Posts Tagged ‘ethics’

Plagiarism

Monday, June 20th, 2011

The Dean of the University of Alberta’s Faculty of Medicine and Dentistry is stepping down because he plagiarized a commencement speech. In his address to this year’s graduates, the dean repeated several passages verbatim from a speech Atul Gawande gave to Stanford Medical School students in 2010.

There’s been no explanation for why the dean plagiarized the speech. In my experience as a classroom teacher, plagiarism becomes a temptation if the assignment is ill-defined, the timeline for producing it is too short, or the writer is unable to grasp the material. In the case of the dean, it’s not likely that a commencement speech assignment caught him by surprise or that he lacked understanding of the occasion.

More likely, it’s the vague role of a commencement speech that motivated him to look to other models. These speeches have to be memorable yet anodyne, uplifting yet realistic. Gawande does seem to have a knack for the pithy platitudes¬† (as evidenced by his address this year at Harvard Medical School). Even if a dean can’t match Gawande’s wisdom, it’s always better to deliver an honest speech and one that reflects the values of the particular institution.

Computer Breach

Monday, April 25th, 2011

For the past 15 years, epidemiologist Bonnie Yankaskas has received federal funding to maintain and analyze a database of mammography results from North Carolina women. Two years ago, her employer, the University of North Carolina School of Medicine, discovered that her server’s security had been compromised.

Although Dr. Yankaskas had hired a computer expert to oversee the database, the medical school ultimately found her responsible for the breach as project PI. The school first tried to fire the professor. Then they tried to demote her. In a settlement, Dr. Yankasas will retain her title and salary, but retire at the end of the year.

Even without evidence of harm to the subjects in the database, it is clear that the PI is responsible for training and overseeing the personnel who manage the data. Along with the prestige of conducting important research comes the responsibility for maintaining ethical standards.

Retractions

Wednesday, April 20th, 2011

Between 1997 and 2009, 1,164 biomedical research articles were retracted. In over half the cases, the cause was scientific misconduct ranging from lack of IRB approval to manipulated data. Though worrisome, these articles represent a small portion of all the literature indexed in PubMed.

More concerning is that, according to a new study, many of these articles continue to be cited well after the retraction is posted. Only 6% of the subsequent citations acknowledge that the original article was flawed. The vast majority of citations occur in literature reviews. Because any search of PubMed would turn up a large “Redacted” watermark on the original article, it could be that authors are not conducting fresh searches to find citations for the literature review section.

Continuing Medical Education

Tuesday, September 14th, 2010

Physicians must earn continuing medical education credits each year to maintain their licenses. These credits come in the form of courses with updates on the latest peer-reviewed findings in medical care. For instance, one doctor I spoke to who works with many Iraq War veterans has set up a workshop to help other physicians identify the signs of PTSD in patients.

Increasingly, pharmaceutical companies and device manufacturers have sponsored CME courses. The accrediting agency for CME found that industry contributed $1.2 billion –nearly half of all funding for CME–in 2007. While that number has dropped as medical schools begin to cut down on conflicts of interest, many companies still pay for doctors to attend CME courses in luxurious locations.

A Harvard Medical School neurologist is part of a team that is developing a new CME curriculum free of industry influence. As the Boston Globe revealed in their story, even the founders of this company have ties to another firm that accepted industry money. And their own plan is to sell courses directly to hospitals. Just as with campaign finance, it seems that it’s impossible to avoid any conflict of interest when it comes to the medical field. Maybe the solution is to require more disclosure of funding sources.

Conduct Unbecoming

Thursday, September 9th, 2010

Charges that Harvard psychology professor Marc Hauser falsified data have been widely reported. Hauser suffered professional embarrassment and the retraction of published papers, but his employer does not seem ready to impose any lasting sanctions. He will take a year off from teaching and advising and then, presumably, return to research.

The Harvard Crimson notes that when other prominent faculty have committed scientific misconduct, the punishment has been similarly lax. The head of psychiatry at Harvard Medical School resigned in 1988 after admitting plagiarism, but was then hired back as chief emeritus. According to sources at Harvard, the university has never revoked tenure for research lapses.

