VroniPlag Wiki case #152: Another German Politician

On Saturday, Sept. 26, 2015, case #152 on the Vroni Plag Wiki site was posted, a doctorate in medicine from 1990. Normally, journalists yawn if they even hear of something like this, as German medical doctorates are more or less a joke. Even the Wissenschaftsrat tried to explain this in 2004 to the medical schools:

Schon seit langem wird - auch von Medizinern - die medizinische Promotion hinsichtlich akademischer und wissenschaftlicher Wertigkeit stark angezweifelt. Aufgrund der in der Bevölkerung weit verbreiteten Gleichsetzung der Begriffe Arzt und Doktor hat sich eine Art akademisches Gewohnheitsrecht entwickelt, demzufolge die Verleihung des Doktorgrades weitgehend unabhängig von der Qualität der Promotionsleistungen erfolgt. Die berufliche und gesellschaftliche Anerkennung als Arzt ist in Deutschland mit dem Doktortitel verbunden. Daraus erklärt sich auch die im Vergleich zu anderen Fächern hohe Promotionsrate (etwa 80 %). Nicht selten wird der Lerneffekt bei Doktorarbeiten angezweifelt. Insbesondere dienen sie durch ihre schlechte Betreuung häufig nicht der wissenschaftlichen Grundausbildung.¹⁰³ Der wissenschaftliche Erkenntnisgewinn dieser „pro-forma“-Forschung ist daher fragwürdig. 

¹⁰³ Dieter Schmid: Die Doktorarbeit im Visier – Titel zwischen Traum und Trauma, in: Via Medici 4, 2003, S. 16-20.[Wissenschaftsrat, Empfehlungen zu forschungs- und lehrförderlichen Strukturen in der Universitätsmedizin, 2004, S. 75]

(Translation by DWW: The academic and scientific credibility of medical doctorates has been called into question for quite some time, even by medical practitioners themselves. Because the general public widely equates the terms physician and doctor, a sort of academic custom has developed by means of which the the doctoral degree is conferred independent of the quality of the research achievements. The occupational and social appreciation of physicians in Germany is linked to the doctoral degree. This explains the high rate of degrees conferred (80 %) when compared to other fields. It is not seldom that the learning effect of the doctoral theses are doubted.  In particular, because of poor mentoring they often do not even serve to teach scientific basics. The scientific contribution of this "pro-forma" research is thus questionable. )

The medical schools have made the occasional attempt to demonstrate that they are doing something, but by and large it has been business as usual.

VroniPlag Wiki case #152 is, however, a special medical thesis. It was submitted by the current Minister of Defense, Ursula von der Leyen. One of her predecessors in office, Karl-Theodor zu Guttenberg, ended up having to step down four years ago after his doctoral dissertation in law was found to be extensively plagiarized.

The press has thus jumped on the case, and is now remembering the academic grumblings about the low quality of medical doctorates. The bloggers are having a field day (Archivalia I - II, Causa Schavan, Erbloggtes I - II - III, all in German, all long). Even Spiegel has both the plagiarism documentation and a discussion of the quality of medical doctorate quality as the lead article in issue 41/2015^*. The Medical University of Hannover has already announced that they have opened an official investigation into the case.

I was at the 7th Prague Forum of the Council of Europe “Towards a Pan-European Platform on Ethics, Transparency and Integrity in Education” this past week, speaking on plagiarism in medical dissertations in Germany. I added a slide on case #152, as so many people were asking me about it. More on the Prague Forum in a coming post, as they have set up ETINED as a site for helping combat academic corruption.

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^* although they demonstrate in the article that they don't understand Creative Commons licenses. CC-BY-SA means that you name the source and put the result, if you reuse or modify it, also under such a license. They changed the color of a bar and reformatted it to fit, and then slapped a "Der Spiegel" copyright on the picture.

Dissertation mining

The past few weeks have certainly been quite stressful for the medical school of the University of Münster in Germany. VroniPlag Wiki began reporting on plagiarism in 21 dissertations to date that were submitted to the school in the years 2004 – 2011. The findings even include a chain of three plagiarized dissertations: Gt (2010) is a plagiarism of Ckr (2009) on 100% of the pages. The Ckr thesis contains plagiarism on 94% of the pages, including Gb (2008), which in turn is a plagiarism of a thesis submitted 2007. All four theses were prepared with the same doctoral advisor. Another cluster of five theses that repeat material from each other, with another advisor, has been documented (Tmm/40 pages/47%; Aeh/15 pages/86%; Clm/27 pages/62%; Clg/21 pages/80%; Amh/21 pages/52%).  In addition to the plagiarism, evidence of data falsification has also been found in some of the theses.

