Last year, physician Rupak Desai co-authored more than three dozen conference abstracts in Circulation, the American Heart Association’s (AHA’s) flagship journal. The works marked a modest fraction of his publications in 2023, which totaled 162. But Desai, scholarly productivity notwithstanding, is not employed by a hospital, university, nor any other type of scientific institution.
Based in Atlanta, Desai runs a business that offers junior doctors from around the world a chance to beef up their CVs before applying for coveted residency or fellowship positions at hospitals or physician offices in the United States. For about $1000 and a commitment to work 10 to 15 hours remotely over a few weeks, last year’s participants in Desai’s Express Research Workshop could get a byline on three abstracts submitted to AHA’s biggest annual conference, the Scientific Sessions meeting, according to an online ad that was removed after Science contacted Desai for this story.
“With our guidance, you could be published in the prestigious Cardiology journal [Circulation] before or during your next application season,” the ad promised. A “combo” deal for an additional $600 also offered abstracts slated for another conference, as well as “continued work” on “at least 2 full papers for PubMed indexation” over the following 6 months. (Although they’re not peer reviewed, published conference abstracts are cited in the same category as peer-reviewed papers on the standard residency application form.)
The Express Research Workshop belongs to a growing cottage industry of businesses, consultants, and nonprofits dangling seemingly easy publications for the more than 12,000 international medical graduates who apply for U.S. residency positions every year. A joint investigation by Retraction Watch and Science identified 24 such organizations across the U.S. and abroad. The programs likely have spawned thousands of publications—most of them full-length, peer-reviewed papers. These include database studies, systematic reviews, and meta-analyses—all through work that can be done entirely online.
Ads for specific projects posted to WhatsApp groups or on LinkedIn typically mention the type of study, its title, how many “seats” or “positions” are available, and the price to participate. One “surgery research opportunity” advertised two paid author slots on a paper that would be submitted “next week.”
At one Arizona-based firm, clients who paid $275 could be part of a web-based cross-sectional study that could be completed in just 2 to 3 weeks and submitted for publication. In Texas, a $4500 online course spanning 6 to 12 months promised four abstracts and four full-length papers. And in California, a program highlighted a recent graduate who landed a residency after adding a whopping 34 publications to his name, according to a post on the messaging platform WhatsApp. Of hundreds of publications reviewed by Science, none mentions how it came about, nor the companies involved.
Although some of these groups may provide bona fide research training—through recorded lectures and Zoom sessions, for instance—all occupy at best an ethical gray area in scholarly publishing. Many of the programs, critics contend, are little more than dressed-up paper mills pumping out quick and dirty studies that degrade the medical literature.
Selling a place in an investigation or study, even if it entails a bit of work and a chance to learn something, “that’s misconduct, in my view,” says Ana Marušić, a professor and research integrity adviser at the University of Split School of Medicine and a council member at the nonprofit Committee on Publication Ethics. “It’s the same as paper mills that sell authorship.”
THE PROGRAMS SPEAK to a real need. Research output is an increasingly important element in medical residency applications, and even more so for international medical graduates (IMGs) without U.S. citizenship, who face especially long odds of “matching” into a residency program.
For a competitive residency such as plastic surgery, for example, matched non-U.S. IMGs had an average of 54 abstracts, presentations, and papers in 2022. Their unmatched peers had just five, according to a report from the National Resident Matching Program, a private nonprofit group. For orthopedic surgery, the numbers were 98 and 25, respectively. After part of the United States Medical Licensing Examination switched from a numeric score to pass/fail in 2022, the perceived importance of publications has grown even more.
Yet, at many medical schools around the world, research plays little to no role in a student’s education. For new graduates, racking up publications to help a residency application is daunting, which makes companies offering quick training and guaranteed output an appealing proposition.
“That’s why you see a rise in all of these groups,” says Siddhesh Zadey, a Ph.D. student at Columbia University who co-founded the India-based think tank the Association for Socially Applicable Research. “Everyone is just trying to buy a publication.”
Many groups advertising research experience specifically mention IMGs on their websites or social media profiles, and several are run by them. But many physicians who have taken part are unhappy customers. “They say they are going to offer you mentorship and they are going to teach you, but that is not their primary goal,” says Digbijay Kunwar, a young doctor in Nepal who participated in an online program offered by the Pakistan-based company Lights of Careers & Research. “Their product is just authorship.”
