Dr. Miriam Shuchman, Associate Professor of Psychiatry in the Faculty of Medicine, University of Toronto
Friday March 31, 2017Posted by Nadine Abdullah, MD, MEd, FRCPC
Today, we took a departure from
our previous talks to examine a less-commonly discussed side to the scholar and
professional CanMEDS roles in medical education: scientific misconduct. We were
excited to have as our guest speaker physician and renowned investigative
journalist Dr. Miriam Shuchman, who has written extensively on the issue of
ethics in research and policy. She led us through a discussion of scientific
misconduct, the subject of her recent publication in which she calls for improving the
investigation process of scientific misconduct allegations in Canada. I have
reflected on the great content of her talk, its place in medical education, and
the unique role that medical journalism has played bringing this issue to
light.
Scientific misconduct in Canada
is investigated under the Tri-Agency Framework:
Responsible Conduct of Research. It comprises the Canadian Institutes of Health Research (CIHR), the
Natural Sciences and Engineering Research Council of Canada (NSERC), and the
Social Sciences and Humanities Research Council of Canada (SSHRC) (the
Agencies) with a mandate to ensure commitment to responsible research conduct.
The framework sets the standards for research integrity and expectations of
individual researchers and institutions in promoting and adhering to a positive
research environment. It outlines processes for addressing and reporting
allegations of breaches of conduct.
Since its recent inception in
2011, filing of allegations has risen, with severity varying from minor
inadvertent breaches to plagiarism and outright falsification and fabrication.
One reason for this wide spectrum is that Canada has chosen a broad and
imprecise definition that equates egregious intentional, conscious misconduct,
with unknowing, unintentional deviations from ethical practice. This, combined
with inherent problems in the investigation process including bias, lack of
oversight, transparency, and due process, and an extremely long process for
deliberation, has led to a system that fails to uphold the public trust and
support new researchers. The myth that "only bad apples get in to
trouble" is unfortunately false because of the definition’s breadth, with
potentially fatal career repercussions for those who act in good faith and
could instead have received education or remediation for innocent deviations.
An even more serious problem
exists with not identifying and immediately punishing the truly egregious cases
of falsification or fabrication of research data. The Chandra case from
Memorial University was investigated by the institution, but not until
mainstream media uncovered the story were his fraudulent publications retracted
and he was publicly exposed, stripped of his Order of Canada, and
shunned from the medical community. A celebrated pediatrician and researcher in
nutritional immunology, Chandra was found guilty of outright fraud in two
studies; one purporting the benefits of a specialized formula to prevent
allergy in infants, and the other purporting the memory benefits of his
patented vitamin and mineral supplement. The case with the greatest societal
fallout from egregious scientific misconduct is that of Wakefield from
the UK, who fabricated studies linking autism to a fictitious gastrointestinal disorder
and the MMR vaccine. The impact of falsifying a link between autism and vaccinations
took too long to be addressed by the institution and medical journal, leaving
irreparable damage to the public trust in science and medicine. This undeniably
caused vaccination rates to fall, loss of herd immunity, and a resurgence of
previously controlled or eradicated infectious diseases responsible for the
deaths of young children and susceptible adults.
