SGEM Xtra: On the Boulevard of Broken Dreams – Citation Errors in the Biomedical Literature

Date: February 22, 2025 Guest Skeptic: Nicholas Peoples, who is a medical student at Baylor College of Medicine in Houston, Texas. Nick’s career has been an exciting blend of global health and emergency medicine. In 2015, Nick was part of the first-ever class to study at Duke University’s new campus in China, where he earned a master’s degree in global health. He went on to spend a couple of years working for medical NGOs in Nepal and Malawi before deciding he wanted to become an emergency medicine doctor. Since then, he’s been at the top of his class in medical school – earning induction into the Alpha Omega Alpha and Gold Humanism Honor Societies. He won the prestigious Schwarzman Scholarship. This past year he published as first author in The Lancet, The BMJ, JAMA, and Academic Medicine. In typical EM fashion, he spends his spare time SCUBA diving and battling a crippling caffeine addiction. This is another SGEM Xtra. Today, we are going to take a deep dive into an essential but often overlooked topic: inaccurate citations in biomedical research. Scientific citations are the foundation of modern research, meant to weave a web of knowledge that is accurate, credible, and informative. However, a startling percentage of these citations are flawed. Inaccurate citations can misrepresent studies, propagate errors, and even shape misguided policies and guidelines. Nick and his colleagues recently highlighted this issue in their paper published in BMJ (Burden of proof: combating inaccurate citation in biomedical literature) and a related letter in The Lancet (Defensive scholarship: learning from academia’s plagiarism crisis). Ingelfinger FJ. Seduction by Citation. NEJM 1976: “The pages of any book, tract or article dealing with medicine are apt to be profusely sprinkled with numerical superscripts (or their equivalents) guiding the reader to a reference list. Not only does the liberal presence of such reference numbers impart an aura of scholarship, but their judicious placement after this or that assertion subtly suggests documented validity. But watch out—those little numbers may be no more than the trappings of credibility. The primary sources cited may be misquoted, inapplicable, unreliable and occasionally even imaginary.” Nick was asked five questions about his study. Listen to the SGEM podcast to hear his answers on iTunes or Spotify.  FIVE QUESTIONS How prevalent are inaccurate citations, and what types exist? Pavlovic V et al. How accurate are citations of frequently cited papers in biomedical literature? Clin Sci (Lond). 2021 Mar  Porrino JA Jr et al. Misquotation of a commonly referenced hand surgery study. J Hand Surg Am. 2008  Greenberg SA. How citation distortions create unfounded authority: analysis of a citation network. BMJ. 2009 Jul SGEM Xtra: Everything You Know is Wrong Charla Viera.Harvard President Claudine Gay Resignation: What it means for the larger academic community? Am J Experts March 2024 Leung PTM et al. A 1980 Letter on the Risk of Opioid Addiction. NEJM. 2017 Jun  What are the underlying causes of inaccurate citations? Authors citing papers they haven’t read fully and either citing nonexistent findings or misinterpreting the findings. Copying citations from other studies rather than reading the primary source, and those citations themselves are inaccurate. This can turn into a long rabbit hole in the literature of sources citing other sources, but no evidence for the claim can be found. Bias or coercion in referencing, such as through peer review. Insufficient gatekeeping for miscitation. The academic community does not take miscitation seriously enough.  How does the rise of AI tools like ChatGPT influence citation accuracy? AI tools can fabricate sources or generate plausible sounding but inaccurate citations. I think what worries me is that I have been seeing numerous AI programs being marketed t...