Is it ethical/legal to withhold information in clinical publications?

[wizzed101]

Say, you are reporting a cohort of patients who underwent a specific surgical procedure. There are many steps in the process that pretty much everyone in the field follows. You, however, was the first to do that surgery using laparoscopy. Apart from that, the rest is routine. However, in step,say 8, instead of infusing liquid X you used Y instead. There is no harm done using X except that the patients would probably have worse outcomes, but still better than conventional. People would not question you because they have already believed laparoscopy was superior when doable. Not mentioning it will ensure your hospital's leading position in the field for years to come until you publish another paper explaining why Y is better.

Is it ethical to do so? I don't think this is that uncommon.

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[CaliforniaDreamer]

I don't think that changing 2 variables could ever be considered illegal, it certainly makes the results more difficult to interpret. From what I have seen, many surgical studies alter more variables than just 1 (the specific surgeons involved in the surgery being something that springs to mind).

 

[LePepe]

Is lying ethical?

No, but you already knew that, didn't you?

But the rewards are that we'll be able to publish another paper!

"What does it profit a man if he gains the whole world but loses his soul?"

 

[Donald Juan]

Clinical studies on surgery outcomes will often leave out particular details, especially in regards to pt infusions during the cases if it is not pertinent to the study. It is accepted that there is some variability, which is why we also want to know in a surgical study if it was a single surgeon study, single institution, multi-institution, etc. You're vague example of "step 8 - infuse liquid X" sounds weird, but if different pt were getting different pre op antibiotics, or some pt got heparin post op q8h vs q12h, or some got normal saline and some had D51/2 NS, these details would likely be left out if that was not the aim of the study.

 

[wizzed101]

Clinical studies on surgery outcomes will often leave out particular details, especially in regards to pt infusions during the cases if it is not pertinent to the study. It is accepted that there is some variability, which is why we also want to know in a surgical study if it was a single surgeon study, single institution, multi-institution, etc. You're vague example of "step 8 - infuse liquid X" sounds weird, but if different pt were getting different pre op antibiotics, or some pt got heparin post op q8h vs q12h, or some got normal saline and some had D51/2 NS, these details would likely be left out if that was not the aim of the study.

The closet analogy I can think of is patient's own plasma instead of saline. Every other institution/surgeon uses saline. They actually said in the paper that they used 'saline' and that was a lie.

 

[aldol16]

The closet analogy I can think of is patient's own plasma instead of saline. Every other institution/surgeon uses saline. They actually said in the paper that they used 'saline' and that was a lie.

Well it sounds like this could affect outcomes and the reproducibility of the results...

 

[deleted781806]

They actually said in the paper that they used 'saline' and that was a lie.

So instead of this long convoluted paragraph question, you could have asked "Is it ethical to lie about your methods in a paper?", which is an obvious "No."

 

[wizzed101]

Well it sounds like this could affect outcomes and the reproducibility of the results...

But it's surgery... If you cannot reproduce the results, they would just say that you suck. It's not like running western blot. You must have the equipment plus the skill to execute it. They are clinical cases, not experiments.

So instead of this long convoluted paragraph question, you could have asked "Is it ethical to lie about your methods in a paper?", which is an obvious "No."

Yea no ****. I asked because this comes from a T20 institution and apparent it is acceptable because "competition."

 

[deleted781806]

But it's surgery... If you cannot reproduce the results, they would just say that you suck.

*Edit*: Also if you fail to reproduce a Western Blot, people can also attribute it to lack of skill, just saying.

*Further Edit*: If it's from a T20 institution then I would suggest going to whatever ethics board is around and tattling on them if this is actually occurring and you have proof of it occurring. Pretty easy position to figure out what to do. (You could also put up the accused article, which might be a fun read). But due to your reputation and how I've come to know you on SDN, I have a strong feeling that this is just some thought-experiment you are trying to get people to somehow fight about.

 

[ortnakas]

Well it sounds like this could affect outcomes and the reproducibility of the results...

So instead of this long convoluted paragraph question, you could have asked "Is it ethical to lie about your methods in a paper?", which is an obvious "No."

This.

Don't lie. It's unethical and it won't end well.

 

[TXMED_1695]

Lying is bad.

Also, in research/testing who does not factor inter/intra-user variability, user dependent ex. Western blot test.

 

[TyrosineLannister]

If you are going to conduct a study on surgical (or any other group of ) patients, you need to get the research approved by an institutional review board (IRB) first. In that application you spell out exactly what the research involves, and what aspects deviate from normal standard of care.

If what you do after obtaining approval for a study deviates from the research plan that was approved, it would not only be considered unethical, but potentially illegal depending on what is done. Also, the results would not be published by any respected journal because all prospective clinical studies need a priori approval of the methods from an IRB.

 

[deleted480308]

This is the second time you've posted about questionable decisions in research. Are you a creative troll or are you surrounded by questionable people?

 

[deleted781806]

Are you a creative troll or are you surrounded by questionable people?

It's likely the former, as they like posting contrarian threads/replies. So far I've seen these two questionable research ones, an anti-vaccination argument, and a flat-earther argument.

 

[wizzed101]

If you are going to conduct a study on surgical (or any other group of ) patients, you need to get the research approved by an institutional review board (IRB) first. In that application you spell out exactly what the research involves, and what aspects deviate from normal standard of care.

If what you do after obtaining approval for a study deviates from the research plan that was approved, it would not only be considered unethical, but potentially illegal depending on what is done. Also, the results would not be published by any respected journal because all prospective clinical studies need a priori approval of the methods from an IRB.

