Ann Blair Kennedy, LMT, BCTMB, DrPH1, Albert Moraska, PhD2, Grant Rich, PhD, BCTMB, LMT3
1University of South Carolina School of Medicine Greenville, Greenville, SC, USA
2College of Nursing, University of Colorado at Denver, Aurora, CO, USA
3Consulting Psychologist, Juneau, AK, USA
Massage therapy practice as well as research in massage therapy is guided by ethical principles and boundaries of professional behavior. Scientific publishing is also guided by a set of ethical standards, about which all aspiring scientific authors should be aware. Honesty, integrity, and conflicts of interest are issues in science and these issues can also impact scientific publishing. Historical ethical issues and current events are discussed.
Ethics help to define professional conduct within a profession and those in massage therapy practice are governed by national association(s), state, and possibly local ethical guidelines to help give guidance to safeguard patients/clients and protect the profession. Ethics are generally a part of entry-level massage education; the Entry-Level Analysis Project (ELAP) recommends that 18 hours of ethics be included in entry-level education.(1) Additionally, to maintain Board Certification through the National Certification Board for Therapeutic Massage and Bodywork, three continuing education hours in ethics must be obtained every two years.(2) The two largest professional massage associations in the United States, and the many others around the globe, require their members to uphold a standard of ethical practice. While massage therapists are generally aware of the need to follow professional ethics in clinical practice, they may not be aware of the professional ethics in the scientific world and in scientific publishing. Therefore, it is important for massage therapists who may be interested in participating in research and/or scientific publishing to be aware of these issues; some of them have come up recently here at the Journal.
Scientific integrity is a cornerstone of ethical principals in scientific research, requiring scientists to be honest, transparent, objective, avoid bias, and respect intellectual property.(3) In addition, ethical issues also go deeper in the protection of human rights in research. After World War II, reports from the Nuremberg Trials resulted in the creation of the Nuremberg Code which required researchers to weigh risk versus benefits, gain informed consent, and to protect participants from injury, death or any type of suffering.(4) The Declaration of Helsinki, originally penned in 1964 and revised as recently as 2013, builds on the Nuremberg Code to add protections for vulnerable populations and to require all research involving human subjects to be reviewed by an independent ethical review board.(5,6) In the United States, these boards are often referred to as Institutional Review Boards (IRB) or Ethical Review Boards (ERB) and in Canada, these are typically called Research Ethics Boards or REBs. These boards help to make sure that research participants’ rights and safety are protected throughout the research process. Further reading about the history of ethics in science reveals some of the infamous cases involving the Tuskegee syphilis experiment,(7) medical experimentation in Philadelphia’s Holmesburg Prision,(8) and the harvesting of cells without consent that led to numerous medical discoveries.(9)
One final issue is the concept of conflicts of interest in research. The Journal has published previously on this issue concerning its impact on the area of therapeutic massage and bodywork research,(10) so I will only expand briefly on one particular topic—corporate funding of research. It seems over the past few years there have been not only news stories, but also discussions in the scientific literature, about potential biases that can come from corporate funding.(11–13) Indeed, in many of the latest news stories, journalists claim that scientists and their resultant research are somehow suspect simply because they have received corporate funding. While this is a cause for concern,(14,15) it should not cause the results of a study to be dismissed simply because of the funding source. There are further questions to ask regarding transparency and control. If the researchers are transparent about their funding sources and the researchers have complete control over study design and methodology, data analysis, and publication of the work,(13) then the research results should not simply be dismissed out of hand because of the funding source.
When it comes to ethical issues in scientific publishing, the main areas of concern that we have here at the IJTMB include plagiarism, falsification of data, lack of ethical oversight, and duplicate submissions. These issues are not unique to the IJTMB and have been expounded on by other journal editors who have dealt with these issues over the years. The first issue of plagiarism is the use of other’s intellectual property and claiming it as one’s own. Those writers not experienced in using citations to back up each claim, may not truly understand the egregiousness of this ethical misstep, though it is expected that most individuals should have been exposed to this concept throughout their formative schooling. Plagiarism can come not only in the form of not citing other’s work, it can also occur when an author fails to cite their own previous work, this is known as “self-plagiarism” and can cause just as many ethical dilemmas.(16) Although journals can combat this problem to an extent with software and literature searches, the problem has not gone away in scientific publishing and sometimes reveals itself in new ways. Just recently, it was discovered that a peer reviewer at the Annals of Internal Medicine stole an article that had been submitted and rejected by that journal and then published the work under her or his own name in a different journal six months later.(17)
Falsification of data in scientific publishing can also be an issue and cause long-lasting public health concerns. Trikalinos et al.(18) in 2008 studied the length of time high-impact journals took to retract articles when there were implications of data falsification; they found that these retractions can take a very long time, especially when senior researchers are implicated in the falsification. Probably one of the most noted studies including fraudulent data, which is today still having lasting implications, is Wakefield’s study falsely implicating the MMR vaccine in the cause of Autism Spectrum Disorder.(19) The fear from parents about possibly harming their children with vaccines has led to outbreaks of preventable diseases in record numbers not seen in years, if not decades.(20)
Lack of ethical approval for studies is an issue that we have faced here at the Journal. We have rejected papers because this oversight is not provided. It should be noted that case reports generally do not require IRB oversight and this has been an area of confusion for some authors. While informed consent is required for case reports, ethical oversight by an IRB is not required in most cases. Case reports found here in this Journal are not seen as experiments, but as reporting what has occurred in clinical practice. The Massage Therapy Foundation Case report contest guidelines clarify this point well: “Case reports are written in the same manner as research reports. However, case reports are not research. They are a report of the assessment, intervention, and results of a single client… Research studies, on the other hand, are developed with the intent of assessing the therapy and frequently focus on the proper and consistent administration of the therapy rather than modification of the therapy to improve the effects on the client.”(21)
The final issue we have faced here recently at the Journal is the area of duplicate submission. This occurs when an author has the same article simultaneously under review at two or more journals. We identified a case of just this situation happening earlier this year, when a manuscript that was still under review with us, having gone through and received generous feedback from IJTMB peer reviewers and editors, was then published in another journal with our suggested edits. Duplicate submissions are considered a form of academic misconduct.(22) While this activity may not have long-lasting effects for the practitioners who only occasionally submit to the Journal, it is still a significant drain on IJTMB resources. Time, effort, and energy go into the peer review process, and to misuse that goodwill through either a duplicate submission or incorporating reviewer comments and submitting to another journal while still under review at the first journal represents dishonesty to the Journal and those who support its mission.
