Was independent peer review of the PACE trial articles possible?

I ponder this question guided by Le Chavalier C. Auguste Dupin, the first fictional detective, before anyone was called “detective.”

mccartney too manyArticles reporting the PACE trial have extraordinary numbers of authors, acknowledgments, and institutional affiliations. A considerable proportion of all persons and institutions involved in researching chronic fatigue and related conditions in the UK have a close connection to PACE.

This raises issues about

  • Obtaining independent peer review of these articles that is not tainted by reviewer conflict of interest.
  • Just what authorship on a PACE trial paper represents and whether granting of authorship conforms to international standards.
  • The security of potential critics contemplating speaking out about whatever bad science they find in the PACE trial articles. The security of potential reviewers who are negative and can be found out. Critics within the UK risk isolation and blacklisting from a large group who have investments in what could be exaggerated estimates of the quality and outcome of PACE trial.
  • Whether grants associated with multimillion pound PACE study could have received the independent peer review that is so crucial to assuring that proposals selected to be funded are of the highest quality.

Issues about the large number of authors, acknowledgments, and institutional affiliations become all the more salient as critics [1, 2, 3] find again serious flaws inthe conduct and the reporting of the Lancet Psychiatry 2015 long-term follow-up study. Numerous obvious Questionable Research Practices (QRPs) survived peer review. That implies at least ineptness in peer review or even Questionable Publication Practices (QPPs).

The important question becomes: how is the publication of questionable science to be explained?

Maybe there were difficulties finding reviewers with relevant expertise who were not in some way involved in the PACE trial or affiliated with departments and institutions that would be construed as benefiting from a positive review outcome, i.e. a publication?

Or in the enormous smallness of the UK, is independent peer review achieved by persons putting those relationships and affiliations aside to produce an impeccably detached and rigorous review process?

The untrustworthiness of both the biomedical and psychological literatures are well-established. Nonpharmacological interventions have fewer safeguards than drug trials, in terms of adherence to preregistration, reporting standards like CONSORT, and enforcement of sharing of data.

Open-minded skeptics should be assured of independent peer review of nonpharmacological clinical trials, particularly when there is evidence that persons and groups with considerable financial interests attempt to control what gets published and what is said about their favored interventions. Reviewers with potential conflicts of interest should be excluded from evaluation of manuscripts.

Independent peer review of the PACE trial by those with relevant expertise might not be possible the UK where much of the conceivable expertise is in some way directly or indirectly attached to the PACE trial.

A Dutch observer’s astute observations about the PACE articles

My guest blogger Dutch research biologist Klaas van Dijk  called attention to the exceptionally large number of authors and institutions listed for a pair of PACE trial papers.

klaasKlaas noted

The Pubmed entry for the 2011 Lancet paper lists 19 authors:

B J Angus, H L Baber, J Bavinton, M Burgess, T Chalder, L V Clark, D L Cox, J C DeCesare, K A Goldsmith, A L Johnson, P McCrone, G Murphy, M Murphy, H O’Dowd, PACE trial management group*, L Potts, M Sharpe, R Walwyn, D Wilks and P D White (re-arranged in an alphabetic order).

The actual article from the Lancet website ( http://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(11)60096-2.pdf and also http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60096-2/fulltext ) lists 19 authors who are acting ‘on behalf of the PACE trial management group†’. But the end of the paper (page 835) states: “PACE trial group.” This term is not identical to “PACE trial management group”.
.
In total, another 19 names are listed under “PACE trial group” (page 835): Hiroko Akagi, Mansel Aylward, Barbara Bowman Jenny Butler, Chris Clark, Janet Darbyshire, Paul Dieppe, Patrick Doherty, Charlotte Feinmann, Deborah Fleetwood, Astrid Fletcher, Stella Law, M Llewelyn, Alastair Miller, Tom Sensky, Peter Spencer, Gavin Spickett, Stephen Stansfeld and Alison Wearden (re-arranged in an alphabetic order).

There is no overlap with the first 19 people who are listed as author of the paper.

