Scientific Misconduct in the Medical Field: The Lies That Lead to Fraud

If you’ve ever heard anyone say that vaccines are ineffective or deceptively dangerous, chances are they got that information from a source lacking scientific credentials. You may be surprised to learn, then, that these unfounded claims originated not from the likes of Jenny McCarthy or Robert F. Kennedy, but from Dr. Andrew Wakefield, a British scientist and medical doctor. Though lacking the platform—and notoriety—of an MTV star or a political dynasty scion, Wakefield’s influence must not be understated; he’s the researcher whose 1998 study on the link between childhood vaccines and the development of autism was later found to be at least partially, if not fully, fabricated. As reported by the British Medical Journal (BMJ) in 2011, Wakefield was responsible for altering or misrepresenting the medical histories of all 12 patients who participated in his study; some of whom had already developed symptoms consistent with autism prior to participating in the study. Perhaps even more troubling is the fact that, prior to the execution of the study, Dr. Wakefield was paid £435,000 (roughly $500,000) by a law firm seeking to sue vaccine manufacturers—a significant conflict of interest which he failed to disclose to the co-authors of his landmark paper.

Yet, even with the retraction of the study and subsequent professional disgrace of Wakefield, who was stripped of his medical license in the United Kingdom, the damage had already been irreversibly done, as demonstrated by rising global rates of diseases that were once all but eradicated, like measles and polio. But Wakefield is hardly a stand-alone offender. Indeed, evidence of misrepresentation found in his vaccines study is just one example in a multitude of cases that fall under the umbrella of “research fraud,” or, as members of the scientific community prefer to call it, “scientific misconduct.”

“Right now, I have about 100,000 papers scanned in for review, and 6,000 papers [have] problematic issues—it’s mainly images, but there are some other signs of misconduct as well. My work has resulted in around 800 retractions, and around the same number of corrections,” says Dr. Elisabeth Bik.

As her data suggests, Dr. Bik is a heavy hitter in the realm of scientific misconduct investigations. In fairness, “heavy hitter” is perhaps a bit of an understatement—Dr. Bik has almost singlehandedly spearheaded the considerable burden of taking scientific fraudsters to task. While she’s not the only scientific integrity researcher operating in the field, she stands out as one of the very few who chooses to put a public name and face to her investigations. With threats like retaliation, harassment, and even lawsuits looming, many so-called image sleuths prefer to work under cover of darkness, sharing their findings under pseudonyms, if they’re capable of sharing them at all. It’s a unique and often vexing challenge in the industry, but one that Dr. Bik intends to meet head on.

A microbiologist by training (her doctorate, from Utrecht University in The Netherlands, is on epidemic Vibrio cholerae strains), Dr. Bik cut her teeth at the Stanford School of Medicine; that is, until 2013, when she stumbled upon a stray corner of the internet that would prove the proverbial game changer. After reading an article about scientific integrity and plagiarism, Dr. Bik started Googling sentences from some of her own papers, out of idle curiosity. Lo and behold, she got a hit.

“I just took a sentence that I had written and, by accident, I found the sentence had been stolen,” she said. “I think if I had [searched] another sentence, I would still be working in microbiology. Later, I found that I have some talent for spotting duplicated patterns. I've always looked at bathroom tiles and floor planks and stuff like that, and I can see when it's not natural wood, when it's porcelain tiles or laminate flooring. Usually there are repetitive patterns in tiles. This might not be a useful talent for a lot of people, but for me, I’ve been able to use it in reviewing images in scientific papers.”

The use of questionable images in academic studies rests at the center of another freshly rendered accusation of scientific misconduct. Printed in July, the preeminent journal Science unleashed a bombshell report, regarding an Alzheimer’s study that was published in rival journal Nature in 2006. The original study, greenlit by the University of Minnesota Twin Cities and co-authored by researcher Sylvain Lesné and lab director Karen Ashe, among others, asserts to have established a connection between a unique protein strain (specifically, amyloid beta, or Aβ) found in the human brain and the development of Alzheimer’s disease. Cited over two thousand times by a myriad of researchers working in the medical field, the study proved as influential as it was groundbreaking. Numerous drugs to treat the devastating disease, which killed an estimated 1.62 million people globally in 2019, were developed as a direct derivative of Lesné’s published hypothesis.

But what if years of funding from internationally recognized institutions and countless recommendations from licensed professionals was all based on a lie? What if untold numbers of dementia patients, facing the hideous reality of a slow, dramatic cognitive decline, were promised a solution and instead sold a prescription as ineffective as a placebo? Put against this context, and suddenly, scientific misconduct appears to take on nightmarish consequences scarcely fathomable within many realms of occupational fraud.

