One study promised that popular blood-pressure drugs were safe for people infected with the coronavirus. Another paper warned that anti-malaria drugs endorsed by President Trump actually were dangerous to these patients.

The studies, published in the New England Journal of Medicine and The Lancet, were retracted shortly after publication, following an outcry from researchers who saw obvious flaws.

The hasty retractions, on the same day this month, have alarmed scientists worldwide who fear that the rush for research on the coronavirus has overwhelmed the peer review process and opened the door to fraud, threatening the credibility of respected medical journals just when they are needed most.

Peer review is supposed to safeguard the quality of scientific research. When a journal receives a manuscript, the editors ask three or more experts in the field for comments. The reviewers’ written assessments may force revisions in a paper or prompt the journal to reject the work altogether. The system, widely adopted by medical journals in the middle of the 20th century, undergirds scientific discourse around the world.

“The problem with trust is that it’s too easy to lose and too hard to get back,” said Dr. Jerome Kassirer, a former editor in chief of the New England Journal of Medicine, which published one of the retracted papers in early May. “These are big blunders.”

If outside scientists detected problems that weren’t identified by the peer reviewers, then the journals failed, he said. Like hundreds of other researchers, Dr. Kassirer called on the editors to publish full explanations of what happened.

Credit…Lisa Poole/Associated Press

In interviews with The New York Times, Dr. Richard Horton, the editor in chief of The Lancet, and Dr. Eric Rubin, editor in chief of the N.E.J.M., said that the studies should never have appeared in their journals but insisted that the review process was still working.

“We shouldn’t have published this,” Dr. Rubin said of the study appearing in the N.E.J.M. “We should have had reviewers who would recognize the problem.”

Dr. Horton called the paper retracted by his journal a “fabrication” and “a monumental fraud.” But peer review was never intended to detect outright deceit, he said, and anyone who thinks otherwise has “a fundamental misunderstanding of what peer review is.”

“If you have an author who deliberately tries to mislead, it’s surprisingly easy for them to do so,” he said.

In addition, the editors said, there is an urgent need to rapidly publish new findings to improve treatments for desperately ill coronavirus patients. Since the pandemic began, The Lancet is receiving three times the usual number of papers for consideration, Dr. Horton said. And the N.E.J.M. has fielded as many as 200 submissions in a day, including essays, according to Dr. Rubin.

“I’m an infectious disease doctor, I treat Covid-19 patients,” Dr. Rubin said. “I’ve been in the hospital recently treating patients, and we have no idea what to do. I’m the primary driver at the journal of saying, ‘We have to get data out there that people can use.’”

“We are very careful,” he added. “At our editorial meetings, this comes up almost every day. ‘If we publish this, will it hurt people?’ That’s our biggest concern.”

The N.E.J.M. and The Lancet are among the oldest, most respected and most widely read medical journals in the world. They were established in 1821 and 1823 and are ranked often first and second among general-interest medical journals by their “impact factor,” the frequency with which their studies are cited in other research.

A report in one of these journals can have immediate repercussions both for patients and for research. After The Lancet’s initial publication of the study concluding that the antimalarial drugs chloroquine and hydroxychloroquine endangered the lives of coronavirus patients, the World Health Organization and other groups halted clinical trials of the drugs while safety reviews were conducted.

Credit…Ben Margot/Associated Press

The reputation of these journals rests in large part on vigorous peer review. But the process is opaque and fallible: Journals generally do not disclose who reviewed a study, what they found, how long it took or even when a manuscript was submitted. Dr. Horton and Dr. Rubin declined to provide those details regarding the retracted studies, as well.

Critics have long worried that the safeguards are cracking, and have called on medical journals to operate with greater transparency.

“We are in the midst of a pandemic, and science is moving really fast, so there are extenuating circumstances here,” said Dr. Ivan Oransky, co-founder of Retraction Watch, which tracks discredited research.

“But peer review fails more often than anyone admits,” he said. “We should be surprised it catches anything at all, the way it’s set up.”

Journals used to take many months, or even a full year, to scrutinize and edit a complicated study, a process that included several weeks for outside experts to peer review the research.

Now peer review may be condensed to as little as 48 hours; some studies deemed of vital importance to patients may be published online within 20 days of submission.

“There is always a tension between getting it fast and getting it right,” said Dr. Marcia Angell, another former editor in chief of the N.E.J.M. “I always favored getting it right. But in the current pandemic, that balance may have shifted too far toward getting it fast.”

It’s not just the journal editors who are inundated. Knowledgeable scientists who donate time as peer reviewers are already stretched thin, trying to understand how the coronavirus affects the body, or to find treatments and vaccines. The research is happening at an unprecedented pace.

