Quoting, Misquoting, and Misinterpretation

“Did I really say that?” Quoting, Misquoting, and Misinterpretation: Academic Integrity in Writing for Publication

Michelle Cleary*, Jan Sayers, Garry Walter, and Leslie H. Nicoll*

nurse author & Editor, 2016, 26(2), 1

The Problem

We are all expected to engage in productive academic writing and scholarly debate, and disseminate research findings in a timely way. In many academic workplace settings, the “publish or perish” ethos rules, such that there are expectations or set requirements for staff on the minimum number of papers to be published each year. This may lead to significant pressure on academic staff to meet their teaching and research obligations. A by-product of this pressure may be “corner cutting” as staff strive to meet performance criteria. With such pressures, and with the rapid spread of information, publishing transgressions can take unanticipated and novel forms (Löfström, 2011) and may constitute unprofessional and unethical behaviour.

It is becoming more common to hear colleagues claim that they have been misquoted or misrepresented, or that their work has been reported out of context in publications. A focus on publication quantity may lead some authors to “save time” by quickly cutting and pasting supporting references or quotes without ever reading the original source. The ready availability of information and databases such as Google Scholar via the internet (Ballantine & McCourt Larres, 2012) can make it very simple to find a reference and write a paper without ever actually reading the original material.

Many problems can ensue from using secondary sources without reading the primary paper or book. For example, mistakes may be copied and references used may not be accurate. Reasons for such errors can include confusion around copyright dates and a book having multiple editions (Stark, 2012). Wherever possible, writers should reference and use the original source (Masters, 2005). There are reported instances where secondary texts have been used with such a vague resemblance to the primary text that the original author cannot even recognise their own work (Masters, 2005). Whilst this may not constitute plagiarism, it is nevertheless a very real problem (Ballantine & McCourt Larres, 2012). The reasons for misquoting or misrepresenting the work of others or using a secondary source may be similar to those contributing to plagiarism such as limited time,  poor time management skills, lack of confidence, inadequate understanding of academic writing, and poor writing skills (Gourlay & Deane, 2012)

It should be noted, however, that misquoting and misrepresenting others’ work may not be intentional. Furthermore, all work is subject to interpretation, and this can make it difficult to ascertain whether misquoting has occurred—this can be a grey area. Paraphrasing may also subtly change the meaning, and direct quotes can be used but this is also no guarantee of accuracy, as parts can be used to present work out of context. It is important, however, that we all behave in acceptable ways and meet expectations of what is and what is not acceptable professionally (Ballantine & McCourt Larres, 2012) including writing respectfully.

It is inevitable that small errors will be made, and this may be more prevalent when authors are part of large writing teams because parts of the manuscript get adapted and moved about, including reference material. These mistakes may not be readily identified during the writing or peer-review process.  In most cases, errors are likely to be trivial and we need to be mindful of this and act professionally and with good will. We all make (or have made) mistakes including referencing, and some of these mistakes may be more significant than others.

Case Study

The United States is in the midst of a heroin epidemic, with increased rates of addiction and deaths from overdoses occurring throughout the country (Seelye, 2015). While the antecedents of this epidemic are complex and multifactorial, part of the problem can be linked directly to a misquoted and misinterpreted “Letter to the Editor” that was published in the New England Journal of Medicine in 1980 (Porter & Jick, 1980).

Figure 1.
Figure 1.

If you read the letter, which is illustrated in Figure 1, you will see that the authors do not discuss heroin use or addiction. Nor do they discuss the use of opioids for chronic pain in non-hospital settings. In fact, the data that are referenced in the letter come from the Boston Collaborative Drug Surveillance Program (BCDSP), which was started in the 1960s with Hershel Jick at the helm. By the late 1970s, the BCDSP contained records of more than 300,000 patients and the drugs they received while hospitalized. Jick would often ponder a question and turn to the computer technicians who built and maintained the BCDSP to see if they could come up with an answer, or at least some data that were illuminating (Quinones, 2015). In this case, Jick wondered how often patients in the hospital who received narcotics became addicted. When asked why this occurred to him, he replied, years later, that he was not exactly sure. “I think it was maybe a newspaper story,” he said (Quinones, 2015, p. 15). Jick wrote the letter and graduate student, Jane Porter, refined it and added to the calculations. Because it is customary, she received the first byline, although “Dr. Jick said he wrote the thing” (Quinones, 2015, p. 16).

In 1986, Portenoy and Foley referenced Porter and Jick, saying that they reported that abuse was minimal with the use of narcotics in hospitalized patients. Portenoy and Foley (1986) did not mention that the “report” was a Letter to the Editor. One citation led to another, and in time, the Porter and Jick (1980) letter was described as “persuasive” (Melzack, 1995, p. 11), “a landmark report,” (Allis, 1992, p. 64; Neal & Rathmell, 2012, p. 214), and “an extensive study” (Melzack, 1990, p. 30) that supported the use of opioid analgesics for chronic pain in non-hospital settings. McQuay (1999, p. 2229) makes this statement:

“The drug-seeking behaviour synonymous with drug addiction does not occur in patients after pain relief with opioids in childbirth, operations, or after myocardial infarction”

and cites Porter and Jick as the source. At the time of this writing, according to Google Scholar, Porter and Jick (1980) have been cited 896 times.

