If you have the good fortune of finding yourself with 36 hours of spare time over the summer months, I suggest you spend it watching the riveting television series Breaking Bad. It is an epic saga about Walter White, a Caltech-trained organic chemist turned dissatisfied high school teacher who is diagnosed with stage IIIA nonsmall cell lung cancer. After accompanying his brother-in-law, a Drug Enforcement Agency agent, on a drug raid, Walt decides that “cooking” methamphetamine would be a quick way for him to quickly amass a substantial financial nest egg for his family. What makes this series so gripping is watching the transformation of Walt from an affable chemistry teacher into a ruthless, evil man.
Rather fail with honor than succeed by fraud.
—Sophocles (496–406 BC)
We learn that his expertise is in the field of crystallography, and along with some of his Caltech colleagues, he had started a biotechnology company. However, after suspecting that his colleagues were stealing his ideas and claiming them as their own, he abruptly quit the enterprise. Armed with his tiny buyout, he relocates to Albuquerque, N.M., where he begins anew as a high school chemistry teacher. Only years later does he discover that the true value of his stolen intellectual property was in the hundreds of millions of dollars. Don’t feel too sorry for Walt. In his new occupation, he quickly makes up for lost income.
Watching Breaking Bad is highly addicting. No wonder it is among the most binge-watched shows on Netflix. According to the show’s creator, Vince Gilligan, “this is not a show about evil for evil’s sake. Walt has behaved at times in what could be regarded as an evil fashion, but I don’t think he’s an evil man. He is an extremely self-deluded man. We always say in the writers’ room, if Walter White has a true superpower, it’s not his knowledge of chemistry or his intellect, it’s his ability to lie to himself. He is the world’s greatest liar. He could lie to the pope. He could lie to Mother Teresa. He certainly could lie to his family, and he can lie to himself, and he can make these lies stick. He can make himself believe, in the face of all contrary evidence, that he is still a good man.”1
When I watch Breaking Bad, I am reminded of those people who, like Walt, are really great at self-deception. They may have started their careers full of good intentions, but over the years, they go astray. One such person is a neighbor of mine, a seemingly thoughtful psychiatrist who was found guilty of having inappropriate relationships with several of his patients and was banned from medical practice. Another is a former colleague, a member of my division who was found guilty of first-degree murder. The victim was his wife. Fortunately, among physicians, such egregious acts are fairly rare events. More often, the crimes being committed by doctors are related to financial misbehavior. As the stock market has boomed and Wall Street profits have soared, the lure of easy money can be overwhelming. There are many stories of doctors being entangled in the web of pecuniary mischief spun by medical billing fraud or by insider trading.2 That, however, is a story for another time.
There are several species of impositions that have been practiced in science, which are but little known, except to the initiated, and which it may perhaps be possible to render quite intelligible to ordinary understandings. These may be classed under the headings of hoaxing, forging, trimming and cooking.
—Charles Babbage: Reflections on the decline of science in England, and on some of its causes (1830)
A Bad Habit That Reaches Back To Ancient Times
For most physicians, the ruthless pursuit of money is not the major driver for either good or bad behavior. In fact, the most common form of medical malfeasance is research fraud. Scientific misconduct is not necessarily a sign of a decline of ethics among researchers today or a manifestation of the current climate of heightened competition for tenure and research funding. In his excellent review of scientific fraud, Charles Gross, PhD, professor of psychology at Princeton University in New Jersey, points out that accusations of misconduct pepper the history of science, dating back to the Greek philosophers.3 Ptolemy of Alexandria (90–168), one of the greatest astronomers of antiquity, has been accused of using, without attribution, observations of stars made by his predecessor Hipparchus of Rhodes (162–127 BCE), who himself had used much earlier Babylonian observations as if they were his own. Isaac Newton was criticized for introducing “fudge factors” into his magnum opus on gravity, Philosophie Naturalis Principia Mathematica (1687), so as to increase its apparent power of prediction.
Many of us fondly recall the seminal studies of the Augustinian friar, Gregor Mendel, who studied the hereditary characteristics of pea-plant crossings and reported near perfect and therefore statistically very unlikely ratios. When Mendel crossed hybrid plants, he predicted and found that exactly one-third of the plants were pure dominants and two-thirds were hybrids. Yet it took nearly 50 years before any scientist questioned the improbability of observing such a precise ratio. An undergraduate at Cambridge University in England, and the future creator of the analysis of variance (ANOVA) and other important statistical tests, Ronald Fisher, was the first to raise doubts about the accuracy of Mendel’s observations.
