US Attorney alleges medical journals are biased, including CHEST

Key takeaways:

• CHEST was one of several journals initially targeted by the prosecutor.
• A CHEST spokesperson said “legal is currently reviewing” the letter.
• Experts emphasized the journal’s peer review process/standards.

A U.S. Attorney is suggesting that CHEST and other medical journals are politically biased and that the financial disclosures of the authors who publish in them are unclear, according to an article in The New York Times.

Gabrielle Y. Liu

“I have no reason to believe that [CHEST] does not adhere to accepted ethical guidelines for scholarly publishing, and I have no reason to believe that the editorial decisions they make are politically biased,” Gabrielle Y. Liu, MD, MS, assistant professor of clinical internal medicine and associate director of the Interstitial Lung Disease Program at UC Davis School of Medicine, told Healio.

Edward R. Martin Jr., interim U.S. Attorney for the District of Columbia, delivered this message in a letter to the American College of Chest Physicians’ journal, which said, “It has been brought to my attention that more and more journals and publications like CHEST Journal are conceding that they are partisans in various scientific debates,” The New York Times reported.

The story about the letters was first reported by MedPage Today.

According to The New York Times, the letter to CHEST also requested answers to questions about whether it accepts submissions from “competing viewpoints,” how it handles situations in which the authors they published “may have misled their readers” and if the journal is transparent concerning influence from “supporters, funders, advertisers and others.”

On April 18, the same day The New York Times article was posted, CHEST posted a statement on its website, saying that the journal follows “guidelines for scholarly publishing,” and that it applies “strict peer review standards to ensure scientific rigor.”

It also stated that “the American College of Chest Physicians respects and supports the journal’s editorial independence.”

Laura DiMasi, spokesperson for the American College of Chest Physicians, confirmed to Healio that CHEST received the letter and that their legal department “is currently reviewing it.”

NEJM also targeted

In addition to CHEST, STAT reported on April 23 that The New England Journal of Medicine (NEJM) also received a letter from Martin Jr.

NEJM media relations confirmed receipt of the letter in an email to Healio. The group also provided a response from Eric J. Rubin, MD, PhD, editor-in-chief of NEJM.

“The New England Journal of Medicine publishes evidence-based scientific information that physicians can trust in delivering high-quality medical care,” Rubin said. “For more than 200 years, the Journal has brought practice-changing and life-saving advances to patients in the U.S. and around the world.”

Similar to the statement from CHEST, Rubin emphasized the role of peer review in NEJM’s process and its support for editorial independence.

“As practicing physicians, our editors recognize our responsibility to doctors and patients,” Rubin said. “We use rigorous peer review and editorial processes to ensure the objectivity and reliability of the research we publish.

“We support the editorial independence of medical journals and their First Amendment rights to free expression,” he continued. “The Journal actively fosters scholarly scientific dialogue and remains steadfast in its commitment to supporting authors, readers and patients.”

Disclosures in journals over the years

Financial disclosures and potential conflicts of interests in medical journals have been a point of concern for years. A 2023 study published in Arthritis Care & Research reported that financial disclosure statements for studies published in the top rheumatology journals are often incomplete or inaccurate.

Another study published in 2019 in Journal of Clinical Oncology found that there was significant discordance between company-reported and self-disclosed financial relationships among authors of clinical oncology research studies.

Experts weigh in

Mike Hess, MPH, RRT, RPFT, a respiratory therapist, senior director of advocacy and regulatory affairs at the COPD Foundation and member of Healio’s Pulmonology Peer Perspective Board, told Healio many of the concerns and questions raised in the letter to CHEST “are already, from an objective point of view, managed.”

“Respected medical and scientific journals like CHEST have a very robust peer-review process that focuses on the scientific strengths and weaknesses of submissions,” Hess said. “Potential authors generally have no idea who the reviewers for a particular paper are, helping ensure they can’t ‘cherry pick’ friends or colleagues to boost their chances of acceptance.”

