Medicine and the media

Lies, damned lies, and science

Michael Baum, professor of surgery at the Royal Marsden Hospital, London, admitted that he had become aware of scientific fraud in his department but failed to report it. Clearly it is difficult to choose between exposing a colleague and discrediting the department on the one hand, and allowing dishonest science to stand uncorrected, potentially harming the public, and allowing the guilty to go unpunished on the other. If such a highly regarded scientist and doctor with an impeccable reputation for integrity felt unable to expose corruption, will junior scientists in a vulnerable position dare to speak up?

In the best traditions of investigative television journalism, four unidentified scientists provided the answer. All disclosed examples of corruption in medical research. The villains were not named and presumably the research is not retracted. Some witnesses explained their desire for anonymity--they had suffered or been threatened when they had tried to expose the fraud.

One person was prepared publicly to point the finger of suspicion. Dr Graham Jackson, editor of the British Journal of Clinical Practice claimed to have evidence of a series of alleged scientific frauds committed by an individual. According to Horizon, Dr Aws Salim has published over 60 scientific papers, often in obscure journals. Suspect elements of his work included sole authorship on papers requiring enormous amounts of work; papers reporting large numbers of patients with unusual conditions, submitted from hospitals where Dr Salim held only brief locum appointments (he claimed to have done pancreatic biopsies in 32 patients with chronic pancreatitis, but the department head could recall only two patients and neither had had a biopsy); and reports seeming to plagiarise the work of others. Dr Barry Marshall, who is widely credited with discovery of the role of Helicobacter pylori in peptic ulceration, seemed surprised to hear that Dr Salim had cultured the organism two years before him.

The raising of questions against Dr Salim may be considered by the establishment to be a curate's egg. After all, Dr Salim is not British, and when questioned he claimed that the disputed research was performed in Iraq. The Iraqi doctors with whom he claimed to have worked, however, denied knowledge of him. The fact that Dr Salim is foreign may allow the British scientific community to deny responsibility for his actions but it cannot ignore the length of time it has taken to institute an investigation. Dr Jackson discovered Dr Salim's alleged frauds in 1990 and tried unsuccessfuly to get the medical community to take action before turning in despair to Horizon. Having made the accusations, the programme has acted as judge and jury, limiting the accused's response to that edited by the producers. We rely on their truthful reporting of facts as much as the public relies on the honesty of scientists.

In another case of alleged fraud, action was unusually swift. Mr Malcolm Pearce, consultant obstetrician and gynaecologist at St George's Hospital, claimed to have transferred an ectopic embryo into the mother's womb with a successful outcome to the pregnancy. The hospital swiftly investigated and has suspended Mr Pearce pending an investigation. Cynics will question whether the hospital would have taken such rapid and punitive action if the suspected offence had been less public. The evidence from documented cases suggests that exposure occurs only when outsiders are prepared to reveal the fraud. Mr Pearce's case involved a case of great "human interest." It would be only a matter of time before the popular press wanted to know the identity of the mother and child. It is fortunate for St George's Hospital that they managed to take remedial steps before the tabloid press got hold of the story.

Dr Stephen Lock (past editor of the BMJ) explained that journals are too afraid of libel actions to expose even obvious dishonesty, and he called for a publicly funded, independent organisation to investigate scientific fraud.

Every community will have individuals who break the rules. The community stands condemned only if it tolerates that behaviour. Scientists and doctors would do well to remember that it was programmes similar to this that showed to the public that a corrupt judicial system had allowed serious miscarriages of justice. Public indignation caused government intervention. It may be too late to avoid the stigma of institutional corruption in science, but voluntary action by the scientific community before more cases are exposed may prevent a British version of the Dingell committee, with senior scientists being made to answer embarrassing questions before a parliamentary select committee, and may stop external controls being imposed on scientists.--PETER WILMSHURST, consultant physician, Royal Infirmary, Huddersfield

Peter Wilmshurst 

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