Practicing “Evidence” Amidst Fraudulent Research
The present era is of evidence based medicine. This evidence is derived from researches which prove which intervention is effective for a disease in question. Practicing medicine relies heavily on the untiring and incessant efforts of researchers across the globe, who have generated this evidence across decades of research.
Whatever we have studied as students of science in general and medicine in particular was once a question under investigation which was answered via research. When an original article is submitted to a peer reviewed journal, the editors have a relationship of trust with the authors. Generating evidence has direct implications on the lives of millions of patients. Thus it is imperative that the results must be heavily scrutinized before application to the patients.
This week, British Medical Journal published a thought provoking featured article of a renowned German anesthetist whose 80 research papers were retracted for fabricated research. It all started when the Chief Editor of journal “Anesthesia” received an email from a reader that one of the research papers of Dr. Boldt has data which appears fabricated due to a number of reasons, for instance through exceptionally tight confidence interval limits.
The diligent Chief Editor emailed several times to the author to give explanation for the data which were continuously ignored. In his interview to the BMJ, Chief Editor of Anesthesia has suggested that Dr. Boldt used to submit a paper almost every month with multiple co-authors suggesting that he is running a very efficient research team. Credit goes to him for pursuing this matter with the University of Dr. Boldt, who carried out an investigation which lead to the expulsion of the entire research team.
Most of Dr. Boldt’s work has focused on the role of colloids versus crystalloids, a hot topic in critical care. He has suggested that the colloid is equally efficacious compared to crystalloids in the management. The Pharmacy department of the German University revealed that it has never issued any colloids to any patient for a number of years, thus confirming that Dr. Boldt’s work was fabricated.
Dr. Boldt’s work was used in formulating guidelines. Thus it would be logical to assume that colloids were prescribed to many patients in different countries of the world. Given the expensive nature of the treatment compared to colloids, this means a financial burden on the patients which should have been averted. Furthermore, a meta-analysis conducted after excluding Dr. Boldt’s studies has suggested that the colloids actually are harmful and linked with mortality suggesting that precious lives must have been lost courtesy of the fraudulent research.
Dr. Boldt’s case is the renowned one but certainly not the only one! A statistical investigation recently revealed that the chances that the prevalence of headache in research papers of Yoshitaka Fujii were of the order of 6.78 x 10-9 are almost impossible.
These cases are thought provoking and emphasize the need of a strict and fool proof peer review system. As I write this blog, my next door neighbor has presented to me with signs suggestive of malaria, and as I intend to prescribe medication and suggest investigations on an empirical basis, I am wondering whether it is actually efficacious or an outcome of a fabricated evidence!
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