Kunwar, who earns about $300 a month working at a government hospital and hopes to land a residency in the U.S., said he quit the workshop out of frustration with the lack of effective mentorship and training. Lights of Careers & Research, which promises “guaranteed publication” on its LinkedIn page, did not respond to phone calls or emails seeking comment.
Others share Kunwar’s assessment. When a self-described Indian IMG with no research experience inquired about two U.S.-based companies in a 2022 post on Reddit, the responses included stark warnings from apparent previous clients: “I feel like I was being tricked,” one wrote, adding, “I won’t mention it on my CV for sure. … I am not sure if the whole thing is even legal.”
In another Reddit post, a commenter said about one of the two firms: “[T]hey won’t share the data base with you and you don’t get to do the statistics part. You basically get to contribute to the introduction and pitch them your ideas.”
Desai’s workshops appear more popular. “You’ll get a chance to contribute to every stage of research, from topic selection to submitting the paper and everything in between. And by the end of it, you’ll be confident to at least talk about research in your interviews efficiently,” one commenter wrote on Reddit. But the comments also make it clear that authorship did not necessarily require work.
Desai, who holds a medical degree from India and says in one ad he has “mentored over 300 students, trainees and physicians” since 2020, told Science in an email that his program and others like it serve an unmet need. “Many IMGs have expressed frustration on social media about the lack of available opportunities as beginners,” he says.
Desai denies that medical residency seekers or others can buy authorship on papers coming out of his workshops; any author, he says, must contribute to the research: “[A]ll group members and submitters have been instructed to determine authorships solely based on contributions in brainstorming, data extraction for systematic reviews, abstract writing, or support for data visualization graphics/tables.”
According to Desai, doing quality research in a matter of weeks is possible “only with significant support from mentors, who have worked on numerous projects with the same data sets, and importantly, with the help of an experienced team of researchers and residents.”
Still, AHA, whose journal and meeting abstracts were advertised as publication opportunities to IMGs, expressed misgivings about Desai’s program when Science provided details on the ad and his workshop. Foreign doctors with limited resources, it said in a statement, “may unwittingly be deceived into participating in and paying for courses that may not provide the value the descriptions suggest.”
Science contacted the Association of American Medical Colleges, which operates the electronic residency-application system and whose members accept IMGs into their residencies, and the Educational Commission for Foreign Medical Graduates, a body that certifies IMGs as ready for residency and offers them guidance on training. Both declined to comment for this story.
Some of the outfits offering research opportunities, including the Research Update Organization and the California Institute of Behavioral Neurosciences & Psychology, have a mechanism to ease publication: their own “channel” at Cureus, a Springer Nature medical journal known for its fast publication turnaround. According to the journal’s website, this allows the groups to appoint “hand-picked editors [who] manage all content from submission to publication.”
In a statement, Graham Parker-Finger, director of publishing at Cureus, said the journal assesses “all organizations that have a Cureus channel carefully before approval, considering their history and ethical standards.” He added that, although channel owners can appoint their own editors, Cureus still maintains editorial oversight of channel content.
SEVERAL RESEARCHERS contacted by Science challenged the quality of the papers produced by these groups and expressed concern about their potential real-world consequences. A case in point is a vaping study organized by the Houston-based Research Update Organization. The resulting paper, which appeared in 2022 in the open-access journal Neurology International by the publisher MDPI, concluded that electronic cigarette users had higher risk and earlier onset of stroke than tobacco smokers. The findings quickly made headlines and became a central part of a campaign by the California Department of Public Health against vaping, with claims like “vaping is anti-aging because you’re more likely to die younger from a stroke” appearing on national TV and billboards.
That’s how the research came to the attention of Gal Cohen and Floe Foxon, two scientists who work at contract research organizations and have ties to e-cigarette maker Juul Labs. The more they looked at the article, the more problems they saw. The work was based on data from an annual survey on health and nutrition by the U.S. Centers for Disease Control and Prevention (CDC), but the reported number of survey respondents was inexplicably off by an order of magnitude—the survey is completed by about 5000 people a year, but the paper cited 266,058 respondents from 2015 to 2018. The authors also failed to report whether the difference in age of stroke onset between vapers and traditional smokers could simply be due to vapers being younger overall. And those were just a few of the obvious issues, according to Cohen and Foxon, who alerted both the authors and the journal to their concerns.