Like the old-fashioned game of telephone, one research report quoted the next, and it seems that no one bothered to do the essential work of looking up the original citation to see what it said and reference it accurately. The New England Journal of Medicine has been progressively putting its archives online, but it wasn’t until 2010 that someone could go as far back to 1980 to read the original letter digitally—and for those without institutional access, it still remains behind a paywall. Given the inconvenience, an author (or graduate assistant) might not make the effort to go to the library to look up the primary source, leading to inaccurate re-quoting. While it is easy to understand why this occurred, that does not minimize the resulting damage.

The face of heroin addiction has changed, moving “from an inner-city, minority-centered problem to one that has a more widespread geographical distribution, involving primarily white men and women in their late 20s living outside of large urban areas” (Cicero, Ellis, Surratt, & Kurtz, 2014, p. 821). Further, 75% of heroin users indicate they were “introduced to opioids through prescription drugs” (Cicero et al., 2014, p. 821). These users switched from prescription drugs to heroin for reasons of accessibility and cost. The rise in prescription opioid use, which started in the 1980s, was driven by a combination of factors, both patient-centered and business-oriented.

“Reformulation of opioids as extended-release preparations to allow longer dosing intervals for patients in discomfort had the unintended consequence of making available large quantities of high-dose opioids and priming the epidemic of opioid misuse, abuse, addiction, and mortality. Sales of opioid analgesics, including both regular- and extended-release, increased 4-fold between 1999 and 2010” (Nelson & Perrone, 2012, p. 457).

Aggressive marketing campaigns, such as that undertaken by Purdue Pharma to promote OxyContin (Van Zee, 2009) also contributed to the problem.

Hershel Jick never intended his letter, which he wrote “because someone else might be interested in the findings” (Quinones, 2015, p. 15) to become a manifesto for the use of prescription opioids to treat chronic, non-cancer pain. If it had been cited correctly and reported accurately, the sequence of events that led to its emergence as a leading source of “evidence” might never have occurred. Granted, not all blame can be tagged directly to this letter. Still, understanding how a misquoted and misinterpreted letter was promulgated through the published literature, both scientific and popular, and the effects that occurred, are illustrative for the importance of correctly reading, citing, and reporting prior research.

What To Do

If one finds oneself in a position of being misquoted, the pros and cons of actions need to be carefully considered.  Did this cause damage to your work or reputation? Perhaps you can run it by a trusted colleague or mentor to see if you were actually misquoted. If that is the case then you need to decide whether it’s worth emailing the person and taking the opportunity to let them know the mistake (calmly and politely). They may actually be grateful and more mindful of this in subsequent writing. That said, the action is not without risks.  As an author, you need to weigh up your current (or potential) relationship to the person, and consider whether or not it is worth entering a potentially acrimonious battle. If a serious transgression has occurred, then you can always consider asking for a published correction in the form of an erratum or corrigendum by writing to the author or editor, bearing in mind corrections are often reserved for serious mistakes and editors cannot arbitrate on issues of interpretation (National Library of Medicine, 2015).

Other options are available. If the misquoting is sufficiently serious—for example, the whole thesis of a paper rests on the issue, then the editor may consider retracting the paper.  There is also a new facility titled “PubPeer,” whereby people can make on-line comments about a paper (Watson, 2016). There are examples in the literature, in which work has been misquoted by the omission of several words, distorting the originally intended meaning, or work has been selectively cited, which also demonstrates an absence of civility and academic integrity (Rolfe, 2009).

Is any publicity really good publicity? Is it good for the profession to be engaging in petty squabbles or public disputes particularly in this era of social communication? We are all required to work and publish, and to adhere to ethical publishing codes and professional behaviour. This means that adequate time and effort needs to be allocated to sources and that relevant material is read when preparing papers (Oermann & Christman, 2008). After all, the thorough reading of others’ work often provides the inspiration for considering alternative viewpoints; it may make us dig deeper in terms of the purpose of our own writing, informing our work and enabling us to crystallise our thoughts about a subject. Taking the time to read carefully encourages critical thinking and further debate about a topic and potentially may lead you to consider whether or not you might make personal contact with the author. This in turn can be invaluable in acquiring a deeper understanding of their views and extending your network and collaborations. This is ultimately far more positive and productive than skimming work which is unrewarding for all concerned. When writing for publication, it important to ensure that writing is clear, cited papers are actually read, and primary sources are used.


