communities, whose partnership is key to doing research right.

If archaeologists embrace this moment that Pääbo’s Nobel Prize is spotlighting, and lean in to the sea changes rocking our field, it can change for the better.

Mary Prendergast does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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Norwegian Makes Covid Change Royal Caribbean, Carnival Have Not

Only one of the three major cruises lines has chosen to make this bold decision.



Only one of the three major cruises lines has chosen to make this bold decision.

This summer, all three of the major cruise lines began loosening their covid protocols.

For a while, there was a standard protocol that the three cruise lines, Royal Caribbean International  (RCL) - Get Royal Caribbean Group Report, Carnival Cruise Line  (CCL) - Get Carnival Corporation Report, and Norwegian Cruise Line  (NCLH) - Get Norwegian Cruise Line Holdings Ltd. Report, followed. The crew had to be vaccinated and regularly tested, while all passengers 12-and-over must be vaccinated and provide proof of that before boarding and all passengers must provide a negative covid test taken no more than two days before their sailing.

Royal Caribbean, Carnival, and Norwegian all moved largely in lockstep during the pandemic. In July 2021, when all three cruise lines returned to service from U.S. ports, they had to deal with oversight from the Centers for Disease Control and Prevention.

But the companies all began relaxing those rules in different ways. For example, Royal Caribbean began accepting results from self-administered home tests, and it also decided that vaccinated guests wouldn’t have to take a pre-cruise test on cruises that are shorter than 10 nights.

While it is important to still be safe and use common sense, there’s now a general sense that we’ve generally turned the corner on the covid-era, and that everyone who is going to get vaccinated has done so by now, and President Biden officially declared the pandemic over.

The cruise industry is following suit, as Norwegian has now decided to do away with most of its covid-era protocols.

Image source: Shutterstock

Norwegian Will No Longer Require Masks, Vaccinations, and Tests

Norwegian effective Oct. 4 will now remove all covid-19 testing, masking and vaccination requirements, owing to what the company terms positive progress in the public health environment.

"Health and safety are always our first priority; in fact, we were the health and safety leaders from the very start of the pandemic," said Harry Sommer, Norwegian Cruise Line president and chief executive officer in a statement. "Many travelers have been patiently waiting to take their long-awaited vacation at sea and we cannot wait to celebrate their return."

The Center for Disease Control has a great deal of jurisdiction over the cruise industry, as ships travel all over the world, and each country has its own health and safety standards. Last year, the CDC labeled sailing a high risk, level 4 activity, but slowly began lowering the risk level until doing away with it entirely in March. Over the summer, the CDC announced that its covid-19 Program for Cruise Ships was no longer in effect. 

Norwegian will continue to follow the health guidelines of every country it visits, and that list for customers is here.

Will Royal Caribbean and Carnival Follow?

Norwegian was the first cruise line to drop pre-cruise covid testing, unless the country the ship sails from requires it.

It’s unclear, at the moment, if Royal Caribbean and Carnival if or when follows suit and drops all its requirements as well.

At the moment, both companies have covid protocols listed on their websites. 

Royal Caribbean’s website states that for cruises departing from North America, “All Royal Caribbean guests age 12 and older must be fully vaccinated against COVID-19 with the final dose administered at least 14 days before sailing. We will ask that you disclose your vaccination status prior to boarding (via the Royal Caribbean app, on our website, or at the terminal).”

On Carnival's website, the company states “Carnival's protocols have evolved, making it easier for more guests to sail with simplified vaccination and testing guidelines.” 

“We encourage all guests to be up to date with their COVID-19 vaccines and to test within three days prior to their cruise. However, testing is required for unvaccinated guests, or irrespective of vaccination status as specified by a destination, and on cruises of 16 nights or longer.”

Vaccinated guests on Carnival cruises that provide proof of vaccination are not required to take a pre-cruise test except on cruises of 16 nights or longer or when required by a destination.

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COVID and the cost of living crisis are set to collide this winter – the fallout will be greatest for the most vulnerable

If governments fail to take action, the cost of living crisis will worsen the impact of the pandemic this winter, and vice versa.




The financial strain many have faced during the pandemic will be compounded by the cost of living crisis. Lena Evans/Shutterstock

The cost of living crisis is affecting people around the world. Although it’s been building for some time, the fact that this crisis comes hot on the heels of an ongoing pandemic only makes matters worse.

It’s not surprising, though still worth highlighting, that the cost of living crisis won’t be felt equally across society. For example, the toll will be greater for people living in more deprived areas, those on lower incomes, older adults, single-parent families, people with disabilities and those from minority ethnic backgrounds.

