When it comes to medical knowledge, I’m aware that there is very little I know and very much I don’t know. I allow myself to be comforted by the old words of Socrates: “The only true wisdom is in knowing you know nothing.”
However, I know I can improve. Seeking knowledge has always been among my highest priorities. My fountain of information is the medical literature and tons of results from scientific studies. To be a better doctor, I can literally bathe every day in a pool of fresh scientific data from peer-reviewed medical journals. Afterward, I will sense the strength of increased wisdom in my veins. I will be wiser than yesterday. I will be better suited to take care of my patients and educate my coworkers.
But, today there is foul-smelling from my fountain of medical knowledge.
The past week saw some new twists in the tale of a prominent Japanese cardiologist, Dr. Hiroaki Matsubara, accused of fabricating and manipulating data for cardiology research later published in a range of cardiology journals. Last year, the American Heart Association (AHA) issued a notice of concern about five of Matsubara’s papers appearing in three of their journals, Circulation, Circulation Research, and Hypertension, between 2001 and 2004. Recently, the American Heart Association retracted these papers.
Concerns about Dr. Matsubara also involve the Kyoto Heart Study presented at the European Society of Cardiology 2009 Congress and later published in the European Heart Journal. This publication was subsequently retracted by the journal.
A few days ago, Japan’s minister of health, Norihisa Tamura, as well as university officials at Kyoto Prefectural University announced that the Kyoto Heart Study data were “very likely” fabricated.
“Incomplete” patient data were used in the study, which concluded that the blood-pressure drug Valsartan reduced cardiovascular events via mechanisms unrelated to blood-pressure lowering. Had “complete patient records” been used, the study would have reached “a different conclusion,” the university concluded.
Finally, it has also emerged that two employees from the pharmaceutical company Novartis were involved in the conduct and analysis of the Kyoto Heart Study, as well as another trial, the Jikei Heart Study. However, their participation was not acknowledged in publications and presentations of the data.
All of us know that the case of Matsubara is not unique. However, we don’t know whether it is just the tip of the iceberg or if this is a rare event. All we know is that scientific misconduct in medicine should not exist. However, I fear it is much more widespread than we realize.
Medical science is about seeking knowledge and testing hypotheses to be able to move forward and increase our understanding of health and disease. But there is another, sometimes darker side to it. It is characterized by ambition, competition, need for acknowledgment, and an obsession to get there first. The words “greed,” “ruthlessness” and “dishonesty” may even sometimes be appropriate. Obviously, there is a risk of foul play.
When I started my blog, I thought I was well suited, due to my education and knowledge, to provide my readers with reliable information about heart disease and cardiovascular prevention. My strength was my knowledge of the medical literature, and how to interpret scientific data. However, if the literature is contaminated with falsified and manipulated data, I wonder: How much do I really know?
I assume nobody could provide me with a clearer answer than Ygritte from Game of Thrones: “You know nothing, Jon Snow.”