Publishing profiteers

By Andrea Niermeier, Contributing Writer, March 1, 2025

High-impact journals like the Journal of the American Academy of Dermatology (JAAD), JAAD Case Reports, JAAD Reviews, and JAAD International publish pioneering research in dermatology, moving not only the specialty forward, but all of medicine. Dirk Elston, MD, FAAD, editor of JAAD, noted the journals’ increased impact factors over the years. “It’s a golden age of true advancement in diagnosis and therapy, and JAAD has been cited as one of the most influential journals in the last 100 years of medicine.”

While most published research in the medical field has been meticulously conducted and reviewed, research fraud does exist. Specifically, organizations use sophisticated marketing tactics and professional looking websites to attract researchers seeking to expedite publication. Paper mills, as they are called, profit from authors who pay these enterprises to prepare academic papers often based on fabricated or manipulated data and submit them to journals. With the rise of artificial intelligence (AI) and digital research results, the threat to scientific integrity has grown. These operations undermine scientific progress, spread misinformation, take focus away from legitimate research, and pose a challenge for publishers and the societies they represent.

Understanding paper mills

Paper mills sell authorship positions, with the creator being an unacknowledged author or potentially AI. These manuscripts often contain fabricated or plagiarized research and may include duplicated or manipulated data and images. Oftentimes, first authorship is the most expensive, with costs decreasing for second or third authorship. While sometimes the paper mills promise submission to a journal with a certain impact factor, other times the manuscript is already accepted by a journal and the author’s name is added. This differs from guest authorship, in which a well-known researcher is credited as an author but does not contribute to the manuscript or do the research. Elisabeth Bik, PhD, author of the blog Science Integrity Digest, has shed light on the prevalence of paper mills and potential academic fraud. A microbiologist by training, Dr. Bik elaborated that what began as the discovery of her own work being plagiarized has led to a collaborative effort to analyze images, with her team finding as many as 600 works from a single papermill based on the same western blot images.

Dr. Bik observed that many of the publications that she has identified have been clustered around biomedical science, specifically non-coding RNA, genes, and human diseases like cancer. However, this does not mean that specialties like dermatology are immune to fraudsters. She and others have identified multiple papers in the field with fraudulent images related to protein and mRNA expression with cancers like melanoma. “Not all of these papers are going to be earth shattering and on the radar for clinicians. They may not be relevant to patients yet,” Dr. Bik said. “However, they dilute scientific literature and potentially influence other researchers to study an area with their bad science.”

Luring researchers

Keeping paper mills in business are the would-be authors who pay for their name to appear on these publications. Why would an academic fall prey to such an offer? The answer is largely the pressure to publish. Shari Lipner, MD, PhD, FAAD, founding editor of JAAD Reviews, pointed out, “While promotions in academics are based on a lot of things — excellent clinical care, teaching, committees — one of them is scholarship. The pressure from academic institutions to publish papers for promotion is high.” She also mentioned that publishing in the field can elevate status and help a researcher gain tenure, earn grants, recruit patients for clinical trials, speak at conferences, and get media interviews, all of which are curriculum vitae (CV) builders. This may be very attractive to physicians who feel the squeeze of providing clinical care, staying on top of EHRs, managing increasing management costs, and making time for quality research.

Dr. Bik highlighted that this pressure may be especially high for physicians who are pressured to publish for promotion. “I’ve found a number of paper mill articles supposedly written by authors in smaller hospitals outside of the U.S. who have never published before. They are clinicians — not researchers — who are trying to check that box. Certain journals seem to be infected with these kinds of submissions.” While paper mill activity is worldwide, she acknowledged that some areas with underfunded research may be motivated by the hope that publishing will help them move to a well-funded area of the world.

The pressure to publish is also felt by medical students. Steven Daveluy, MD, FAAD, associate editor of JAAD Case Reports, described the motivation of medical students applying to residency and even residents applying to fellowship. “Dermatology is a competitive specialty, and students have to work really hard and have an impressive CV when they apply. Every year, the number of publications for people who apply to dermatology and receive residency positions versus applicants who don’t get positions is tracked.” With the high rejection rates of top-ranking journals and the time-consuming, costly nature of research studies that may not have desired outcomes, both novice and experienced researchers may feel tempted by these unscrupulous organizations.