How were these theses identified? And why were so many found in such a short time?

It was a rather simple application of data mining techniques to dissertations that are available as open access digital publications from university libraries. Medical dissertations were chosen, as there are a large number of them available and they often deal with similar topics. Many theses in the past 10 years are available as open access publications from the university libraries. The theses are also often painfully short, sometimes even consisting of just one publication by a research group that one of the authors submitted as their dissertation.

Volker Rieble, a German law professor, discussed open access repositories in his 2010 book Das Wissenschaftsplagiat: Vom Versagen eines Systems (p. 52ff). The book has unfortunately been taken off the market, as one of the persons named as a plagiarist won a lawsuit filed against Rieble. He argues that open access repositories, especially ones operated by universities, should be taking measures to make sure that their authors are not being plagiarized if their texts are being openly offered. He feels that this publicly available material is a simple invitation to plagiarize. Of course, he does recognize that open access could help discover plagiarism, but he pointed out that no one was taking any action against copyists.

Well, now someone has. The work of VroniPlag Wiki in the past three years has shown that there is extensive plagiarism in dissertations and other academic texts throughout Germany, in all fields, and done in many different ways. The cases in Münster were discovered using a collusion identification method applied to open access dissertations.

While reading an early version of my book, one of the VroniPlag Wiki researchers stumbled over the section on collusion. What exactly was that? Collusion is when two or more students cooperate in producing materials in situations in which they were expected to work alone. For example, two students write a program together and each turns it in as their own work. Or five students in a very large course cooperate to write a paper together and then each turns in his or her own slightly modified version. Students hope that the teachers will not be reading carefully (or not at all?) and thus will not identify the "work-saving" efforts. It is not necessary for the participants to knowingly participate in the collusion. If author A re-uses text from author B without B being aware of the situation, this would also be considered collusion.

The researcher noted that he could imagine students doing such a thing, but no doctoral candidate would be so careless as to do something like that, would they, especially when they plan on publishing online? Would people collaborate on a dissertation, each submitting their own copy, or each writing half of the dissertation, or would someone copy another dissertation from the same school or even the same professor? Unimaginable. But there was a precedent.

There was a case of collusion discovered at the medical school in Münster in 2011 that was identified by a Wikipedia author who stumbled upon two practically identical dissertations that were submitted three years apart – to the same examiners ([1] submitted in 2009 and since withdrawn, is a copy of [2] from 2006). This was found just after Germany was rocked by the Minister of Defense, Karl-Theodor zu Guttenberg, stepping down after his dissertation was found to be extensively plagiarized.  The dean of the medical school in Münster emphasized then in a press release that plagiarism in a dissertation was an absolute singularity. He also noted that they would be looking into punishing the advisor, perhaps by barring him from taking on doctoral students in the future.

Would it be possible to check whether it is indeed true that such a plagiarism is a singularity? After all, many theses are, indeed, available online. All a dishonest author would need to do would be to download one or more theses, touch them up, and submit them. Since they are apparently not read closely (or why is such a thesis acceptable in Münster? The formatting from PDF page 14 is so erratic as to make the text unreadable) this might seem a good strategy for someone who is trying to get that "Dr." with as little effort as possible.

Intra-University Clusters
The first step in identifying collusion within a university department is to obtain a good number of theses from a university and then check each one against all the others from the same school. A list of the dissertation-granting medical schools in Germany was quickly found online. An attempt was made to download medical theses for a selection of these schools, including Münster.

As is usual for data mining applications, the most time-consuming part of the exercise is getting the data ready for work. The university libraries' offerings of digital publications are of quite varying quality. Some offer wonderfully clean metadata with URLs to the entire thesis; others have chaotic catalogs, upload the same dissertation more than once under different names, or for some reason split a thesis into chapters. The names of the files are quite amusing, as they appear to be named by the candidates themselves: "copyshop-fassung.pdf" [copyshop version], "dissertation_finish.pdf", or just "doktor.pdf". Most are called "dissertation.pdf" or "doktorarbeit.pdf".