These are the allegations leveled at Lesné and, by extension, Nature. As outlined in the Science exposé, the once-lauded researcher is now under suspicion for having potentially misrepresented the findings of his study, via a series of images purported to demonstrate his groundbreaking results. The images in question depict Western blots, a laboratory technique used by researchers to help determine what sets of protein strains are present in blood or tissue samples. The blots published in Lesné’s paper allegedly show the development of Aβ*56 (a sub-strain of the protein thought to be the proximate cause of Alzheimer’s) in lab mice exhibiting dementia symptoms. The problem, however, appears to take shape when looking at, well, shapes. That is, unusual patterns that emerge in the images presented as the cornerstone of this study.

“[The paper] appeared to have composed figures by piecing together parts of photos from different experiments,” Dr. Bik told Science in its report on the Alzheimer’s study. “The obtained experimental results might not have been the desired results, and that data might have been changed to … better fit a hypothesis.”

The whistleblower in this case, Dr. Matthew Schrag, has long been a vocal critic of the FDA’s authorization for Alzheimer’s drugs developed around the Aβ protein strain, thanks to his own research in the field, which has come into conflict with claims made by drug manufacturer Cassava Sciences. What finally tipped the investigative scales was Dr. Schrag’s close review of the images used in Lesné’s study. Prompted by a call from an attorney, requesting help with an investigation into an experimental new drug, Dr. Schrag discovered numerous instances of cut-marks, duplications, and multiple image patterns that strongly suggested improper image tampering. For its part, Nature has not retracted the published study, but, as of July 14, 2022, placed a disclaimer on it, indicating concerns have been reported and are being reviewed.

Given all of this, one must wonder: why would a scientist, distinguished or ascending, risk reputation and career on the basis of a fraud? Isn’t the threat of international disgrace enough of a deterrent?

Perhaps not, if we look at scientific misconduct through the lens of any other prosaic fraud scheme. Unlike most industries, many scientists are paid based off grant funding from universities and institutions on a per-project basis. This framework renders their industry almost unimaginably competitive and cutthroat—“publish or perish” might be putting it too lightly. Additionally, many researchers are working at universities on foreign, labor-specific visas, which can expire or be revoked if they are not able to continue funding their projects. The pressure to apply for and obtain numerous grants, combined with the rationalization almost certainly supplied, and one begins to get a stronger idea of how the research fraud triangle comes together.

Unfortunately, the inherent nature of trust within the scientific community unwittingly enables the final portion of the fraud triangle: opportunity.

“Scientists don't really think there's a lot of fraud. [We] are sort of very blindly trusting each other. I think a lot of scientists still have this rosy impression, that all scientists are really good and there would just absolutely be no fraud in science,” says Dr. Bik. “I'm, of course, very skeptical. Most reviewers, people who review these grants or papers, are not really looking at these things with the idea this could be fraud. They just assume everything is good. All the experiments as presented have actually been done. And so, I think people have just no idea that there's fraud in science.”

As with any other industry, accusations of fraud are not taken lightly. Dr. Bik cautions reviewers to be mindful of potential mislabeling or accidental repetition of images in papers that could be misinterpreted as fraud but end up having an innocent explanation. Dr. Bik herself has been threatened with a number of lawsuits, but, to date, none have come to pass. Unintimidated, she hopes to train up a new generation of image sleuths, and does so in part with her engaging public speaking gigs, but also by posting suspicious images from papers (all identifying information concealed, of course) she’s reviewing to her Twitter page, where she challenges her 130,000 followers to see if they can find the fraud.

“I think with the games I play on Twitter, those have been very successful because basically I show a photo and then [ask] what is wrong with it? I let other people spot the duplication,” she said. “I don't make it usually about the papers or the authors, but just having fun with the images and people love that. And I think secretly I've trained all my followers to find these cases themselves. That's sort of my secret mission: to teach all these people. Just make them aware that this happens. And I think once you're aware, you starting to see red flags. Hopefully it makes them more skeptical.”

Alongside Dr. Bik, several organizations, both private and federal, have been established to help combat scientific misconduct. Some of these include:

-              Retraction Watch: A site that tracks scientific papers and studies that have been retracted.

-              Office of Research Integrity: A branch of the Department of Health and Human Services, this office is the official federal watchdog organization for the United States federal government. It is also responsible for identifying the three most popular fraud schemes associated with scientific misconduct:

• Plagiarism
• Fabrication
• Falsification

-              PubPeer: A scientist-supported nonprofit organization, which allows researchers to upload potentially problematic papers for critique.

-              Committee on Publication Ethics: Also known as COPE, this British organization’s mission statement is to “move the culture of publishing towards one where ethical practices become a normal part of the publishing culture.”

-              Image Data Integrity: A consulting firm that assists “institutions, publishers, journals, biotech, and legal counselors” with biomedical image data manipulation concerns.

-              Association of Research Integrity Officers: A collective of researchers that provides support for research misconduct allegations and promotes ethical research best practices.

-              Scientific Integrity Digest: Dr. Bik’s website where she publishes blogs on her investigations and findings.