Trials and tribulations of responsible people trying to uphold scientific standards

Abstract

Scientific misconduct threatens patient safety, progress, and trust in medicine. On October 3, 2020, Frass and colleagues published a randomized, placebo-controlled, double-blind trial in The Oncologist (published by Wiley at the time) claiming that add-on homeopathy significantly prolonged survival in advanced non-small-cell lung cancer. Since homeopathy contradicts established scientific principles, doubts about the trial’s validity quickly emerged.

Concerns were first published in October 2020, followed in 2021 by a detailed analysis alleging scientific misconduct. This prompted the Medical University of Vienna, the affiliation of the study's lead author, to request an investigation by the Austrian Agency for Research Integrity (OeAWI). After conducting an in-depth review, OeAWI concluded in September 2022 with a clear recommendation for retraction. However, The Oncologist issued only an ‘Expression of Concern’ at the time, despite five co-authors formally requesting the withdrawal of their authorship— a demand that remained unaddressed as of November 2025. Repeated inquiries to the journal and its publisher, Oxford University Press (OUP), yielded only vague assurances that the matter was “under review,” with multiple deadlines passing without resolution. Finally, by November 24, 2025, The Oncologist retracted the paper. However, the retraction notice fails to address the specific concerns raised about the study’s results and conclusions, nor does it provide a clear rationale for the retraction itself.

Meanwhile, the paper has been cited more than 60 times (according to Google Scholar) and is widely circulated online as “proof” that homeopathy benefits cancer patients. This highlights the harmful consequences of delayed editorial action. According to COPE guidelines, misconduct must be dealt with swiftly and transparently. Our case reveals the opposite: incomplete corrections, prolonged inaction, and even the defense of implausible claims. Against the backdrop of increasing organized scientific fraud, this experience underscores the urgent responsibility of journals and publishers to protect the scientific record and prevent harm to patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41073-026-00191-5.

Main text

Paraphrasing Einstein’s famous ‘bon mot’ [1], one might state that trust in science will not be destroyed by fraudsters, but by those who observe fraud without doing anything about it. Once we suspect scientific misconduct, we should act, particularly if the suspected misconduct puts patients at risk. Here we summarise the trials and tribulations that awaited us as we were trying to follow this principle.

On October 3, 2020, Michael Frass from the Medical University of Vienna (MedUni Vienna) and colleagues from MedUni Vienna and other institutions published a randomized, placebo-controlled, double-blind, three-arm, multicenter trial about add-on homeopathy in non-small-cell lung cancer which concluded that, in patients with advanced disease, “survival was significantly longer in the homeopathy group versus placebo and control” [2]. Homeopathy is a healing system founded more than 200 years ago before scientific medicine’s dawn. One of its dogmata is that dilutions of substances even beyond the Avogadro number and thus containing only impurities of solvents and from dilution devices exert a strong healing effect. A public statement of EASAC (European Academies Science Advisory Council) from 2017 about homeopathy reads “The scientific claims made for homeopathy are implausible and inconsistent with established concepts from chemistry and physics” [3]. If homeopathy were to hold scientific testing, numerous textbooks in medicine and natural sciences would have to be rewritten. Considering the widespread consensus that homeopathy has no effects beyond placebo, many sceptics wondered whether the findings could be trusted.

Doubts were published as early as October 7, 2020 [4], after the publication of the article on October 3, 2020, followed by a thorough analysis in 2021 alleging scientific misconduct [5–7].. Further scrutiny revealed that the study protocol was uploaded to ClinicalTrials.gov after the study’s completion, with the initial version backdated to falsely suggest it predated the begin of the trial. Additionally, numerous exclusion criteria were introduced post hoc, raising concerns about adherence to the original study design. The trial’s conduct does raise concerns about potential disparity between its design and execution. Specifically, the post hoc modification of exclusion criteria and the falsification of the protocol date collectively suggest deviations from established research practices.