So how many people can claim to be an author of this paper? Are all these 19 people of the “PACE trial management group” (not identical to “PACE trial group”???) also some sort of co-author of this paper? Do all these 19 people of the second group also agree with the complete contents of the paper? Do all 38 people agree with the full contents of the paper?

The paper lists many affiliations:
* Queen Mary University of London, UK
* King’s College London, UK
* University of Cambridge, UK
* University of Cumbria, UK
* University of Oxford, UK
* University of Edinburgh, UK
* Medical Research Council Clinical Trials Unit, London, UK
* South London and Maudsley NHS Foundation Trust, London, UK
* The John Radcliffe Hospital, Oxford, UK
* Royal Free Hospital NHS Trust, London, UK
* Barts and the London NHS Trust, London, UK
* Frenchay Hospital NHS Trust, Bristol, UK;
* Western General Hospital, Edinburgh, UK

Do all these affiliations also agree with the full contents of the paper? Am I right to assume that all 38 people (names see above) and all affiliations / institutes (see above) plainly refuse to give critics / other scientists / patients / patient groups (etc.) access to the raw research data of this paper and am I am right with my assumption that it is therefore impossible for all others (including allies of patients / other scientists / interested students, etc.) to conduct re-calculations, check all statements with the raw data, etc?

Decisions whether to accept manuscripts for publication are made in dark places based on opinions offered by people whose identities may be known only to editors. Actually, though, in a small country like the UK, peer-reviewed may be a lot less anonymous than intended and possibly a lot less independent and free of conflict of interests. Without a lot more transparency than is currently available concerning peer review the published papers underwent, we are left to our speculation.

Prepublication peer review is just one aspect of the process of getting research findings vetted and shaped and available to the larger scientific community, and an overall process that is now recognized as tainted with untrustworthiness.

Rules for granting authorship

Concerns about gift and unwarranted authorship have increased not only because of growing awareness of unregulated and unfair practices, but because of the importance attached to citations and authorship for professional advancement. Journals are increasingly requiring documentation that all authors have made an appropriate contribution to a manuscript and have approved the final version

Yet operating rules for granting authorship in many institutional settings vary greatly from the stringent requirements of journals. Contrary to the signed statements that corresponding authors have to make in submitting a manuscript to a journal, many clinicians expect an authorship in return for access to patients. Many competitive institutions award and withhold authorship based on politics and good or bad behavior that have nothing to do with requirements of journals.

Basically, despite the existence of numerous ethical guidelines and explicit policies, authors and institutions can largely do what they want when it comes to granting and withholding authorship.

Persons are quickly disappointed when they are naïve enough to complain about unwarranted authorships or being forced to include authors on papers without appropriate contribution or being denied authorship for an important contribution. They quickly discover that whistleblowers are generally considered more of a threat to institutions and punished more severely than alleged wrongdoers, no matter how strong the evidence may be.

The Lancet website notes

The Lancet is a signatory journal to the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, issued by the International Committee of Medical Journal Editors (ICMJE Recommendations), and to the Committee on Publication Ethics (COPE) code of conduct for editors. We follow COPE’s guidelines.

The ICMJE recommends that an author should meet all four of the following criteria:

  • Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work;
  • Drafting the work or revising it critically for important intellectual content;
  • Final approval of the version to be published;
  • Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.”

The intent of these widely endorsed recommendations is that persons associated with a large project have to do a lot to claim their places as authors.

Why the fuss about acknowledgments?

I’ve heard from a number of graduate students and junior investigators that they have had their first manuscripts held up in the submission process because they did not obtain written permission for acknowledgments. Why is that considered so important?

Mention in an acknowledgment is an honor. But it implies involvement in a project and approval of a resulting manuscript. In the past, there were numerous instances where people were named in acknowledgments without having given permission. There was a suspicion sometimes confirmed, that they had been acknowledged only to improve the prospects of a manuscript for getting published. There are other instances where persons were included in acknowledgments without permission with the intent of authors avoiding them in the review process because of the appearance of a conflict of interest.