Spotting paper mill products

With advancements in AI, paper mills have the tools to make their outputs more believable and produce them faster. AI-powered image generation can fabricate data, and generative pre-training transformer (GPT) tools can increasingly create manuscripts with more natural-sounding text. While Dr. Bik commented that many of the journals where she finds paper mill publications have mid- to low- impact factors, retractions sometimes occur in high-impact journals due to fraud and ethical concerns, and these journals should not feel immune. Dr. Lipner recounted, “If you would have asked me a month ago, I would have said that this is not a problem for JAAD Reviews. However, just a few weeks ago, a managing editor said to me that a paper looked suspicious. The cover letter read like it had been written by AI, and when I looked through the paper, it didn’t look like a real paper. In this case it was obvious. However, I think with technology, paper mills have the potential to get through the door and trick people.” She stressed the thousands of fake manuscripts that have been published in peer-reviewed journals that she has come across in her own research using the Retraction Watch Database, noting that oftentimes the reason given is fraud.

She said that some of the things she looks for in submitted manuscripts are no cover letter, details in the cover letter not matching the manuscript, or even a cover letter similar to one recently submitted for a different paper. If an author requests to add a new author — either in the revision or acceptance stage — the journal requires all authors to sign a form saying they accept the author, and the editor must approve the addition. Other potential red flags include submitting or corresponding authors having multiple user accounts in the same journal, affiliations with companies or institutions without research programs or from multiple disparate locations, and problematic references.

While sometimes an author will recommend certain peer reviewers who may be an expert in the field, this could potentially raise suspicion if the review comes back positively but lacks critical details or analysis. Peer reviewers working on a manuscript potentially coming from a paper mill may flag writing style changes within the text or subpar writing such as tortured phrases, or language appearing to have been translated from English to a foreign language and then back to English. Superficial or generic hypotheses to justify analyses on different topics lacking specific reasoning and lack of disclosure of important details and raw data supporting the reported experimental results are also characteristics of paper mill products. If a study has unrealistic productivity — including trials with unusually large numbers of participants, an implausible short recruitment period for the trial, or rapid submission to the journal after the completed study — an editor or peer reviewer may take pause.

Dr. Bik highlighted that in her own investigation, paper mill papers allegedly coming from different labs often follow similar figure layouts, order, or formatting. With some paper mills, she and her collaborators have been able to spot them based on the title structure. “If we found a paper in a journal, one of us would scan all the papers that seemed to follow this title structure and usually we would find the same western blots.” Other paper mills may use stock or manipulated images. Also, unusual levels of text similarity across papers from different authors or institutions may suggest use of manuscript templates.

For authors who come across an entity wanting to help with publishing a paper, Lara Graf, MS, director of medical journals publishing for the American Academy of Dermatology, has a warning: buyer beware. “If a publisher or organization reaches out to you with flattery and urgency or is aggressive in their targeting, be suspicious.” It may be a predatory journal or an organization looking to sell authorships, data, images, or manuscripts — all of which should not be purchased. “If your gut tells you that something is not right, listen to that and check it out,” Graf added.

Protecting scholarship

While Graf acknowledged that high-impact journals like JAAD have been largely spared from the impact of paper mills thus far, she admitted that as technology advances and paper mills become more pervasive that it may only be a matter of time. However, she is hopeful. “Dermatology is a small but mighty specialty, and so a lot of people in the field know each other. We have a very large reviewer pool who have many connections and vast knowledge of the field, and we have researchers who are diligent and honest.” Dr. Lipner agrees that networking and collaboration by attending conferences and being part of professional organizations can help editors and peer reviewers prevent paper mill manuscripts from making it to publication.