Are you absolutely sure? They actually wrote in the paper that later patients were treated with improved methodology compared to the first few. And how can there be standard of care in surgery if, I know for a fact that, two hospitals in the same medical center do a same procedure differently? Do you mean standard of care as in standard goal of care or in standard of procedure of care? Say, treating dehydration using saline vs Gatorade.

This is the second time you've posted about questionable decisions in research. Are you a creative troll or are you surrounded by questionable people?

Neither.

It's likely the former, as they like posting contrarian threads/replies. So far I've seen these two questionable research ones, an anti-vaccination argument, and a flat-earther argument.

I don't remember you in any other thread. But let's refresh the memory a bit. Anti-vaccination: someone said something I considered incredibly stupid/arrogant. They were along the line of proving a negative and that they didn't need to read the Lancet paper to refute it because "basic immunology." Flat-earth thread: so there were some people making fun of the flat-earthers while themselves said stupid **** like "just fly a drone up high you will see the curve!!" "using binocular to see the curve on the horizon!!!"
But why did I care? My bad. I hope I didn't hurt your feeling.

 

[deleted781806]

I don't remember you in any other thread.

Glad to have made a lasting impression.

My bad. I hope I didn't hurt your feeling.

Seems like you are the one upset by these things, with the profanity and such. Contrarianism is boring, and the examples you gave to combat "stupid/arrogant" assertions in the other threads were equally ridiculous.

Also with all of these new things being brought up, you're really going to have to start pulling some evidence besides "I know for a fact". It's hard to have a discussion about these kinds of issues if we are only being given the necessary information to evaluate what is happening in this supposed surgical study in bits and pieces and only in response to others' points.

*Edit*: For example, these statements of yours seem to be contradictory: "They actually said in the paper that they used 'saline' and that was a lie." vs. "They actually wrote in the paper that later patients were treated with improved methodology compared to the first few."

 

[sammiesings]

I skimmed everything outside of your original post.

If the infusion compound was specifically named in your irb approved protocol and you gave a different infusion than you were approved for, not only is that highly unethical, it's illegal.

You will also get caught because the clinical report will have the actual infused item in there and it's only a matter of time before someone puts your deception together.

When that happens, not only are you risking being barred from ever doing research at your institution, depending on how serious and the specifics of the project (ie if the infusion itself was an investigational component being regulated), you could be barred by the FDA from ever working on clinical trials (sponsored or otherwise).

Not to mention all y'all involved will just look plain stupid and greedy.

 

[wizzed101]

Glad to have made a lasting impression.

que?

Seems like you are the one upset by these things, with the profanity and such. Contrarianism is boring, and the examples you gave to combat "stupid/arrogant" assertions in the other threads were equally ridiculous.

I don't remember what I wrote. Or did you mean the youtube vid with the non-distorted camera?

Also with all of these new things being brought up, you're really going to have to start pulling some evidence besides "I know for a fact". It's hard to have a discussion about these kinds of issues if we are only being given the necessary information to evaluate what is happening in this supposed surgical study in bits and pieces and only in response to others' points.

*Edit*: For example, these statements of yours seem to be contradictory: "They actually said in the paper that they used 'saline' and that was a lie." vs. "They actually wrote in the paper that later patients were treated with improved methodology compared to the first few."

There is nothing contradictory about it. The whole paper discussed many things. The thing they improved upon was the surgical techniques, things that they would probably be called out on. The infusion is something that no one will ever notice. Using 'saline' can be considered standard of care. In fact, if they did not use 'saline,' it would've raised some questions. 'Patients' plasma' is not just something you have on a moment notice you know. People will wonder why you would go through the troubles.

I skimmed everything outside of your original post.

If the infusion compound was specifically named in your irb approved protocol and you gave a different infusion than you were approved for, not only is that highly unethical, it's illegal.

You will also get caught because the clinical report will have the actual infused item in there and it's only a matter of time before someone puts your deception together.

When that happens, not only are you risking being barred from ever doing research at your institution, depending on how serious and the specifics of the project (ie if the infusion itself was an investigational component being regulated), you could be barred by the FDA from ever working on clinical trials (sponsored or otherwise).

Not to mention all y'all involved will just look plain stupid and greedy.

That was my impression. I posted this because I think chances are they won't get caught. The base procedure itself is extremely challenging technically even for skilled surgeons. I just wonder if this was standard. My boss just shrugged it off. It's not we who are doing it btw. We will do something even more advanced.

 

[Seldon]

Don't do it.

 

[aldol16]

But it's surgery... If you cannot reproduce the results, they would just say that you suck. It's not like running western blot. You must have the equipment plus the skill to execute it. They are clinical cases, not experiments.

You're thinking from the authors' perspective. Think from the readers' perspectives. Sure, the authors can claim incompetence or something of the sort. You're mistaken to say that this is isolated to clinical studies. I have seen PIs in the basic sciences who have basically told other people that their grad students suck when getting called out on something that's irreproducible. Equipment plus skill is requisite for any good science. The authors could claim that everybody else is just incompetent and nobody will be able to prove it but keep in mind that reputation matters a hell of a lot in academia. Word will spread that your results just aren't reproducible and people will stop trusting you. Future papers will also have difficult reviewers because you'll be known as the guy whose data is irreproducible. So they'll demand a higher bar for your future studies.

 

[deleted781806]

The whole paper discussed many things.