Since the main piece of software compares each thesis with all the others, the number of comparisons grows quadratically with the number of texts examined. Comparing only a few dissertations with each other only takes minutes, but as the number of dissertations examined increases, the time quickly grows to days or even months.

The results of the comparisons are not an automatic plagiarism determination: only identical text sequences are identified. Each and every suspicious pair of theses needs to be investigated manually. Often, both authors identified their thesis as joint work or the text is a direct quote, so this is not a plagiarism. Or both had a copy of the same questionnaire in the appendix and a very similar literature list that is responsible for the text similarity. Or two copies of the thesis were uploaded to the library database under different names. But occasionally, there is no such explanation for the numerous and at times extensive swaths of identical text. And so, researchers with VroniPlag Wiki began to document the theses – manually.

Manual documentation of plagiarism involves locating the text overlap positions, recording the overlap, and having a second researcher sign off on the documentation. Once a potential source for a thesis has been located, the text comparison tool SIM_TEXT that researchers at VroniPlag Wiki implemented so that it can run locally in the browser can be used to identify the positions of the text overlap. These are documented as fragments, recording the page and line numbers, and documenting the portion of text similarity in both the source and the potential plagiarism.

The result lists from the comparisons can be sorted by amount of text overlap, so that one can work down from the most extensive ones. Investigating Münster, quite a number of theses turned up that were able to be rapidly documented, as the theses were quite short and the text copying was often page-wise.

The University of Münster has set up an investigative committee that includes external experts for what the press speaker has termed a "conflagration" (Flächenbrand). The committee is to convene in July. The dean is quoted in the press as being extremely irritated by the number of cases documented, the head of the medical association of Westfalen-Lippe is quoted in the same article as stating that since it is expensive to train doctors and they are urgently needed, it would be a "waste of labor" to demand that medical students spend two to three years working on a dissertation. I respectfully request, then, that medical students just quit producing sham dissertations. They should be awarded an "M.D." upon finishing their studies and let those interested in furthering science and academics invest their labors in producing dissertations that are original work.

Die Ausbildung zum Mediziner ist teuer. Mediziner werden dringend gebraucht. Da sei es eine "Vergeudung von Arbeitskraft", wenn von einem Studenten verlangt würde, zwei, drei Jahre an einer Doktorarbeit zu arbeiten – wie in anderen Fächern üblich.

Münster - Münstersche Zeitung - Lesen Sie mehr auf:
http://www.muensterschezeitung.de/staedte/muenster/48143-M%FCnster~/Kammerpraesident-ueber-Plagiate-in-der-Medizin-Mogel-Aerzte-muessen-nicht-mit-Strafen-rechnen;art993,2384095#plx1248430946

Die Ausbildung zum Mediziner ist teuer. Mediziner werden dringend gebraucht. Da sei es eine "Vergeudung von Arbeitskraft", wenn von einem Studenten verlangt würde, zwei, drei Jahre an einer Doktorarbeit zu arbeiten – wie in anderen Fächern üblich.

Münster - Münstersche Zeitung - Lesen Sie mehr auf:
http://www.muensterschezeitung.de/staedte/muenster/48143-M%FCnster~/Kammerpraesident-ueber-Plagiate-in-der-Medizin-Mogel-Aerzte-muessen-nicht-mit-Strafen-rechnen;art993,2384095#plx89862196

There is also an interesting collection of statistics on dissertations in Münster put together by a VroniPlag Wiki researcher in an attempt to try and understand what may have caused this extreme cluster of plagiarism. What one sees here, though, is that the number of dissertations submitted has declined, as has the number of online publications.

Münster is not the only university that has been shown to have accepted massive plagiarisms. A thesis from the Charité in Berlin was recently posted (Ali) that has more than 75% plagiarism on all (100%) of the pages. It is also evident that data was falsified in this thesis, as the numbers of patients interviewed are different from the older thesis, but the percentages given are the same ones in the older thesis, not for the numbers published in the thesis itself. When Spiegel-Online questioned the doctoral advisor about the thesis, he could only vaguely remember it. The Charité is currently investigating.

