New problems in scientific publications and academic circles, such as career pressure to be published quickly and often.

But the research, which, in his opinion, was problematic, seemed to have intensified during the COVID-19 pandemic. The pace and scale of scientific publications have increased dramatically, and preprints (articles published on the Internet before review) have become more visible than ever. And this speed was a problem for quality control. All this galvanized Besançon "While I was sitting at home and looking at poor quality science, poor quality control and opaque research published and discussed, I felt more and more inspiration to become a scientific detective," he says.

The Internet was both harmful and useful in terms of false information attack. He posted an appeal on Twitter to researchers who could help analyze the articles that were published after short periods of review. In June 2021, Besanson and his staff, who worked in various institutes and in several areas of health research, analyzed the publications of metadata of 8,455 articles related to COVID-19 published by July 1, 2020. They found that 699 (8.3%) articles were accepted by the journal on the same day or the next day. For 42.5% of these articles, at least one of the authors had an editorial role in the journal in which they were published.

"Listen, maybe there is no generally accepted definition of what an editorial conflict of interest is," Besançon says. "But this is an alarming signal, and the lack of transparency of expert evaluation processes in case of a potential conflict of interest, that's the problem, plus a very fast expert assessment." He emphasizes that he did not consider this fraud, but doubted whether such documents could be properly reviewed; in cases where reviewers' comments were published, some of them were only in one sentence. This made him think about both the rigor of the review process and the consequences for the employed clinicians who rely on such documents. Besançon says that he realized the desire to accelerate clinically significant research during the pandemic, but he believes that if the journals softened their review policy, it should have been disclosed. For example, in August 2020, the magazine FASEB, published by the Federation of American Societies of Experimental Biology, announced what types of articles, at the discretion of the editor, can be accelerated without review.

Investigation of a high level of COVID-19 treatment

Among the articles that were published unusually quickly, there was a work in March 2020, evaluated by the malaria drug hydroxychloroquine as a treatment for COVID-193. It was published in the International Journal of Antimicrobial Agents within a few days of publication as a preprint. In this article, French microbiologist Didier Raoul and his colleagues concluded that hydroxychloroquine was associated with a significant decrease in viral load in a small sample of 20 people (another 16 participants formed a control group). The newspaper immediately attracted great interest, including from U.S. President Donald Trump, then in his first term. According to the Web of Science database, it will be cited almost 3,400 times before being withdrawn in December 2024. Many praise Raul as a pandemic hero.

Besançon saw how hydroxychloroquine gained popularity and attention in the French media and politics. At the end of March, just a week after the publication of the article, the French Minister of Health authorized hydroxychloroquine as a treatment for COVID-19 under surveillance in some severe cases. This permission was withdrawn in May, but Rault continued to inject hydroxychlorochine into people with COVID-19.

Politicians were not the only ones who paid attention to this. Besançon continued to work with other research researchers in response to an article on hydroxychlorochine. It was special, usually in their free time, he says. One of the employees was Alexander Samuel, a mathematics and physics teacher at a high school in Nice, France, and an open science activist with a doctorate in molecular biology. Samuel reported on the results through his blog and social networks, but Besanson helped bring their work to the audience of scientists. "He connects people and then makes an article. He was a kind of PI for me," says Samuel. "I think it brings a scientific level to activism."

Besanson and his fellow researchers indicated serious concerns about the design of the hydroxychloroquite study, such as the fact that 6 people receiving the drug (out of 26 participants) abandoned the study and were ignored in the analysis. Of these six, one person died, and three were transferred to the intensive care unit.

The Sythecs' attention extended beyond one article to other studies published by the Institute of Mediterranean Infection at the University Hospital (IHU) in Marseille, France, which was then led by Raoul. They found what they considered significant ethical violations, including non-compliance with the guidelines and research ethics for human participants. They realized that Raul was a co-author of more than 200 works with the same approval number of the Ethics Committee, which was a single statement, including studies involving children in African countries. Raol justified the lack of an individual ethical review, arguing that research involving human feces, for example, did not require unique ethical approval in France.

By the time this article was published, IHU had not answered Nature journalists' questions about the culture of the institute and alleged ethical violations.

Nevertheless, Raul made concessions. In January 2021, he and other authors of the original article on hydroxychloroquine confirmed in a letter to the editor of the International Journal of Antimicrobial Agents that, due to the urgency during the COVID-19 pandemic, they did not conduct a randomized, double-blind, placebo-controlled study. They claimed that "despite their limitations, weaknesses and shortcomings, our study provided preliminary evidence that allowed us to treat a large number of patients with the HCQ-AZ [hydroxychloroquine-azithromycin] combination, which has been confirmed to be effective against COVID-19".

A separate analysis of 26 hydroxychloroquine trials published in April 2021 concluded that this drug was associated with increased mortality in people with COVID-19.