I'm sure it did, that's kind of the point. Anyways, claiming that the authors flat-out lied about not using saline and then saying the authors acknowledge the change of methodology within the paper is a contradictory statement on your part. Also, apparently the infusion part wasn't something "nobody" would notice, but that's another point. To continue: please share this mythical article with us, otherwise :troll:. Your original inquiry about the ethics surrounding misrepresenting data/methodology has been answered several times at this point.

 

[wizzed101]

I'm sure it did, that's kind of the point. Anyways, claiming that the authors flat-out lied about not using saline and then saying the authors acknowledge the change of methodology within the paper is a contradictory statement on your part. Also, apparently the infusion part wasn't something "nobody" would notice, but that's another point. To continue: please share this mythical article with us, otherwise :troll:. Your original inquiry about the ethics surrounding misrepresenting data/methodology has been answered several times at this point.

There is this revolutionary idea that the thing they improved upon had nothing to do with 'saline' vs 'plasma.'

"Man, they did the surgery in 1 hour and there was no contusion. And they only cut a 2cm hole. We did it in 3 hours and there was bleeding everywhere. Our hole was like 4cm. But obviously, the thing that needs improving is that dang IV line! If we had used plasma instead of saline, the surgery would've gone way better!!!!" - Said you. And plus, you keep comparing western blot with laparoscopic surgery. Like, have you ever tried your hand on the equipment? Trying to move the thing around, picking up stuffs, doing suture etc... on bench?

I am here to see if this was common. Basically, someone developed a methodology but did not want to share it but had to publish a paper to showcase his results. The target readers would be primary care physicians who then referred patients to the author.
Is there a tacit consensus that to match the outcome of the author, other surgeons would have to do a fellowship or discover the little details by themselves?

You're thinking from the authors' perspective. Think from the readers' perspectives. Sure, the authors can claim incompetence or something of the sort. You're mistaken to say that this is isolated to clinical studies. I have seen PIs in the basic sciences who have basically told other people that their grad students suck when getting called out on something that's irreproducible. Equipment plus skill is requisite for any good science. The authors could claim that everybody else is just incompetent and nobody will be able to prove it but keep in mind that reputation matters a hell of a lot in academia. Word will spread that your results just aren't reproducible and people will stop trusting you. Future papers will also have difficult reviewers because you'll be known as the guy whose data is irreproducible. So they'll demand a higher bar for your future studies.

There is a key difference, I believe. In clinical cases, the patients who came in with that disease and came out vastly improved are the proofs that the result is reproducible.

 

[deleted781806]

- Said you.

No, I didn't, but that's okay I guess.

And plus, you keep comparing western blot with laparoscopic surgery. Like, have you ever tried your hand on the equipment?

"Keep comparing" is a bit of an exaggeration, also I am not saying that laproscopic surgery is easy but rather Western Blot is still variable with user error. (And thus, as Aldol has said, failure to replicate a Western Blot can also be blamed on lack of skill).

Either way, your posts are becoming nonsensical so I'm just going to throw on the ignore button, once I can find it. (Cue goro joke about feeling pressure between the eyes).

 

[TyrosineLannister]

Are you absolutely sure? They actually wrote in the paper that later patients were treated with improved methodology compared to the first few. And how can there be standard of care in surgery if, I know for a fact that, two hospitals in the same medical center do a same procedure differently? Do you mean standard of care as in standard goal of care or in standard of procedure of care? Say, treating dehydration using saline vs Gatorade.

100% sure.

When you submit a study to an IRB for a prospective clinical study, they will require you to attach a protocol which spells out exactly what will be performed and how the data will be analyzed. Additionally, they will review your "Informed Consent" form that you go over with the patient to explain what is being done and the associated risks. Now, if an investigator wishes to use an "improved methodology" for later groups of patients, this can be done but not until they submit what's called an amendment to the study which will also be reviewed by the IRB & relevant clinical groups before being approved for use. Publishing results without following these steps will cause MAJOR trouble for the individual and the institution.

"Standard of care" applies to what the individual surgeon typically does for patients who are not participating in research. Different surgeons in the same hospital may perform operations and manage the post-operative care of patients in different ways, although they are usually guided to following standardized evidence-based protocols.

Someone mentioned above that if something is administered during surgery then it will be recorded in the patient's medical record. You possibly could do what is called a "retrospective" study to look at differences in outcomes of past patients receiving infusion X vs infusion Y. But to do this, you would also need IRB approval before collecting information from a patient's medical record with the intention of conducting research. And that surgeon would likely need a good clinical justification for why they were doing infusion Y in the first place for that set of patients.

 

[aldol16]

There is a key difference, I believe. In clinical cases, the patients who came in with that disease and came out vastly improved are the proofs that the result is reproducible.

That's not how reproducibility is measured. You're saying that if A and B are mixed and you get C, the result is reproducible as long as you get C. That's not how we do science. Nobody can publish a paper saying that "A plus B gets you C" and leave it like that, just like nobody in the clinical sciences can say "Treat with X and patients get better" and leave it at that. Scientists measure results. In other words, mixing A and B and getting C in 20% yield (plus or minus 2) is not the same as mixing A and B and getting C in 60% yield (plus or minus 5). This analogy, when carried through to the clinical case, means that if you claim that your novel surgical technique results in 70% (+/- 5) of patients being cured and not having to come back, then somebody else better be able to reproduce that 70% (+/- 5). If only 50% (+/- 2) of patients are cured when somebody else tries to do your procedure, then your results aren't reproducible and you've exaggerated your numbers. The magnitude of the difference of course would depend on exactly what X and Y are in your case.