Even the father of microbiology, Louis Pasteur, can be faulted for his ethical lapses. According to the late Gerald Geison, PhD, professor of history at Princeton University, Pasteur lied about his research, stole ideas from a competitor, and was deceitful in ways that would now be regarded as scientific misconduct, if not fraud.4 These conclusions were reached through Geison’s analysis of Pasteur’s 102 laboratory notebooks, which confirmed that, for several of his landmark experiments in developing vaccines against anthrax and rabies, data were falsified. This behavior failed to deter Pasteur from receiving, in some years, as much as 10% of all the French government research funding. In fact, it probably helped fuel his rise to stardom.
The F words: Fabrication and Falsification of Data
According to the National Institutes of Health (NIH), scientific misconduct consists of circumstances when an investigator fabricates or falsifies data or plagiarizes material from other sources. This definition of fraud is virtually identical to the one proposed by Charles Babbage, written nearly two centuries ago, when he employed the more moderate terms such as hoaxing, forging, trimming, and cooking. Some ethicists consider the “F” words, fabrication and falsification, to be more serious crimes than plagiarism, since scientific research ultimately depends on data integrity and honesty.
How common are these problems? A study published in 2005 found that approximately one-third of American biomedical scientists reported engaging in some level of research misconduct during the previous three years.5 The researchers surveyed 3,600 mid-career and 4,160 early-career scientists, all of whom received some funding from the NIH. In descending order, the respondents admitted to: changing the design, methodology, or results of a study in response to pressure from a funding source (15.5%); short-cutting minor aspects of human-subjects protection requirements (7.6%); failing to present data that contradicted the researcher’s own previous research (6.0%); the unauthorized use of confidential information (1.7%); using another’s ideas without obtaining permission or giving credit (1.4%); and falsifying research data (0.3%). Although respondents to this study were kept anonymous, the true frequencies of data falsification and fabrication remain difficult to determine. Investigating systematic scientific fraud is time consuming, costly, and often a politically challenging process.
The effects of fraud in clinical medicine can be particularly deleterious, owing to a catastrophic domino effect. Patients may be exposed to treatments that are based on false premises. Younger investigators discover that they devoted their academic careers to work with highly successful investigators who turn out to be fraudulent researchers. Dwindling financial resources are totally wasted. There is considerable collateral damage.
The P Word: Plagiarism
Compared to fraud and data fabrication, the damage caused by plagiarism remains significant but more limited in scope. Recently, researchers at the University of Texas Southwestern Medical School in Dallas created a web server, eTBLAST, and an affiliated database called “Déjà vu” that can scan the entire Medline database to detect potentially plagiarized manuscripts.6 In one study, they examined a sample of over 62,000 Medline citations, and a database of manually verified duplicate citations was created to study author publication behavior. The researchers found that 0.04% of the citations with no shared authors were highly similar and thus considered to be potential cases of plagiarism and 1.35% with shared authors were sufficiently similar to be considered a duplicate. Extrapolating this data, the authors estimate that there are about 120,000 duplicate citations listed in Medline. The researchers sent anonymous questionnaires to the duplicate authors suspected of plagiarizing. Of these, 28% denied any wrongdoing, 35% admitted to having “borrowed” previously published material (and were generally apologetic for having done so), and 22% were from coauthors claiming no involvement in the writing of the manuscript. An additional 17% claimed they were unaware that their names appeared on the article in question. Perhaps plagiarism has become, for some, the research version of identity theft.
The fallout from scientific plagiarism can even extend into politics. Recently, it has threatened to bring down the ruling party in Romania following the revelation by the journal Nature of plagiarism in the doctoral thesis of a cabinet member and in several publications authored by the prime minister, a computer scientist.7 Earlier this year, the German minister for science and education resigned after the discovery of 60 passages in her doctoral thesis that were paraphrased without adequate citation.
