Web edition: March 17, 2009
A little over a week ago I wrote a two-parter on software that has uncovered hundreds of instances of apparent plagiarism in biomedical science. Copycatting someone else’s work is lazy at best; more likely it’s just amoral. But the current issue of Anesthesiology News highlights an even more egregious type of fraud: blatant fabrication of medical data.
In two investigative news stories, Adam Marcus describes the case against anesthesiologist Scott S. Reuben. This prominent Massachusetts pain researcher is accused of faking data that served as the basis for a minimum of 21 published medical studies. At least plagiarists “borrow” data that are ostensibly real and therefore might have some medical validity. Fabricated data benefit no one but the author who is looking to bolster his reputation by fattening his portfolio of published studies.
Indeed, the potential for harm in seeding fake findings within the medical journals is substantial. They encourage an undue belief by clinicians that certain treatments will — or will not — help patients.
In Reuben’s case, his publications focused on the purported benefits in prescribing non-opiate painkillers, such as celecoxib (sold as Celebrex), a drug that inhibits cyclooxygenase-2, an enzyme that triggers an inflammatory cascade of changes in the body. His studies claimed it worked well, particularly when paired with a neuropathic pain medicine pregabalin (sold as Lyrica). But these Pfizer drugs are not the only ones that Reuben claimed performed well in place of more powerful old-line painkillers.
Together, Reuben’s studies have served as the foundation of a field of medicine known as multi-modal analgesia. It recommends administering painkilling combos around the time of surgery, in some instances as a form of “preemptive analgesia.”
Reports Marcus: “Due to the sheer scope of the misconduct … this field now requires major bolstering to regain the confidence of clinicians and researchers.” He quotes Paul F. White of the University of Texas Southwestern Medical Center at Dallas as saying, ”We are left with a large hole in our understanding of this field [of multi-modal analgesia].” White is the editor of Anesthesia and Analgesia, which had to retract 10 of Dr. Reuben’s papers.
How did Reuben’s co-authors respond? At least two have apparently come forward and claimed that they had no knowledge they were listed as authors of the papers. If true, publishing forgery will be added to the charges being leveled against the discredited Reuben.
Inklings of the academic misconduct, which Reuben has admitted to, came to light a year ago when the hospital he was working for performed a routine audit of summaries for two of his studies. Marcus reports that this audit turned up no approval for the studies by the hospital’s institutional review board. “It turned out there was not IRB approval because the data were partially or completely fabricated,” the hospital’s chief academic officer told Anesthesiology News.
This realization ultimately triggered a wholesale audit of Reuben’s work and a slew of retractions of his oft-cited papers. Reuben is now on “medical leave” from his job as director of acute pain service at Baystate Medical Center.
Marcus quotes White as saying the scandal "compromises every meta-analysis, editorial, systematic review of analgesic trials" or anything else that cited the fraudulent findings. The costs of reviewing and undoing this fraud will just snowball in the coming months.
People always point to peer review as the gold standard for vetting research — confirming that it is not only important but also solid. As the Reuben incident points out, peer review is far from perfect. Reviewers assume their colleagues won’t cheat to get their name in print. In this case, that’s proved to be a pervasive and dangerous assumption.
The big question: What change in policy could have routed this cheat’s bad deeds earlier? Now that it’s gotten a black eye from its trust of Reuben, the medical-publishing field will have to reevaluate its policies.
Of course, there’s no reason to suspect such misconduct is unduly represented in medicine, although the ramifications of any cheating here could prove especially deadly. No, cheating can happen in any field. Which is why chemists, physicists, environmental scientists, nutritionists and others need to also reevaluate their practices in light of the Reuben affair.
Marcus, A. 2009. Routine Audit Uncovered Reuben Fraud: Missing IRB Info Led To Discovery of Fabricated Data. Anesthesiology News 35(March). [Go to]
Marcus, A. 2009. Fraud Case Rocks Anesthesiology Community: Mass. Researcher Implicated in Falsification of Data, Other Misdeeds Anesthesiology News 35(March). [Go to]