Inter-University Clusters
After investigating theses from just one university, clusters from two or more different universities can be combined in order to see whether there has been any "borrowing" of text between the universities. This is an extremely time-consuming process, but it turns up fascinating results. Two theses have been found that are around three-quarters identical that were handed in within a few weeks of each other to two different universities under different advisors. If this was joint work, it is not mentioned in either thesis. There are quite a number of theses that are patchwork quilts of text from different universities. There is a 30-page thesis submitted to Mainz (Tz), of which over half of the pages are from a thesis submitted seven years prior to Gießen.

There are so many text identities that have been found, it would take an enormous effort to document them all. But it has been shown that it is possible, using a rather simple (if time-consuming) method, to detect collusion plagiarism. Universities that publish epubs should at least make sure that they are not re-publishing material before they put a text out in public. After checking against their own text collection, perhaps a test against a selection of other university libraries is worth the investment of time. And at the risk of sounding like a broken record: the examiners should actually read the theses and perhaps keep better track of their students and the topics they pose.

The next blog article will be quite technical and explain the methodology used to find these collusion plagiarisms.

P.S. While finishing up writing this blog post today, medical dissertation #22 from Münster was posted, Aaf. The 48% of the 31 pages that have text overlap appear to be taken from a thesis submitted one year previously. The text has been disguised by substituting synonyms and re-wording sentences. This makes it difficult for software to identify the thesis as a possible plagiarism, although there are some longish portions that are taken verbatim. Page 13 shows a problem that appears when plagiarized text is rephrased: the original author writes that S. aureus appears to increase the mortality rate. That word was left out of the reworded text in Aaf, making it appear to be a known fact.

Plagiarism or best practice in medicine?

VroniPlag Wiki [where the author is a participant] has documented extensive text parallels in four medical dissertations published on eDoc servers in the past weeks: Tz - Aho - Da - Feb. Tz and Feb are doctorates in dentistry, Aho and Da in medicine. Tz sports three "Dr." titles in front of his name, Feb uses this impressive collection of titles on his home page in his native country:

Dr. Dr. <Feb> D.D.S., Dipl. Funct. Dent., Dipl. Orth., M.S.D., Ph.D., Ph.D.

The doctorates were granted from different universities:

• Feb was granted two doctorates in dentistry, one in 2009 from the University of Tübingen and one in 2010 from the Charité in Berlin.  The Charité thesis is the one documented at VroniPlag Wiki, and it builds strongly on a thesis submitted to the University of Gießen in 2005, and the University of Würzburg in 2004. The thesis was given the Alex-Motsch-Preis 2009, awarded by the Deutschen Gesellschaft für Funktionsdiagnostik und -therapie – see [1], [2]. The thesis is a heavyweight for a medical thesis with 150 pages in the main part. However, almost 30 % of these pages are plagiarized.
• Tz has one doctorate in medicine, one in dentistry, and one in natural science. 56 % of the thesis in dentistry, which consists of just 30 pages and was submitted to the University of Mainz, is taken from a thesis submitted to the University of Gießen in 2003.
• Aho has 18 pages of his 58 page medical thesis that was submitted to the University of Hamburg that are completely taken from other works. In all, 51 % of the pages are found to contain plagiarism. One interesting copy & paste problem can be seen in this fragment, the formula becomes completely senseless: Aho/Fragment_040_01. This thesis was published in 2012, well after the zu Guttenberg plagiarism discussions were going on in Germany, so one wonders why the author would put a copied thesis online.
• The medical thesis of Da, with 45 pages, was submitted to the University of Freiburg/Br. in 2007. 51 % of the thesis is taken from other sources, in particular two dissertations from the Humboldt University Berlin [3], [4].

The three cases documented before these on VroniPlag Wiki are not from medicine directly, but from natural sciences close to medicine. Iam (Göttingen) has 35 % of the 81 pages containing text parallels, Mag (TU Braunschweig) 28 % of 110 pages, and Arc (FU Berlin) has a whopping 62 % of the 51 page thesis taken from earlier sources.

