Lambert here: This post shows how to add narrative analysis to your toolkit of critical thinking skills.
By Roy Poses, MD, Clinical Associate Professor of Medicine at Brown University, and the President of FIRM – the Foundation for Integrity and Responsibility in Medicine. Originally posted at Health Care Renewal website
Tales of medical research misconduct seem increasingly prevalent in the media, and are getting increasing attention. They often may present a simple narrative, like this recent story in the New York Times, “An NYU Study Gone Wrong, and a Top Researcher Dismissed.”
The Narrative Arc
A Renowned Researcher
The researcher in question was one Dr Alexander Neumeister. Oddly enough, the article provided very little information about his background, but made it clear he was at New York University, and was a “top researcher.”
The Potentially Ground-Breaking Studies
The NY Times article noted that the studies were of “an experimental, mind-altering drug.” In particular,
In one of the shuttered studies, people with a diagnosis of post-traumatic stress caused by childhood abuse took a relatively untested drug intended to mimic the effects of marijuana, to see if it relieved symptoms.
The study was ground-breaking, in that
It’s a critical time for two important but still controversial areas of psychiatry: the search for a blood test or other biological sign of post-traumatic stress disorder, which has so far come up empty, and the use of recreational drugs like ecstasy and marijuana to treat it.
The drug was not identified, but the article noted that it was
a drug intended to produce some of marijuana’s effects, made by Pfizer
and was thus like the drug in “a French trial,” that caused six patients to be “hospitalized with severe neurologic problems.”
The study was apparently a small short-term randomized controlled trial
Some participants took the drug over a seven-day period; others took a placebo pill. The N.Y.U. team performed scans on each person to see whether brain activation patterns correlated with symptom relief.
The study called for recruiting 50 people with a PTSD diagnosis, according to study documents.
Research Misconduct Discovered
Dr. Charles Marmar, the chairman of the psychiatry department at N.Y.U., said that people working with Dr. Neumeister had reported concerns about the lab’s compliance with research standards.
This led to
The federal inspection, from July 16 to Aug. 5 last year, found that the research team had failed to assess at least three subjects 24 hours after they had taken the experimental drug, contrary to study protocol, according to the F.D.A. letter. In several instances, the agency found, Dr. Neumeister had falsified documents by signing a fellow investigator’s name on reports. ‘However, in fact, you or another study employee actually conducted these study procedures,’ not the colleague, the F.D.A. concluded.
The violations ‘jeopardize subject safety and welfare, and raise concerns about the validity and integrity of the data collected at your site,’ the F.D.A. said in a letter
Note that the article did not explain why the FDA was called upon to investigate this problem.
Aggrieved Research Subjects
The article focused on one Ms Diane Ruffcorn, who “writes a popular Facebook blog on trauma,”
‘I think their intent was good, and they were considerate to me,’ said one of those subjects, Diane Ruffcorn, 40, of Seattle, who said she was sexually abused as a child. ‘But what concerned me, I was given this drug, and all these tests, and then it was goodbye, I was on my own. There was no follow-up.’
After the trial, she was concerned because
Ms. Ruffcorn said she had several odd symptoms after the trial, including a hyper, wired sensation that occurred without the usual memories of abuse. For months, she tried to find out whether those reactions were tied to the experimental drug, but because the study was shut down and the data belonged to Pfizer, the N.Y.U. doctors could not tell her whether she had taken the drug or placebo.
Earlier this month, after much persistence, she found out that she’d taken the placebo. ‘It was a big relief,’ she said.
Note that the article did not explain by Pfizer owned the data, and would not reveal it.
The Researcher Punished
The researcher did not agree that things were so bad,
Georges Lederman, a lawyer for Dr. Neumeister, said there may have been protocol violations, ‘but N.Y.U. has taken the position that those violations were more egregious than we believe they actually were.’ The issues could have been easily remedied, he said, and noted that they did not cause the sponsor of the research, the pharmaceutical giant Pfizer, to shut it down.
Note that the article did not explain why Pfizer was empowered to shut such a study down.