 

[wizzed101]

No, I didn't, but that's okay I guess.

"Keep comparing" is a bit of an exaggeration, also I am not saying that laproscopic surgery is easy but rather Western Blot is still variable with user error. (And thus, as Aldol has said, failure to replicate a Western Blot can also be blamed on lack of skill).

Either way, your posts are becoming nonsensical so I'm just going to throw on the ignore button, once I can find it. (Cue goro joke about feeling pressure between the eyes).

When you put those two in the same sentence meant to compare, you don't know what you are talking about. And sorry the last sentence after the schooling wasn't directed to you.

And good riddance. You came to my thread to ****post and when got BFTO you declared to the whole world that you were going to ignore me. And don't let me start on telling me to file a complaint to the ethics board. LMAO. I see that you are a funny person. We should be friends ^_^. I like funny people.

100% sure.

When you submit a study to an IRB for a prospective clinical study, they will require you to attach a protocol which spells out exactly what will be performed and how the data will be analyzed. Additionally, they will review your "Informed Consent" form that you go over with the patient to explain what is being done and the associated risks. Now, if an investigator wishes to use an "improved methodology" for later groups of patients, this can be done but not until they submit what's called an amendment to the study which will also be reviewed by the IRB & relevant clinical groups before being approved for use. Publishing results without following these steps will cause MAJOR trouble for the individual and the institution.

"Standard of care" applies to what the individual surgeon typically does for patients who are not participating in research. Different surgeons in the same hospital may perform operations and manage the post-operative care of patients in different ways, although they are usually guided to following standardized evidence-based protocols.

Someone mentioned above that if something is administered during surgery then it will be recorded in the patient's medical record. You possibly could do what is called a "retrospective" study to look at differences in outcomes of past patients receiving infusion X vs infusion Y. But to do this, you would also need IRB approval before collecting information from a patient's medical record with the intention of conducting research. And that surgeon would likely need a good clinical justification for why they were doing infusion Y in the first place for that set of patients.

Interesting. But how often is it scrutinized? If the surgeries went smoothly and patient outcomes were good, do people really go through all of that? Or only if there were something wrong that was typically linked to specific procedural error?

That's not how reproducibility is measured. You're saying that if A and B are mixed and you get C, the result is reproducible as long as you get C. That's not how we do science. Nobody can publish a paper saying that "A plus B gets you C" and leave it like that, just like nobody in the clinical sciences can say "Treat with X and patients get better" and leave it at that. Scientists measure results. In other words, mixing A and B and getting C in 20% yield (plus or minus 2) is not the same as mixing A and B and getting C in 60% yield (plus or minus 5). This analogy, when carried through to the clinical case, means that if you claim that your novel surgical technique results in 70% (+/- 5) of patients being cured and not having to come back, then somebody else better be able to reproduce that 70% (+/- 5). If only 50% (+/- 2) of patients are cured when somebody else tries to do your procedure, then your results aren't reproducible and you've exaggerated your numbers. The magnitude of the difference of course would depend on exactly what X and Y are in your case.

I understand your point but consider these: there is only 2 hospitals in the entire US that can do this procedure. And this paper, I suspect, is meant to be a promotion to get patients in. I don't think it is in their interests to make the results reproducible by anyone but themselves. And you are quite a miser in your confident intervals, +/-20 is more on point. With that in mind, do you think then that the claim of lack skill is legit?

Case in point. This is an semi-unrelated paper. I crossed some labels out because reasons.

 

[aldol16]

I understand your point but consider these: there is only 2 hospitals in the entire US that can do this procedure. And this paper, I suspect, is meant to be a promotion to get patients in. I don't think it is in their interests to make the results reproducible by anyone but themselves. And you are quite a miser in your confident intervals, +/-20 is more on point. With that in mind, do you think then that the claim of lack skill is legit?

Well, if you didn't notice, the only constraint I needed to construct my confidence intervals was that they didn't overlap. If they overlap as in your example, then there is no 95% confidence that the procedures are any different. I have no idea what those p-values are comparing but it can't be the two columns. Also, if there are only two hospitals in the U.S. that do this procedure and the sole point of the paper is to get patients into their hospital, there's really no reason to withhold the X vs. Y information. Since they are the only ones who do it anyway. It's not good science at all.

 

[TelemarketingEnigma]

I crossed some labels out because reasons.

If those reasons are anonymity/obscuring of field reasons, be advised that it took me all of about 30 seconds to figure out the source of that table.

 

[mcloaf]

I don't think it is in their interests to make the results reproducible by anyone but themselves.

Science--how does it work? Apparently no one involved in this research project has any idea.

 

[wizzed101]

Well, if you didn't notice, the only constraint I needed to construct my confidence intervals was that they didn't overlap. If they overlap as in your example, then there is no 95% confidence that the procedures are any different. I have no idea what those p-values are comparing but it can't be the two columns. Also, if there are only two hospitals in the U.S. that do this procedure and the sole point of the paper is to get patients into their hospital, there's really no reason to withhold the X vs. Y information. Since they are the only ones who do it anyway. It's not good science at all.

That X vs. Y information can help many related procedures :/

I don't think it is good science either. But say, you are a primary care physician and you just read that and your patient needs surgery. Would you recommend going to said hospital or just tell them to do the conventional procedure?