The expectation is that anyone contributing enough to a manuscript to be acknowledged as a potential conflict of interest in deciding whether it is suitable for publication.

But, as in other aspects of a mysterious and largely anonymous review process, whether people who were acknowledged in manuscripts were barred from participating in review of a manuscript cannot be established by readers.

What is the responsibility of reviewers to declare conflict of interest?

Reviewers are expected to declare conflicts of interest accepting a manuscript to review. But often they are presented with a tick box without a clear explanation of the criteria for the appearance of conflict of interest. But reviewers can usually continue considering a manuscript after acknowledging that they do have an association with authors or institutional affiliation, but they do not consider it a conflict. It is generally accepted that statement.

Authors excluding from the review process persons they consider to have a negative bias

In submitting a manuscript, authors are offered an opportunity to identify persons who should be excluded because of the appearance of a negative bias. Editors generally take these requests quite seriously. As an editor, I sometimes receive a large number of requested exclusions by authors who worry about opinions of particular people.

While we don’t know what went on in prepublication peer review, the PACE investigators have repeatedly and aggressively attempted to manipulate post publication portrayals of their trial in the media. Can we rule out that they similarly try to control potential critics in the prepublication peer review of their papers?

The 2015 Lancet Psychiatry secondary mediation analysis article

Chalder, T., Goldsmith, K. A., Walker, J., & White, P. D. Sharpe, M., Pickles, A.R. Rehabilitative therapies for chronic fatigue syndrome: a secondary mediation analysis of the PACE trial. The Lancet Psychiatry, 2: 141–52

The acknowledgments include

We acknowledge the help of the PACE Trial Management Group, which consisted of the authors of this paper, excluding ARP, plus (in alphabetical order): B Angus, H Baber, J Bavinton, M Burgess, LV Clark, DL Cox, JC DeCesare, P McCrone, G Murphy, M Murphy, H O’Dowd, T Peto, L Potts, R Walwyn, and D Wilks. This report is independent research partly arising from a doctoral research fellowship supported by the NIHR.

Fifteen of the authors of the 2011 Lancet PACE paper are no longer present, and another author has been added. The PACE Trial Management Group is again acknowledged, but there is no mention of the separate PACE trial group. We can’t tell why there has been a major reduction in the number of authors and acknowledgments or why it came about. Or whether people who would been dropped participated in a review of this paper. But what is obvious is that this is an exceedingly flawed mediation analysis crafted to a foregone conclusion. I’ll say more about that in future blogs, but we can only speculate how the bad publication practices made it through peer review.

This article is a crime against the practice of secondary mediation analyses. If I were a prospect of author present in a discussion, I would flee before it became a crime scene.

I am told I have over 350 publications, but I considered vulgar for authors to keep track of exact numbers. But there are many potential publications that are not included in this number because I declined authorship because I could not agree with the spin that others were trying to put on the reporting of the findings. In such instances, I exclude myself from review of the resulting manuscript because of the appearance of a conflict of interest. We can ponder how many of the large pool of past PACE authors refused authorship on this paper when it was offered and homely declined to participate in subsequent peer review because of the appearance of a conflict of interest.

The 2015 Lancet Psychiatry long-term follow-up article

Sharpe, M., Goldsmith, K. A., Chalder, T., Johnson, A.L., Walker, J., & White, P. D. (2015). Rehabilitative treatments for chronic fatigue syndrome: long-term follow-up from the PACE trial. The Lancet Psychiatry, http://dx.doi.org/10.1016/S2215-0366(15)00317-X

The acknowledgments include

We gratefully acknowledge the help of the PACE Trial Management Group, which consisted of the authors of this paper, plus (in alphabetical order): B Angus, H Baber, J Bavinton, M Burgess, L V Clark, D L Cox, J C DeCesare, E Feldman, P McCrone, G Murphy, M Murphy, H O’Dowd, T Peto, L Potts, R Walwyn, and D Wilks, and the King’s Clinical Trials Unit. We thank Hannah Baber for facilitating the long-term follow-up data collection.

