Fraud under a microscope

Five or six times a year when Dr. Richard Smith was editor of the British Medical Journal, he would receive scientific papers that he suspected were fabricated or had other ethical problems. Simply declining to publish them didn't seem like enough to protect the public.

So Smith would look for someone, anyone, to investigate - an employer, a government agency in the researcher's country, a fellow journal worried that the scientist ultimately would get a flawed study published elsewhere if it weren't discredited.

But all too often, Smith said, he wouldn't be able to find anyone to help - or enough time or money for the journal to pursue such an investigation itself.

"As editors, you have an obligation to say you want to find someone to look at it, unless it becomes completely impossible," he said of suspect research.

These days, the kinds of falsified papers Smith spotted are the easiest-to-identify piece of a much larger problem.

At the growing number of professional journals, printed and online, editors face an array of challenges as they attempt to separate work worthy of further examination from flawed research that could lead others astray.

Among recent examples:

A flurry of questionable papers, including Hwang Woo-suk's celebrated ones on the cloning of human cells in the journal Science. Seoul National University announced last week that its investigation had concluded that two Hwang cloning papers in Science were fabrications.

Other examples include papers Eric T. Poehlman, a former University of Maryland and University of Vermont researcher, agreed last year to retract after federal findings of misconduct; and a 1992 British Medical Journal article by Dr. Ram B. Singh, which the journal said last year was of questionable validity. (Singh, according to The Wall Street Journal, denied fabrications).

The propensity of researchers to report positive science while hiding negative data.

The New England Journal of Medicine said in December that authors of a 2000 study on the painkiller Vioxx had failed to disclose that three patients had heart attacks while taking the drug in a clinical trial, making Vioxx look safer than it was. And Journal of the American Medical Association Editor-in-Chief Catherine D. DeAngelis said authors made a study of painkiller Celebrex look better than it should have in 2000 when they submitted only six months of data, though they had 12.

The growing number of researchers whose work is backed by private industry, requiring journals to aggressively seek information about what conflicts scientists might have so they can inform readers.

Scandal ensued, for example, when Nature Neuroscience published a 2002 review of mood-disorder treatments without disclosing author Charles B. Nemeroff's patent, stock options and consulting fees from companies whose products he wrote about. The journal hadn't asked.

More recently, stories in The Wall Street Journal detailed financial relationships between companies and researchers testing medical devices at The Cleveland Clinic. At least two didn't disclose the relationships when submitting their work for publication in the Journal of Thoracic and Cardiovascular Surgery, that journal's editor told The Sun.

The problems aren't just academic. The world's thousands of journals perform a gatekeeping function arguably as important as that of the Food and Drug Administration, though they have no regulatory authority. Most print only studies that have been reviewed by panels of volunteer experts, making publication a sort of stamp of approval from the world of science.

A study published in a credible journal can influence the trajectory of a researcher's career, the focus of future science and - perhaps of the most immediate importance to the public - the practice of medicine itself.

"The stakes are huge," Brian C. Martinson, a researcher who has studied competition and misconduct among scientists, said, singling out the Hwang case. "The financial stakes, the prestige stakes, are huge for the Korean government as well as for the scientist."

The underlying problem the journals are dealing with is the competitive nature of science run amok, argues Martinson, a research investigator for HealthPartners Research Foundation in Minneapolis.

Martinson co-authored a paper in Nature last year that indicated misconduct might be far more prevalent than high-profile anecdotes indicate. The study found that 33 percent of researchers surveyed acknowledged engaging in more "mundane" kinds of misbehavior, such as "changing the design, methodology or results of a study in response to pressure from a funding source."

In the wake of the recent problems, journals have taken a number of steps. Many, for example, are trying to ensure that clinical trial data are fully reported and that authors' conflicts are fully disclosed.