Whistleblowing, research misconduct, and mental health

 

Book Review

Carl Elliott. The Occasional Human Sacrifice: Medical Experimentation and the Price of Saying No.  W. W. Norton, 2024. ISBN: 978-1-324-06550-0

 

This book should be required reading for three groups of people. First, every member of university or hospital administration, and those who sit on ethics committees (Institutional Review Boards) in such institutions. Second, people interested in the psychology and sociology of moral behaviour. And finally, anyone who has experience of being a whistleblower regarding academic malpractice, and anyone who is thinking of acting in that role.

 There are many books on bioethics, and readers may be familiar with at least some of the seven cases described in The Occasional Human Sacrifice:

• The Markingson case, where a severely disturbed man was persuaded to take part in a drug trial against the wishes of his mother, leading, as she had predicted, to his death by suicide.
•  The Tuskegee study where black men were coerced to take part in a study of the consequences of untreated syphilis.
• Willowbrook School, a residential institution where children with intellectual disability were deliberately infected with hepatitis.
•  Protocol 126 at the Fred Hutchinson Cancer Center, which involved patients being given an experimental bone marrow transplant treatment that proved to be ineffective, without adequate informed consent.
• The Radiation Effects study at Cincinnati Medical Center, where cancer patients were exposed to whole body irradiation, not as treatment, but in order to study its effects. 
•  "The Unfortunate Experiment" in Dunedin, New Zealand, an observational study that involved monitoring rather than treating precancerous abnormalities of the cervix, without sufficient explanation to the woman concerned.
• The case of Paolo Macchiarini, who performed experimental stem cell transplants on the trachea in humans without having done adequate animal studies to justify the approach, with dire outcomes for most patients.

The details of each of these cases makes for sobering reading: patients who trusted their doctors to look after them were experimented on without proper consent procedures, in some cases over a period of years. Most accounts of these events focus on the doctors who allowed this to happen: what motivated them, why did they ignore conventional medical ethics, and why didn't they listen to those who expressed misgivings? Elliott's primary focus, however, is on a different aspect of these cases - the whistleblowers who drew attention to the problems, their motivations, and the impact of their whistleblowing on their lives.

Elliott speaks from personal knowledge - he was the whistleblower in the Markingson case, and his account makes for uncomfortable reading. When he drew attention to the unethical practices in his department of psychiatry he was first ignored and then ostracised. He became obsessed with the case, with a major toll on his mental health. In the concluding chapter he notes:

I am the last person to advise anyone to ignore the demands of conscience, but to encourage potential whistleblowers to speak out without noting the long odds of success and the grim personal costs would be like advising them to leap blindfolded off a cliff. (p 290).

All but one of the whistleblowers featured in this book had a particularly difficult time of it because they were speaking out about ethical abuses within their own institutions. As Elliott noted, the line between a traitor and a whistleblower is a fine one, relating to the perceived motivation of the person involved. A whistleblower may feel they are acting on the purest of motives, to do the right thing, yet others will interpret it as disloyalty to the institution, or attribute their behaviour to a sense of self-importance and moral superiority. Even when, as in several of these cases, the whistleblower is eventually vindicated, they are not thanked, there is seldom restitution for victims, and the mental scars of their battles with authority stay with them.

My own forays into challenging dodgy research are nothing like as serious as the cases covered by Elliott: no lives were at stake in the instances of fraud and malpractice that I've focused on, all of which have been outside my own department. Nevertheless, I resonated strongly with what Elliott had to say about the transformation that occurs in whistleblowers when they first try to report a problem. 

Unlike most people, who are used to the darker side of human behavior, whistleblowers are genuinely shocked when they discover dishonesty, greed, or corruption. They naively assume that if they blow the whistle, others will be just as outraged as they are. They might even imagine they'll be thanked." (p. 158).

 And

 "...if becoming a whistleblower requires a certain naivete, then surviving the experience demands a hard shell of cynicism." (p 159). 

I've definitely been on that journey, after years of observing the delays and obfuscations that routinely occur when a sleuth reports a fraudulent paper to a publisher, or when an institution manages to exonerate a researcher despite ample evidence of misconduct.

I've also been thinking a lot lately about parallels with political life. Here in the UK we've had a number of scandals where citizens were harmed, and sometimes killed, by people in power who were at best incompetent and at worst corrupt. Politicians handed lucrative contracts for personal protective equipment to their cronies who failed to deliver, leaving health professionals without protection; NHS patients were given contaminated blood products long after a problem had been identified; A horrendous fire in a tower block in West London arose after contractors ignored regulations and installed inappropriate cladding on the building - in each of these cases the stories came out, there was a public outcry, and a sense that "something must be done" - but the process gets mired in red tape and nothing actually is done, nobody gets punished, and those affected aren't compensated. This is terrible not just because of the impact on the individuals who were directly harmed, but also because it destroys people's trust in the institutions that we assume will look after us. I see the failure of institutions to deal adequately with academic misconduct as just one part of this broader picture.

