Comment
Generative artificial intelligence and scientific publishing:
Yuichiro Chino/Getty Images
Published Online
March 6, 2024
https://doi.org/10.1016/
S0140-6736(24)00416-1
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urgent questions, difficult answers
Azeem Azhar describes, in Exponential: Order and
Chaos in an Age of Accelerating Technology, how human
society finds it hard to imagine or process exponential
growth and change and is repeatedly caught out by this
phenomenon.1 Whether it is the exponential spread of a
virus or the exponential spread of a new technology, such
as the smartphone, people consistently underestimate
its impact. Azhar argues that an exponential gap has
developed between technological progress and the pace at
which institutions are evolving to deal with that progress.
This is the case in scientific publishing with generative
artificial intelligence (AI) and large language models
(LLMs). There is guidance on the use of generative AI from
organisations such as the International Committee of
Medical Journal Editors.2 But across scholarly publishing
such guidance is inconsistent. For example, one study
of the 100 top global academic publishers and scientific
journals found only 24% of academic publishers had
guidance on the use of generative AI, whereas 87% of
scientific journals provided such guidance.3 For those
with guidance, 75% of publishers and 43% of journals
had specific criteria for the disclosure of use of generative
AI.3 In their book The Coming Wave, Mustafa Suleyman,
co-founder and CEO of Inflection AI, and writer
Michael Bhaskar warn that society is unprepared for the
changes that AI will bring.4 They describe a person’s or
group’s reluctance to confront difficult, uncertain change
as the “pessimism aversion trap”.4 For journal editors
and scientific publishers today, this is a dangerous trap
to fall into. All the signs about generative AI in scientific
publishing suggest things are not going to be ok.
Within months, LLMs could pass medical examinations
and have now been trained to evaluate text medical
conversations with trained actors as patients.5 Preliminary
research indicates generative AI shows greater diagnostic
accuracy than clinicians in some diseases and better
empathy for text conversations than their human
counterparts.6 In 2023, Springer Nature became the first
scientific publisher to create a new academic book by
empowering authors to use generative AI.7 Researchers
have shown that scientists found it difficult to distinguish
between a human generated scientific abstract and one
created by generative AI.8 Noam Chomsky has argued that
generative AI undermines education and is nothing more
than high-tech plagiarism, and many feel similarly about
AI models trained on work without upholding copyright.9
Plagiarism is a problem in scientific publishing, but those
concerned with research integrity are also considering
a post-plagiarism world,10 in which hybrid human–AI
writing becomes the norm and differentiating between
the two becomes pointless. In the ideal scenario, human
creativity is enhanced, language barriers disappear, and
humans relinquish control but not responsibility.10 Such
an ideal scenario would be good. But there are two urgent
questions for scientific publishing to address.
First, how can scientific publishers and journal editors
assure themselves that the research they are seeing is real?
Researchers have used generative AI to create convincing
fake clinical trial datasets to support a false scientific
hypothesis that could only be identified when the raw
data were scrutinised in detail by an expert.11 Papermills
(nefarious businesses that generate poor or fake
scientific studies and sell authorship) are a huge problem
and contribute to the escalating number of research
articles that are retracted by scientific publishers.12 The
battle thus far has been between papermills becoming
more sophisticated in their fabrication and ways
of manipulating the editorial process and scientific
publishers trying to find ways to detect and prevent
these practices. Generative AI will turbocharge that race,
but it might also break the papermill business model.
When rogue academics use generative AI to fabricate
datasets, they will not need to pay a papermill and will
generate sham papers themselves. Fake studies will
exponentially surge and nobody is doing enough to stop
this inevitability.
Prevention lies in big and small changes that will be costly
and difficult. A major step is to recognise that although
few people can disagree with the open science movement
and its many benefits,13 the implementation of the open
access business model in scientific publishing has generally
worked in opposition to limiting fabrication and research
misconduct. To maintain profits and a sustainable business
responsible to shareholders, scientific publishers have
focused on the quantity of papers over quality, because
the main revenue has been through article-processing
www.thelancet.com Vol 403 March 23, 2024

charges (APCs)—the more papers that are published,
the more APCs publishers secure.14,15 This approach
needs to change. Part of that process will involve finding
new ways to finance the open access model, of which
there are some credible alternatives, such as new types
of group deals with countries and institutions that
remove the focus from APCs.16 Another major step will
be reforming academic environments to reward quality
research over quantity and diminish the link between
publication and promotion, with efforts underway
towards this goal.17,18 Some of the smaller actions involve
technology to prevent fraud, including developing AI
tools that can identify discrepancies and errors in raw
datasets, increasing the use of tools that detect image
manipulation and duplication,19 and developing security
log-ins for authors that confirm they are humans and
linked to an institution. Other solutions lie in more
robust editorial processes that scrutinise studies with
fabrication in mind and detect signs of data fabrication.
