A new Columbia University School of Nursing audit has found nearly 3,000 peer-reviewed medical papers with fake citations that do not exist in scientific databases. The study, published in The Lancet, examined a growing problem in academic publishing as AI tools become more widely used.
The team built an automated verification system to scan 2.5 million papers published in PubMed Central’s Open Access collection from January 1, 2023, to February 18, 2026. Across 97.1 million verified references, they identified 4,046 fake citations in 2,810 papers. The rate of fake references increased more than 12-fold since 2023, with the sharpest rise beginning in mid-2024, which coincided with the spread of AI writing tools.
According to Maxim Topaz, who led the study, “This discovery directly impacts patients as medical professionals make treatment decisions based on clinical guidelines.” He added, “A medical professional or clinical guideline developer has no way of knowing that the evidence they are relying on does not exist. For example, one paper we reviewed had 18 out of 30 fake references. Some of those citations are already being cited by other papers and appear in systematic reviews that inform clinical care.”
The authors recommend that publishers verify references at the time each paper is submitted. They also suggest that indexing services add metadata that would help users judge whether references are accurate. In addition, they call on major research integrity databases to create a specific category for fake references so the problem can be tracked more systematically. The team also urges publishers to review older papers and issue corrections or retractions when fake references affect conclusions. At the time of the audit, 98.4% of affected papers had not received any publisher action.
In a commentary that accompanied the study, Howard Bauchner and Frederick P. Rivara said the findings highlight a serious concern for research integrity. They wrote, “Given that public trust in science appears to be waning in countries around the world, renewed efforts are needed to enhance research integrity. Authors must take responsibility and be held accountable for the entire content of a manuscript, including the references.”
Publication details: Topaz M, Roguin N, Gupta P et al.
Fabricated citations: an audit across 2·5 million biomedical papers
The Lancet, 407, 1779-1781
The team built an automated verification system to scan 2.5 million papers published in PubMed Central’s Open Access collection from January 1, 2023, to February 18, 2026. Across 97.1 million verified references, they identified 4,046 fake citations in 2,810 papers. The rate of fake references increased more than 12-fold since 2023, with the sharpest rise beginning in mid-2024, which coincided with the spread of AI writing tools.
According to Maxim Topaz, who led the study, “This discovery directly impacts patients as medical professionals make treatment decisions based on clinical guidelines.” He added, “A medical professional or clinical guideline developer has no way of knowing that the evidence they are relying on does not exist. For example, one paper we reviewed had 18 out of 30 fake references. Some of those citations are already being cited by other papers and appear in systematic reviews that inform clinical care.”
The authors recommend that publishers verify references at the time each paper is submitted. They also suggest that indexing services add metadata that would help users judge whether references are accurate. In addition, they call on major research integrity databases to create a specific category for fake references so the problem can be tracked more systematically. The team also urges publishers to review older papers and issue corrections or retractions when fake references affect conclusions. At the time of the audit, 98.4% of affected papers had not received any publisher action.
In a commentary that accompanied the study, Howard Bauchner and Frederick P. Rivara said the findings highlight a serious concern for research integrity. They wrote, “Given that public trust in science appears to be waning in countries around the world, renewed efforts are needed to enhance research integrity. Authors must take responsibility and be held accountable for the entire content of a manuscript, including the references.”
Publication details: Topaz M, Roguin N, Gupta P et al.
Fabricated citations: an audit across 2·5 million biomedical papers
The Lancet, 407, 1779-1781