So is there anything that can be done to challenge wrongdoing without crashing out over the cliff? A major point made by Elliott is that whistleblowers should not go it alone: that way madness lies. One option that he raised in a recent talk on this topic was to consult a lawyer with expertise in whistleblowing cases: they will be able to advise on the likelihood of success, and may be able to bring a complaint directly to an organisation, so the whistleblower can fly under the radar. There is also the option of going to the press, but, though Elliott describes some cases where this was effective, he notes it can be a two-edged sword, because journalists will want a good story, and it may not coincide with the whistleblower's viewpoint. In my experience, it's worth forming links with responsible journalists: institutions who have been inert for years may spring into action when confronted with the possibility of adverse publicity. Perhaps the most important point is that you need to have allies. They can restore confidence that there are other people who share one's values, who appreciate what one is doing and provide moral support. Although Elliott doesn't say this, I think the internet has made it easier to find one's tribe in this regard.

Where, perhaps, I take issue with Elliott is in the implication that many people aren't troubled by the issues that worry whistleblowers. When I give talks about reproducible research practices, I reliably get a question along the lines of "What advice can you give an early-career researcher whose supervisor is encouraging them to adopt questionable research practices?" The questioner clearly finds it troublesome but is being told that their career is at risk if they don't cut corners, and that "everyone is doing it". I reply that this is an issue that has serious consequences for mental health: doing what you know to be wrong causes internal conflict that can eat away at you, leading to a clash between your model of a good person and your current behaviour.

For this reason I advise those starting out in research to read this piece by Sarah Kendzior. Her advice is intended to help people survive under the threat of authoritarianism, but many of the points apply to academic survival in an age of cynicism:

Write down what you value; what standards you hold for yourself and for others.... Write a list of things you would never do. .... 

But most of all, never lose sight of who you are and what you value. If you find yourself doing something that feels questionable or wrong a few months or years from now, find that essay you wrote on who you are and read it. Ask if that version of yourself would have done the same thing.

 And if the answer is no? Don’t do it.

 

 

Defence against the dark arts: a proposal for a new MSc course

 

Since I retired, an increasing amount of my time has been taken up with investigating scientific fraud. In recent months, I've become convinced of two things: first, fraud is a far more serious problem than most scientists recognise, and second, we cannot continue to leave the task of tackling it to volunteer sleuths. 

If you ask a typical scientist about fraud, they will usually tell you it is extremely rare, and that it would be a mistake to damage confidence in science because of the activities of a few unprincipled individuals. Asked to name fraudsters they may, depending on their age and discipline, mention Paolo Macchiarini, John Darsee, Elizabeth Holmes or Diederik Stapel, all high profile, successful individuals, who were brought down when unambiguous evidence of fraud was uncovered. Fraud has been around for years, as documented in an excellent book by Horace Judson (2004), and yet, we are reassured, science is self-correcting, and has prospered despite the activities of the occasional "bad apple". The problem with this argument is that, on the one hand, we only know about the fraudsters who get caught, and on the other hand, science is not prospering particularly well - numerous published papers produce results that fail to replicate and major discoveries are few and far between (Harris, 2017). We are swamped with scientific publications, but it is increasingly hard to distinguish the signal from the noise. In my view, it is getting to the point where in many fields it is impossible to build a cumulative science, because we lack a solid foundation of trustworthy findings. And it's getting worse and worse.

My gloomy prognosis is partly engendered by a consideration of a very different kind of fraud: the academic paper mill. In contrast to the lone fraudulent scientist who fakes data to achieve career advancement, the paper mill is an industrial-scale operation, where vast numbers of fraudulent papers are generated, and placed in peer-reviewed journals with authorship slots being sold to willing customers. This process is facilitated in some cases by publishers who encourage special issues, which are then taken over by "guest editors" who work for a paper mill. Some paper mill products are very hard to detect: they may be created from a convincing template with just a few details altered to make the article original. Others are incoherent nonsense, with spectacularly strange prose emerging when "tortured phrases" are inserted to evade plagiarism detectors.