Let me try again to make a point on that interval. Say, you have a patient who is paralyzed from the waist down and has severe recurring infection. The conventional procedure treats that recurring infection well but patients still cannot walk. The procedure in our imagined paper can lead to one of 3 outcomes: infection free + walking with great difficulty, infection free + walking with modest assistance, and infection free + walking unassisted. Let say outcome one is 50, two 70 and three 90. The paper claims CI of 70 +/- 20. Now no matter what you do, without infusing Y instead of X, you cannot get pass 70, mostly likely 50. But still that result is a huge improvement. You ask and the authors say you suck and if you don't think the procedure is valid then feel free to do the conventional one. What now?

On that table, each of the 250+ data point costs hundred of thousands of dollars and tremendous coordination. With such project, can there ever be "good science?"

If those reasons are anonymity/obscuring of field reasons, be advised that it took me all of about 30 seconds to figure out the source of that table.

Good for you. But if you were right, you should be able to deduce that I cannot possibly be connected to that
I am actually waiting for the haters to trash that table claiming the journal sucks. When that happens, I will slap them around and it's gonna be sweet ^_^

 

[mistafab]

OP - it may just be that you think you understand how the science occured more than you actually do.

You aren't a doctor, and you are definitely not a surgeon. It is always possible in these 'interpretation of doctor/scientist X's work" that your understanding is just a misinterpretation of what actually happened due to lack of knowledge. I'm not saying that this is definitely the case - but you must understand that this is definitely a possibility in these types of cases.

 

[aldol16]

That X vs. Y information can help many related procedures :/

I don't think it is good science either. But say, you are a primary care physician and you just read that and your patient needs surgery. Would you recommend going to said hospital or just tell them to do the conventional procedure?

Let me try again to make a point on that interval. Say, you have a patient who is paralyzed from the waist down and has severe recurring infection. The conventional procedure treats that recurring infection well but patients still cannot walk. The procedure in our imagined paper can lead to one of 3 outcomes: infection free + walking with great difficulty, infection free + walking with modest assistance, and infection free + walking unassisted. Let say outcome one is 50, two 70 and three 90. The paper claims CI of 70 +/- 20. Now no matter what you do, without infusing Y instead of X, you cannot get pass 70, mostly likely 50. But still that result is a huge improvement. You ask and the authors say you suck and if you don't think the procedure is valid then feel free to do the conventional one. What now?

On that table, each of the 250+ data point costs hundred of thousands of dollars and tremendous coordination. With such project, can there ever be "good science?"

I understand what you're trying to say. Let's use your intervals: 50, 70, and 90, all +/- 20 for the confidence interval. Confidence intervals mean that we have a 95% confidence that the "true" value lies in that range, or that if you repeat the experiment 100 times, your mean will lie within that range at least 95 times. Now, statistically speaking, you can't say that these results are statistically significant because statistical significance is arbitrarily defined as 95% confidence. But that doesn't mean that you can't say with 80% confidence that they are different results. Depending on the spread of numbers, you probably could. These are all number tricks. They say nothing about about clinical significance. The variable leading to the 70 could in fact be different clinically from the 50.

But in science, the burden is on the authors to prove statistical significance. You have to prove that the 70 is actually different from the 50 in order for people to believe you. And when somebody tries to reproduce your results, they have to measure a mean that is within that margin of error. Otherwise, people are going to start doubting your scientific results.

Now, let me address the bolded part above. What happens if you infuse Y instead of X? You get to 90? That means that when somebody goes to reproduce your results, they would only be getting 70, correct? What I would do as a scientist is 1) I would recommend treating patients with your protocol as published since it's better than conventional therapy (50) and 2) I would write a letter to the editor of the journal claiming that you over-exaggerated your results and it's closer to 70, not 90 as you claim. When enough people write letters to the editor, your paper will be flagged and there will be a notice attached to it. That's when people stop believing you and you become that guy who inflated your numbers (even though you could easily have avoided this by just writing Y instead of X in the first place).

 

[wizzed101]

I understand what you're trying to say. Let's use your intervals: 50, 70, and 90, all +/- 20 for the confidence interval. Confidence intervals mean that we have a 95% confidence that the "true" value lies in that range, or that if you repeat the experiment 100 times, your mean will lie within that range at least 95 times. Now, statistically speaking, you can't say that these results are statistically significant because statistical significance is arbitrarily defined as 95% confidence. But that doesn't mean that you can't say with 80% confidence that they are different results. Depending on the spread of numbers, you probably could. These are all number tricks. They say nothing about about clinical significance. The variable leading to the 70 could in fact be different clinically from the 50.

But in science, the burden is on the authors to prove statistical significance. You have to prove that the 70 is actually different from the 50 in order for people to believe you. And when somebody tries to reproduce your results, they have to measure a mean that is within that margin of error. Otherwise, people are going to start doubting your scientific results.

But in clinical case, it is not realistic to reproduce the results. If a data point costed 500k, and the authors did like 150 of them to get that statistics, while it is not good science that their result not reproducible, but how can it be good science if you and others can only afford to do 1 case and do not get that result? Regardless of whether their protocol is 100% truthful or not they can just claim that you lack expertise and the lower end of their performance or even occasional failure is to be expected.

Now, let me address the bolded part above. What happens if you infuse Y instead of X? You get to 90? That means that when somebody goes to reproduce your results, they would only be getting 70, correct? What I would do as a scientist is 1) I would recommend treating patients with your protocol as published since it's better than conventional therapy (50) and 2) I would write a letter to the editor of the journal claiming that you over-exaggerated your results and it's closer to 70, not 90 as you claim. When enough people write letters to the editor, your paper will be flagged and there will be a notice attached to it. That's when people stop believing you and you become that guy who inflated your numbers (even though you could easily have avoided this by just writing Y instead of X in the first place).