Liu, who is a member of Healio’s Pulmonology Peer Perspective Board as well, also highlighted the value of the peer review process when asked about potential bias in CHEST.

“As someone whose work has been published in CHEST and has read CHEST for many years, I do believe that CHEST applies rigorous peer review standards to ensure that the research that is published is scientifically sound,” Liu told Healio.

Physicians conducting peer reviews for major medical journals may receive industry payments, however. A research letter published in JAMA found that over half (58.9%) of peer reviewers received at least one industry payment between 2020 and 2022.

Hess further told Healio the way journals are managed allows for “competing viewpoint” submissions to be accepted.

“Reviewers are ethically bound to recuse themselves from submissions where there might be a conflict of interest or bias, helping increase the chance that ‘competing’ viewpoints are accepted,” Hess said. “Similarly, potential authors are ethically bound to divulge any financial or other conflicts, and those conflicts are reported in published works.”

Hess said experts “love a good debate,” and journals allow for opportunities to show different viewpoints.

“When a potentially controversial paper is published, it is almost always followed by at least one letter to the editor or similar work,” Hess said. “In addition, there are myriad other ways papers are discussed, dissected, reviewed, critiqued, etc (Healio among them), so it is not difficult to find robust discussion and multiple viewpoints.”

In his letter to CHEST, Martin Jr. also inquired about how NIH is involved “in the development of submitted articles,” since the agency is a repeated funder of the research in the journal, according to The New York Times.

In response to this part of the letter, Hess told Healio involvement from government officials on scientific studies should be minimal.

“I can’t speak to the degree that CHEST (or really any other journal) sees their role in combating misinformation or evaluating the role of NIH in articles, but I will say that government officials should have very little role in developing or evaluating the scientific validity, accuracy or import of published works,” Hess said.

“This serves no one, especially not anyone interested in advancing our knowledge of science and medicine,” he added.

Spending time on both sides of the journal review process, Hess said it is “certainly not” perfect, but there are efforts in place, such as the ones described above, to combat bias and misinformation.

“It relies upon the integrity and commitment to ethical behavior of each person involved in the process, and people aren’t perfect,” Hess told Healio. “But that’s also why journals have a process for retracting articles that are subsequently found to not meet the appropriate standards.”

As a final thought, Hess said that some journals “do not have particularly high standards for publication” and focus more on volume vs. accuracy. Rather than targeting “well-established journals with long track records of quality and integrity,” Hess told Healio the “predatory journals” ought to be investigated.

The American Thoracic Society declined to comment for this story.

References:

• Affirming the standards of the journal CHEST. https://www.chestnet.org/newsroom/chest-news/2025/04/affirming-the-standards-of-the-journal-chest. Published April 18, 2025. Accessed April 25, 2025.
• Garrett-Mayer E, et al. J Clin Oncol. 2019;doi:10.1200/JCO.19.02467.
• Guan ML, et al. Arthritis Car Res (Hoboken). 2023;doi:10.1002/acr.25211.
• Medical journals get letters from DOJ. https://www.medpagetoday.com/special-reports/exclusives/115180. Updated April 19, 2025. Accessed April 29, 2025.
• New England Journal of Medicine gets swept up in U.S. attorney inquiry into alleged bias. https://www.statnews.com/2025/04/23/new-england-journal-of-medicine-us-attorney-letter-scientific-journals/. Published April 23, 2025. Access April 24, 2025.
• Nguyen DD, et al. JAMA. 2024;doi:10.1001/jama.2024.17681.
• Trump-allied prosecutor sends letters to medical journals alleging bias. https://www.nytimes.com/2025/04/18/health/trump-martin-us-attorney-medical-journals.html. Published April 18, 2025. Accessed April 25, 2025.

For more information:

Mike Hess, MPH, RRT, RPFT, can be reached at mhess@copdfoundation.org.

Gabrielle Y. Liu, MD, MS, can be reached at gabliu@ucdavis.edu.