One can see by the size of the theses that that they are more similar to Master's theses than doctoral dissertations. The universities are often not interested in rescinding the doctorates, see for example the University of Gießen ([5, dentistry], [6, medicine], [7, medicine], [8, dentistry], three of the four not rescinded, one still under consideration, one other dissertation in law not rescinded). And as one of the authors of a medical dissertation documented on the VroniPlag Wiki pages stated when we spoke on the phone, they were told to use particular texts in their theses by their advisors. There was a folder next to the machine they used for their experiments, and everyone just copied the text from there. The real value of the thesis, he explained, was in the experiments conducted. Did they not realize that when publishing their theses online, the whole world can see the text copied?

So is this not plagiarism, but best practice in medicine and dentistry? Even if it is the same experiment, is it not possible to give the reference to the paper that first described the experiment, explaining changes that one has made to the setup? Why is it necessary to take so much text when the theses themselves are quite small? Two theses from the LMU Munich have been found that discuss experiments done in different years, but for which the text is practically identical ([9, 2006], [10, 2007]), without the later thesis mentioning the earlier one.

If it is best practice, then I think German universities should stop awarding doctorates in medicine. This is not science, but going through the motions in order to have those letters "Dr." (or multiples of the letters) to put on one's shingle. Let's not confuse the two.

Retractions as references

A reader pointed out an interesting article to me that was published in October 2012 on PLoS:

Investigation of CD28 Gene Polymorphisms in Patients with Sporadic Breast Cancer in a Chinese Han Population in Northeast China by
Shuang Chen equal contributor, Qing Zhang equal contributor, Liming Shen, Yanhong Liu, Fengyan Xu, Dalin Li, Zhenkun Fu, Weiguang Yuan, Da Pang, Dianjun Li

Down in the article there is a statement that is referenced like this:

Compared with rs35593994 ‘G’, rs35593994 ‘A’ may promote transcription of the CD28 gene by the presence of a binding site available for the CCAAT enhancer-binding protein, but not GFI1 (which functions as a transcriptional repressor) [36]. 

Okay, I don't understand a word of this, but I can follow the reference:

36. Rathinam C, Klein C (2012) Retraction: transcriptional repressor gfi1 integrates cytokine-receptor signals controlling B-cell differentiation. PLoS One 7.

Retraction? Are they citing the retraction of the article as a reference for what had been stated in the article retracted? The retraction notice from July 2012 is pretty clear:

The authors wish to retract the article "Transcriptional repressor Gfi1 integrates cytokine-receptor signals controlling B-cell differentiation" by Chozhavendan Rathinam and Christoph Klein. PLoS ONE 2007, 2(3):e306.

After publication of the article, concerns were raised regarding the control bands in Figure 5A, and in particular, whether the bands represent total STAT5. Examination of the original Western blot data revealed that primary Western blot documents were not archived with due diligence. As a consequence, the doubts about the proper representation of the control bands in Figure 5A could not be unambiguously resolved. This course of action is in line with the recommendation issued by Hannover Medical School.

Retraction Watch noted in September 2012 that this was the second retraction for these authors, who often publish together. The retracted paper is listed on a CV of Rathinam's (that may, however, be automatically gathered from the web), but the retraction notice is not there. Klein has neither the retracted paper nor the retraction listed on his CV.

The question asked by my correspondent is: Does anyone actually READ the papers that are submitted to PLoS? It is supposedly a peer-reviewed online journal. Or is there a reason for quoting the retraction notice in this manner that escapes me?
 

Share and share alike

Laborjournal and the local newspaper Wochenblatt report that the University of Regensburg has rescinded the doctorate of a dentist who had submitted a dissertation that was essentially that of her husband's.

The story begins with a organ transplantation scandal that broke in Germany in mid-2012.  Apparently, in 2010 and 2011 patient data was manipulated in order to enable certain patients to jump the queue for receiving an organ, as the weekly Zeit reports, for example many persons from Italy. The liver transplantation specialist from the University of Göttingen, Aiman Obed, was in the middle of this scandal, stepping down from the university at the end of 2011.

Obed had submitted his thesis on liver cancer to the University of Regensburg in 2004. His wife, Manal, is a dentist and had submitted her thesis to the same advisors on the same topic in 2006, although liver cancer is quite an unusual topic for a dentist. According to the news weekly Focus, the dissertations are not word-for-word copies, but have a similar structure, strikingly similar data, identical graphs, and even some of the same spelling and grammar errors. Focus obtained the theses and offer them as pdfs for others to check. Laborjournal published an editorial in October 2012 comparing a number of passages from the two dissertations.

