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Derek Lowe The 2002 Model

Dbl%20new%20portrait%20B%26W.png After 10 years of blogging. . .

Derek Lowe, an Arkansan by birth, got his BA from Hendrix College and his PhD in organic chemistry from Duke before spending time in Germany on a Humboldt Fellowship on his post-doc. He's worked for several major pharmaceutical companies since 1989 on drug discovery projects against schizophrenia, Alzheimer's, diabetes, osteoporosis and other diseases. To contact Derek email him directly: Twitter: Dereklowe

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March 19, 2009

Fraud: How, and Why, and How Again

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Posted by Derek

Readers may have seen the recent stories of an academic anaesthesiologist, Dr. Scott Reuben, who published an entire string of fraudulent papers in the pain management field. Various rabble-rousing sources have used this as a chance to run “Big Pharma Pays For Deception” stories, but I’m not going to give that angle much time at all. I’m sure that the companies involved (Pfizer, prominently) were glad to see studies that showed that their compounds worked and were glad to cite them, but the idea of some bigwig picking up the phone and saying “Fake me up some clinical data” is too much for me.

The biggest problem is that the physican involved seems to have decided that he could make a good living by telling people what they wanted to hear. That’s always a danger, and it works the same way in all sorts of fields. It isn’t always money that drives this kind of thing, either, although that’s a good place to start. Prestige is often a big part of it, too. And there's a problem on the receiving end, too - when someone brings you a company news that their compounds perform well and should be prescribed more often, the first impulse isn't necessarily to ask "Gosh, are you sure?" (It's worth keeping in mind, though, that asking just that question is a key part in making scientific research work - but if someone is going to fake numbers from top to bottom, it's not going to be enough to catch them at it, either).

There’s another factor at work that I think about every time a major fraud or plagiarism case comes up. The minor ones I can understand, actually – someone at an obscure school rewrites an equally obscure paper, slaps their name on it and sends it off to a third-rate journal, keeping their publication rate up so as to keep their better-than-the-alternatives academic position propped up for a while longer. It’s shabby and sad, but it makes a dingy sort of sense. The major cases, though, puzzle me.

I think this topic last came up around here during the Korean stem cell fiasco a few years ago. That one set off a lot of sniping among journal editors, and a lot of speculation about how someone can think that they'll get away with fraud in an area that hotly contested.

Now, it's not like post-operative pain management is the cutting edge of medical science - no Nobels are likely to be on the line - so the question of how Reuben thought he could keep doing this doesn't apply as much. He seems, in fact, to have gotten away with doing it for many years, with no apparent problems until recently. (How, in fact, was he caught? The only details I've been able to find were that it was an internal reviewer at his medical center who noticed something). But how someone can do this sort of thing is what baffles me: not the mechanics of it, but the mental aspect is what's a mystery. How do you look at yourself after turning out fake results of any kind? Especially, how do you do it when you're affecting how people are treated for pain after surgery? And year after year. . .no, I just can't get a handle on this. There are aspects of human behavior which apparently are closed off to me, and I hope that they stay that way.

Comments (18) + TrackBacks (0) | Category: The Dark Side


1. MedChemMan on March 19, 2009 10:31 AM writes...

Such sporadic incidents of scientific fraud will happen in the future also. However, science is driven by rational and evidence. If one commits fraud today, it will come into light tomorrow or a day after.

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2. RB Woodweird on March 19, 2009 10:43 AM writes...

The psychology of the fraud is similar across a lot of different venues. Look at Madoff. Surely he didn't think he could keep it up forever, did he? What made him think he could pull it off in the first place? Well, most probably he didn't set out to run a huge Ponzi. Probably he had a short quarter and used some creative accounting to make his friends happier. The he saw it wasn't as bad as he thought, and when he needed to do it again it was easier. After a while what were once vices were now habits.

The same way you look into a boiling pot with a dead frog in it and say, "Why on earth did that frog jump into boiling water?"

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3. DrKai on March 19, 2009 11:59 AM writes...

Yes, eventually the fraud will be discovered due to follow-up studies, but what about the years of wasted work trying to build on work that was fabricated?

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4. HelicalZz on March 19, 2009 12:11 PM writes...