If you infuse Y instead of X, you have a shot at going to 90. If not, you will be <70 at best. The thing is if people perceive that you do not produce good results and they do, then you will get fewer and fewer patients and you know the rest.

 

[aldol16]

But in clinical case, it is not realistic to reproduce the results. If a data point costed 500k, and the authors did like 150 of them to get that statistics, while it is not good science that their result not reproducible, but how can it be good science if you and others can only afford to do 1 case and do not get that result? Regardless of whether their protocol is 100% truthful or not they can just claim that you lack expertise and the lower end of their performance or even occasional failure is to be expected.

You're only carving out a narrower and narrower interpretation for yourself that is not consistent with your original post. If there is 1 hospital in the world that can do this and they wrote that they use Y instead of X and nobody else has the resources to reproduce it anyway and the sole purpose of the paper was to convince physicians to refer patients to them, then nobody is going to catch that omission. But that goes against your original post for two reasons. First, you asked whether it's ethical. It's not ethical in any case. Second, you stated clearly: "There are many steps in the process that pretty much everyone in the field follows. You, however, was the first to do that surgery using laparoscopy. Apart from that, the rest is routine." I find it hard to believe that if only such a minor difference in the procedure was used, then one could claim "skill" as being what sets them apart. Furthermore, not only one hospital in the entire world can use laparoscopic techniques.

In the end, you can claim whatever you want. Scientists do that all the time. But there's a difference between claiming something you know to be BS and everybody else knows to be BS so that you don't get sanctioned and people actually believing that your BS is true. If you came up with some new technique that yields the drastic result you claim and you're the only hospital in the world to use it, then why not just patent the whole damn process?

 

[freak7]

Am I the only one thinking "just politely ask the surgeon about it"?

 

[wizzed101]

You're only carving out a narrower and narrower interpretation for yourself that is not consistent with your original post. If there is 1 hospital in the world that can do this and they wrote that they use Y instead of X and nobody else has the resources to reproduce it anyway and the sole purpose of the paper was to convince physicians to refer patients to them, then nobody is going to catch that omission. But that goes against your original post for two reasons. First, you asked whether it's ethical. It's not ethical in any case. Second, you stated clearly: "There are many steps in the process that pretty much everyone in the field follows. You, however, was the first to do that surgery using laparoscopy. Apart from that, the rest is routine." I find it hard to believe that if only such a minor difference in the procedure was used, then one could claim "skill" as being what sets them apart. Furthermore, not only one hospital in the entire world can use laparoscopic techniques.

There are two hospitals in the US that can do this and they are competing with each other. And I am sure they have variations in technique. If the other hospital comes out and says that they cannot replicate the results, what does it say about them? And I asked because it was a research article. The real question is, if you actually read my post, if such practice is acceptable. And I never said that it was the SOLE reasons they wrote that is to attract patients. They want to convince people in their field that they cannot do it. Patients typically don't read these things. And if some of their peers actually try to follow their procedures. Many patients don't have the resource to fly half-way across the country for surgery. Again, not to you, is it acceptable to write clinical research papers like this? There are many things that unethical if scrutinized. Secondly, I don't need to convince you. It just is. The sole purpose of doing it laparoscopically(?) is to reduce happenstance of complications associated with conventional surgeries. This very simple variation improves one of the outcome. The paper on that hasn't been published yet. And your last sentence suggests that you don't appreciate the difficulty of the operation. Yes, there are many hospitals that can do laparoscopic but only for certain procedures. You can't seriously believe that laparoscopic removal of something is the same as insertion. They are world apart.

In the end, you can claim whatever you want. Scientists do that all the time. But there's a difference between claiming something you know to be BS and everybody else knows to be BS so that you don't get sanctioned and people actually believing that your BS is true. If you came up with some new technique that yields the drastic result you claim and you're the only hospital in the world to use it, then why not just patent the whole damn process?

They may. Actually, some of parts of the process has already been. Someone is gonna be rich.

 

[Stagg737]

If they're reporting that they utilized one procedure and actually used another, that's unethical and just crappy research. If it doesn't make a big difference or the research/procedure is only being done by 2 or 3 institutions, then reporting the actual procedure shouldn't make a difference. Either way, if it gets out that they lied then the authors and/or institution will face repercussions. Maybe it'll just be the paper getting retracted, maybe it'll be massive lawsuits from patients for whom the procedure didn't go well, maybe it'll be a government sanction. Regardless, it's just bad science.

Good for you. But if you were right, you should be able to deduce that I cannot possibly be connected to that
I am actually waiting for the haters to trash that table claiming the journal sucks. When that happens, I will slap them around and it's gonna be sweet ^_^

Even the best journals publish crap papers and publish irresponsibly at times. Thinking that a paper is legit just because it's in a high-power or influential journal is a fallacy (appeal to authority) and a poor argument for a study's validity.

 

[Lost In Transcription]

Don't pay attention to @wizzed101, everyone. Wizzed just likes to make scarcely understandable arguments or just stir people up- poorly, at that.

It's unethical to mislead in any research. You surely know this or you wouldn't have asked.
Report them to the ethics committee at the institution. Duke is a T20, pretty sure, also, and it's gotten in trouble recently for scientific misconduct. It happens everywhere, and it isn't justifiable for any reason, at all- competition or otherwise. Don't fool yourself.

Be proactive and go do something to stop it, or stfu and also gtfo because you are the lowest of low slime in the research world, in my opinion, if you do nothing- whether this is your act or not.