In The Mind of the Cheater
What turns a rational scientist into a liar? Is there a biological basis for this transformation? Perhaps. Magnetic resonance imaging of the cerebral cortex of pathological liars demonstrates a relatively widespread increase in the white matter volume of the orbitofrontal, middle, and inferior—but not superior—frontal gyri compared with the imaging results found in antisocial and normal controls.8 There may also be some form of psychologic adaptation akin to the changes that viewers observed in Walter White’s personality. To be capable of lying to others, one must first become capable of lying to oneself. As Mark Twain wryly observed, “When a person cannot deceive himself, the chances are against his being able to deceive other people.”
Robert Trivers, PhD, professor of anthropology and biological sciences at Rutgers University in New Brunswick, N.J., has proposed that self-deception evolved to facilitate interpersonal deception by allowing people to avoid the cues to conscious deception that might reveal deceptive intent.9 Self-deception provides two additional advantages to the “user”: It eliminates the costly cognitive load that is typically associated with deceiving, and it can minimize retribution if the deception is discovered. Beyond its role in specific acts of deception, self-deceptive self-enhancement also allows the individual to display more confidence than is warranted, which has a host of social advantages. The question then arises of how the self can be both deceiver and deceived. This may be achieved through dissociations of mental processes, including conscious versus unconscious memories, conscious versus unconscious attitudes, and automatic versus controlled processes.9
Can We Prevent Research Fraud?
As challenging as this question may sound, there may be some useful strategies to reduce the incidence of fraudulent research and discourage those individuals who may be tempted to follow the path to false success. For example, collaborators at Saint Louis University and Washington University Schools of Medicine, both in St. Louis, Mo., have developed a novel remediation program known by its acronym, RePAIR (Restoring Professionalism and Integrity in Research). It provides a second chance for researchers who have been noncompliant with research regulations but whose sponsoring institutions feel are capable of changing their behaviors.10 This is a refreshing change from the position of many research institutions, which often prefer to deal with the issue of fraud on an ad hoc basis.
Peer reviewers can sometimes help identify questionable findings. Francis Collins, MD, PhD, director of the NIH, retracted five papers published in 1995 and 1996 about a possible genetic cause of leukemia when Amitav Hajra, a graduate student working in his laboratory, first at the University of Michigan and then at the NIH, admitted to having fabricated the results. The fraud was discovered by a reviewer of a paper that Hajra had submitted to the journal Oncogene. The incident changed the way that Dr. Collins oversees his research group. “It caused me to become more skeptical, which is something I am not entirely happy about,” he says. “I always had a skeptical eye in terms of looking at the technical aspects of data, but until this awful experience, that did not include a concern about whether the data were real or fabricated. Now it does.”11
The behavioral economists have proposed another solution. Many written forms required by businesses and governments rely on honest reporting. For example, proof of honest intent is typically provided through signature at the end of tax returns or government-issued forms. Still, people sometimes cheat to advance their financial self-interests—at great cost to society. These authors tested an easy-to-implement method to discourage dishonesty: signing at the beginning rather than at the end of a self-report, thereby reversing the order of the current practice.12 Using laboratory and field experiments, they observed that signing before, rather than after the opportunity to cheat, makes ethics salient when they are needed most and significantly reduces dishonesty.
At the time of publication, the final season of Breaking Bad is about to start. Walter White’s fate remains a mystery. “Cooking meth” or cooking research data may both provide the user with a short-lived euphoria, but the long-term effects of each can be tragic.
Dr. Helfgott is physician editor of The Rheumatologist and associate professor of medicine in the division of rheumatology, immunology, and allergy at Harvard Medical School in Boston.
Research Hall of Shame
Here are a few of the more shameful examples of falsified medical research.
- In 1974, while working in the laboratory of the famed immunologist Robert Good at the Memorial Sloan Kettering Institute in New York City, researcher William Summerlin, MD, observed that the success of skin transplants between genetically unrelated rodents was enhanced by culturing the skin in special medium for several weeks. If confirmed, his findings had major implications as an antirejection therapy. However, attempts to reproduce his original results failed. Since the experiment involved a transfer of melanocytes between black and white mice, the outcome of each experiment could be readily observed. Fortuitously, one of the animal-care technicians discovered Dr. Summerlin’s ruse. He had been using a black-tipped felt pen to achieve the desired results. When the technician accidently removed one of the black patches with alcohol, he thought that he had committed a serious error and reported it to his superiors. That led to the end of Dr. Summerlin’s career in medical science.