Elsevier, the publisher of the JAAD journals, has significantly expanded its Research Integrity and Ethics team, growing from two to more than 20 people in just a few years. They have also committed to providing education and guidelines to editors and reviewers about paper mills. Even though AI may be helping paper mills quickly generate submissions, it has also been integrated into software tools to help editorial staff catch research fraud. One of these tools is the Duplicate Submission Check tool. This scans manuscript submissions to Elsevier journals and leverages data to determine if a recently submitted manuscript is identical or very similar to a pre-existing manuscript. In addition, editors for JAAD journals have access to Crossref Similarity Check, powered by iThenticate text comparison software, to catch scholarly and professional plagiarism by providing immediate feedback regarding a manuscript’s similarity to other published academic and general web content. Another AI software tool in use is called Proofig, which assesses images for manipulation.

Elsevier also offers Identity Confidence Check (ICC) that can help editors assess the identity of an author by analyzing an email domain and establishing whether the author has served on an editorial board or been a peer reviewer. Moreover, some technology has started to target paper mills directly. In April 2023, the International Association of Scientific, Technical, and Medical Publishers (STM) released the STM Integrity Hub, a web application where submitted journal manuscripts can be uploaded and examined for indicators suggestive of paper mills. Graf emphasized, “It’s a marriage of both humans and technology to try to catch some of the things that paper mills do.”

Although technology can play a role in thwarting paper mills, shifts in academia and the publishing process could potentially lessen the power of these organizations. “Institutions are coming to grips with the fact that teaching, patient care, and community service are all ways people can achieve success beyond publish, publish, publish,” Dr. Elston stated. This emphasis on quality over quantity has also begun to echo in the medical field for students. Dr. Daveluy recalled, “There have already been changes to the application process to help us choose people who are going to be great doctors and dermatologists over people who have a great test score. They are also looking into limiting the number of publications a person can list so the focus is on producing quality research as opposed to churning out articles.” Certainly, less emphasis on the number of articles published may decrease the motivation to seek outside help with manuscripts.

Do no harm

One worry Dr. Daveluy has is that if he and his team reject an article for JAAD Case Reports that the paper mill will go to the next journal, perhaps even a predatory one, to get it published. Will it potentially get indexed and cited? The harm of paper mills can be far reaching. The retraction process on fraudulent research can take years as shown by the recently retracted study on the drug hydroxychloroquine treating COVID-19 more than four years after it was published. While streamlining the retraction process seems like a potential solution to minimize damage, Graf clarified, “There’s a process you have to follow if someone suspects something isn’t right. You must do your due diligence and gather all the facts, and this takes time.” If a media outlet reports on the research, the impact on public opinion may be long lasting, despite a retraction.

Paper mills can be damaging for a journal or publisher and ultimately the author who uses them. Loss of reputation and credibility, loss of job, and loss of income are all potential consequences. Most important is the impact they can have on science moving forward. Dr. Bik criticized, “They waste time and resources and could influence a clinical trial idea or be included in meta-analysis of data, potentially skewing results.”

Similar to other types of scammers, paper mills can be difficult to catch or shut down. As journals improve paper mill detection, these shifty organizations can quickly pivot their operations. For dermatologists and others in the medical field, being aware of their existence and reading research with a critical eye is important. Dr. Lipner encourages JAAD readers to contact the journal if they read something that could potentially be inaccurate or fraudulent, and Dr. Bik recommends installing PubPeer, a browser extension, so that if a person does a literature search and a paper has been commented on, a green bar will list concerns for the reader.

“I believe that medicine is a noble calling and a very noble profession. Part of that professionalism is having respect for academic honesty,” Dr. Elston affirmed. “In a time of real innovation in dermatology, with advancements in oncology, immunology, and inflammatory skin disease, our journals have a mission to vet all information so what is published is trustworthy and usable by physicians to make therapeutic decisions. This is the vast majority of what is published in dermatology journals, certainly the ones that AAD members depend on.” This emphasis on integrity and dedication to the field may ultimately be the best way to deprive paper mills of the very things they feed on to grow.

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