Who Will Guard the Guardians?

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In a grove of trees in the grounds of the National Academy of Sciences in Washington, DC, is a statue in memory of Albert Einstein. On it are engraved three of his sayings. One reads: “The right to search for truth implies also a duty; one must not conceal any part of what one has recognised to be true.”

Thus starts the scathing editorial in the BMJ regarding the issue of the Wakefield MMR crisis that I had mentioned in passing HERE. The editorial takes a very rational outlook in not falling into the trap of being a pessimistic hypercritical critique of the mishap. Instead, they take a wonderful look on the scenario: as an adverse reaction!

The editorial reminds us how, throughout the history of medicine and research, there have been so many examples of poor research, both morally and ethically. The Wakefieldian fiasco has led to an eye opening of sorts. It has gone on to show how the matter of research fraud affects people in general. The MMR scare that followed in the wake of Wakefield was so severe that it has spawned an entire culture of anti-vaccination campaigners. In the period of a few years, Measles has assumed focal epidemic forms from being an almost unheard of disease in the developed world. It is indeed a matter of great sorrow how the poor little children have ended up paying with their health and lives for the research fraud perpetrated, for the most part, by one person.

This year began with the BMJ hitting out hard at the MMR-Autism links, and effectively bringing to the notice of the public how the fraud was perpetrated. As one article after another was published by Brian Deer exposing the whole sham, it became clear as daylight the million and millions that Wakefield stood to gain off his shady research.

The question now is: how, then, do we trust science that comes up with new, and potentially scandalous results? While there has been a sense of scientific skepticism within the peer review system to guide whether a study is suitable for publication or not, there is a lot of tacit, implied trust in the matter of the study being ethically and morally acceptable. Questions like whether the study was conducted or not, whether the moral and ethical issues were adequately resolved, what kind of conflicts of interests were at question: they rarely get raised in the peer review process.

In fact, the very fact that Wakefield’s work got through all the loop holes and managed to get published in what is considered to be one of the most revered journals in the medical publication business, stands testimony to the fact that the security systems in place is vastly inadequate when it comes to verifying the validity of a research question. Now although I have been a student editor and peer reviewer for several international medical journals, I have always remained intensely skeptical about the whole process of peer reviewing (more on that some time later).

It took 13 long years before the myth of the MMR-Autism scare was busted. In the meantime, numerous children have been harmed. the multiple systemic weaknesses which allowed this to happen is unlikely to change in the foreseeable future, and it does not look good. One must, however, echo the sentiment of the BMJ when they say:

Let’s start now. We must transcend traditional hierarchies and authority gradients to empower everyone in the research enterprise—especially those on the front lines, such as research assistants, data analysts, and project managers—to raise questions and “stop the line.”12 We must train our research leaders—such as department chairs and medical school deans—to manage such inquiries. We must not allow it to be “customary” for journal editors “to discuss and take the word of those against whom the allegations are made.”3Lastly, when allegations of research misconduct or unethical research are brought to the attention of research leadership, these leaders must recognise that they often have a conflict of interest in managing these allegations. As occurred in the Darsee case, institutions may have an overwhelming drive to keep things internal rather than utilise an independent mechanism—such as an audit by a panel of scientists unaffiliated with the institution—to search for the truth. And as in the Wakefield case, journal editors may find it hard to put aside their own investment in a piece of research that they have decided to publish and defended against post-publication criticism. That it fell to a journalist to expose the extent of the misconduct in Wakefield’s research is telling.

We are the guardians of the wisdom of our generation, it is our onus to prevent this from happening again. But as Neitzsche had said, we who fight monsters must be very careful, lest we ourselves turn into the same monsters we fight.

It is time we stood up to be counted for our integrity and commitment towards scientific justification. It is time we raised our hands and said: the buck stops here.

Article in Focus:

Opel, D., Diekema, D., & Marcuse, E. (2011) Assuring research integrity in the wake of Wakefield. BMJ, 342(jan18 2), d2-d2. DOI: 10.1136/bmj.d2 

Skeptic Oslerphile, Scientist at the Indian Council of Medical Research, National Institute of Cholera and Enteric Diseases. Interests include: Emerging Infections, Public Health, Antimicrobial Resistance, One Health and Zoonoses, Diarrheal Diseases, Medical Education, Medical History, Open Access, Healthcare Social Media and Health2.0. Opinions are my own!

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