And now you know why Pfizer has a position like "Vice President of Corporate Reputation and Policy Communications"


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5. Sleepless in SSF on March 19, 2009 12:21 PM writes...

Regarding the psychological motivation: I know absolutely nothing about the Reuben case, but I can't help but wonder if he might have been making up data to justify strongly held hypotheses. I'm sure most of us are familiar with someone who was overly devoted to their idea of how something should work, often in the face of contrary data. Perhaps Reuben *knew* he was right but either couldn't or wouldn't generate the necessary supporting data the old fashioned way and so he invented what he needed. In a scenario like that he might have believed he was actually helping patients by encouraging others to adopt his ideas.

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6. CMC Guy on March 19, 2009 2:14 PM writes...

With the general deterioration of ethics in society do you expect Scientists to behave differently. I would be nice to think such would be the case but no group/profession is immune to having people take short cuts. I do agree that Prestige can be a driver with certain negative contributors (ego, arrogance). The financial motive seems illogical as is a MD/Prof making say $250K/year is going to falsify data to get $10-20K grant? (Not to say it can't happen but the risk/reward is high)

You avoided discussion of commentators who were eager to pin this on "evil pharma" but unfortunately there are many out there with deep seeded prejudices against Pharma who don't know/care about truth related to industry and they seem to influence popular/press opinion. Not to ignore bad acts that have occurred or presence of undesirable types however the majority of people I know joined this industry as a means to help people and also practice high ethical values (indeed greater that general society in spite of my opening lines) so to paint everyone with that stain is bigotry. Doing something like post subject is probably much easier to do in academia (where argue also majority maintain high standards) than Industry, unless there is an outright conspiracy (can happen but rare). There are lots of checks and balances (multi-functional interactions) inherent in the system and everything involving humans gets reviewed by FDA/other Agencies. There is always room for improvement but to blindly blame pharma because someone misused/misrepresented their drugs goes too far.

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7. on March 19, 2009 3:04 PM writes...

I imagine that it's similar to people who have lies on their resumes. They lie once to get a job, and then they have to keep the lie going.

Remember the Notre Dame football coach (George O'Leary) who was caught with lies on his resume? The lies were from his distant past (said he had played college ball when he hadn't and also said he had a master'd degree when he didn't) but they were impossible to remove. He certainly wasn't hired because of those two items, but he certainly was fired because of them.

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8. SRC on March 19, 2009 3:55 PM writes...

The biggest problem is that the physican involved seems to have decided that he could make a good living by telling people what they wanted to hear. That’s always a danger, and it works the same way in all sorts of fields.

Was Reuben reading from a teleprompter, by any chance?

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9. A M on March 19, 2009 4:11 PM writes...

From what I've read, he was found out when someone noticed that his clinical trials had generated results, but no other paperwork. No expenses, no subject recruitment, no ethics approvals.

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10. Palo on March 19, 2009 4:30 PM writes...

The biggest problem is that the physican involved seems to have decided that he could make a good living by telling people what they wanted to hear.

Exactly. That is the problem with Pharma-sponsored research. And that is exactly what critics say. The idea of some bigwig picking up the phone and saying “Fake me up some clinical data” is too much for you, and it is too much for everyone. Show me anyone who ever claimed something remotely like that.

So we agree. Pharma-sponsored research is dangerous.

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11. incha on March 19, 2009 4:39 PM writes...

Why on earth has it taken so long for this guy to be found out? From what the article says, his recommendations for pain management have become common practice at least here in the states. So how come some other physicians haven't questioned this research previously? Surely an experienced doctor should be able to say 'hey this drug combination doesnt seem to be any better than what I was using before'. Either that, or despite his false research maybe it actually works. Instead of blaming the pharma companies, maybe someone should be asking serious questions about the medical profession?

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12. milkshake on March 19, 2009 5:11 PM writes...