In May 2021, three authors (JH, NA, VW) submitted a ‘letter to the Editor’ of the journal, communicating flaws in the study (see Additional files). This letter was never published, on September 10, 2024, the status was still “with editor” which still has not changed as yet (Dec 2025). In June 2021, the authors also sent their critique to all study authors, the rector, the vice-rector for research and innovation and the chair of the Ethics Committee of the MedUni Vienna, the former employer of the lead author Frass and sponsor of the study. The vice-rector reacted by referring the matter to the Austrian Agency for Research Integrity (OeAWI) for a thorough investigation.

In August 2021, the Chief Editor of The Oncologist, Bruce Chabner, contacted the vice-rector, as he had learned from an article in the Austrian newspaper “Der Standard” [8] that the rectorate of the MedUni Vienna had commissioned the OeAWI to investigate the study. He asked to be informed about the results of the investigation in order to “protect the scientific record, if necessary”.

On 30 September 2022, the vice-rector of the MedUni Vienna informed us that the OeAWI had issued its report and mentioned that both the OeAWI and MedUni Vienna prepared the results to prompt The Oncologist to retract the paper. The assessment of the OeAWI [9] could not have been any clearer:

… In a very time-consuming and comprehensive investigation, requiring—among other things—an on-site inspection of original documents, the Commission was able to substantiate the suspicion of data falsification, fabrication and manipulation. In a final statement, the Commission provided the accused, who is no longer associated with the university in question, and his numerous co-authors detailed information about the investigative procedure and its results; and it informed them of its recommendations to the university and the journal. The Commission recommended that the university concerned ought to consider examining its own responsibilities and then proceed accordingly, and that the publication should be withdrawn as a matter of urgency. The journal responsible for the publication was asked to withdraw the publication on the basis of the findings of the investigation. … [9].

On 2 November 2022, an ‘Expression of Concern’ regarding the study appeared on the website of The Oncologist and in electronic databases like PubMed [10]. We thus contacted the authors of the study on 5 November 2022 suggesting that they now consider withdrawing their authorship. Two days later, we were informed that a total of 5 co-authors had asked The Oncologist already in September of 2022 to retract their co-authorship (see an example in the ‘Additional files’). Up to the present day (6 January 2026), the journal has neither complied with their request nor given any response to the authors.

As none of these activities resulted in the retraction of the paper, we again inquired with The Oncologist in August 2023 about the matter. The answer was always the same: the investigation was ongoing, the matter is being taken very seriously and a decision is expected shortly. The executive office of the publisher Oxford University Press (OUP) initially replied to our inquiry in a similar fashion and later informed us that a decision would be taken by the end of August 2023. Since this did not happen, we wrote again in November 2023. This time our email remained entirely unanswered.

Meanwhile, our frustration grew into disbelief, and in December 2023 we tried our luck with the CEO of OUP explaining that communication with the Executive Office had been unsuccessful. His assistant replied that they had appointed someone to look into the matter. A further inquiry with the CEO informed us that a suitable German-language reviewer was now being sought - despite the manuscript and all correspondence already being in English, the standard language of the journal. A result could be expected at the beginning of March 2024.

In April 2024, we learned that the review by The Oncologist had been concluded and that a meeting to discuss the results would take place “soon”. In May 2024, still without any information about a decision, we contacted the CEO of OUP again but did not receive a reply. In the hope that this might speed things up, one of us published on 27 May 2024 an account of the affair in the German weekly, ‘DER SPIEGEL’ [11]. In response to a supplementary inquiry from ‘DER SPIEGEL’, The Oncologist stated that it was taking concerns ‘relating to academic integrity’ very seriously and that the review of the study was still ongoing. In August 2024, after inquiring yet again, The Oncologist confirmed that the withdrawal of the 5 co-authors had been received almost 2 years ago. In September 2024, ‘Retraction Watch’ featured the case, pointing towards extensive corrections following the OeAWI report [12].

In the meantime, a second correction of the paper had been published on September 24, 2024 [13] in an attempt to refute some of the points of criticism. Still, major points of our and OeAWI’s critique remained uncommented. Furthermore, an editorial [14] was published in The Oncologist defending the decision not to retract the study arguing that the homeopathic preparations might exert a pharmacologic effect in a highly aggressive cancer. However, this interpretation overlooks a critical issue: Given the extreme dilutions used in homeopathic preparations (dilutions; from the point of view of homeopathy called “potencies”), only the lowest dilutions—if any—would contain sufficient concentration of the active substance. This fundamental challenge to a pharmacological explanation is not addressed in the editorial by Figg and Bates [14], leaving a significant gap in their reasoning.