People from these groups are already more likely to have had to reduce their gas and electricity use, to struggle to pay their bills and to face fuel poverty.

We also know that COVID-19, although challenging for everyone, is an unequal pandemic. People from minority ethnic groups, from the most deprived neighbourhoods, older people and those with underlying health conditions have been at higher risk of death or serious illness from COVID.

This will be the first winter since the pandemic began where many countries have removed all non-pharmaceutical protections, including face masks, testing, social distancing and self-isolation. After two-and-a-half years of uncertainty, what we’re about to experience is, again, unprecedented.

Unless we learn from past missteps, both in government responses to economic crises and the pandemic, these two crises will collide to make for a devastating winter, especially for the most vulnerable.

Some examples

If people are struggling to pay their bills, how can they be expected to buy COVID tests? Or to stay home from work when they have COVID symptoms, if they’ll lose out on their wages?

Governments and councils in the UK are already setting up “warm banks”, which are public spots, such as places of worship or community centres, that people can go to if their homes are too cold. There are a number of concerns over warm banks, not least that they treat the symptom rather than the cause of the problem.

However, we know that COVID spreads easily indoors, especially where large numbers of people are mixing for extended periods. So another concern is that warm banks might increase the spread of COVID among those who are both most vulnerable to the effects of the virus, and most in need of somewhere warm.

Read more: Cost of living crisis: the health risks of not turning the heating on in winter

Many people will have already been under increased financial strain during the pandemic as a result of lost or lower income, making them more vulnerable to the cost of living crisis.

Research has found a link between recession and lifestyle-related health risk factors, such as poor diet and obesity, particularly for those from lower socioeconomic backgrounds. We know obesity is a significant risk factor for getting very sick and dying from COVID.

Indeed, past experience tells us that economic crises can be devastating to the health of the most vulnerable. Austerity measures implemented in Europe following the 2008 recession saw cuts to public spending, including social protections, education and health. This coincided with an overall widening of health inequalities in the decade from 2010.

So as many countries hurtle towards another recession, how can we learn from the pandemic, and the last recession, to better weather these twin crises?

Shared responsibility

I am a social scientist with expertise in public health, and I’ve been leading research looking at public experiences during the COVID pandemic. Over the course of the pandemic, I have argued that too much responsibility was put in the hands of the public. The long-term solution to reducing the impacts of infectious respiratory diseases is less about washing hands and more about ensuring public buildings and transport have adequate ventilation (although clean hands help too).

Similarly, the long-term solution to the cost of living crisis is less about suggesting people buy new kettles, and more about building warmer houses – and making them more affordable for all.

A person warms their hands on a radiator.
A cost of living crisis is taking hold. Jelena Stanojkovic/Shutterstock

There are of course ways that we, as individuals, can help ourselves and each other. Earlier in the pandemic, we saw how communities came together to support one another. A large number of grassroots groups, often organised via Facebook or WhatsApp, worked to provide food and other essentials to people who were self-isolating or after they had lost their jobs, for example.

It’s encouraging that a portion of these mutual aid groups are still active, and have pivoted to helping people cope with the cost of living crisis.

But ultimate responsibility lies with governments and society at large.

The solutions are complex

In the immediate term, we need to be strengthening rather than cutting funding and policies that protect public health. In the UK for example, there are concerning signs that the new cabinet is looking to undo hard-fought public health measures designed to reduce obesity.

Energy price caps can help to alleviate the crisis somewhat, but don’t go far enough. As Michael Marmot, an epidemiologist at University College London, argues, now is the time to deal with the longer-term problems that underpin fuel poverty.

Universal basic income has been put forward as one possible solution to the inequalities exacerbated by the pandemic. But what about, as some have proposed, universal basic energy, where each household has a portion of its energy paid for by the government?

Read more: How to tackle the UK cost of living crisis – four economists have their say

One approach which might guide us moving forward is proportionate universalism, where those most in need are given the most support. Energy price caps fail to achieve this on their own.

Payments for the most vulnerable are a start, but, as we learned from financial support for COVID self-isolation, it’s not just about making money available, but making it quick and easy to apply for and access.

As with the pandemic, although we will all be affected by the cost of living crisis this winter, for the most vulnerable, it might be more fitting to call it a “cost of surviving” crisis.

Simon Nicholas Williams has received funding from Swansea University, the University of Manchester, Senedd Cymru, Public Health Wales and the Wales COVID-19 Evidence Centre for research on COVID-19. However, this article reflects the views of the author only and no funding bodies were involved in the writing or content of this article.

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