Focus reported that a letter from Manal O. had been sent to the medical faculty of the university stating that she had plagiarized her dissertation and announcing that she would "return" her doctorate. Her lawyer insisted that she did not write the letter, but the university began investigations, as reported by the local Wochenblatt.

Laborjournal points out that there is no news on whether the university will be taking action against the advisors for the two theses. Since both are still active, Hans-Jürgen S. as a director of an institute for medicine at the University of Regensburg and Bernhard K. at the Mannheim Clinic at the University of Heidelberg, the question does arise as to how they are to be permitted to continue advising doctoral students. Although, when one looks at other medical theses from the University of Heidelberg, for example the case documented on VroniPlag Wiki of a doctoral thesis copying extensively from the habilitation of her doctoral advisor, it seems that quite a number of doctorates in medicine in Germany do not have anything to do with good scientific practice.

...
FORSCHUNG UND TECHNIK, MEDIZIN: Herr und Frau Doktor - weiter lesen auf FOCUS Online: http://www.focus.de/gesundheit/arzt-klinik/news/forschung-und-technik-medizin-herr-und-frau-doktor_aid_815715.html

Medical Triple Header

It was a busy Friday afternoon on the VroniPlag Wiki site. Even though there are still fragments still awaiting a second opinion, three German medical dissertations were named on the home page:

• #31: http://de.vroniplag.wikia.com/wiki/Ch, clocking in with just 60 pages, already has 53 % of those pages documented with text parallels. Eleven of those pages contain more than 75 %. The thesis was submitted to the medical department of the University of Freiburg/Breisgau in 2009, defended in 2010, and published in 2011. 
• #32: http://de.vroniplag.wikia.com/wiki/Raw, is a veterinary thesis submitted to the  Tiermedizinische Hochschule Hannover in 2007, "only" has text parallels on 28 % of the pages, but there are some complete pages that are copied (Page 13 and Page 33) as well as extensive copying from the Wikipedia and a number of other dissertations submitted in veterinary medicine both at the Hannover school as well as other schools.   
• #33: http://de.vroniplag.wikia.com/wiki/Qf, is a medical thesis submitted to the University of Tübingen in 2001. There are text parallels on  21 % of the pages, and it seems that this thesis was also the basis of some of the plagiarism in Case #32. Most of the text parallels found to date in this thesis are from older dissertations published in the year 2000.

Should we bother documenting plagiarism in medical theses? The discussion rages on behind the scenes. A medical doctorate is just not the same level of work as a doctorate in other fields. I think the German universities need to switch to a more honest M.D. degree that they award (so they can still call themselves "Doktor"), but to quit the pretense of doing research. It appears that fragments of text, much like DNA or RNA, splits apart and recombines with other texts, with a few different numbers thrown in here or there. 

I've written to the universities in question, but I'm not holding my breath. There is a lot of feet-dragging going on in investigating the accusations of plagiarism.

Welsh Medical Dean under Investigation

The Times Higher Education reports on investigations being launched in Wales into an image manipulation case. There have been allegations of six papers published by B. P. Morgan, who is dean of medicine at Cardiff University, containing manipulated images.

Morgen is a prolific author, having published 400 172 papers since 1998. As one of the commenters noted: "That's one every single fortnight, rain, hail or sunshine, Christmas, Easter and summer for fourteen years. And he has had time to be Dean for part of that, too?"

Science Fraud has more detail on the cases,  and Retraction Watch details one paper that was retracted from the Journal of Immunology.

Inquiry results published

The Ludwigshafener hospital has published a press release about the results of the inquiry into the research of Joachim Boldt. He was the former "retraction king", having had to retract 88 of his publications. He has since been "de-throned" by Yoshitaka Fujii (as reported by Retraction Watch).

Boldt already left the hospital in November of 2010, after criticism of his research grew too loud to ignore. The board examining his papers needed a good 18 months to go through everything and determine that "in a large number of the studies investigated, the conduct of research failed to meet required standards. False data were published in at least 10 of the 91 articles examined, including, for instance, data on patient numbers/ study groups as well as data on the timing of measurements."

They try and play it down as being mostly a procedural thing, and are relieved that no patients came to harm. They promise that they have fixed procedures.

