Jane McCredie: Health fraudsters

ANAESTHETIST Scott Reuben was once an influential figure in pain management: his research showing the benefits of COX-2 inhibitors for postoperative pain in patients undergoing orthopaedic surgery was widely cited and influenced clinical practice around the world.

Problem was the former professor of anaesthesiology at Tufts University in Boston made a lot of it up, publishing papers on studies that were never actually conducted and naming other researchers as coauthors without their knowledge.

He got away with it for a decade or more before fellow researchers started to question why his industry-funded research was so uniformly positive about the drugs he studied.

The editor in chief of Anesthesia & Analgesia (which published 10 of Reuben’s fraudulent papers) told Scientific American the fake research would have affected postoperative treatment of millions of patients around the world.

A 2007 editorial in the journal had said Reuben’s carefully planned and meticulously documented studies had put him at the “forefront of redesigning pain management protocols”.

After the whole sorry mess was finally exposed in 2009, Reuben was charged with health care fraud, culminating in a substantial fine and six-month jail sentence.

That might not be a surprising outcome for a financial fraudster, but it’s rare for perpetrators of scientific fraud to end up in prison, or even to face criminal charges.

Disgraced doctor Andrew Wakefield has never faced criminal charges, despite the UK’s General Medical Council finding him guilty of serious professional misconduct and saying he had acted “dishonestly and irresponsibly” in the conduct of now-discredited “research” claiming to show a link between the MMR (measles–mumps–rubella ) vaccine and autism.

Should he have? Would criminal charges have undermined his credibility among those who continue to believe the claims? Would they have deterred others from perpetrating similar deceptions?

In a recent debate in the BMJ, New Zealand allergy specialist Professor Julian Crane argues research misconduct should not be considered a criminal matter.

“Criminalising research misconduct is a sad, bad, even mad idea that will only undermine the trust that is an essential component of research and requires good governance not criminal investigators”, he writes.

Rather than “calling the cops”, research organisations need to reduce opportunities for misconduct, encourage open and verifiable information on which trust can be built, investigate appropriately and correct misconduct, he says.

Those are good principles, but when a researcher manages to perpetrate serious fraud in spite of such measures should they really be beyond the reach of the criminal law?

On the other side of the debate, Canadian paediatrician Professor Zulfiqar Bhutta argues research misconduct belongs in the same category as criminal fraud.

“Research misconduct is not just related to instances of harmless manipulation of molecules and chemicals in laboratory settings: its consequences on health and society can be huge”, he writes.

“The damage to global vaccination coverage caused by the fraudulent and discredited research by Andrew Wakefield published 16 years ago and finally formally retracted by The Lancet in 2010 has been incalculable. Yet he lives a free man in Texas, raking in money from various support groups.”

A review of the 2047 retracted research papers listed on PubMed between 1977 and 2012 found only 21% of retractions were due to errors made by the researchers.

More than two-thirds were retracted because of misconduct (43% for fraud or suspected fraud, 14% for duplicate publication and 10% for plagiarism).

The researchers also found the percentage of papers retracted because of fraud had increased around 10-fold since 1975. So research fraud may be on the rise or, more optimistically, perhaps we are just getting better at detecting it.

Either way, it’s hard to see why those who practise deliberate deception should be beyond the reach of the criminal law — especially, as has been alleged with both Reuben and Wakefield, the perpetrators may stand to profit from their fraud.

Jane McCredie is a Sydney-based science and medicine writer.