Research fraud among doctors who want the kudos and money that go with publication in a leading medical journal is a problem that is "surfacing like a decomposing corpse" and yet the guardians of medical integrity are not taking the necessary steps to stamp it out, according to editors.
Yesterday the editors of three of the most prestigious medical publications in the UK, Richard Horton of the Lancet, Richard Smith of the British Medical Journal, and Michael Farthing of Gut, denounced the General Medical Council and the Royal Colleges for failing to set up a national body to root out the fraudsters and deter others from faking research results.
A year ago, they say in a letter to be published in their journals this week, the GMC and the colleges promised to act, but they had not.
Dr Horton said that the medical institutions had been promising to take fraud seriously ever since the journal editors set up the Committee on Publication Ethics as a forum in which to discuss research misconduct.
"The GMC and the Royal Colleges have not shown the resolve they said they would show," he said at the launch of the COPE's third annual report yesterday.
Last week the GMC found a consultant surgeon, Anjan Banerjee, guilty of serious professional misconduct for publishing an article in Gut that contained information that had been deliberately falsified.
It took 10 years to bring him to book. While a junior doctor at King's College Hospital Mr Banerjee carried out a study investigating drug-induced damage to the small intestine. Not only was it published in Gut but it also went out as an abstract at a scientific meeting. Mr Banerjee based his results on the urine samples of "12 healthy patients". It was in fact his own urine.
"Dr Banerjee was suspended and not struck off, in spite of the finding of fact about fraud," said Dr Horton.
He attacked the Academy of Medical Sciences, which acts as an umbrella body for all the royal colleges. It ought to be taking the lead in fighting misconduct, he said. "They have been especially negligent with respect to promoting research integrity. They have issued two sets of guidelines, neither of which deal with research misconduct when they should have done."
The GMC is deep in a process of reform, revising its constitution and reviewing the way it disciplines doctors. Only last month, Dr Horton said, the academy gave its advice. "It was the best opportunity any independent body has had in recent years to strengthen the GMC's resolve in respect of misconduct."
But instead, they said they had grave misgivings about making the GMC more accountable to the public. "They are more concerned about protecting the profession," he said.
The COPE's annual report is only a snapshot of the sort of research misconduct that is taking place, its members believe. The cases it discusses are only those which are raised at meetings by a journal editor who has nagging doubts about a paper that has been submitted for publication. Although papers are always sent for peer review to other scientists in the field, fraud is hidden and malpractice - such as a failure to ask the ethics committee for approval or the patients for consent - will not be picked up.
The COPE has dealt with 110 cases by now, 30 of which came to light this year. There must be many more. "Many, many editors in Britain don't bring cases to COPE," said Dr Smith. "We have no idea still what fraction of the whole this represents," said Professor Farthing." Not all of them involve fraud - a common complaint is that research studies are submitted to more than one journal. In the case of a successful drug trial, this could make it appear as if there is more evidence for its safety and efficacy than really exists.
Not all doctors agree there is a problem and if there is, then some argue about the solution. Richard Peto, the professor of epidemiology at Oxford University, famous for his work on the link between smoking and cancer, opposes the establishment of any new body that may impede scientists. He argues that scientists are already subject to "harassment and hassle" from ethics committees and other bureaucracies.
Other cases include the British Medical Journal being sent a paper for publication from a surgeon who claimed to have a new treatment for migraine. His big idea was to put stitches in an artery that runs down the outside of the head. He claimed to have carried out the operation on 1,200 patients.
"There is no clear definition of how the diagnosis (of migraine) was made," says the COPE report. There was also no control group - no patients in the study who were not given the operation and whose condition could be compared with those who had the treatment.