A transformative re-evaluation of what can be trusted
in the scientific literature should mean that more value
is placed on journals and publishers that prioritise
trustworthiness.
Second, to what extent do we want scientific journals
to continue being for human readers and led by human
editors? Selecting, reviewing, curating, and optimising
scientific content in journals has always been a human
endeavour. Scientific journals change personality from
one editorship to the next. They rightly come under
scrutiny for matters relating to diversity and inclusion,
because journals so acutely represent the priorities
and interests of editors. But alongside the human
face of journals, the scientific community also faces
an enormous information overload challenge with far
too much research waste.20 This is a problem human
editors and publishers have not been able to solve. AI is
well placed to wade through millions of data points and
decide what is relevant. Pharmaceutical companies are
already using AI to trawl through thousands of abstracts
and full-text articles to gain new insights into diseases.21
What if the solution to our bloated scientific information
problem is to use AI as the main readers and curators of
scientific advances? Robot journals for robot readers?
Nobody can predict the future, but for now, robot
editors would be a mistake. There are important
concerns about the use of closed LLMs for peer review
and editorial processes in terms of compounding bias
www.thelancet.com Vol 403 March 23, 2024
Comment
and hallucinations or not having enough training data
in the system to identify a scientific advance.22–24 And
although some commentators have argued that it is
surely easier to remove bias from an algorithm than
from a person,25 there remain many aspects to a journal
that still require human general intelligence. Journals are
much more than the research they publish. At this stage,
AI can help improve the efficiency, transparency, and
objectivity of peer review26 to help human editors make
better decisions, but it cannot replace human decision
making. At their best, scientific journals are a creative,
inclusive, and leading expression of science woven
together with the richness of human interpretation. To
live up to this ideal—and to survive—research integrity,
risk management, and the value of human thought
leadership must be every journal’s new priority.
I am Senior Executive Editor at The Lancet.
Jessamy Bagenal
jessamy.bagenal@lancet.com
The Lancet, London EC2Y 5AS, UK
1 Azhar A. Exponential: order and chaos in an age of accelerating technology.
London: Penguin, 2022.
2 International Committee of Medical Journal Editors. Updated ICMJE
recommendations (January 2024). https://www.icmje.org/news-and-
editorials/updated_recommendations_jan2024.html (accessed
Feb 26, 2024).
3 Ganjavi C, Eppler MB, Pekcan A, et al. Publishers’ and journals’ instructions to
authors on use of generative artificial intelligence in academic and scientific
publishing: bibliometric analysis. BMJ 2024; 384: e077192.
4 Suleyman M, Bhaskar M. The coming wave. London: Bodley Head, 2023.
5 Kung TH, Cheatham M, Medenilla A, et al. Performance of ChatGPT on
USMLE: potential for AI-assisted medical education using large language
models. PLoS Digit Health 2023; 2: e0000198.
6 Van den Heuvel M. AI excels in patient interaction and diagnosis in pilot
study. Medscape. Jan 30, 2024. https://www.medscape.com/viewarticle/ai-
excels-patient-interaction-and-diagnosis-pilot-study-
2024a100022e?form=fpf (accessed Feb 26, 2024).
7 Springer Nature Group. Springer Nature and authors successfully use
generative AI to publish academic book. Springer Nature. Oct 18, 2023.
https://group.springernature.com/gp/group/media/press-releases/first-ai-
generated-book/26189712 (accessed Feb 26, 2024).
8 Else H. Abstracts written by ChatGPT fool scientists. Nature 2023; 613: 423.
9 Stewart J. Noam Chomsky says ChatGPT is “high-tech plagiarism”.
My Modern Met. Feb 17, 2023. https://mymodernmet.com/noam-
chomsky-chat-gpt/ (accessed Feb 26, 2024).
10 Eaton SE. Postplagiarism: transdisciplinary ethics and integrity in the age of
artificial intelligence and neurotechnology. Int J Educ Integr 2023; published
online Oct 12. https://doi.org/10.1007/s40979-023-00144-1.
11 Naddaf M. ChatGPT generates fake data set to support scientific hypothesis.
Nature 2023; 623: 895–96.
12 Van Noorden R. More than 10,000 research papers were retracted in 2023—a
new record. Nature 2023; 624: 479–81.