Others agree the work is fatally flawed. “The paper seems like a joke,” said biostatistician and epidemiologist Miguel Hernán of the Harvard T.H. Chan School of Public Health. “No self-respecting journal should have published this.” The results have since appeared as a conference meeting abstract in the journal Stroke.
The Neurology International article’s corresponding author, and the one noted as responsible for the statistical analysis, is Urvish Patel—founder and director of the Research Update Organization. On the paper, however, Patel lists his only affiliation as the Icahn School of Medicine at Mount Sinai. Mount Sinai has no records of an employee called Urvish Patel, a spokesperson for the institution told Science in an email. But the spokesperson did say “someone by the name of Urvish Patel” had “received an MPH [Master of Public Health] degree from the school in 2015.”
Although several of Patel’s 13 co-authors on the vaping paper listed well-known U.S. universities as their affiliations, none was a faculty member at those institutions. Nearly all were IMGs and at least some attended Patel’s programs, according to interviews and //www.google.com/maps/place/Research+Update+Organization/@29.8461193,-95.4120534,9z/data=!4m8!3m7!1s0x89c257304451da59:0x3b78b0394ff300d9!8m2!3d29.7099063!4d-95.396515!9m1!1b1!16s%2Fg%2F11lgzll0fw?entry=ttu" style="box-sizing: border-box; color: rgb(202, 32, 21); text-decoration: underline; background-color: transparent; word-break: break-word;">Google reviews.
“You have to admire the business model,” said epidemiologist John Britton, who recently retired from the University of Nottingham and is a proponent of using vaping to help smokers quit. “Get people to pay for ‘training,’ give them a Mickey Mouse project to comment on, gift them authorship, and publish the paper in a journal that doesn’t care. Nice one.”
Emails seeking comment from MDPI and the editor-in-chief of Neurology International, on whose advisory panel Patel sits, went unanswered. But in an interview, Patel rejected the criticism and said his paper had “clearly described very well [the] methodology, data, every single thing.” All the same, Patel has published other studies using the same CDC survey data in ways that appear incorrect or misleading, several researchers tell Science.
Patel acknowledged that several of his co-authors were IMGs who had paid his organization for training—but “for publication, no.” He continues to use the Mount Sinai affiliation in his publications, as well as in his Google Scholar, Orcid, and Cureus profiles, explaining that “because you’re a graduate and alumni [sic] from Mount Sinai, it’s [a] privilege for them if you are publishing the paper.”
Zadey and Reese Richardson, a Ph.D. student at Northwestern University whose team has also investigated the programs advertising research opportunities, flagged several other questionable papers, including a systematic review and meta-analysis from the Global Remote Research Scholars Program exploring the effect of breathing exercises on blood pressure and heart rate. Zadey points out the study, published in the International Journal of Cardiology: Cardiovascular Risk and Prevention, an Elsevier title, failed to describe the design of each included study, a standard practice for systematic reviews. And this, he says, was just one of a long list of “bizarre” shortcomings that even included not comparing the intervention with the control condition.
Rahul Kashyap, the paper’s corresponding author and CEO of the Global Remote Research Scholars Program, said his team avoided a direct comparison for several reasons, including challenges related to assessing variability and combining data across different types of studies. “Variability (variation) between the intervention and control groups was not our main research question,” he wrote in an email to Science.
Josée Dupuis, chair of the department of epidemiology, biostatistics, and occupational health at McGill University, also sees serious problems with the statistical methods used by Kashyap and colleagues. In her view, the many subpar publications coming out of these programs are a sign of a “failing” peer-review system. “There’s just not enough high-quality reviewers to weed out these poor-quality papers,” she says. Another factor, Dupuis suggests, is misguided priorities: “Maybe the emphasis on publications for these residency programs, maybe that’s what needs to be looked at.”
Jigisha Patel, a physician and independent research-integrity specialist in the United Kingdom, agrees. “The current research culture, which rewards publication quantity over quality, sets up a demand for publications that is so easy to exploit,” she says.
