A major medical journal has issued expressions of concern for more than 120 published study protocols after questions were raised about their registration records, peer review timelines, and authorship patterns.
The case traces back to early 2022, when an unusual editorial issue involving a missing table in a clinical trial protocol prompted closer scrutiny. The journal ultimately retracted that article after stating that the authors failed to respond to repeated correspondence. The situation, however, drew the attention of an academic editor who began examining related publications more closely.
During a review of linked articles, numerous protocol papers appeared to share nearly identical structures and formatting. Many were published in the journal Medicine, owned by Wolters Kluwer. A recurring feature among the papers was their registration in the Research Registry, a database established by Riaz Agha.
A systematic search for articles containing both “research registry” and “protocol” identified 127 publications, the majority submitted in 2020 and authored by researchers based in China. According to publicly available registry entries, several studies were registered on the same date the manuscripts were submitted to the journal. In some cases, the start and end dates for participant enrollment were identical. Additionally, multiple registrations across different studies listed the same user name.
Other anomalies were noted within article abstracts, including wording inconsistent with standard clinical research terminology. Acceptance timelines also raised questions, with several manuscripts reportedly approved within days or even hours of submission.
In March 2022, a detailed list of potentially problematic papers was provided to the journal. After an extended review period, the journal issued an expression of concern in late 2025, stating that 126 articles were under investigation. Expressions of concern are typically used to alert readers while an inquiry is ongoing.
The publisher has not publicly detailed the outcome of its investigation. However, the scale of the review highlights broader challenges facing high-volume journals, particularly in screening protocol submissions. Unlike completed clinical studies, protocol papers often present planned methodologies rather than finalized data, which may make them less likely to attract post-publication scrutiny.
The case also underscores the growing concern around coordinated submissions and third-party involvement in manuscript preparation. In recent years, publishers have increased their use of research integrity checks, including verification of trial registration timing, peer review monitoring, and metadata analysis.
For the scholarly publishing community, this episode reinforces the importance of robust editorial oversight, transparent registration practices, and timely institutional responses when concerns are raised.