13 Rafols I, Meijer I, Molas-Gallart J. The benefits of open science are not
inevitable: monitoring its development should be value-led. LSE Impact Blog.
Aug 14, 2023. https://blogs.lse.ac.uk/impactofsocialsciences/2023/08/14/
the-benefits-of-open-science-are-not-inevitable-monitoring-its-
development-should-be-value-led/ (accessed Feb 26, 2024).
14 Horton R. Offline: The scramble for science. Lancet 2022; 400: 983.
15 Ioannidis JPA, Pezzullo AM, Boccia S. The rapid growth of mega-journals:
threats and opportunities. JAMA 2023; 329: 1253–54.
16 Sanderson K. Who should pay for open-access publishing? APC alternatives
emerge. Nature 2023; 623: 472–73.
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 Comment
17 The Lancet. Safeguarding research integrity. Lancet 2024; 403: 699.
18 Declaration on Research Assessment (DORA). About. 2024. https://sfdora.
org/ (accessed Feb 26, 2024).
19 Jones N. How journals are fighting back against a wave of questionable
images. Nature 2024; 626: 697–98.
20 Kleinert S, Horton R. How should medical science change? Lancet 2014;
383: 197–98.
21 The Medicine Maker. How AI is changing pharma’s approach drug
development. The Medicine Maker. July 7, 2023. https://themedicinemaker.
com/discovery-development/how-ai-is-changing-pharmas-approach-drug-
development (accessed Feb 26, 2024).
22 Donker T. The dangers of using large language models for peer review.
Lancet Infect Dis 2023; 23: 781.
UK Public Health Science 2024: a call for abstracts
Published Online We are delighted to invite abstract submissions for UK
March 18, 2024
https://doi.org/10.1016/
Public Health Science: A National Conference Dedicated
S0140-6736(24)00527-0 to New Research in UK Public Health that will be held in
Cardiff, UK, on Nov 29, 2024. This annual conference
showcases leading, innovative public health research
from across the UK and Ireland with accepted submissions
published online by The Lancet. The conference will bring
together researchers, practitioners, policy makers, and
experts by experience to share and discuss contemporary
issues, perspectives, and challenges in public health
science and explore their impacts for practice, policy,
health services, and research.
Abstracts are welcomed from people and groups
working across all sectors and disciplines on topics
related to any aspect of public health in the UK or Ireland.
Relevant research is invited from the National Health
Service (NHS), local authorities, charities and advocacy
services, government bodies, universities, or other
Vitaly GolovatyUK/Amazing Aerial agency/Science Photo Library
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23 Hosseini M, Horbach SPJM. Fighting reviewer fatigue or amplifying bias?
Considerations and recommendations for use of ChatGPT and other large
language models in scholarly peer review. Res Integr Peer Rev 2023; 8: 4.
24 Stokel-Walker C, Van Noorden R. What ChatGPT and generative AI mean for
science. Nature 2023; 614: 214–16.
25 Lobel O. The equality machine: harnessing digital technology for a brighter,
more inclusive future. London: Hachette UK, 2022.
26 Bhosale U, Kapadia A. AI integration can future-proof peer review—but only if
we define and drive the right principles. Enago Academy. Sept 29, 2023.
https://www.enago.com/academy/ai-integration-in-peer-review/ (accessed
Feb 26, 2024).
research bodies. This cross-sectoral approach will make
for a fascinating and valuable event where participants
can be inspired by novel world-class research.
Alongside the overall focus on public health science, this
year’s conference will explore the connection between
healthy neighbourhoods, the built environment, and
public health from a multidisciplinary perspective.
Cities have a central role in shaping population health.1
Understanding and optimising the built environment
within urban settings is vital for cultivating health-
promoting spaces. Submissions are invited that address
evidence-based interventions and policies relating
to not only the physical aspects of neighbourhoods,
but also to the quality of the air, reduction of noise
pollution, and mitigation of other environmental
stressors.2–4 By highlighting these issues, the conference
seeks to stimulate discussions that can inform policies,
interventions, and research initiatives dedicated to
fostering healthier communities and mitigating the
impact of environmental pollutants on population
health.
The conference will consist of oral paper presentations,
chaired poster sessions, and keynote speeches.
Submissions are now open for oral and poster
presentations. Abstracts can be submitted under any
of the three core categories: creativity in public health
science; new methodological approaches to public
health science; or impact and implementation of public
health science in policy and practice. Research described
in the abstracts may have been undertaken anywhere
in the world but must be relevant to public health
science, practice, and policy in the UK or Ireland. We
particularly encourage submissions that include experts
by experience or early career researchers.
www.thelancet.com Vol 403 March 23, 2024