{"id":20895,"date":"2012-09-27T16:19:09","date_gmt":"2012-09-27T15:19:09","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=20895"},"modified":"2012-09-27T16:19:48","modified_gmt":"2012-09-27T15:19:48","slug":"steve-yentis-infamous-names-in-anaesthesia-part-three","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2012\/09\/27\/steve-yentis-infamous-names-in-anaesthesia-part-three\/","title":{"rendered":"Steve Yentis: Infamous names in anaesthesia\u2014part three"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/2012\/07\/24\/steve-yentis-infamous-names-in-anaesthesia-part-one\/steve_yentis\/\" rel=\"attachment wp-att-18861\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-18861\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2012\/07\/steve_yentis.jpg\" alt=\"\" width=\"160\" height=\"130\" \/><\/a>My short list of infamous anaesthetists [<a href=\"https:\/\/blogs.bmj.com\/bmj\/category\/steve-yentis\/\">read part one and part two of this blog series<\/a>] has developed into a musing about research misconduct\u2014and particularly fraud\u2014in general, prompted by the <a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1365-2044.2012.07133.x\/full\">Fujii<\/a> case, with up to perhaps 200 retractions on their way.<\/p>\n<p>Here, I\u2019m pondering the cost of research fraud: who loses, and who loses more (for nobody really wins, in the end). Some of these themes have been raised by Peter Kranke in a recent <a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1365-2044.2012.07318.x\/full\">editorial<\/a> in <em>Anaesthesia<\/em>, in which he reflects on the ten years since he and his colleagues first raised suspicions about Fujii\u2019s work in a beautifully understated letter entitled: &#8220;<a href=\"http:\/\/www.anesthesia-analgesia.org\/content\/90\/4\/1004.2.long\">Reported data on granisetron and postoperative nausea and vomiting by Fujii et al. are incredibly <em>nice<\/em><\/a>!&#8221; (the italics unfortunately lost in modern e-versions of the reference. It was nice (or even, <em>nice<\/em>) to be able to offer Peter the opportunity to achieve &#8220;closure&#8221; in an editorial, a decade later).<!--more--><\/p>\n<p>First, there\u2019s the cost to the perpetrator, and those close to him. Whilst not suggesting anyone should be too sympathetic for fraudsters themselves, it\u2019s sad nonetheless to see an eminent figure struck down and humiliated, even one I haven\u2019t met personally. I\u2019ve no idea whether Fujii has a family, but presumably he has (or had) friends and colleagues, at least some of whom were unaware of what was going on. Fujii\u2019s predecessors, <a href=\"http:\/\/journals.lww.com\/ejanaesthesiology\/Fulltext\/2011\/06000\/The_Boldt_debacle.1.aspx\">Boldt<\/a> and <a href=\"http:\/\/www.anesthesia-analgesia.org\/content\/112\/3\/512\">Reuben<\/a>, travelled and lectured widely before their fall from grace, and were presumably wined and dined accordingly by the great and the good.<\/p>\n<p>Then there\u2019s the shame that might be felt by the institutions, professional bodies, and individuals concerned with regulating the system, and the time, effort, and distress of dealing with the fallout. This can\u2019t be helped by the fact that Fujii\u2019s misdemeanours were apparently taking place for the past 15 years or more, and across several institutions, so the number of people potentially tainted (or who might feel\u2014or be accused of being\u2014thus tainted) must be large.<\/p>\n<p>There\u2019s the cost of reviewing, processing, sub-editing, typesetting, and printing all those thousands of words. With the sad, needs-to-get-out-more curiosity that goes with this job, I\u2019ve counted the number of words in the first five of Fujii\u2019s papers, identified via PubMed, whose full-text versions I\u2019ve been able to access. It comes out as about 1600 words per article\u2014not a lot, though remember we\u2019re talking about approximately 200 retractions here, some of them reviews so quite a bit longer: perhaps a total of a third to half a million words. <a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1365-2044.2012.07318.x\/full\">Kranke<\/a> estimated at least 3000 hours of processing time. Not to mention the hours and hours (I shall bear the scars for ever) spent investigating, discussing, and eventually retracting the articles.<\/p>\n<p>The one thing in Fujii\u2019s favour is that the number of patients suffering bodily harm as a result of his retracted work is small, despite its volume. Few\u2014if any\u2014will have died, since most of his work was on peri-operative antiemetics, particularly granisetron. (The canine population will have suffered more, since a sizeable minority of his work was in dogs, selflessly giving up their diaphragms and occasionally other organs in the interests of science). Antiemetics are, on the whole, fairly inoccuous drugs, and granisetron is not very widely used\u2014in the UK at least\u2014though there must have been quite a few patients who would have received it but with less benefit than expected, or been deprived of other, perhaps more effective drugs. Perhaps a few might have suffered serious complications as a result, but it\u2019s unlikely. Although far fewer of Boldt\u2019s and Reuben\u2019s papers were retracted, in the areas of intravenous fluids and analgesics, respectively, patients are more likely to have suffered. And of course many thousands of children will have been harmed through not receiving the MMR as a result of just two retracted articles by <a href=\"http:\/\/www.bmj.com\/content\/340\/bmj.c696\">Wakefield<\/a>, so the harm isn\u2019t necessarily in direct proportion to the number of retractions.<\/p>\n<p>Sales of antiemetics might have been falsely influenced, which could have resulted in additional, unnecessary costs to hospitals (typically, the new &#8220;-etrons&#8221; aren\u2019t cheap), and some drug companies\u2019 suffering reduced sales in favour of granisetron. Conversely, the manufacturers of granisetron could have unwittingly benefited, through no fault of their own. Moneys gained and lost may well have been greater for other areas of practice, such as those of Boldt and Reuben.<\/p>\n<p>But the big loser, of course, is trust. Doctors still remain top in the <a href=\"http:\/\/www.ipsos-mori.com\/researchpublications\/researcharchive\/2818\/Doctors-are-most-trusted-profession-politicians-least-trusted.aspx\">list<\/a> of trusted professions, whilst &#8220;professors&#8221; and &#8220;scientists&#8221; are third and fifth, respectively. Will scandals like the Boldt, Reuben, and Fujii cases dent this record? Or is it mainly damage to trust within the &#8220;scientific community&#8221; (whatever that is) that\u2019s the main victim? There\u2019s lots of talk currently about increasing regulation in order to prevent and\/or detect such scandals, which can only increase the barriers for other researchers, already facing a mountain of regulation. Perhaps, in the end, this will be the main cost we\u2019ll all have to bear, along with the loss of research never done as a result.<\/p>\n<p>Competing interests and acknowledgements: I am editor in chief of <em>Anaesthesia<\/em>, and a co-signatory of the joint editor-in-chief letters to Boldt\u2019s and Fujii\u2019s institutions. I was a member of the Committee on Publication Ethics Council until earlier this year.<\/p>\n<p><em><strong>Steve Yentis<\/strong> is a consultant anaesthetist in London and Editor-in-Chief of <a href=\"http:\/\/www.anaesthesia-journal.org\/\">Anaesthesia<\/a><\/em>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>My short list of infamous anaesthetists [read part one and part two of this blog series] has developed into a musing about research misconduct\u2014and particularly fraud\u2014in general, prompted by the [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2012\/09\/27\/steve-yentis-infamous-names-in-anaesthesia-part-three\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[2605,1462],"class_list":["post-20895","post","type-post","status-publish","format-standard","hentry","category-uncategorized","tag-anaesthesia","tag-research-fraud"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - 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