Again, there are authors and acknowledgments missing from the early paper and were in the dark about how and why that happened and whether missing persons were considered free enough of conflict of interest to evaluate this article when it was in manuscript form. But as documented in a blog post at Mind the Brain, there were serious, obvious flaws in the conduct and reporting of the follow-up study. It is a crime against best practices for the proper conduct and reporting of clinical trials. And again we can speculate how it got through peer review.

… And grant reviews?

Where can UK granting agencies obtain independent peer review of past and future grants associated with the PACE trial? To take just one example, the 2015 Lancet Psychiatry secondary mediation analysis was funded in part by a NIHR doctoral research fellowship grant. The resulting paper has many fewer authors than the 2011 Lancet. Did everyone who was an author or mentioned in the acknowledgments on that paper exclude themselves from review of the screen? Who, then, would be left

In Germany and the Netherlands, concerns about avoiding the appearance of conflict of interest in obtaining independent peer review of grants has led to heavy reliance on expertise from outside the country. This does not imply any improprieties from expertise within these countries, but rather the necessity of maintaining a strong appearance that vested interests have not unduly influenced grant review. Perhaps the situation of apparent with the PACE trial suggests that journals and grant review panels within the UK might consider similar steps.

Contemplating the evidence against independent peer review

  • We have a mob of people as authors and mentions in acknowledgments. We have a huge conglomerate of institutions acknowledged.
  • We have some papers with blatant questionable research and reporting practices published in prestigious journals after ostensible peer review.
  • We are left in the dark about what exactly happened in peer review, but that the articles were adequately peer reviewed is a crucial part of their credability.

What are we to conclude?

The_Purloined_LetterI think of what Edgar Allen Poe’s wise character, Le Chevalier C. Auguste Dupin would say. For those of you who don’t know who he is:

Le Chevalier C. Auguste Dupin  is a fictional detective created by Edgar Allan Poe. Dupin made his first appearance in Poe’s “The Murders in the Rue Morgue” (1841), widely considered the first detective fiction story.[1] He reappears in “The Mystery of Marie Rogêt” (1842) and “The Purloined Letter” (1844)…

Poe created the Dupin character before the word detective had been coined. The character laid the groundwork for fictitious detectives to come, including Sherlock Holmes, and established most of the common elements of the detective fiction genre.

I think if we asked Dupin, he would say the danger is that the question is too fascinating to give up, but impossible to resolve without evidence we cannot access. We can blog, we can discuss this important question, but in the end we cannot answer it with certainty.

Sigh.

14 thoughts on “Was independent peer review of the PACE trial articles possible?”

  1. Thank you again for all that you are doing for people with ME/CFS to expose the processes behind the baffling failure of peer review that has allowed PACE papers to be published despite glaring, serious problems in methodolology, analysis and interpretation.

    Patients and supporters might like to sign a second, major PACE petition from #MEAction that aims to bring the weight of the US HHS (health department) to protect patients both in the US and overseas from harm from PACE and other Oxford-criteria trials.

    Sign and share! Pile on the pressure!

    http://my.meaction.net/petitions/call-for-cdc-and-ahrq-to-investigate-pace

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    1. Sasha, CDC and AHRQ both have substantial conflicts of interest. According to William Reeves’ own word he and Peter White spoke every week. CDC adopted White& Wessely hook line and sinker. You have to figure out who has standing and for what. Congress can investigate anything. It is CDC that needs to be investigated for having extensively adopted the work of White and Wessely and for a while giving readers no American sources. Also parts of and persons at NIH.

      Congress should investigate why the work they pay for with grants ends up behind paywalls that benefit European companies like Elselvier and Springer while the taxpayers who have paid for the work with their taxes have to pay again to access it. Then you can call for investigation of why it is crooked and misleading in ways that harm these same taxpayers.