  1. Allis, S. (1992, October 19). Less pain, more gain. Time, 140(16), 61, 64.
  2. Ballantine, J. A., & McCourt Larres, P. (2012). Perceptions of authorial identity in academic writing among undergraduate accounting students: Implications for unintentional plagiarism. Accounting Education, 21(3), 289-306.
  3. Cicero, T. J., Ellis, M. S., Surratt, H. L., & Kurtz, S. P. (2014). The changing face of heroin use in the United States: a retrospective analysis of the past 50 years. JAMA Psychiatry , 71(7), 821–826. http://doi.org/10.1001/jamapsychiatry.2014.366
  4. Gourlay, L., & Deane, J. (2012). Loss, responsibility, blame? Staff discourses of student plagiarism. Innovations in Education and Teaching International, 49(1), 19-29.
  5. Löfström, E. (2011). “Does Plagiarism Mean anything? LOL.” Students’ conceptions of writing and citing. Journal of Academic Ethics, 9(4), 257-275.
  6. Masters, K. (2005). Flawed evidence: a case study of misquoting and inaccurate referencing: research article. South African Journal of Libraries and Information Science, 71(3), 282-288.
  7. McQuay, H. (1999). Opioids in pain management. The Lancet, 353(9171), 2229–2232. http://doi.org/10.1016/S0140-6736(99)03528-X
  8. Melzack, R. (1990). The tragedy of needless pain. Scientific American, 262(2), 27-33.
  9. Melzack, R. (1995). Model of scientific reasoning. Canadian Family Physician Medecin de Famille Canadien41, 9, 11–12, 17–19. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/7894286
  10. National Library of Medicine. (2015). Fact Sheet: Errata, Retractions, Partial Retractions, Corrected and Republished Articles, Duplicate Publications, Comments (including Author Replies), Updates, Patient Summaries, and Republished (Reprinted) Articles Policy for MEDLINE. Retrieved from https://www.nlm.nih.gov/pubs/factsheets/errata.html
  11. Neal, J., & Rathmell, J. P. (2012). Complications in Regional Anesthesia and Pain Medicine.  Philadelphia, PA: Wolters Kluwer Health.
  12. Nelson, L. S., & Perrone, J. (2012). Curbing the opioid epidemic in the United States: the risk evaluation and mitigation strategy (REMS). JAMA: The Journal of the American Medical Association, 308(5), 457–458. http://doi.org/10.1001/jama.2012.8165
  13. Oermann, M. H., & Christman, J. (2008). Reading assignments in nursing courses: Some guidelines for faculty. Teaching and Learning in Nursing, 3(2), 56-58.
  14. Portenoy, R. K., & Foley, K. M. (1986). Chronic use of opioid analgesics in non-malignant pain: report of 38 cases. Pain, 25(2), 171–186. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/2873550
  15. Quinones, S. (2015). Dreamland: The True Tale of America’s Opiate Epidemic. New York, NY: Bloomsbury Press.
  16. Rolfe, G. (2009). The convenient myth of good scholarship. Journal of Psychiatric and Mental Health Nursing, 16, 390-394.
  17. Seelye, K. Q. (2015, October 30). In heroin crisis, white families seek gentler war on drugs. The New York Times. Retrieved from http://www.nytimes.com/2015/10/31/us/heroin-war-on-drugs-parents.html
  18. Stark, J. E. (2012). Quoting AT Still with rigor: An historical and academic review. The Journal of the American Osteopathic Association, 112(6), 366-373.
  19. Watson, R. (2016). PubPeer: never heard of it? You have now. Nurse Author & Editor, 26(1), 2. http://naepub.com/social-media/2015-26-1-2/
  20. Van Zee, A. (2009). The promotion and marketing of OxyContin: Commercial triumph, public health tragedy. American Journal of Public Health, 99(2), 221-7. doi: 10.2105/AJPH.2007.131714.

About the Authors

Michelle Cleary, PhD, RN, is Professor, Faculty of Health, University of Tasmania, Sydney, Australia. Email:  michelle.cleary@utas.edu.au

Jan Sayers, PhD RN, is an Independent Research Advisor, Sydney, Australia.

Garry Walter, MBBS, BMedSc, PhD, is Chair of Child and Adolescent Psychiatry, University of Sydney, Professor, Centre for Values, Ethics and the Law in Medicine, University of Sydney, and Clinical Director, Child & Youth Mental Health Service, Northern Sydney Local Health District. Email: garry.walter@sydney.edu.au

Leslie H. Nicoll, PhD, MBA, RN, FAAN is President and Owner of Maine Desk, LLC. She is the Editor-in-Chief of CIN: Computers, Informatics, Nursing and Nurse Author & Editor.

*NB: Dr. Cleary and Dr. Nicoll are equal contributing authors to this article. A poster presentation adapted from this work will be presented at the 35th Annual Meeting of the International Academy of Nursing Editors, London, England, August 1-3, 2016.

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Copyright 2016: The Authors. May not be reproduced without permission.
Journal Complication Copyright 2016: John Wiley and Sons Ltd