> While the instructions for authors for Paediatrics & Child Health has at times indicated the case reports are fictional, that disclosure has never appeared on the journal articles themselves.

Sounds like they were asking authors for fiction, so probably plenty of them are.

They asked the authors for fiction “at times”. Meaning that some are fiction, and some very well might not be. The best they can do is try to contact the authors and see if the case report they wrote is fictional or not. The second best is to admit that they made a mess and say “the case reports might or might not be fictional, we have no way of knowing”.

I suspect you're reading too much into that phrase. It seems more likely to me that the reporter here contacted one or more of the case report authors directly to ask for a copy of what instructions they received from the journal at the time. (This would be good journalistic practice, rather than just take the journal's word for it, when they might have an incentive to lie.) But they obviously couldn't explicitly confirm that every single author received similar instructions, so they used the “at times” phrase to cover their ass.

If they had direct evidence that some author's instructions failed to ask for the case study to be fictionalized, I think they would have specifically said that. It's more definitive, and catches the journal in a lie.

I'm pretty sure what happened here is that:

1) The journal always asked for and thought they received fictionalized case studies.

2) It never occurred to them that they were presenting the case studies in a way that could be misinterpreted. (This is indefensible negligence, but I also understand how it could have happened "innocently".)

3) Once the issue came to light, they issues blanket corrections to every case study study to describe them as fiction because they asked for fiction and edited them all as fiction. (I.e., Didn't do any fact checking or independent confirmation, beyond medical broad strokes.)

4) At least one author didn't read the instructions carefully enough and sent in a real case study, which as the article says, wasn't caught by the editors during the review process. (And really, how would they catch it? If they thought they asked for fiction, they wouldn't be fact checking it.)

I actually think the disclaimer may be appropriate, even on the article that was written as a true story, if it wasn't reviewed as one.

> If they had direct evidence that some author's instructions failed to ask for the case study to be fictionalized, I think they would have specifically said that.

Which they do. They specifically say that. “Neither the instructions for authors from 2010 — when Koren and his coauthor Michael Rieder would have written their article — nor the linked list of article types — state the cases are fictionalized, or fictional.”

“An archived version from September stated, ‘Each highlight is a teaching tool that presents a short clinical example, from one of the studies or one-time surveys,’ with no mention of fiction.”

These are direct quotes from the article. The exact kind you are asking for. With inline links to the archived documents. And yes it is very definitive.

> I'm pretty sure what happened here is that:

No need to speculate. Just read the article.

> 1) The journal always asked for […] fictionalized case studies.

This is false. As evidenced by the article.