      Alternately, buy an ADR of REXL (formerly Reed Elselvier) and then complain to the SEC and ask them to file an amicus brief to the QMUL appeal on grounds that the interests of shareholders are being endangered and the risk is not properly disclosed so long as Queen Mary’s holds on to the data — shareholders can’t tell the extent of the fraud and the extent of Lancet’s loss of value as a result. Lancet is the Queen Bee of the Medicals & Journals division, which is their larges by revenue. Or if not SEC any ambulance-chasing lawyer who likes to file lawsuits on behalf of shareholders will do. That way you can really cause some trouble and get out the info we need to prove PACE a fraud.

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  2. Time and time again the medical establishment (such as NICE) have used the fact that PACE was peer-reviewed to ignore any criticisms or analysis from patients. Thanks for spelling out so clearly exactly why reliance on that system is so inappropriate, and showing how such faulty work can pass through the system. The ironic thing is that the editor of The Lancet is on record as saying that the peer-review system is faulty, despite defending the PACE trial.

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  3. One more reason to throw the PACE study into the trash bin and start over. Wasn’t even Prof. Wessely supporting funding for more studies? Ones I hope are done by researchers far removed from him.

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  4. Too many questions remain! It would have been (and still would be) better if the PACE authors and Queen Mary University would give open answers to the highly pertinent inquiries which ME patients and advocates have been raising.

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  5. I think this post also raises the question of why the British media also maintain total silence about the problems with PACE. It’s not as though patients and charities haven’t been trying to get them interested all these years.

    And it’s such a great story! What’s wrong with our journalists? Why don’t they bite?

    And how do we solve the problem?

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  6. Peer review is supposed to be anonymous – somewhat like a double-blind trial. You’re not supposed to know whose paper you are reviewing, and the authors are not supposed to know who reviewed it. But it would have been impossible not to know you were reviewing the PACE trial, and therefore, precisely whose work it was.

    And it would have been impossible not to know who you would offend if you didn’t approve the paper. This disease should not be controversial – but it is. Researchers focusing on biomedical research on ME and CFS have lost their jobs because of it.

    In particular, the “biopsychosocial” school of thought regarding ME and CFS has been very aggressive in defending their position. Sasha wondered why mainstream journalism has not picked this story up. I can tell you the answer for the UK: there is a committee, the Science Media Centre (SMC) that essentially releases press releases for the major newspapers to follow. Billed as a useful filtering process, it has become a means for both blocking positions not in favor and promoting their own pet projects. In other words, the SMC is engaged in activities that look a lot like censorship and propaganda to a social scientist. And the “biopsychosocial” school has always ensured that one of their crew (or possibly a spouse) is on the SMC.

    One question I would have asked, were I a reviewer who presumably knew something about M.E. and CFS, would be why there are no references to the literature on the disease outside of psychiatry. That is true for the entire body of literature regarding ME and CFS in psychiatry. It is a parallel universe.

    It is a cardinal rule of scholarship that one may disagree with other views; one may even consider other views so poorly done as not to merit mention – but you still have to face them. You have to say, in a footnote, at least, that (for example) an article in JAMA in 1995 found that a large percentage of patients diagnosed with CFS (Fukuda 1994 definition) concurrently met the definition for Neurally Mediated Hypotension/Postural Orthostatic Tachycardia Syndrome (NMH/POTS), a type of autonomic nervous system dysfunction. One would THINK that a JAMA article should count. (There are actually around 4,000 peer-reviewed published articles on biomedical facets of ME and CFS.) If the authors had problems with the research; or if their own definition (Oxford) depicted NMH/POTS as actually exclusionary for ME and CFS (it does), they should have said so in a footnote. But they should have addressed that literature.

    That is what concerns me the most about this school of thought regarding ME and CFS – they ignore anything that could disprove their own theories. I was taught that, in scholarship, if you were going to ignore other theories, you had to explain why – even if only in a footnote – and direct the reader to the article to decide for himself. I used the JAMA article as an example because clearly that was what we call a big hit – but they have never referenced it in their own work, including the PACE study. Nor articles on biomedical information on ME and CFS in other scholarly journals such as the Archives of Internal Medicine or the American Journal of Medicine. If all you read was the literature coming out of the “biopsychosocial” school, you would not know there was a biological part at all. Or that reseachers had been publishing about non-psychiatric explanations for decades.