In any case,
Dr. Neumeister and N.Y.U. continue to disagree over the seriousness of the research violations, both sides said. But the university has tossed out all of the data as unreliable, and tracked down the study participants to check on their health, Dr. Marmar said.
And apparently Dr Neumeister quit, or was fired, although the article only said NYU “parted ways with a top researcher.”
So, in summary, the story was that a prominent researcher was doing cutting edge research at a big university, but people onsite noted some problems, the government was called in to investigate, the investigation found problems, the research was stopped, and the researcher lost his job. However, while the article mentioned that Pfizer sponsored the study, Pfizer had control of the study’s data, and Pfizer had the power to shut the study down, the article did not comment on whether the involvement of Pfizer could have had any relationship to the narrative of alleged individual researcher misconduct.
Research Misconduct as a Problem with Bad Apples
Thus, in my humble opinion, this story followed the usual narrative arc of research misconduct stories: an individual scientist over-reaches, possibly in pursuit of fame and money, is discovered and punished, and things get back to normal. The implication is that research misconduct is a bad-apple problem, although fueled by a hyper competitive research environment. For example, last week the (UK) Times Higher Education Suppplement published an article entitled, “Is There a Problem with Research Integrity,” that opened,
For many academics today, research is not about pushing intellectual boundaries. It is not about investigating a fascinating issue so much as it is about churning out publications, demonstrating impact and generating revenue in order to meet the performance targets upon which institutional reputation and individual careers depend.
The temptation to cut corners is immense. Tricks include getting your name on a paper that you contributed little towards, or “salami-slicing” the same research across several publications. More seriously, some researchers falsify – misrepresent – their data, or even fabricate them entirely. Some universities tacitly encourage such behaviour and the boundary between academic integrity and malpractice is becoming blurred.
The current case seems to be on of attempted falsification, misrepresentation of research data.
Notice the use of the pronoun “you,” emphasizing that research misconduct is about individual misconduct. Similarly, tha THE article included commentaries by various individuals. One was by a “research integrity expert,” who began,
Having positive and preferably spectacular research findings is wonderful. It helps you to get a publication in a journal with a high impact factor, which will be cited often and may attract a lot of media attention. This is not only a pleasant ego boost but may also be instrumental in getting your next grant or strengthening your academic position. So, in an ever more competitive and metrics-driven scientific environment, it is tempting to make such results occur by any means necessary.
All this is true as far as it goes. But in my humble opinion, the usual research misconduct narrative is vastly oversimplified, as is the case reported by the New York Times.
We have been writing for years about massive problems with manipulation of clinical research to increase the likelihood that the results would satisfy vested interests, and suppression of research whose results remain unsatisfactory after such manipulation. The vested interests are most commonly pharmaceutical, biotechnology or device companies and those working with them. Such suppression and manipulation may make treatments that do not work look efficacious, and treatments that are dangerous look safe, and may lead to excess costs, and worse, harms to patients. This kind of research misconduct may be facilitated by individual researchers seeking fame and fortune, but is hardly an individual sport.
Focusing on individual research misconduct thus leaves the larger problem of vested interests dominating clinical research anechoic.
Looking carefully at the NYU/ Neumeister case as reported, and a little research on the web suggests that there may be more involved than just the conduct of one researcher. But that could only be confirmed, or refuted, by investigation beyond what this humble blogger can do.
A Pharmaceutical Company Sponsored, Likely Pharmaceutical Company Designed, Phase II Drug Study Gone Wrong
The NY Times article acknowledged, almost parenthetically, that the study on which the article was focused was sponsored by Pfizer, although it first did so in the context of Dr Neumeister’s lawyer arguing that the problems with the study were not that serious:
[he] noted that they did not cause the sponsor of the research, the pharmaceutical giant Pfizer, to shut it down.
Later, the article stated,
Pfizer said that N.Y.U. was responsible for conducting the trial,
the company had previously tested the same drug, known as an F.A.A.H. inhibitor, for osteoarthritic pain, without significant side effects. ‘The safety profile we observed does not preclude future development of our compound,’ a Pfizer spokesman said by email.