No doubt the exposure has been devastating for Hauser and will cloud any of his future accomplishments. Still, it is not clear that he incurred any institutional penalty for his actions. Falsifying data erodes the core of a university’s academic mission. There should be some commensurate punishment for violating those values. Firing Hauser is not the solution either because he could return to research chastened and invigorated. As befitting an educational setting, Hauser’s experience should become a teachable moment for the rest of the community, not an excuse to banish him for a year.

False Claims

Thursday, July 22nd, 2010

Dr. Anil Potti seemed to fit the definition of a successful medical school faculty member. An Associate Professor of Medicine at Duke, he had received over $1 million in funding for his research on lung cancer tumors. He was an active presence on campus and appeared in press releases.

Then it emerged that Dr. Potti had lied about one seemingly small part of his resume. On different applications for grants he claimed to have been a Rhodes Scholar from Australia. Though he later dropped that claim from his CV, it appears he misrepresented his qualifications on federal grant applications. Duke has placed Dr. Potti on leave, and the NIH may review his funding.

It seems trivial that a single honor could have tipped the balance in favor his grant application. And it is unclear if there were any flaws in the clinical trials he had been funded for. Yet, maintaining the integrity of the research enterprise is crucial. In a competitive academic environment, it can be tempting to exaggerate credentials. Dr. Potti did not receive his training at prestigious universities, but how you perform your role matters more than how people perceive your background.

Conflicts of Interest

Wednesday, July 21st, 2010

The Boston Globe published a story today about new rules at Harvard limiting medical faculty involvement with the health care industry. Pressure from the U.S. Senate and an embarrassing episode with a child psychologist who failed to disclose over a million dollars in drug company funding motivated the change.

Boston University has its own guidelines for interactions between clinicians and industry, which aims to avoid the same appearance of impropriety. The Globe article does not mention how Harvard will enforce the new rules. BU relies on department chairs to report violations of the policy, but that assumes department chairs have detailed knowledge of faculty activities.

I understand the difficulties of navigating industry influence in medicine. Particularly where physicians in academic institutions may accept lower pay than private practice, supplementing with drug company food and honoraria presents an attractive trade off. In applying for Continuing Medical Education credit for the faculty development seminar series, I learned that all the speakers must sign disclosure forms and all the evaluations must include a question about perceived conflicts of interest. The CME forms provides some accountability, but how will departments monitor the less visible ties between faculty and industry?

Ethics and the NIH

Thursday, June 17th, 2010

In 2008, Emory University ruled that Charles Nemeroff, a professor of psychiatry, was ineligible to apply for NIH grants for two years. Dr. Nemeroff had failed to disclose over $1 million in payments from pharmaceutical companies whose products he promoted in academic journals.

Now, a Chronicle of Higher Education investigation has revealed that Dr. Nemeroff ducked punishment by applying for a jot at the University of Miami Medical Center. One of his recommenders was none other than the National Institute of Mental Health director who wrote the ethics rule that Nemeroff violated. While Nemeroff was accepting drug company donations, he was also cultivating friends at the NIH, who returned his favors.

Revealing conflicts of interest is not just some nicety that applies to researchers with little clout. It is integral to the research process itself. Unsurprisingly, Nemeroff promoted drugs in which he had a financial stake, consistently downplaying their serious side effects. Penalties should follow a researcher from institution to institution, pointing to the need for better oversight at the NIH.

Conflicts of Interest

Monday, May 24th, 2010

The National Institutes of Health recently unveiled new guidelines governing conflicts of interest in biomedical research. These suggestions will be subject to public comment for sixty days.

According to InsideHigherEd.com, which published a report on the new regulations, most stakeholders seemed pleased with the move to increased transparency. Everyone from the AAMC to Iowa Senator Charles Grassley applaud the idea of holding institutions accountable for revealing financial ties between researchers and industry.

In an age of eroding public confidence in institutions, it seems crucial that biomedical research remain untainted by the appearance of impropriety. Still, I’m struck by what the additional reporting assumes about the scientific process.

If having a financial stake in the research can affect the study’s outcome, what does it say about the objectivity of science? Are PIs intentionally manipulating data to produce a favorable result, or, are there less conscious ways that bias creeps in?