    I am old-fashioned. I believe that the scholarly review process, WHEN DONE CORRECTLY, and when there are sufficient outlets for publication, works well to get information and ideas out to other scholars and, eventually, the public. It is worrisome when the rules are not only ignored – but deliberately so. I am glad you have taken this subject on (the PACE trial), and I hope you do not lose interest. It is the tip of an iceberg.

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    1. Well said. The activities of the proponents of psychosomatic explanations for CFS resemble a cult that is primarily interested in promoting its ideology and expanding its influence, even if it means harming patients, ignoring inconvenient facts, or fabricating results.

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  7. Your comment about German and Dutch efforts to internationalise the review process is interesting. In fact it’s quite likely that some of the original PACE referees were Dutch, as shown by Bleijenberg and Knoop’s Lancet commentary (invited comments on papers often come from the reviewers). Does that indicate a healthy enlargement of the reviewer gene pool?

    A recent search for all ME/CFS treatment studies since 2013 found 70% behavioural, 30% non-behavioural, and: “Over two-thirds of the behavioral studies originated in two countries – the United Kingdom (22) and the Netherlands (14). Other countries included the US – 5, Belgium – 4, Norway – 3, Australia – 2, Spain – 1, India – 1, Japan – 1.”
    http://www.cortjohnson.org/blog/2015/11/11/chokehold-behavioral-treatments-chronic-fatigue-syndrome/

    The ME/CFS psychotherapy cult is as entrenched in the Netherlands as in the UK. Both groups can comply with stricter transparency criteria by taking in each other’s washing leaving the net result unaltered.

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  8. I’ve just checked the acknowledgements in the 2011 PACE trial paper, and I counted roughly sixty names listed. And the trial protocol lists roughly 33 names under the ‘Trial Management Group’. And the 2011 paper lists roughly 19 names under ‘PACE Trial Group’, which includes the trial steering committee. And then there are the trial authors for the protocol and the 2011 paper, and further trial authors and acknowledgements across at least another six published papers.

