Bad apples to rotten forests

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Sifting through some British Medical Journal (BMJ) articles to further my knowledge of the methodology of scientific research, I found a reference to the work of Barbara Redman from NYU Grossman School of Medicine titled, Research Misconduct Policy in Biomedicine: Beyond the Bad-Apple Approach. An interesting viewpoint, the author argues that research misconduct is a system problem where the dirty hands don’t just belong to the authors, but also conflicted organisations and institutions. She describes it as a system that lacks checks and balances and encourages publishing fraudulent research. In her words, ‘We need to shift focus from targeting bad apples to bad barrels if not simply rotten forests or orchards.’

The wisdom that the men of old had never ceases to amaze me. American writer and humorist Samuel Clemens (aka Mark Twain) could pass as a soothsayer for stating then, what is obvious now:

Get your facts first. Then you can distort them as you please.

One cannot un-know what is known. Some are waking up to the issue purely by chance and have been relentless in bringing light to it. This well-written article of February 2023 in The Economist titled, There is a worrying amount of fraud in medical research and a worrying unwillingness to do anything about it is a good read. On similar tones, researcher Daniele Fanelli et al published in PLoS How Many Scientists Fabricate and Falsify Research. A Systematic Review and Meta-Analysis of Survey Data which indicates a figure of 2-34 per cent, stating it could be much higher.

While a lot of the alleged medical misconduct happens with the knowledge of a certain sect of corrupted scientists and physicians, a large proportion of innocent doctors are victims being exploited to generate lavish profits for the pharmaceutical industry.

In the scientific and medical community, there are three distinct categories of people:

  1. Ethical people of strong integrity who have ploughed their way through their careers and are still standing by honest science. They may have suffered immensely along the way for their decisions, but they just cannot be bought.
  2. Then we have the Men in Grey. These are people who know right from wrong but are not grounded in ethics and morals and can be misguided and swayed into dishonest acts. In addition to the third category, these people work for the industry, cannot regulate their moral compass when lured, and have no control over how they work.
  3. Finally, there are the corrupt, malicious and self-seeking individuals whose primary motivation is self-enrichment. They would be outright incompetent owing to these reasons and harmful to the course of science.

Unfortunately, it is quite easy to see why individuals without strong ethical and moral principles are prepared to engage in such practices when financial gains can be quite substantial and lucrative. While we may be talking about a few throw-away pennies for the industry, they are silver and gold for working-class physicians and scientists.

Professor John Ioannidis, an acclaimed expert in meta-research and a Professor at Stanford School of Medicine, thinks the situation is even more dire. In his 2005 essay titled Why most published scientific research is false, he concluded that most clinical trials cannot be replicated. A scientific study is considered of strong value if it has a positive reproducibility potential. He draws attention to the existence of a vast network of global scientists publishing false research and organisations conducting zombie trials, most of which come from countries such as China, India, Iran, Egypt, Japan, South Korea, and Turkey.

Until researching for this article, I had never heard of the term zombie trials. Digging deeper, it refers to several things: trials that never took place and trials that had authors who never knew their names were included on the list of authors until the paper got published (or authors who never contributed a single patient to the study). It gets even more interesting. Some of these trials even have authors attached to ‘ghost institutions’, ones that are non-existent! All of this could make a good script for a light-hearted weekend Netflix binge.

Dr Marcia Angell left politeness aside (Drug Companies & Doctors: A Story of Corruption):

It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgement of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as editor of The New England Journal of Medicine.

And then we have Richard Horton, Editor of The Lancet, who said:

The case against science is straightforward: Much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness.

To conclude, a 2010 paper co-written by Glen Spielmans and Dr Peter Parry titled From Evidence Based Medicine to Marketing Based Medicine, states as follows:

Sadly, evidence-based medicine has been overtaken by marketing-driven medicine where drug companies fiduciary duty is to their shareholders, not to the patient or their safety. The industry and its associated medical communication firms state that publications in the medical literature primarily serve marketing interests. Suppression and spinning of negative data and ghost-writing have emerged as tools to help manage medical journal publications to best suit product sales, while disease mongering and market segmentation of physicians are also used to efficiently maximise profits.

The article further asserts:

The analyses of internal industry documents allow a glimpse into the shadowy world of MBM (marketing-based medicine) where data serves the needs of marketing and inconvenient data is often recast as positive or buried away entirely. However, in the current world of MBM, journal articles are an overly positive representation of safety and efficacy, articles are often prepared by drug marketers (whose influence is hidden by honorary authors), marketing efforts contain misleading information about both diseases and treatments and physicians are partitioned into market segments to best persuade them to believe various marketing pitches. Until such issues are resolved, particularly those regarding widespread access to accurate data, any great enthusiasm for so-called evidence-based medicine should be viewed with scepticism.

The evidence of malfeasance has been piling up for decades. The forest is now truly overgrown and it’s difficult to make out the wood from the weeds. Fortunately, undoing the mess will not take too much time. But it is going to take an army of committed doctors and scientists who are willing to walk the line through the red sea. How long do we wait before freedom in science is re-established? How long before science regains its lost glory and the public restores faith in the medical profession? How much longer? Are we there yet?

This article first appeared in The Spectator Australia here.

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