@ZedsDed this time I'll tag you.

 

[aldol16]

There are two hospitals in the US that can do this and they are competing with each other. And I am sure they have variations in technique. If the other hospital comes out and says that they cannot replicate the results, what does it say about them? And I asked because it was a research article. The real question is, if you actually read my post, if such practice is acceptable. And I never said that it was the SOLE reasons they wrote that is to attract patients. They want to convince people in their field that they cannot do it. Patients typically don't read these things. And if some of their peers actually try to follow their procedures. Many patients don't have the resource to fly half-way across the country for surgery. Again, not to you, is it acceptable to write clinical research papers like this? There are many things that unethical if scrutinized. Secondly, I don't need to convince you. It just is. The sole purpose of doing it laparoscopically(?) is to reduce happenstance of complications associated with conventional surgeries. This very simple variation improves one of the outcome. The paper on that hasn't been published yet. And your last sentence suggests that you don't appreciate the difficulty of the operation. Yes, there are many hospitals that can do laparoscopic but only for certain procedures. You can't seriously believe that laparoscopic removal of something is the same as insertion. They are world apart.

I believe every single person on here has told you that it is unethical and not okay. If you're looking for a way to justify it, go elsewhere. You're not going to find it here.

 

[ZedsDed]

Don't pay attention to @wizzed101, everyone. Wizzed just likes to make scarcely understandable arguments or just stir people up- poorly, at that.

It's unethical to mislead in any research. You surely know this or you wouldn't have asked.
Report them to the ethics committee at the institution. Duke is a T20, pretty sure, also, and it's gotten in trouble recently for scientific misconduct. It happens everywhere, and it isn't justifiable for any reason, at all- competition or otherwise. Don't fool yourself.

Be proactive and go do something to stop it, or stfu and also gtfo because you are the lowest of low slime in the research world, in my opinion, if you do nothing- whether this is your act or not.

@ZedsDed this time I'll tag you.

Oh man... I forgot about our friend here, lol

 

[ZedsDed]

This is the second time you've posted about questionable decisions in research. Are you a creative troll or are you surrounded by questionable people?

"Creative" is way too generous. OP just can't read/write/think good.

:troll:

 

[wizzed101]

Don't pay attention to @wizzed101, everyone. Wizzed just likes to make scarcely understandable arguments or just stir people up- poorly, at that.

It's unethical to mislead in any research. You surely know this or you wouldn't have asked.
Report them to the ethics committee at the institution. Duke is a T20, pretty sure, also, and it's gotten in trouble recently for scientific misconduct. It happens everywhere, and it isn't justifiable for any reason, at all- competition or otherwise. Don't fool yourself.

Be proactive and go do something to stop it, or stfu and also gtfo because you are the lowest of low slime in the research world, in my opinion, if you do nothing- whether this is your act or not.

@ZedsDed this time I'll tag you.

Oh the irony.

Anyway. No I am not going to do a thing. I hate hypocrites the most so seeing you two here really energizes me. Thanks ^_^

I believe every single person on here has told you that it is unethical and not okay. If you're looking for a way to justify it, go elsewhere. You're not going to find it here.

I merely try to explain to you why your requirement of proofs in basic science cannot be realistically applied here.

I just want to know if there is the practice in clinical, surgery to be specific. Is this why certain hospitals are famous for certain procedures? Maybe this is the wrong forums to ask. I am no surgeon/doctor so I cannot read other papers to find a trend. I don't have the expertise.

 

[ZedsDed]

I know you already understand all this, but I think it's worth going through for premeds who may be interested in research.

it isn't justifiable for any reason, at all- competition or otherwise. Don't fool yourself.

Be proactive and go do something to stop it, or stfu and also gtfo because you are the lowest of low slime in the research world, in my opinion, if you do nothing- whether this is your act or not.

Thank you! It's really annoying when people don't "get it."

Thinking rationally is not something that comes naturally to humans. As scientists, we're trained to minimize the role of our human biases in experiments and the conclusions we draw from them. But that's difficult to do, right? We fall victim to our own biases all the time, which is why the enterprise of science has built-in error-checking mechanisms. Peer review is essential because it allows other individuasl with a different set of biases to get around our own. If results are reproduced we gain confidence that we might be correct in spite of our biases. The process is slow and laborious, but essential. This is how we find truth.

The idea that -- of all people -- this guy should be "given a pass" or something is hilarious.

 

[ZedsDed]

@efle Post smart people stuff. Or a dank meme.

I'm fine with either

 

[wizzed101]

Even the best journals publish crap papers and publish irresponsibly at times. Thinking that a paper is legit just because it's in a high-power or influential journal is a fallacy (appeal to authority) and a poor argument for a study's validity.

The paper is like what, 10+ years old and is still being quoted/studied. The authors of that table are so influential that if you want to apply for a grant to further research the methodology and deviate even a tiny bit from their non-human models, you can kiss goodbye to that grant. Everything goes through them. So no, it is not a crappy paper. And,again, I have already stated that it wasn't the paper in the OP.

If they're reporting that they utilized one procedure and actually used another, that's unethical and just crappy research. If it doesn't make a big difference or the research/procedure is only being done by 2 or 3 institutions, then reporting the actual procedure shouldn't make a difference. Either way, if it gets out that they lied then the authors and/or institution will face repercussions. Maybe it'll just be the paper getting retracted, maybe it'll be massive lawsuits from patients for whom the procedure didn't go well, maybe it'll be a government sanction. Regardless, it's just bad science.