After all unsuccessful attempts to resolve the matter with The Oncologist, in November 2024 we decided to file a complaint with COPE about the conduct of The Oncologist. COPE recommended that The Oncologist contacts the MedUni Vienna and the OeAWI. In June 2025, a video conference was held between representatives of The Oncologist, MedUni Vienna, and the OeAWI, during which the arguments against the study were presented to the editor-in-chief of The Oncologist, Susan Bates. This seems to have been the final, decisive impetus. After another five months, on November 24, 2025, The Oncologist finally decided to retract the study [15], five years after its publication and approximately four years after the first criticism of it had been brought to their attention.

The reason given for the retraction notice was: “the journal no longer has confidence in the results and conclusions reported in the article” without any further details. This is not compatible with the COPE guidelines for a retraction note, which require that "the reasons and basis for retraction be clearly stated so that readers understand why the article is unreliable." Additionally, the guidelines specify that "a link to relevant content (e.g., online community peer reviews or critical articles) could be published if the material was used to inform the retraction decision." (See Additional File for examples of retraction notices). This failure to provide more detailed specific reasons for the retraction has now prompted the author to claim on his website [16]: “The data, which were verified as correct in September 2024, was not questioned in any way.” And: “Conclusion: The data in the study are correct, as they were thoroughly checked by the journal several years ago. The abstract of the study can therefore of course still be cited.” [16], thus continuing to misinform patients, which might lead to harm.

Scientific fraud is neither rare nor is it innocuous. It can harm patients, waste resources, hinder progress and undermine trust in science. In our case, the paper in question is cited by other research publications and review articles (to date, 28 citations according to Scopus and 64 citations according to Google Scholar, January 2026). Even more importantly, many websites [17] promote it as proof that homeopathy is effective against cancer and prolongs survival (see also Additional Files).

To combat scientific misconduct, the Committee on Publication Ethics (COPE) has been founded, OUP being a member of it. According to COPE guidelines, it is essential that, once scientific misconduct has been identified, it should be dealt with adequately and swiftly. There are examples where this has happened: The nature publishing group journal ‘Scientific Reports’ retracted 2 papers when it became clear, that the “drugs” investigated were diluted beyond the Avogadro number and did not contain pharmacologically active concentrations [18, 19]. We therefore feel strongly that OUP should have withdrawn the article in question without hesitation. Sadly, there are also examples of the opposite, e.g. Wakefield et al., The Lancet, 1998 [20] – 11 years and 11 months between publication and retraction [21, 22]. In addition, research integrity bodies have been widely established across several continents including Australia, Europe, and North America [23], many of these bodies possess both naming and sanctioning authority [24].

Yet, our case—alongside many others—demonstrates that correcting the scientific record requires not only institutional oversight but also sustained, systematic efforts that individual researchers cannot realistically provide alone. A growing body of documented cases, including those tracked by Retraction Watch, reveals persistent delays in addressing flawed or misleading research [25–27]. In the field of medicine, such delays carry particularly grave consequences: misinformed treatment decisions can lead to patient harm, unnecessary suffering, or even fatalities.

A striking example is the inclusion of Frass et al.’s work in clinical guidelines. Despite its methodological limitations, a 2015 publication by Frass and colleagues [28] remains cited as a basis for recommending homeopathy to improve quality of life in cancer patients—even influencing the German S3 guideline for complementary medicine in oncology [29]. Worse still, the now-retracted 2020 study by Frass et al. [2] was proposed as evidence for a new recommendation to integrate homeopathy into lung cancer treatment, despite its lack of scientific validity [29].

These cases underscore a systemic issue: without persistent advocacy—often led by organizations like Retraction Watch or formal bodies such as COPE—problematic studies may linger in the literature, continuing to misinform clinical practice. The consequences extend beyond academic integrity, directly impacting patient care and public trust in evidence-based medicine.