But I still have a few questions:

• Where did the money for this research come from? Was this government money? Was it from a pharmaceutical company?
• Has anyone used the since-withdrawn studies? That is, did anyone else quote his papers or try and replicate the experiments?
• Is Boldt still permitted to practice medicine?
• The hospital states that they will be monitoring future clinical studies - how will they be encouraging people to speak up about falsification of data? That has nothing to do with monitoring, which brings up notions of even MORE paperwork. How are they going to foster an environment in which people can question the research being done without fear of retaliation.
• Why did this take 18 months?

The German Dissertation Factory

The daily newspaper Main Post reports on the current state of investigations into the German "dissertation factory" at the medical faculty of the University of Würzburg. The university is doing its best, the article says, to dig out under the investigation of 20 dissertations, of which four are found to be plagiarized.

In 2009 the prosecutor's office investigated claims that a Würzburg medical professor who had had over 200 students write their dissertations with him was selling titles. Or rather, he was accepting loans to fund his research. He was fined for taking bribes. In May 2011 an anonymous dossier turned up with many names and dates - but there was no way to prove that money had been exchanged here for titles, so the case was officially closed, the professor is now retired. The person who arranged for the prospective doctoral students to be accepted and took a 1000 € fee for this was, however, fined.

The university was somewhat skittish about the situation and started an investigation into the matter. 20 of the theses were of a very questionable nature - I have seen some of the theses, for example one by a dentist writing a short dissertation (27 pages) in the field of the history of medicine by transcribing fifteenth century texts about the pharmaceutical use of some flowers. Not analyzing anything, not translating, just transcribing. The university has determined that four of the theses are plagiarisms to boot, and has decided to rescind the doctorates. The persons in question are, as seems usual in Germany, taking the university to court in the hopes of keeping their titles because the university has made some procedural error.

When the newspaper tried to contact one of the dentists involved a lawyer answered forbidding any reporting that might point to his client - who is apparently a friend of a former governor of a German state.

I wish the university a strong case in court - and hope that they set up procedures for not accepting theses like this ever again.

Update: Just including a link to an in-depth article at Zeit online about this case from 2012.

New Fake Data Record Holder

A reader alerted me to the new fake data record holder from Japan, displacing the current German record holder, Joachim Boldt, with only 88 retractions to his name, according to Retraction Watch. Both Retraction Watch and ars technica report on the Japanese anesthesiologist Dr. Yoshitaka Fujii from the medical school of Toho University. Fujii has published 212 papers, but the data to back up the papers can only be found for 3. Currently, 172 papers have been found to contain fabricated data. He also apparently forged signatures of supposed co-authors.

J. B. Carlisle published a statistical paper in Anesthesia in May 2012 ( DOI: 10.1111/j.1365-2044.2012.07128.x) entitled "The analysis of 168 randomised controlled trials to test data integrity":

"The published distributions of 28/33 variables (85%) were inconsistent with the expected distributions, such that the likelihood of their occurring ranged from 1 in 25 to less than 1 in 1 000 000 000 000 000 000 000 000 000 000 000 (1 in 10³³), equivalent to p values of 0.04 to < 1 × 10⁻³³, respectively."

Highly unlikely, that. The university then started an investigation into this research, which was published in over 20 journals. They have just published their report. A comment on Retraction Watch hits the nail on the head: "Anesthesiologists need to WAKE UP to fraud".

Heidelberg happy with 75% plagiarism

The Frankfurter Rundschau reports in a short notice that the University of Heidelberg Medical School has decided that a medical dissertation that has plagiarism on over 75% of the pages (and most of the plagiarism is from the habilitation of the doctoral advisor) is perfectly all right. Oh, it is not good scientific practice, but the doctorate will not be rescinded and the grade will not be lowered.

This bizarre decision led to further investigations at this university that has been deemed an "Excellent" school in Germany. One of the VroniPlag researchers dug up the document explaining how the theses are evaluated in Heidelberg in the medical school. Failure is not an option. If you just hand in something, it is considered passing. I find this shocking

Another VroniPlag researcher has suggested that the medical schools just have their students hand in an Excel sheet and a lab book instead of suggesting that they actually wrote complete sentences, since in fact they appear to just take a textual stencil and plug in their values.

