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The number of retractions and expressions of concern in high-impact medical journals is steadily increasing. A dedicated retraction database has been created [1]. The studies and editorials published on retraction in different medical fields have led to this problem becoming news [2–4]. Compromised or fake peer reviews, forgery, plagiarism, non-compliance with ethical declarations, and inappropriate authorship are the most common examples, while bona fide errors account for a minority of cases [2, 3]. Predatory journals flourish and add to the confusion. Physicians are not alone, and stories of fake news and falsifications in science are widespread: fossil birds and the controversial “memory of water” research are good examples of the fine line that divides sincere from counterfeit and the role played by economic issues [5, 6]. These last years have seen several waves of retractions, the most recent and important one regarding papers from China on transplanted organs, when it appeared that the organs had come from prisoners whose death sentence had been timed to coincide with demand; Iranian teams are also frequently cited in retraction affairs [4, 7]. In both cases, the political authorities were involved: military hospitals and prisons in the China affair, and on a lesser, but still disturbing scale, the fact that political authorities were included as authors of the Iranian papers. China has been accused of systematic organ harvesting from political prisoners, mainly Falun Gong practitioners, whose mean age is between 20 and 30. The scandal has received attention in both medical journals and non-scientific newspapers, such as The Guardian, The Independent and The New York Post [8]. These newspapers are however exceptions and the generalized silence of the media is surprising. Is it motivated by respect for patients waiting for a kidney graft in our countries who could be psychologically hurt by such news, or is it due to reluctance to share disturbing information that points to the involvement of economic interests? The issue is not new, but the recent alert came from a scoping review published earlier this year, which succeeded in its aim of obliging all the major nephrology journals to take a position, at least with respect to previously published papers [7, 8]. The conclusions of the study are clear: reviewers, editors and publishers were guilty of lack of attention. Researchers and clinicians who cite and use this research implicitly accept organ procurement from executed prisoners. Immediate retraction is therefore demanded [7]. The review succeeded where the media had not; in fact you will probably be surprised, as I was, by the quantity of information available on the web, including a BBC podcast, long and detailed documentaries and official reports. I admit that I was guilty of lack of attention. Moving from the realization of having been superficial, to my professional role of clinical researcher and journal editor, I see that several questions remain open. As authors, to what extent should we ascertain that each paper we cite meets the ethical requirements of informed consent, compliance with the Helsinki principles and, when transplantation is involved, with the Istanbul declaration? How much care must we exercise in checking that a study’s methods have been ethical and, in cases of doubt, demand the raw data? Can we be satisfied with generic statements or is more required of us? In fact, as the BMJ open review specifies, many papers declare compliance with principles that were clearly not respected. Is checking compliance with ethical * Giorgina Barbara Piccoli gbpiccoli@yahoo.it

Ethics of publication, between forgery, retraction and protecting freedom: an ENJOY score for authors and editors