So this was not a case of a company funding a study merely to advance medical science. The implication was that the company was testing its own compound in hopes of seeking approval from the US Food and Drug Administration. That must be why it was the FDA that investigated the research misconduct, particularly to the extent that the conduct of the research violated a “protocol” to which the FDA was apprently privy.
More evidence that the study was under the control of Pfizer, rather than of Dr Neumeister, could be inferred from the problems Ms Ruffcorn had in determining whether she had taken the drug or placebo.
For months, she tried to find out whether those reactions were tied to the experimental drug, but because the study was shut down and the data belonged to Pfizer, the N.Y.U. doctors could not tell her whether she’d taken the drug or a placebo.
Note that the “data belonged to Pfizer,” not to NYU or Dr Neumeister.
In fact, in perhaps the only critical look given to this story, in a post on Neuroskeptic,
I believe the compound in question is PF-04457845.
I believe this because ClinicalTrials.gov lists a trial of PF-04457845 for PTSD, a trial which was recently terminated. NYU was one of the research sites. I also think that this trial is the fateful one, as it matches the NYT’s description of that study. Interestingly, ClinicalTrials.gov says that the trial was stopped ‘based on Pfizer portfolio prioritization and not due to safety and/or efficacy concern or change in benefit:risk assessment of PF-04457845′.
So given that the study was a small randomized controlled trials of patients, not of healthy volunteers, it appeared to be a Pfizer sponsored, Pfizer designed, Pfizer controlled Phase II study being done in the hope of eventually marketing PF-04457845.
As noted in an article about agreements between academia and industry on the conduct of randomized controlled trials(1),
Many randomized clinical trials (RCTs) are designed and sponsored by for-profit companies. Companies typically contract academic investigators to identify, recruit, and manage patients. Clinical research under these circumstances is a business transaction that bears the potential for conflicts of interest, including those regarding the publication of trial results
It also appears that Pfizer was spending a more than tiny sum on this work. A Politico article from 2014 revealed that Dr Neumeister at that time had a $1.7 million grant from Pfizer, presumably for this particular study. Thus this drug trial was likely providing NYU with more than negligible monetary support, most likely including salary support for Dr Neumeister.
Dr Neumeister apparently has had some previous involvement with pharmaceutical companies, and with Pfizer specifically. A search of the ProPublica Dollars for Docs 2009-13 database revealed that Dr Neumeister received consulting, travel funds and a more than $227,000 grant from Eli Lilly. Dr Neumeister apparently is currently on the advisory board for Fiorello Pharmaceuticals. In a 2015 article in the Journal of Clinical Psychiatry(2), Dr Neumeister acknowledged that he “has received consulting fees from Pfizer.”
So it seems that in this case a study which may not have been conducted according to research standards was likely a pharmaceutical sponsored, designed, and controlled Phase II trial done as part of an effort to seek approval for a new drug. Hence this case was not only about allegations of individual research misconduct, but about yet more problems with the implementation of commercially controlled human experiments designed to ultimately further marketing as well as science. Yet none of the public discussion so far of this case was about whether Pfizer had any responsibilities to assure the quality of the research in which it was so involved, much less whether interactions between the company, the university which was being funded by the company, and the researcher employed by the university but whose salary was probably partially underwritten by the company might have affected how the study was implemented.
There may be many problems with individual misconduct affecting clinical research. But failure to consider how this research is now mainly conducted within a commercial milieu seems to be missing the elephant in the room. If we cannot plainly discuss research misconduct as part of the larger picture of health care dysfunction, we will not be able to do much about it. True health care reform would help end the taboo on discussion about how powerful organizations and their wealthy and powerful leaders distort health care.
1. Kasenda B, von Elm E, You JJ, Blumie A et al. Agreements between Industry and Academia on Publication Rights: A Retrospective Study of Protocols and Publications of Randomized Clinical Trials. PLoS Med 13(6): e1002046. doi:10.1371/journal.pmed.1002046. Link here.
2. Mota N, Sumner JA, Lowe SR, Neumeister A et al. The rs1049353 Polymorphism in the CNR1 Gene Interacts With Childhood Abuse to Predict Posttraumatic Threat Symptoms. J Clin Psychiatr 2015; 76(12):e1622–e1623. Link here.