Wednesday, January 21, 2009

Research Fraud and Misconduct



Dr Zabidi Hussin FRCPCH

Professor of Paediatrics Universiti Sains Malaysia

and Former Council Member of Malaysian Medical Council

(This article is part of an invited lecture delivered by the author in the “National Ethics Seminar” organized by the Academy of Medicine Malaysia on 2nd Dec 2006)

Research fraud, misconduct and misrepresentation are not new phenomena. Various forms of misconducts have occurred throughout history of medicine. One may recall the well publicized Nuremberg Trial when numerous forms of misconducts and human experimentations were exposed purportedly committed by Nazis. The cases of unethical research on stem cell by Dr Hwang Woo-Suk and 6 Korean professors are the more recent examples of misconduct in the 21st century, citing their ‘blinded desire for achievements’ and work as their reason for misconduct. This reflects many more unspoken reasons for similar conducts by other researchers throughout the scientific world. As a consequence, legislations have been formulated over the past 50 years to safeguard the general population against possible unethical researches. However as new demand for research become necessary, newer forms of misconducts became known, requiring a complete revisit of the subject.

Research demands creation of new knowledge, and requires ‘careful, patience, systematic and diligent inquiry’ into a problem in order to establish the truth. As many of these attributes are subject to human fallacies, the temptation for a lesser and easier option frequently arise, leading to the various forms of misconducts.

Among the forms of misconducts are:

  • Misappropriation of ideas, or funds
  • Not complying with International Guidelines and Principles on Research Ethics
  • Unable to protect human subjects or animals
  • Fabrication, falsification, plagiarism ,data fraud- ‘Statistical Gymnastics’
  • Not respecting guidelines on publication and authorship, double submission, false declaration
  • Denial of publication of rightful articles
  • Misleading the Ethics Committee- methodology, sample size, budget allocation, honorarium payment to subjects and to researchers, conflict of interest of members of committee
  • Breach of research protocol- recruitment of subjects, randomization, blinding,

Recent developments among the scientific community in Malaysia may also contribute to the tendency of research misconduct. Among these are:

  • Intense competition for Research Institution/University status and the ‘reward’ such status brings
  • Personal gain and glory and a possible overcompensation for research achievements either in the forms of monetary rewards or research exhibition medals
  • Corporate intrusion into research and academic freedom undermining foundations of scientific inquiry
  • ‘Publish or perish culture’ cultivated in universities and research institutions to encourage healthy research competitions among researchers
  • Intense desire to patent and commercialize research achievements and research findings

In order to safeguard possible opportunities for research fraud and misconduct, the following measures may be considered appropriate and necessary:

  • Revisit the purpose of research, revival of altruisms in research objectives and minimizing unhealthy corporate intrusion in academia
  • Strengthen Ethical Research Guidelines and upgrade the guidelines into Acts of Law wherever appropriate
  • Laws and legislations (Copyright Laws, Breach of Trust. Fraud ,Medical Act etc) ought to be revised to include research issues
  • Institutional Review Boards to be made more transparent and accountable for their decisions
  • Composition of Review Boards ought to be carefully chosen to maintain independence in decision-making with greater participation of the general public
  • Role of Medical Council to be expanded and be made explicit to include research misconduct
  • Public Auditing of Research with ‘Annual Reports on Research Approval’ be made accessible to the general public
  • Independent research auditors and ombudsman to receive complaints related to medical research. Research frauds are currently underreported worldwide
  • Research findings to be made public and not only confined to medical fraternity. This is important for research scrutiny
  • Establishment of an independent body called Medical Research Monitoring Committee – multisectorial representation where research annual reports are highlighted to safeguard public interest
  • Facilitate publication of research findings especially by young researchers through increasing use of ‘Open-Access’ electronic journals. Unnecessary difficulties imposed by editors of reputable journals through whatever forms on newer, young researchers may encourage unethical research behaviour by some unscrupulous medical researchers
  • Strengthening the number of medical personnel and improving the support system in any particular academic institution so that medical researches are done by personnel who are not too heavily burdened by teaching or provision of clinical service. A system where the same, small number of staff are expected to perform ‘miracles’ by being able to undertake good research in the background of multitude of other commitments ( teaching, clinical service or administrative duties) may inadvertently encourage a medical researcher to be fraudulent for his academic ‘survival’

In the final analysis, the motive for research fraud and misconduct stems from a multitude of factors; from a faulty system to a ‘faulty’ person. Reexaminations of each of these factors will be necessary to eliminate the possibility of fraud and misconduct.