- John Darsee, MD, was a rising star in the division of cardiology at Brigham and Women’s Hospital (BWH) in Boston. A prolific investigator, he had already published well over 70 abstracts and articles during his medical residency at Emory University in Atlanta and as a cardiology fellow at BWH.13 Wait a second. Seventy publications over seven years of training. This must have been a world record for trainee productivity! Was anybody paying attention to this glaring statistical anomaly? When I arrived at BWH, the word was already out. Dr. Darsee had been frequently seen after hours at the copying machine “working” with a stack of canine electrocardiograms. Many of his fellow trainees were aware that he was fabricating data, but somehow, his superiors were blind to the outrageous reality. Subsequently, it was discovered that most, if not all, of his previous work at Harvard and Emory, including studies of purported HLA gene associations with certain cardiac anomalies, had all been fabricated. Most of the patients did not even exist. Somehow, this did not prevent Dr. Darsee from finding many coauthors for most of his papers.
- With over 500 peer-reviewed publications, Don Poldermans, MD, a noted researcher at the Erasmus Medical Center in The Netherlands, heavily influenced the clinical practice of perioperative medicine.14 His work in the area of beta-blockers and statins in noncardiac surgery helped to shape guidelines and national policies on the use of these treatments. In just one day, all this data was called into question. An official press release from the hospital cited concerns including “carelessness in collecting the data for his research, using patient data without written permission, using fictitious data, and submitting two reports to conferences which included knowingly unreliable data.” Sadly, warning signs were missed before this avalanche of allegations. A 2005 systematic review of randomized trials that were stopped early for benefit isolated a prematurelyhalted Poldermans study, finding that “the very large treatment effect is likely too good to be true. It is inconsistent with the researchers’ expectations; with the magnitude of effect of beta-blockers in tens of thousands of patients with acute myocardial infarction or chronic management of congestive heart failure; with results in day-to-day clinical practice; and with results of other trials.”14
- Brown L. In Conversation: Vince Gilligan on the end of Breaking Bad. New York Magazine. May 20, 2013. Available at www.vulture.com/2013/05/vince-gilligan-on-breaking-bad.html?utm_content=buffer7bfc1. Accessed June 6, 2013.
- Gruley B, Voreacos D. Harvard doctor turns felon after lure of insider trading. Bloomberg. Nov. 27, 2012. Available at www.bloomberg.com/news/2012-11-27/harvard-doctor-turns-felon-after-lure-of-insider-trading.html. Accessed June 6, 2013.
- Gross C. Disgrace: On Marc Hauser: A case of scientific misconduct at Harvard. The Nation. Dec. 21, 2011. Available at www.thenation.com/article/165313/disgrace-marc-hauser#. Accessed June 6, 2013.
- Geison, GL. The Private Science of Louis Pasteur. Princeton, NJ: Princeton University; 1996.
- Martinson BC, Anderson MS, deVries R. Scientists behaving badly. Nature. 2005;435:737-738.
- Long TC, Errami M, George AC, Sun Z, Garner HR. Scientific integrity: Responding to possible plagiarism. Science. 2009;323:1293-1294.
- Suspend disbelief. Nature. 2012;492:7-8.
- Yang Y, Raine A, Narr KL, et al. Localisation of increased prefrontal white matter in pathological liars. Br J Psychiatry. 2007;190:174-175.
- von Hippel W, Trivers R. The evolution and psychology of self-deception. Behav Brain Sci. 2011;34:1-56.
- DuBois J. Remediating misconduct. The Scientist. May 14, 2013. Available at www.the-scientist.com/?articles.view/articleNo/35544/title/Opinion–Remediating-Misconduct. Accessed June 6, 2013.
- Bonetta L. The aftermath of scientific fraud. Cell. 2006;124:873-875.
- Shu LL, Mazer N, Gino F, et al. Signing at the beginning makes ethics salient and decreases dishonest self-reports in comparison to signing at the end. Proc Natl Acad Sci USA. 2012;109: 15197-15200.
- Relman AS. Lessons from the Darsee affair. N Engl J Med. 1983;308:1415-1418.
- Chopra V, Eagle, KA. Perioperative mischief: The price of academic misconduct. Am J Med. 2012;125:953-955.