In fact, the case of the Frass article in The Oncologist is not an isolated one; similar patterns of delayed or absent retractions persist in the medical literature, such as GSK’s Study 329 on paroxetine [30], where misconduct allegations have yet to result in retraction despite prolonged scrutiny [31]. Only recently—25 years after the study’s initial publication—did the Journal of the American Academy of Child & Adolescent Psychiatry issue an ‘Expression of Concern’ [32], following extensive COPE involvement and a lawsuit [33]. Such delays reflect systemic challenges in addressing fraudulent research, often allowing flawed studies to remain influential long after concerns are raised.

Yet, there is a decisive difference between our case and most of the other ones: While the concept of "scientability"—the idea that clinical studies should not be conducted in fields where no effect beyond placebo is scientifically plausible—remains controversial within evidence-based medicine, the Frass study [2] and its editorial handling raise an even more pressing concern: the responsibility of journals and reviewers in evaluating manuscripts on alternative medicine. Editors bear a heightened duty to rigorously assess such submissions, particularly as the volume of research on complementary and alternative therapies grows. Reviewer selection is critical: An expert with extensive publications in homeopathy, for example, may not approach a manuscript with the necessary scientific scrutiny but rather as an advocate of the method. This concern is especially relevant in systems like Germany’s, where certain therapies ("Besondere Therapierichtungen") gain recognition not through scientific evidence but via the so-called “Binnenkonsens”—a consensus among practitioners within the field, rather than empirical validation.

We recognize that most editors may lack specialized knowledge in alternative medicine. However, basic principles of homeopathy—such as the implausibility of increasing effects with increasing dilutions—should be common medical knowledge or, at minimum, verifiable during manuscript review. In the Frass study [2], the dilutions used were explicitly described:

"Homeopathic medicines were produced through sequential agitated dilutions in alcohol/water or by trituration in powdered lactose (…) quinquaginta millesimal (1:50,000) potencies (Q-potencies/LM-potencies) […] All homeopathic therapies started with Q1 potencies […] toward Q30 [2]."

This description alone made it abundantly clear that a direct pharmacological effect was impossible—a fact the journal’s later editorial [14] misrepresented. While the manuscript itself may not have revealed how data manipulation occurred, publishing our Letter to the Editor (and potentially others that were submitted but overlooked) would not have undermined the journal’s credibility. On the contrary, it would have strengthened the integrity of evidence-based medicine, which thrives on open debate, scrutiny, and the continuous refinement of scientific discourse.

Our trials and tribulations with The Oncologist might remind journal editors of their obligations as guardians of ethical standards. Above all, they should facilitate open scientific discourse and not systematically suppress it, as in this case. Retraction notes should not be vague, but rather formulated in a concrete manner so that readers can understand the reasoning behind them: Given that The Oncologist's retraction note is obviously vague in its wording, which indeed differs significantly from many other retraction notes published by other journals (see Additional File for examples of retraction notices); this fact should also be clearly stated and The Oncologist should be asked to disclose the true reasons for the retraction – and not to shirk its responsibility. This concern is amplified by a recent study [34], which highlights that fraud in science is increasingly driven not only by individuals but also by organized entities such as paper mills, brokers, and predatory journals—phenomena that are growing rapidly and adept at evading countermeasures. This broader context underscores the urgency of reinforcing editorial standards and systemic safeguards to prevent fraudulent work from entering and contaminating the scientific record, especially when it infiltrates and ‘hijacks’ well-reputed journals.

Our experience with The Oncologist underscores that journal editors must act as true guardians of ethical standards. As the recent study [34] shows, organized fraud is expanding rapidly; only decisive editorial vigilance can prevent it from also hijacking reputable journals.

Abbreviations

MedUni Vienna

Medical University of Vienna

OeAWI

Austrian Agency for Research Integrity

OUP

Oxford University Press

COPE

Committee on Publication Ethics

Authors’ contributions

All authors conceptualized, discussed, wrote and reviewed the present work.

Funding

The publication of this work is supported by the Medical University of Vienna.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

N/A.

Consent for publication

N/A.

Competing interests

The authors declare no competing interests.