You may wonder whether it matters if a proportion of the published literature is nonsense: surely any credible scientist will just ignore such material? Unfortunately, it's not so simple. First, it is likely that the paper mill products that are detected are just the tip of the iceberg - a clever fraudster will modify their methods to evade detection. Second, many fields of science attempt to synthesise findings using big data approaches, automatically combing the literature for studies with specific keywords and then creating databases, e.g. of genotypes and phenotypes. If these contain a large proportion of fictional findings, then attempts to use these databases to generate new knowledge will be frustrated. Similarly, in clinical areas, there is growing concern that systematic reviews that are supposed to synthesise evidence to get at the truth instead lead to confusion because a high proportion of studies are fraudulent. A third and more indirect negative consequence of the explosion in published fraud is that those who have committed fraud can rise to positions of influence and eminence on the back of their misdeeds. They may become editors, with the power to publish further fraudulent papers in return for money, and if promoted to professorships they will train a whole new generation of fraudsters, while being careful to sideline any honest young scientists who want to do things properly. I fear in some institutions this has already happened.

To date, the response of the scientific establishment has been wholly inadequate. There is little attempt to proactively check for fraud: science is still regarded as a gentlemanly pursuit where we should assume everyone has honourable intentions. Even when evidence of misconduct is strong, it can take months or years for a paper to be retracted. As whistleblower Raphaël Levy asked on his blog: Is it somebody else's problem to correct the scientific literature? There is dawning awareness that our methods for hiring and promotion might encourage misconduct, but getting institutions to change is a very slow business, not least because those in positions of power succeeded in the current system, and so think it must be optimal.

The task of unmasking fraud is largely left to hobbyists and volunteers, a self-styled army of "data sleuths", who are mostly motivated by anger at seeing science corrupted and the bad guys getting away with it. They have developed expertise in spotting certain kinds of fraud, such as image manipulation and improbable patterns in data, and they have also uncovered webs of bad actors who have infiltrated many corners of science. One might imagine that the scientific establishment would be grateful that someone is doing this work, but the usual response to a sleuth who finds evidence of malpractice is to ignore them, brush the evidence under the carpet, or accuse them of vexatious behaviour. Publishers and academic institutions are both at fault in this regard.

If I'm right, this relaxed attitude to the fraud epidemic is a disaster-in-waiting. There are a number of things that need to be done urgently. One is to change research culture so that rewards go to those whose work is characterised by openness and integrity, rather than those who get large grants and flashy publications. Another is for publishers to act far more promptly to investigate complaints of malpractice and issue retractions where appropriate. Both of these things are beginning to happen, slowly. But there is a third measure that I think should be taken as soon as possible, and that is to train a generation of researchers in fraud busting. We owe a huge debt of gratitude to the data sleuths, but the scale of the problem is such that we need the equivalent of a police force rather than a volunteer band. Here are some of the topics that an MSc course could cover:

• How to spot dodgy datasets
• How to spot manipulated figures
• Textual characteristics of fraudulent articles
• Checking scientific credentials
• Checking publisher credentials/identifying predatory publishers
  
• How to raise a complaint when fraud is suspected
• How to protect yourself from legal attacks
• Cognitive processes that lead individuals to commit fraud
• Institutional practices that create perverse incentives
• The other side of the coin: "Merchants of doubt" whose goal is to discredit science

I'm sure there's much more that could be added and would be glad of suggestions. 

Now, of course, the question is what could you do with such a qualification. If my predictions are right, then individuals with such expertise will increasingly be in demand in academic institutions and publishing houses, to help ensure the integrity of work they produce and publish. I also hope that there will be growing recognition of the need for more formal structures to be set up to investigate scientific fraud and take action when it is discovered: graduates of such a course would be exactly the kind of employees needed in such an organisation.

It might be argued that this is a hopeless endeavour. In Harry Potter and the Half-Blood Prince (Rowling, 2005) Professor Snape tells his pupils:

 "The Dark Arts, are many, varied, ever-changing, and eternal. Fighting them is like fighting a many-headed monster, which, each time a neck is severed, sprouts a head even fiercer and cleverer than before. You are fighting that which is unfixed, mutating, indestructible."

This is a pretty accurate description of what is involved in tackling scientific fraud. But Snape does not therefore conclude that action is pointless. On the contrary, he says: 

"Your defences must therefore be as flexible and inventive as the arts you seek to undo."

I would argue that any university that wants to be ahead of the field in this enterprise could should flexibility and inventiveness in starting up a postgraduate course to train the next generation of fraud-busting wizards. 

Bibliography

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Boughton, S. L., Wilkinson, J., & Bero, L. (2021). When beauty is but skin deep: Dealing with problematic studies in systematic reviews | Cochrane Library. Cochrane Database of Systematic Reviews, 5. Retrieved 4 June 2021, from https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.ED000152/full

 Byrne, J. A., & Christopher, J. (2020). Digital magic, or the dark arts of the 21st century—How can journals and peer reviewers detect manuscripts and publications from paper mills? FEBS Letters, 594(4), 583–589. https://doi.org/10.1002/1873-3468.13747

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