Sydney Ideas, Westmead - Scientific fraud and truth

Scientific fraud carries heavy moral freight. In 2001, the former editor of the BMJ, Stephen Lock, and his colleague Frank Wells ventilated about medical fraud in their book Fraud and Misconduct in Biomedical Research. They wrote that it is uncommon, and only temporarily misleading, because sources of medical information can be scrutinised. Fraud is thus eventually revealed and the perpetrator’s career destroyed.

But if fraud is uncommon, why do Richard Horton, editor of The Lancet, and John Ioannidis, an eminent epidemiologist, claim that half of all published research is erroneous?

I suggest that some unintended distortions may be responsible.

The ‘publish or perish’ adage places great pressure on academics, especially juniors. The number of publications, and not necessarily their quality, is often used for career advancement.

Horton explains in a Lancet comment that “in their quest for telling a compelling story, scientists too often sculpt data to fit their preferred theory of the world.”

Richard Harris’s book, Rigor mortis: how sloppy science creates worthless cures, crushes hope, and wastes billions, records that America spends 30 billion US dollars annually on biomedical research. Much, with hastily devised, poor design, improper methods and/or sloppy statistics, is wrong. Harris gives an example of 900 publications on a cell which was thought to be a breast cancer cell; it was not.

Editors, reluctant to publish negative outcomes, favour positive papers, attracting readers who cite them, and elevating the journal’s status. Erick Turner and colleagues published an article about this in the New England Journal of Medicine in 2008. They pointed out that, of 38 FDA-registered trials of a new antidepressant “viewed by the FDA as having positive results”, 37 were published. Of the 36 trials with negative results, 22 weren’t published, and 11 were published in a way that ‘conveyed a positive outcome’.

In Umberto Eco’s novel Foucault’s Pendulum a young monk expresses dismay that an older monk has not revealed the entire truth about a contentious matter. The older replies, “My son, think of it this way, that we have simply drawn a veil across the truth – to grant it respite.” Publishing only positive trials draws a veil over the truth.

Revelations about bias have a profound impact. In a recent BMJ article, the authors quoted results from a survey of a group of citizens and a group of GPs. Both groups were asked if they believed the results of new drug trials. Most participants in both groups did not believe them, more so the GPs, and the GPs were especially hostile towards pharmaceutical company-sponsored trials. With this low level of confidence, why would anyone participate in trials?

The fact that so many people are turning to unproven alternative and complementary medicines, rather than trusting ‘evidence-based Science’, reflects the cumulative effect of several factors. These factors include small manipulations, perceived investigator bias and the influence of pharma-sponsored dinners and travel, rather than distrust of research because of fraud. Ray Moynihan, in a Sydney Morning Herald article last week, drew from a recent BMJ article by Lisa Bero, Alice Fabbri, Moynihan and colleagues, and wrote about the extent of pharmaceutical sponsorship underpinning continuing professional education and the CPD requirements. A Fairfax investigation with Medicines Australia revealed that from October 2011 to September 2015, Westmead Hospital held 1,858 such events, costing $630,000. .http://www.smh.com.au/national/health/royal-north-shore-hospital-tops-list-of-sydney-hospitals-hosting-drug-company-events-20170706-gx68lq.html .

Fraud, unless ‘beaten up’ by the media as was the MMR vaccination furore, is of less public consequence.

Scientists often over-promise and speak in certainties. Good science is sceptical, and scientific truth only provisional. For example, anthropogenic global warming is a provisional statement from scientists who, if they are true to the sceptical nature of Science, should agree that they might be wrong. But when fashion dominates thinking can be an uphill battle to change attitudes. For example, when it was accepted that peptic ulcer was due to stress, it was difficult for Nobel Prize winners Barry Marshall and Robin Warren to ‘shift the paradigm’ by showing that infection was the causative factor.

Research, as former University of Sydney philosopher Ron Johnstone said, is the competitive generation and dissemination of new knowledge. There are no second prizes. Competition is intense – for grants, being first to publish and to accumulate a curriculum vitae in support of career advancement. Such competition tests weak spots in our ethical armour, with fraud eventually shaming the perpetrators and damaging the reputation of their institutions and their colleagues. 

But Science is, at its base, ethical. We must be alert to ethical challenges and take preventive action. Facts depend on honesty, not popularity. While we must respect prevailing ideologies and societal concerns, we should not be seduced, beguiled or misled. We must remain sceptical, and, as the great Nobelist Sir Peter Medawar argued, must always see results as provisional. On these foundations we must train our juniors and build our future.