Book Reviews

As an editor, author and researcher I have become increasingly aware of the problem of fraud in medical research in recent years, quite apart from the high-profile cases that have led to action by the General Medical Council, the regulatory body for medicine in the United Kingdom, and am in sympathy with the tone, that sometimes comes through in this book, of impatience and irritation that the British medical establishment has done almost nothing about the problem. Of course local and regional research ethics committees have been set up and their procedures made more robust. Michael Farthing was involved in the establishment of COPE (the Committee on Publication Ethics) three years ago, and Royal College reports indicate that opinion is edging towards some kind of regulatory framework. Research governance will, of course, be one of the many responsibilities of the newly established Primary Care Trusts in the NHS. However, statutory bodies to safeguard the probity of biomedical research exist in other countries, notably the US and Scandinavia, and it probably is about time that the UK set up something analogous to the Office of Research Integrity that seems to work well in North America. This is both a serious and highly entertaining book. When it was first published, the Secretary of the Medical Protection Society in the UK issued a warning that, once picked up, it was not an easy book to put down. The third edition is no less gripping, and 80-odd pages longer, with new material on topics such as research ethics committees, COPE, the experience of a whistle-blower and the prevention of research misconduct. Whistle-blowers face particular difficulties; if they expose misconduct on the part of a senior colleague, their career may be at risk and, as in the case of the general practitioner whistleblower described here, their partnership and livelihood may be threatened. The ubiquity of research misconduct is striking and, whilst damaging everywhere, is nowhere more worrying than in the numerous instances of falsification of trial results as part of the development of new medicines for human consumption, whether in toxicological or pharmacological studies or in the later phase III or IV clinical trials. Peer pressure, unreasonable expectations and greed are advanced as reasons for fraudulent behaviour, and these may cover some of the cases, but others, such as the notorious gynaecological scandal of totally invented surgical procedures at a London teaching hospital leading to the resignation of the President of the Royal College of Obstetrics and Gynaecology, are frankly baffling in terms of aetiology. Clinical academics may be in thrall to the Research Assessment Exercise, but some of the cases reported indicate the workings of minds more than two standard deviations outside the normal. Perhaps Michael Farthing, who will be responsible for subsequent editions of this book, might consider getting a psychologist to explore the motives, both overt and hidden, behind acts of scientific fraud, some of which are committed with quite breathtaking incompetence and naiveté. It might also be interesting to focus the ethical spotlight a little more sharply on the international conference industry, where the quality of peer review, of submitted abstracts and of the abstracts themselves may become relaxed, to say the least, in the effort to ensure maximum attendance at high-profile gatherings in high-cost venues. The NHS’s research governance framework will have been thoroughly road-tested in a few years’ time, and it might also be interesting and instructive to include a lay perspective on probity and dishonesty and biomedical research. This really is an excellent book, enjoyable, stimulating and informative, and one that is likely to avoid becoming trapped in the cliché that it belongs in every hospital and health centre library; it does, of course, but is much more likely to end up on the bedside table. Roger Jones, London