We had a serious fraud case at my first company that got swept under the carpet. There were two large (competing) biology groups that were supported by chemistry. One of the two biology groups was always escalating their demands on us in chemistry in one never-ending campaign while they were always pitching their great screening technology platform to the management. After while we noticed that nothing confirmed ever came out of that biology group and they were not seriously trying to find out why their assay did not work as supposed. They always claimed everything worked and they already moved to the next great thing, and they were not fond of getting questions like "what happened to all those series we were making for you three months ago, where are the data?". It was all huge waste of effort, going on for about two years. The problem was the ambitious self-promoting biology group boss that exaggerated how great his stuff was etc and never figured out how to deal in the background problem in his fluorescence-bases assays. His instrumentation was not behaving the way he hoped and was generating lots of false-positive HTS hits hence what he found was never confirmed by re-screening or re-synthesis. It was a big mess and he commanded tremendous resources and was blatantly making stuff up to please the management who was then boasting about these successes to investors. Everybody in both chemistry and biology whispered about this crap but no-one was going to risk making himself unpopular and do something abut it. Eventually I went to HR and complained that part of our company research results was probably a fabrication, and that burst the bubble, finally. The boss was demoted and re-assigned to do an screening automation job (his HTS robot that he installed never worked either). Nothing was ever retracted in the publications, and our vice-president for research who was probably very complicit in what was going on saved his ass by shifting all the blame on the demoted dude. (The VP then went on to have his own HTS and custom synthesis company that then promptly went out of business because he promissd all kinds of baloney to everyone and never delivered)

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13. Big Bob on March 20, 2009 4:54 AM writes...

Putting aside the whole issue of the psychology involved in why you would construct such a fraud and continue with it. Working in the area of pain I can maybe shed some light on why this wasn't detected earlier. The placebo effect in pain management is huge and shouldn't be underestimated, couple this with the way in which medications are liberally given out, it wouldn't suprise me if there are a number of poorly efficacious drugs in the clinic, through no deliberate act of deception.

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14. qetzal on March 20, 2009 9:06 AM writes...

A M wrote:

From what I've read, he was found out when someone noticed that his clinical trials had generated results, but no other paperwork. No expenses, no subject recruitment, no ethics approvals.

That's pretty stunning, if true. Fudging the results of a real trial is one thing. I can see where someone could get away with that for a long time. Esp. in pain management. As Big Bob notes, the huge placebo effect means no one's likely to detect falsified results unless they re-analyze the raw data themselves. In that case, if Reuben could keep the raw data files under his control, it would be difficult for others to even suspect, let alone prove fraud. (Esp. if his claimed results were in line with the field's preconceived expectations.)

But publishing results of trials that never happened? That's not gonna be easy to conceal. Someone's gonna notice that no protocol was ever approved by the IRB, that no CRFs were ever created (much less filled out), etc.

If that's really what Reuben was routinely doing, it boggles my mind that he got away with it for so long.

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15. Sili on March 20, 2009 3:36 PM writes...

From what I've read he was caught by the ethics committee.

He published 'results' from 'human trials', but he'd never bothered obtaining permission to work with human subjects for the last coupla papers.

That's obviously a big no-no. And perhaps that points the way to how this thing can be prevented in future. Only I hope that fraud is not so widespread as to necessitate an extra layer of bureaucracy.

(No, I do not think ECs are unnecessary bureaucracy, and in fact I laud the emergence of aninmal ECs. Animal testing is a necessary 'evil', but that doesn't mean the 'evil' shouldn't be kept to a minimum.)

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16. Robert on March 24, 2009 3:41 PM writes...

Why not have a law that says pharma-funded research has to be double-blinded to the researcher? I.e., the researcher can't know who is funding the research? Wouldn't that help?

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17. doctorpat on March 25, 2009 11:40 PM writes...

On the same theory, why don't we have blind trusts for all political donations. You can donate a million dollars to H.Candidate Jr. but she doesn't know who gave it to her. All she gets is a monthly account balance.

Seems it solves the whole problem of political vote buying right there, but leaves free speech alone.

Of course you can walk up to newly elected Senator H.Candidate and tell her you donated a million dollars. And see if she trusts you enough to introduce that new zoning law you were interested in...

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18. Emmett Tallman on August 18, 2012 9:43 AM writes...

Yet another issue is that video gaming has become one of the all-time biggest forms of recreation for people of all ages. Kids engage in video games, plus adults do, too. The actual XBox 360 has become the favorite video games systems for people who love to have a lot of video games available to them, and who like to experiment with live with people all over the world. Thank you for sharing your ideas.

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