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Research misconduct—easy to suspect, hard to prove

BMJ 2007; 334 doi: (Published 22 February 2007) Cite this as: BMJ 2007;334:0-a
  1. Douglas Kamerow (dkamerow{at}

    Academics and editors always chide clinicians for not practicing evidence based medicine. But what about when the evidence is possibly falsified? Take the case of neurosurgeon Julio Cruz, who authored papers from three clinical trials finding high dose mannitol infusions superior to conventional dosages in the treatment of head trauma (doi: 10.1136/bmj.39118.480023.BE). His studies were published in respected, peer reviewed journals in 2001-4 and included in a subsequent Cochrane systematic review endorsing the treatment. Ian Roberts and colleagues investigated this research when later Cochrane Collaboration investigations were unable to confirm that the trials had actually been performed. Dr Cruz was not available to defend his studies, having committed suicide in 2005. His co-authors refused to take responsibility or action. The result is inconclusive and unsatisfactory. Charles Young and Fiona Godlee attempt to sort out lessons learned from this messy and potentially dangerous fiasco (doi: 10.1136/bmj.39129.611516.80).

    Use of oral chemotherapeutic agents has increased in recent years, providing increased convenience to patients. The oral drugs are still toxic, however, and would seem to require the same careful handling as infusion chemotherapeutics. Saul Weingart and colleagues surveyed US comprehensive cancer centers to evaluate the safety practices being used for oral chemotherapy (doi: 10.1136/bmj.39069.489757.55). They found that few of the safeguards routinely used for infusion chemotherapy had been adopted for oral agents, such as notation of dose calculation, diagnosis, or treatment cycle and double checking of prescriptions. In a related editorial, Sandeep Parsad and Mark Ratain suggest standardizing oral chemotherapy doses as much as possible (doi: 10.1136/bmj.39128.449317.BE).

    Dog bites are common and (especially in children) can be serious. Marina Morgan and John Palmer review their epidemiology and treatment (doi: 10.1136/bmj.39105.659919.BE). Superficial, easily cleaned bites are not likely to get infected and don't require prophylactic antibiotics. When needed, the oral antibiotic of choice is amoxicillin/clavulanate (called “co-amoxiclav” in the UK). Delayed closure of most wounds is recommended.

    Finally, Enyinnaya Ofo and others briefly review a primary care approach to the patient with olfactory loss (doi: 10.1136/bmj.39035.624583.68). The most common causes—nasal polyps, deviated nasal septum, viral infection, allergic rhinitis, smoking, and head injury—can be elicited by history and physical examination. Most respond to treatment with either corticosteroids or tincture of time.

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