The purpose of this Editorial is to raise awareness by our readers, authors, and future authors. The massage profession is governed by ethics and boundaries for practice, as well as ethics in scientific research and publishing. We ask that those practitioners who wish to publish in the Journal to have the same respect for scientific ethics as they do for ethics in their clinical practices.
1 Archer P, Chandler C, Garbowski R, Lochhaas T, O’Hara J, Ribeiro C, et al. The Core: the Entry-Level Analysis Project report [Internet]. The Coalition of National Massage Therapy Organizations; 2013. Accessed 2017 April 19. Available from: http://www.elapmassage.org/_files/ELAP_FinalReport.pdf
2 National Certification Board for Therapeutic Massage and Bodywork. Board Certification [Internet]. Accessed 2017 April 19. Available from: http://www.ncbtmb.org/board-certification
3 Resnik DB. What is Ethics in Research & Why Is it Important? [Internet]. North Carolina: Research Triangle Park; 2015. Accessed 2017 April 19. Available from: https://www.niehs.nih.gov/research/resources/bioethics/whatis/
4 Nuremberg Code. Trials of war criminals before the Nuremberg Military Tribunals under Control Council Law No. 10. Vol. 2: The Medical Case. The Milcii Case. [Internet]. Washington, DC: US Government Printing Office; 1949. Accessed 2017 April 19. p. 181–182. Available from: https://www.loc.gov/rr/frd/Military_Law/pdf/NT_war-criminals_Vol-II.pdf
5 Barrett DH, Ortmann LW, Dawson A, Saenz C, Reis A, Bolan GA. Public Health Ethics: Cases Spanning the Globe. New York: Springer; 2016.
6 World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–2194.
7 Jones JH. Bad Blood: the Tuskegee Syphilis Experiment, new and expanded edition. New York, Toronto, New York: Free Press; 1993.
8 Hornblum AM. Acres of Skin: Human Experiments at Holmesburg Prison. Hoboken: Routledge; 2012.
9 Skloot R. The Immortal Life of Henrietta Lacks, 1st paperback edition. New York: Broadway Paperbacks; 2011.
10 Porcino AJ. Identifying conflicts of interest in therapeutic massage and bodywork research [Internet]. Int J Ther Massage Bodyw. 2013;6(1). Accessed 2017 April 19. Available from: http://www.ijtmb.org/index.php/ijtmb/article/view/216
11 Kroll D. What The New York Times Missed On Kevin Folta And Monsanto’s Cultivation Of Academic Scientists [Internet]. Forbes. 2015 Sept 10. Accessed 2017 April 19. Available from: https://www.forbes.com/sites/davidkroll/2015/09/10/whatthe-new-york-times-missed-on-kevin-folta-and-monsantoscultivation-of-academic-scientists/#68b8842d619a
12 Bero L. “Experimental” institutional models for corporate funding of academic research: unknown effects on the research enterprise. J Clin Epidemiol. 2008;61(7):629–633.
13 Brisbois BW, Cole DC, Davison CM, Di Ruggiero E, Hanson L, Janes CR, et al. Corporate sponsorship of global health research: questions to promote critical thinking about potential funding relationships. Can J Public Health Rev. 2016;107(4–5):e390–e392.
14 Patsopoulos NA, Ioannidis JPA, Analatos AA. Origin and funding of the most frequently cited papers in medicine: database analysis. BMJ. 2006;332(7549):1061–1064.
15 Stamatakis E, Weiler R, Ioannidis JPA. Undue industry influences that distort healthcare research, strategy, expenditure and practice: a review. Eur J Clin Invest. 2013;43(5):469–475.
16 Babalola O, Grant-Kels JM, Parish LC. Ethical dilemmas in journal publication. Clin Dermatol. 2012;30(2):231–236.
17 Dyer O. Peer reviewer stole article and published it as his own. BMJ. 2016;355:i6768.
18 Trikalinos NA, Evangelou E, Ioannidis JPA. Falsified papers in high-impact journals were slow to retract and indistinguishable from nonfraudulent papers. J Clin Epidemiol. 2008;61(5):464–470.
19 Godlee F, Smith J, Marcovitch H. Wakefield’s article linking MMR vaccine and autism was fraudulent. BMJ. 2011;342(1):c7452.
20 Federman RS. Understanding vaccines: a public imperative. Yale J Biol Med. 2014;87(4):417–422.
21 The Massage Therapy Foundation. Student Case Report Contest: guidelines [Internet]. Evanston, IL: The Foundation; 2016. Accessed 2017 April 19. Available from: http://massagetherapyfoundation.org/wp-content/uploads/2017-Student-Case-Report-Contest-guidelines.pdf
22 Leopold SS. Editorial: Duplicate submission and dual publication: what is so wrong with them? Clin Orthop. 2013;471(5):1401–1402.
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INTERNATIONAL JOURNAL OF THERAPEUTIC MASSAGE AND BODYWORK, VOLUME 10, NUMBER 3, September 2017