“I think the academic system is saturated — it’s at capacity,” said Dr. Peter Jüni, a professor of epidemiology at the University of Toronto who has reviewed papers for scientific journals.

“People are tired; they’re working at the edge of their limits,” he said. “They struggle to get good peer reviewers and try to do as well as they can, but the system is at risk of failing, as you see here.”

The retracted paper in The Lancet should have raised immediate concerns, he added. It purported to rely on detailed medical records from 96,000 patients with Covid-19, the illness caused by the coronavirus, at nearly 700 hospitals on six continents. It was an enormous international registry, yet scientists had not heard of it.

The data were immaculate, he noted. There were few missing variables: Race appeared to have been recorded for nearly everyone. So was weight. Smoking rates didn’t vary much between continents, nor did rates of hypertension.

“I got goose bumps reading it,” said Dr. Jüni, who is involved in clinical trials of hydroxychloroquine. “Nobody has complete data on all these variables. It’s impossible. You can’t.”

Both retracted studies were led by Dr. Mandeep R. Mehra, a widely published and highly regarded professor of medicine at Harvard, and the medical director of the Heart and Vascular Center at Brigham and Women’s Hospital.

  • Frequently Asked Questions and Advice

    Updated June 12, 2020

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • Does asymptomatic transmission of Covid-19 happen?

      So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.

    • How does blood type influence coronavirus?

      A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

    • How many people have lost their jobs due to coronavirus in the U.S.?

      The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

    • Will protests set off a second viral wave of coronavirus?

      Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.

    • How do we start exercising again without hurting ourselves after months of lockdown?

      Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.

    • My state is reopening. Is it safe to go out?

      States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.


In a statement last week, Dr. Mehra apologized for the retractions, which he attributed to an eagerness to publish helpful information during the pandemic. He stopped short of calling them fraud, saying only that the data could not be verified by independent auditors.

The data in both studies were produced by a small company outside Chicago called Surgisphere, run by another of the papers’ authors, Dr. Sapan Desai. In an interview with The New York Times in May, Dr. Desai vigorously defended his work and the authenticity of his data registry, which he said included patient records from 1,200 hospitals and other health facilities around the world.

But when the N.E.J.M. and The Lancet demanded independent audits, he refused, citing confidentiality agreements with client hospitals. Following the retractions, Dr. Desai has declined further comment.

“This got as much, if not more, review and editing than a standard regular track manuscript,” Dr. Rubin, the editor in chief of the N.E.J.M., said of the heart study, which was based on a smaller set of Surgisphere data, that appeared in the medical journal. “We didn’t cut corners. We just didn’t ask the right people.”

He said the journal should have tapped outside experts familiar with big hospital data sets to be involved in the peer review. And The Lancet, Dr. Horton said, will demand independent verification of the quality of a database when reviewing studies from now on.

But, both editors said, peer reviewers cannot be expected to detect outright fabrication. Reviewers do not examine the raw data underlying the studies they review, except in exceedingly rare cases. That would be too laborious, and reviewers are not paid for their time.

But editors and reviewers do know who the study authors are, critics note, and that may bias them toward a positive review even when data are suspect. Dr. Mehra is well respected in scientific circles.

“We do tend to trust our authors,” Dr. Rubin said. “All journals do.” Both editors pointed out that Dr. Mehra had signed statements indicating he had access to all of the data and took responsibility for the work, as did other co-authors.

The politicization of the pandemic also may have played a role in The Lancet’s publication, critics charge. Mr. Trump has vigorously endorsed hydroxychloroquine as both preventive and curative treatment for Covid-19. The study’s conclusions at first appeared to rebuke the president.

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Dr. Horton is no fan of Mr. Trump, calling his decision to withhold funding from the W.H.O. in April “a crime against humanity.”

“Every scientist, every health worker, every citizen must resist and rebel against this appalling betrayal of global solidarity,” Dr. Horton wrote on Twitter.

On Friday, he said he chose to publish the hydroxychloroquine study only because it showed an immediate danger in widespread use of the drug. The clinical trials should not have been halted, he added.

“Because of the political context, and people using this drug on the basis of minimal evidence in its favor, it seemed very important to publish work that at least gave some sense of whether the drug was safe or not,” he said. “That was the motivation behind the publication.”

Journal editors are caught in a Catch-22 of sorts, said Dr. Hassan Murad, of the Mayo Clinic, who works with a federal project to review medical evidence. “You want to push the information out quickly to practitioners,” he said. “It’s a pandemic, it’s an urgent situation.”

“At the same time, you want quality control.”