Let's forget about the paper in the OP for a moment.

Did you mean all valid results must be reproducible or that all results must be reproduced by other groups? There is a significant difference here. If I publish something, and, to the best of my ability, detail every single steps, my paper would still be crap because I had 30 data points and each cost about 5k in, material only, to collect, that is not taken in accounts the practices to perfect the technique. In other words, if the paper is cost prohibitive (in labor or capital) to replicate in other institutions, it is automatically crap? I mean you are a med student I should have experience this but if the procedure calls for a closure of an anastomosis leak to be done within say, 2 minutes (lol), and there are like 3 people in the fields that can do it (with video evidence), 2 of whom are the authors, while the 3rd is not interested in the research so they won't do it, does it mean that such procedure is crap because it cannot be done by the lesser surgeons?

Slightly off-topic, is it also your opinion that any experiment done using the Hadron Collider is crap because there is only 1 in the world and only a few can access it?

I am not asking that to arguing with you. I really want to know. I find this insinuation that Western Blot and surgical cases are similar because they are both "data point" ridiculous.

 

[freak7]

Kellyanne, is that you?

 

[Lost In Transcription]

Oh the irony.

Anyway. No I am not going to do a thing. I hate hypocrites the most so seeing you two here really energizes me. Thanks ^_^


I merely try to explain to you why your requirement of proofs in basic science cannot be realistically applied here.

I just want to know if there is the practice in clinical, surgery to be specific. Is this why certain hospitals are famous for certain procedures? Maybe this is the wrong forums to ask. I am no surgeon/doctor so I cannot read other papers to find a trend. I don't have the expertise.

1) I see you still haven't read my Wiki link, lol.
2) Requirements of basic science absolutely apply here- statistics are important regardless the application.

If your point is that "Well we have fewer data points than someone in basic", that is true. That doesn't mean you can't do good science with what you have. You try to minimize your biases (what are the actual results and how can this be explained?). Scientists- basic or clinical- should be looking for the answer they want to be the least viable answer possible. The result is almost always due to some methodological error unnoticed, in reality. For ex: did one think that, maybe, that enzyme doesn't work as well on the bench as opposed to some recent in vivo study because it's at room temp and not 37oC? So many scientists are so quick to jump to conclusions...and we wonder why our journal reproducibility rate is around 20%.

Even with small number of data points, it's all in how you intepret it, and being honest about the limits of said interpretations.

I'm going to go out on a limb and say that most irreproducibilities come from these things- not incompetence. Sure, some grad students are less than bright. But, IMO, students spend more time trying to reproduce something with an incomplete methods section. Which vould make the difference between it working or not. Did you mix the solution? Did you leave it on the bench or ice while you prepared the rest?

Which is what you have implied is going on here, wizzed: incomplete methods section.

By using Y instead of X, that could be the boost, as you have said to getting it to "90%" as below

If you infuse Y instead of X, you have a shot at going to 90. If not, you will be <70 at best. The thing is if people perceive that you do not produce good results and they do, then you will get fewer and fewer patients and you know the rest.

So this aspect of the method, basically, if someone doesn't do, won't yield results.

Then in theory, from a none-the-wiser perspective, the hospital will just have "magic hands" (no procedural difference otherwise between the two hospitals) and patients will come there. AND the other hospital will be unable to reproduce it.

This is, in fact, scientific misconduct, along with breaking the IRB protocol, so if you AREN'T LYING, get yourself out of there. And report them.

But since, in the post I quoted, you say that you will "do nothing", you are a pathetic excuse for someone entering a field where accountibility, responsibility, honesty, and ethical consideration are needed personality traits. I hope you change your mind and will say something.

This is the ultimate sin in science, and it's incredibly disturbing to see you fairly complacent with it.

3) You don't need to be an expert in a field to hunt for scientific problems or statistical differences in data. There are pretentious pricks in every field who love it when their stuff is barely comprehensible. But it often means they are doing poor science or poor writing. If an undergrad can't eventually understand it, then you've done something wrong.

And no, I'm not a loser researcher trying to make it in the world who is jealous of your sketchy stem cell research. I'm currently working under the world renowned expert of the field I'm working in (mostly non-medical) and leaving the field to start a new field (medical) with a prestigious research award.

Me and aldol both know what we are talking about. If you're crossing both of us on a research/science/stats topic, you can be certain you're doing it wrong.

 

[JustAPhD]

Plain and simple deliberatly misleading your audience in a published paper is scientific fraud. There's not much to this conversation. Trying to protect a competitive advantage is in no way a justifiable excuse for fraud, the mental gymnastics you're going through is admirable but silly.

Yes this does happen, and is just one of a plethora of reasons why reproducibility is actually quite low. It's a real problem.

 

[wizzed101]

Plain and simple deliberatly misleading your audience in a published paper is scientific fraud. There's not much to this conversation. Trying to protect a competitive advantage is in no way a justifiable excuse for fraud, the mental gymnastics you're going through is admirable but silly.

Yes this does happen, and is just one of a plethora of reasons why reproducibility is actually quite low. It's a real problem.

Ah so that actually what is routinely going on then. Thank you. That's all I need to know. I kinda figured that was the case because some people seem to be evasive about it.

 

[JustAPhD]

Ah so that actually what is routinely going on then. Thank you. That's all I need to know. I kinda figured that was the case because some people seem to be evasive about it.

I'm not saying it's routine; generally I like to think people are better than that. But unfortunately it does happen.