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Last month, an odd paper appeared online in the Journal of Evaluation in Clinical Practice. “Maternal kisses are not effective in alleviating minor childhood injuries (boo-boos),” blared the title, which also announced that it was a rigorous “randomized, controlled and blinded study.”

The authors of the article, who called themselves “The Study of Maternal and Child Kissing (SMACK) Working Group,” claimed, among other things, to have encouraged children to injure themselves by leaving pieces of chocolate under a low table edge. After the children crawled to the candy, “Invariably, the child would then stand to eat the chocolate and would strike his or her head on the table edge.” Some of those children had their boo-boos kissed by their mothers, some had them kissed by people other than their mothers, and some didn’t have them kissed at all.


The conclusions? “Maternal kissing of boo-boos confers no benefit on children with minor traumatic injuries compared to both no intervention and sham kissing.” Based on these findings, the authors “recommend a moratorium on the practice” of moms kissing boo-boos.

If that sounds ridiculous, well, it was. It turns out that the study – which was published in a peer-reviewed journal – was based on fake data.

Now, as we’ve learned, journals publish studies filled with fake data more frequently than they’d like to admit, much to their chagrin. One science journalist has made a name for himself by submitting fake papers to journals to see how many would publish them. (A frighteningly large percentage did.) But when that kind of skullduggery is uncovered in published papers, journals retract them. The difference here is that the editor of the journal, Andrew Miles, knew the data were fake, and published the study anyway. Why? The paper “is very clearly ironic and published with reference to the time of year, much as the [British Medical Journal] BMJ does with its own Christmas edition,” Miles told The Federalist.


As ridiculous as the paper is, however, it’s not marked as fiction. The BMJ’s Christmas issue — indeed famous for its humor — may be silly but its data are real. Take, for example, a 2003 tongue-in-cheek “systematic review” of whether parachutes were effective for jumping out of planes, a paper to which Miles likened the boo-boos study. This is not the sort of intervention it would be ethical to test, so unsurprisingly the authors couldn’t find any rigorous studies to review. But while hilarious, and provocative, the study was not fake.

Miles did point us to one example of a fake abstract knowingly published in the BMJ, although not in the Christmas issue, claiming that the best way to rid children — aka “urchins” — of head lice was to pay them to pick the nits themselves, in a strategy abbreviated PIGPEN. The author, Trish Greenhalgh, later acknowledged, wryly, that the paper was fake, although it was not marked as satire.

Perhaps, then, that’s why Jack Marshall, a Washington, D.C., lawyer who styles himself as a professional ethicist, told the Ottawa Citizen — hometown publication to the 943 nonexistent children who were injured in the boo-boo study — that the paper “needed a disclaimer to make it clear it was not real.”

Hogwash, said Miles. The boo-boo article, he told STAT, is “a piece of medical satire.” Its author, Mark Tonelli, a professor of intensive care medicine and bioethics at the University of Washington, in Seattle, “has not deliberately … concocted original scientific data, presenting them as the results of true and ethical investigation, in order to deceive the international medical and scientific community.” (We’d argue he most definitely has.) There is, Miles said, an editorial in the upcoming issue of the journal that will explain the paper’s purpose. He told Nature that he was considering linking the paper’s entry in PubMed, the database of abstracts most frequently used by researchers, to the editorial.

And yet that editorial has yet to be published, which means the study sits on its own, without any context, and no clear indication it’s satire. And to be fair, we’re only assuming that the editorial makes that clear, since Miles declined to share it with us. Readers will likely also believe that the paper was peer-reviewed by outside experts, but Miles tells us that wasn’t the case, since its nature made it unsuited for such review.

Miles’ and Tonelli’s real aim, said Miles, was to “convey a series of important lessons” about evidence-based medicine. Miles’ feelings on evidence-based medicine, which others would define as an attempt to use data from rigorous trials to guide medical decisions, are evident; he has called the movement “unscientific and antiscientific” in the pages of his journal. For Miles, the ends justifies the means: “You would do well to investigate how such satirical pieces, through their clear strategic, academic intentions, lead to novel research of importance to medicine.”

Perhaps. But they also sow distrust when they’re not clearly marked as satire. In an era when public trust in science is under siege from some quarters, why give the anti-science crowd ammunition? Marshall is right. As Matthew McLennan, assistant professor of public ethics at St. Paul University in Ottawa, told the Citizen, “The Internet is already a source of confusion. I would expect a scholarly journal to not contribute to the confusion.”