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  9. I don’t have a medical background and I am not familiar with all (unwritten) rules in regard to double-blinded peer-review for medical papers, but I do note that there are in general no fixed rules of anonymous peer review.
    .
    I even hold the opposite view. Full transparency of the entire process of peer review is the only option when there are doubts of (perceived) conflicts of interests between peer reviewers / authors / affilations / journals. This is particular necessary when the topic is highly controversial and when many parties are connected to an important paper about this controversial topic. My point of view implies that the names of the peers are public and that the peer-review reports are public as well.
    .
    I also hold the opinion that all parties (authors and affilations) of the 2011 PACE Trial paper in The Lancet have a full accountability which implies towards my opinion that all must be willing to engage in public debates, in particular public debates in a scientific context organized by one of the affilated universities. I hold the strong opinion that such public scientific debates at universities are a core business of any well-respected university, in particular when there are issues about controversial findings which have been published in well-respected peer reviewed journals. I totally fail to understand why all these UK universities (Queen Mary University of London, King’s College London, University of Cambridge, University of Cumbria, University of Oxford, University of Edinburgh) seem unwilling to organize at their university such public debates. I fail to understand as well that all authors seem unwilling to join / organize such a debate. I am sure such public debates at the university (for example first with a lecture, followed by two hours for asking questions) will attact lots of people (and of course lots of interest by the media). Such public debates at a venue of any of the UK universities is of course also a great opportunity for all students to see how scientists with opposing opinion are debating with each other. The apparent failure of all these UK universities to organize such public debates is therefore as well disasterous when it comes to a proper academic education for their students.
    .
    Excuse me very much, but scientists affilated to universities who refuse to get involved in a public debate at the university (of course with all interested students and with all other parties) about their findings don’t know what they are doing. These scientists are even obstructing the scientific debate and their decision of ‘no dialogue with scientific opponents ‘ can be classified as ‘faith-based activity’. It is extremely troubling that all these UK universities seem unwilling to organize such scientific debates.
    .
    I would like to give an example from around ten years ago from The Netherlands of a full disclosure of the names of the peers and the peer review reports in technical reports about a highly controversial topic (the negative effects on birds of large scale commercial dredging of cockles from the Dutch Wadden Sea).
    .
    See journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.0040376 and http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2664.2001.00652.x/full and http://icesjms.oxfordjournals.org/content/64/9/1735.full and http://www.rug.nl/research/portal/files/6666977/2002BiolConservCamphuysen.pdf for some papers in peer-reviewed journals about this topic.
    All authors of these papers and all affilations of course agree with the entire contents of the papers in question. They were as well often engaged in all kind of public debates about this topic. My name is listed in the Acknowledgement of the paper on the mass mortality of the Eiders. I am therefore aware that this paper is the result of an extensive scientific debate with all authors and with all affilations and that of course all agree with the contents of the paper. It is a misunderstanding, at least in my field of research, that people listed in the Acknowledgements need to agree with the contents of the paper.
    .
    Two technical reports about this highly controversial topic were published in 2004 ( https://www.researchgate.net/publication/40798488 and https://www.researchgate.net/publication/40124944 ). Both technical reports are in Dutch. The research was conducted by Alterra, a research institute affilated to WUR (Wageningen University Research Centre).
    The strong debate about this highly controversial topic resulted in a so-called ‘external audit committee’ who were responsible for the peer review of a draft of both reports. This is of course identical to peer review of papers.
    .
    The full report of the three peers (together with the rebuttal of the authors) and their names (Prof.Dr. P.L. de Boer, Prof.Dr. C.H.R. Heip en Prof.Dr. W.J. Wolff) have been added as ‘appendix 2’ at both reports (see page 133 and page 157). Of course still people might disagree with the findings of the peers and of course still people might argue that there are (potential) conflicts of interest between the peers and the authors (etc), but all is transparant. See for example also https://peerj.com/articles/313/ for a recent example of a paper with the full peer review reports aside the paper.
    .
    So maybe it was indeed impossible to conduct an independent peer review of the various PACE trial papers. I don’t know. I do know that good and honest scientists are always willing to have scientific dialogue about their findings. I do know that good and honest scientists are always willing to admit they have made mistakes and/or errors. I finally do know as well that a full transparency of all parties, a full accountability of all parties, and much willingness of all parties to have extensive scientific dialogues in public with all opponents is the only option to hammer down the arguments of all critics that parties were involved in what can be called ‘partial behaviour’.

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  10. Oxford University is listed as one of the affiliations of the 2011 paper in The Lancet. Professor Ewan McKendrick, the Registrar of Oxford University, wrote to me in an e-mail, dated 20 August 2015: “(…) while it is the case that acting as an editor of an academic journal is an activity commonly carried out by academic members of staff, such activity does not constitute research, (….)”
    .
    I have send a response on the same day to professor McKendrick in which is stated: “I fail to understand why Oxford University holds the opinion that activities conducted as editor of a scientific journal don’t constitute research. Can you please provide me with some solid references (eg papers in peer-reviewed journals) for this point of view of Oxford University?”
    .
    No one has until provided me with the requested references. Lateron, I have send an e-mail to Oxford University with three references in which it is clearly stated that (peer) review is an (important) part of conducting science / research. These three references are:
    (1): http://ukrio.org/wp-content/uploads/UKRIO-Code-of-Practice-for-Research.pdf
    (2): http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/r39.pdf
    (3): http://www.rug.nl/about-us/organization/rules-and-regulations/algemeen/gedragscodes-nederlandse-universiteiten/code-wetenschapsbeoefening-14-en.pdf
    .
    There is until now no response from the side of Oxford University with the requested references and there is until now also no response from the side of Oxford University which rebuts my statements about this topic.

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