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cljanney
03-16-2009, 04:41 AM
http://scienceblogs.com/authority/2009/03/massive_academic_fraud_in_anes.php
Massive Academic Fraud in Anesthesia Research

Category: Medicine
Posted on: March 12, 2009 9:19 AM, by Mike Dunford

Several news agencies are reporting that a massive academic fraud case has surfaced. A single researcher apparently fabricated data used in the publication of at least 21 journal articles published over a 12-year period.

After an internal reviewer raised concerns, Baystate Medical Center conducted an investigation into research conducted by Dr. Scott S. Reuben, who was - at that time - the chief of their acute pain service. As the phrase "at that time" suggests, the results of the investigation did not exonerate Dr. Reuben. Anything but, in fact. In late January, Baystate sent out a letter to a number of journals recommending the retraction of articles, and Dr. Reuben is now reported to be on "medical leave".

I'll tack the full list of affected articles on the end of this post for those who are interested, but the problems go well beyond just those 21 papers. The extent of the revealed fraud will necessarily call into question all of the work that Reuben has ever published. Any other work - clinical protocols, published articles, ongoing research - that relies on the veracity of Reuben's articles will also need to be re-examined.

All academic misconduct is bad, but this particular case is particularly destructive. Dr. Reuben's work has served as the basis for the use of what's known as "multimodal anesthesia" - using a combination of NSAIDs and neuropathic pain medications after orthopedic and spinal operations instead of narcotics. This practice has become very common in the field, and the vast majority of the evidence-based support for these protocols no longer exists.

Anesthesiology News' report on the case provides a good description of the extent of the problem:

Jacques Chelly, MD, PhD, MBA, director of the Division of Regional Anesthesia and Acute Interventional Perioperative Pain at the University of Pittsburgh Medical Center (UPMC), said that the Reuben episode has left multimodal analgesia "in shambles concerning many of the drugs we use"--particularly celecoxib and pregabalin. "The big chunk of what people have based their protocol on is gone."

In light of the situation and economic concerns, UPMC has stopped giving celecoxib and pregabalin to surgery patients "until we have some very formal evidence that we should do something else," Dr. Chelly said. "In this day and age, doing multimodal [therapy] is expensive. Any institution is going to look at evidence-based clinical decisions, and unless we have very strong data, it is a problem."

It appears that whatever Dr. Reuben's motives might have been, he may have received some financial benefits as a result of his work. Much of his research focused on the use of celecoxib and pregabalin instead of opiates. These two drugs are better-known as Celebrex and Lyrica, and both are manufactured by Pfizer. Pfizer provided Reuben with research grants from 2002 to 2007, and he was a member of their speakers' bureau.

Money - whatever the source - is a potential corruptive influence in science. Researchers who receive funding will have an incentive to make sure that the money keeps coming, no matter what the source of the funding might be. Most researchers - I hope and believe - will be able to resist any urges they might have to falsify their results in order to make themselves more attractive to funders. A few - hopefully, only a very, very few - will not. Fortunately, science is self-correcting - eventually.

Peer review, as it stands now, is not equipped to catch fraud. Reviewers necessarily start their work assuming that the actual data presented in the paper is real and accurate. There's no way they can reasonably be expected to do anything else. Any pre-publication attempt to catch fraud would require physically replicating some of the study, and that's expensive and time consuming. more....

Mike C
03-19-2009, 12:02 AM
Pimping yourself for corporate giants. Who knows how many have died or have had health problems because of this idiot. Lawyers are going to slobber over this.

dejerine
03-20-2009, 06:50 PM
Again, thanks CLJ for your interesting articles.


How deep does this fraud rabbit hole go? Or perhaps I should ask, how wide? Does making you feel woozy and dopey qualify as pain relief?

This willl sound cynical, but sometimes I feel like there is generally a massive overestimation of anticonvulsants as real pain relievers for central nerve injury pain, and NOT just at this one institution. The articles I have reviewed have often lumped ALL neuropathic pain togther, whether of peripheral origin (very common) or central origin (rate).

Once you altar the angles and articulations of the spine, one is likely to have all kinds of pain, central and otherwise. The studies are not separating out these etiologies but lumping them all together. If you help the facet pain, does that mean you have helped the central pain, No.

Another flaw in the experimental design is very vague measurement of "benefit". Admittedly, in a condition where verbal descriptions are difficult, then the description of benefits would be difficult. But if anything, before putting people on expensive meds in large doses, they should err on the side of NOT assuming things are working unless it is clear.

I say this as one whose kidneys were apparently affected by massive NSAIDs over a long period of time. Like a dummy, I followed the cue of my doctor but I still burned. People in acute pain are excitable, frantic and moved to action. People in pain forever are apathetic AND pathetic.. They will not resist any idea, however dumb. I am at the head of this list. Magnets? Sure. Herbs? sure. Sarno's book? Sure. NSAID's? Sure, of course these lightweights will take care of the most severe pain known to man.

All during this era, the NIH has found that NONE of these are effective in relieving severe central pain. So why the difference in the reported results? Are the NIH docs idiots, or is the profession generaly unable to grasp what they are dealing with and how the patient turns to putty from the pain after a while, confessing anything and everything. These waterboarded CP patiients provide plenty of data for any remedy.

What IS pain relief? It is pain relief. Helping one cope etc is not pain relief. Except in an obtuse way, "quieting" the entire CNS is not actually pain relief. Sedation is not pain relief. Being retained in a study because you are playing ball, making the clinician's ego be fulfilled and telling them what they want to hear, and insist on hearing, is NOT pain relief.

It is time Pfizer and all the rest stopped beating the anticonvulsant drum, and started finding ways to knock out the TRPV-1 calcium channel, which feeds central pain. Has there ever been any controlled study which showed Lyrica was better than just large doses of very cheap dilantin at "quieting" the CNS?

Pfizer supposedly spends about six percent on research and about 30% on marketing. I think Lilly is even more marketing weight., They should spend fifty percent on research and less on marketing. If they actually had something that stopped central pain, they wouldn't have to market at all. People would beat a path to their door. Right now they remind me of the TV diet programs.