This article was published in ‘Berita Akademi” the Official Newsletter of the Malaysian Academy of Medicine March 2007. It was also presented in the National Ethics Seminar organized by the Academy of Medicine , Malaysia

Thursday, January 15, 2009

Musings from Riyadh and Madinah

1)The first day was pretty relaxing. Found a mosque adjacent to the Al Khozaymah Hotel. Quite convenient for congregation prayers

2) Second day was spent examining final year medical students at the Department of Paediatrics, King Saud University. It was OSCE station for abdominal xamination

3) Students spoke good English and typical for OSCE, they were irritatingly well rehearsed almost to the level of a pre-programmed performance.

4) Most did well, except one or two who almost swore that he felt a big spleen when there was none. A few digged well into the abdomen, claiming to elicit tenderness.

5) The next day was a debate on results.Presented my analysis of events and trying to make hosts as comfortable as I could. One dared asked " Are our students as good as any in the world?".Difficult to say on OSCE alone.There were generally safe. I thought

6) Then the formalities with Deputy Dean, Dean, Cheif of Clinical Services. Cordial and diplomatic

7) They made me deliver a talk. I choose " Research- For Whose Sake;Really?.Someone thought the talk was 'dangerous' !

8) I then took the postgrads for 1 hour. Fun, assertive lady docs fully clad in burkhas. Very intelligent tho. The men folks were typically quiet

9) Visited ENAYAH - an organization to help the poor - impressive efforts

10) Madinah was a far cry from the bustle of Riyadh.Serene, wise,cold and very friendly from the start. A Syrian University student gave me a lift from airport to hotel. Most hotels were empty as the Haj season had just ended. As usual, emotional scene near the Prophet's tomb, with people queing up to say 'salam' to prophet, and his 2 beloved companions, buried next to him. Always a moving scene.You could almost hear murmurs of confession " Yes, we failed to do as you said, and now people are killing your children and grand children ;in brutal murder"

11) Met a Malaysian studying at the Madinah Islamic University.A confident young man whose knowledge of history of Madinah was a pleasure to listen to. He'll be organizing my zam zam water delivery in few days. Gave me a lift to the airport

12) Back in Riyadh the same evening, I attended a sumptous wedding reception. Almost 40 tables,; the main table had 10 large plates. In each saw a roasted lamb resting on a bed of rice; the torso was savoured and shared by a company of 4. Impossible to finish the rice and the lamb. although everyone made sure that the torso lost its resembelance to a sheep at the end of the feast. A pure act of sharing. I was told that what remains of the uneaten food will be handed to a company specializes in handling leftover food to be repackaged and distributed to the poor.

130 The next day was time to pack things up. Had to buy 2 extra bags to place the 30 kg dates that were given as gifts. Lovely , memorable visit, but alas, it could have been more enjoyable had the killing of children by adults whom they have never met and hated, happening in the north hadnt taken place!!

Saturday, January 10, 2009

Second Visit to Middle East

1)Its my second visit to the Middle East this year.Coming too close to the first , it caused a bit of anxiety to my family. Nonetheless, as usual, my wife and family unanimously gave their blessings.

2) This visit is to the King Saud University (KSU)and I'll be examining the medical students who are in their final year. KSU is the first University in the Saudi Kngdom and has a long history to its credit

3) My immediate host is Dr Ebrahim ElAyed, formerly from Newcastle upon Tyne. He is in his 50's but you can recognize his charm from afar, despite not having met from 1987

4) We sat in an old style Arabian restaurant in central Riyadh, recalling the good old days in Newcastle. Names like Aynsley-Green, Parkin, Lawson, Heather, Lamb,Eastham, Watson,Craft,Nelson,Wariyar, were among the few that came to mind when the warmth of Arabian tea took it's desired effects. We recoiled with laughters as he recalled his inability to drive in snow and tested his car against a Newcastle double decker bus!

5) Theres an invasion in Gaza at this time, with kids bearing the main brunt of war and its consequences.Its quite difficult to be too happy during this occasion, as both of us are Paediatricians.Our life centres on making kids better and free from pain.Yet we could only watch and listen from far the cries from these children,amplified many times over and repeatedly done as though to challenge us sitting comfortably in our rooms.

6) Geographical borders ensure that we remain isolated to those suffering from this unjust war and can only pray that someone can stop the brutalities of it.Perhaps no one could , as killing one soul leads to the killing of another in reciprocity.Hence the praying is to God who has power over man's heart and intention. May He makes human have mercy on his fellow.Man share the same pangs of hunger and pains from injuries, whichever side he is on.