Why is this relevant to medical
education? Two reasons:
First, as a medical educator and
non-researcher, the width of the net that captures misconduct in Canada came as
a surprise. While there is a universal code of research conduct, specific
policies vary between institutions. Young researchers may not be aware of minor
digressions that would qualify as misconduct. For example, copying sections of
their own published work in subsequent papers to avoid redundancy, in some
jurisdictions could count as plagiarism. More shocking is the immediate finding
of guilt by association of shared authorship with someone found to breach
ethical conduct, even if the fraudulent behaviour was not their own. The immediate professional
consequences on the researcher for being found guilty of research misconduct
can include retraction of research papers, termination of employment,
requirement to repay grant funding, and loss of a licence to practice medicine. I do not think we prepare our
trainees to avoid or mitigate these risks. A Cochrane review showed there is no evidence that education
prevents fabrication or falsification, or promotes integrity in research. Those
determined to be dishonest, driven by the academic pressures of achieving high
volumes of high impact publications, will likely not be deterred by any form of
education. However, some small studies have found a reduction in plagiarism
with educational programs for trainees if accompanied by technological tools. I
do wonder if education can attune trainees to plagiarism, and other less
obvious deviations from ethical standards. As a start, undergraduate and
postgraduate curricula should incorporate the topic of scientific misconduct
into the curriculum to heighten trainees' awareness if they choose a career in
research, as many do. We need
to teach medical trainees about research codes of ethics, writing skills, and
pitfalls to avoid unintentional deviations from the expected standard. In
between the extremes of inadvertent plagiarism and outright fraud, it is well
described that minor digressions can be tempting when results are rewarded, and
can “open the doors to the slippery road from
minor digressions to outright misconduct.” Education may be able to teach
trainees how to spot unethical conduct by collaborators and supervisors, and
give them an awareness for their own weaknesses that can lead them to break the
code. Educational programs should teach trainees how to handle data and
authorship disputes and hostilities, and there should be a mechanism in place
for seeking anonymous advice, with an appointed ombudsperson to guide them
through a complaints process. I think all of this is possible. In contrast, there will always be
dishonest researchers. While it may not be possible to eliminate the risks of
association, we can give trainees the tools to identify and steer themselves
away from associating with the real bad apples.
Second, whose responsibility is
it to teach our trainees on this topic? Judging
from the statistics, if not taught with care, I fear our promising and emerging
leaders in medical research will choose a different path if they see the risks
as unavoidable in research. The culture of academic medicine rewards high
impact work, and the recognition and reward of disseminating one’s
practice-changing work is powerful. Dr. Shuchman highlights, "Just as
publishing builds a scientific career, retractions dismantle it." Whether
the drive for success is perpetuated by clearly articulated expectations or a
hidden curriculum, we need an explicit curriculum to model ethical research
practice. How else can we hope to encourage trainees to enter research careers
despite the risks, and adequately prepare them for a successful, fulfilling
career? Educators
do need to share ownership with researchers teaching about scientific
misconduct, but until now, it has been largely absent from our curricula. This
talk prompted me to consider the role that medical journalism could play. While
the researchers and educators have not taken this on, it is fascinating to
consider that the issues presented in Dr. Shuchman’s talk today and her
published work could be the platform for a curriculum. There is a role for a
different lens and a different way of knowledge informed by investigative
journalism, to lead the educational curriculum in scientific misconduct. Talks
like this one provide more opportunity for trainees to be exposed to this
perspective.
I was first drawn to the topic of
scientific integrity after reading Dr. Shuchman's earlier investigative
articles. Universities and medical journals have historically failed in their
prompt responses to egregious scientific misconduct, leading to great public
mistrust. Mainstream media has played a critical role in exposing cases like
those above. They also have reported inaccurately, sensationalized information,
and misrepresented the truth in others. There are
pitfalls and limitations in leaving scientific misconduct in the hands of the
lay media. The dissemination of scientific research findings, and the
subsequent questions of fraud, should be led by those trained in research and
medicine. Dr.
Shuchman argues that both researchers and the media share the
responsibility for accurate communication to the public, and in her 1997 paper, she
proposed ways to improve health news reporting, focusing on four
problem areas: sensationalism, biases and conflicts of interest, lack of
follow-up, and stories that are not covered. I was still a medical
student when this was published. Have we progressed since 1997?
The integrity of medical research
requires skills not traditionally taught in medical school and residency
training programs. Editors of medical and scientific papers will readily offer
that authors lack writing skills. Research integrity requires robust writing
skills to avoid inadvertent plagiarism, and knowledge of politics that governs
research institutes and journal oversight committees to understand the local
policies, and the mechanisms for reporting discrepancies. Medical journalists
can be agents of change in medicine and health care. This talk has
certainly highlighted for me the gaps in medical education developing scholars
and professionals armed with the knowledge and skills to uphold scientific
integrity.
Resources:
Bio – Miriam Shuchman, MD
Dr. Miriam
Shuchman is an Associate Professor of Psychiatry in the Faculty of Medicine,
University of Toronto. She is an award-winning journalist and former
national correspondent for the New England Journal of Medicine who
writes on medicine and bioethics for journals and magazines. She has a
clinical practice at the University of Toronto Scarborough Health &
Wellness Centre.
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