The German Wissenschaftsrat already noted in 2004 that medical dissertations are not really dissertations as they are in other faculties. I find it scandalous that this obvious plagiarism does not have consequences - and there are a number of strange things around the thesis itself, for example that it was handed in in 2002, but not defended until 2006. The university replies, when questioned, that this is all in the realm of personal privacy and they won't answer questions.

How do I explain to my students that they are not allowed to copy text without attribution, but that it is just fine for a medical student to do so?

It is time for a serious renovation at German medical schools - time to move to an M.D. for general doctors and reserve a Dr. med. for those who can do real research.

I just had a look at the statistics for 2010. 3,6 % of the student population in Germany studies medicine. 28 % of the dissertations are in medicine. A whopping 49% (867 out of 1755) of the habilitations done in Germany in 2010 were in medicine. This raises a lot of questions - the number of habilitations compared to the number of dissertations would be about commensurate with the rate of students in medicine. If we take out all the medical dissertations and add in the medical habilitations, we would have 4,5% medical theses. So it seems that indeed, a dissertation in medicine is just a Master's degree and the habilitation should be considered the doctorate. A very strange state of affairs. 

Medical dissertations in Germany

A reader pointed out to me that in 2004 the Wissenschaftsrat, an advisory board on science in Germany, already reported on the desolate state of medical dissertations: http://www.wissenschaftsrat.de/download/archiv/5913-04.pdf  (pp. 74-78, in German)

Medical dissertations and habilitations, with the exception of the occasional exceptional work, often do not reach the scientific standards of other disciplines [...] as a result the study [meant is M. Weihrauch, J. Strate und R. Papst: Die Medizinische Dissertation - kein Auslaufmodell. Ergeb-nisse einer Befragung von Promovierenden stehen im Widerspruch zu oft geäußerten Meinungen, in: Deutsche Medizinische Wochenschrift 128, 2003, 2583-2587] demonstrates that medical dissertations are more similar to diploma theses in the natural sciences than the dissertations done in these fields, when one looks at the data for amount of effort invested and publication success. [translation dww]

It is nothing new that the theses that are original are often very thin. The shortest dissertation I have seen to date in medicine is four pages. VroniPlag has been demonstrating that excessive text recycling takes place in some research groups. What are the consequences? If there has been no reaction to the report of the Wissenschaftsrat in 2004, it is doubtful that any reaction is forthcoming in the near future. Germany just stumbles on, business as usual.

Professor barred from advising for 2 years

The University of Münster in Germany has barred a professor from accepting doctoral students for two years, the Westfälische Nachrichten reports.

In July 2011 the university rescinded a doctorate that was found to have replicated one submitted to the same advisor a few years earlier. The duplicate disseration was found by a Wikipedia editor researching a topic.

The university continued the investigation into the role of the advisor. It was decided that he had been "inattentive", not remembering that he had seen the same thesis a few years earlier. The faculty voted to give him two years time to work on focusing his attention - he is not allowed to advise doctoral students during that time, but can continue to teach and keeps his job as a professor.

He has been quite a popular advisor, and was given a prize for teaching just prior to the story of the duplicate dissertation breaking.

The university hopes that everything is now okay, as they make all doctorates and advisors sign a contract with each other and run all the theses through a software system.

On the basis of my tests of plagiarism detection systems I would not be so sure.

Medical doctorate rescinded

The German University of Münster announced on July 14, 2011 that they have rescinded a doctorate from the medical faculty.

A Wikipedia editor reports on a strange occurrence while researching an article about growth factors in prostate cancer in the Wikipedia Kurier from May 28, 2011. The editor was using a dissertation from 2006 as the basis for the Wikipedia article. Dissertations - the non-plagiarized ones - are very useful for this task, as they offer a succinct overview of the literature on the topic.

The editor stumbled over the term Xxxxxxxxx xxxxxxxxxxxx xxxxxx something s/he had not heard before. It was references from a book from 1996. Instead of running to the library to get the book, the editor first asked the "all-knowing garbage heap" if there was anything on this term around.

The editor was amazed to find a dissertation from 2009 on the same topic from the same university. The university puts all of its dissertations online, so only a click was necessary to download it. A short read was, as Yogi Berri would have put it, "déjà vu all over again". The editor thought this might just be a typo on the downloads page and that s/he now had two copies of the same dissertation. But no, each was by a different author.

Since zu Guttenberg had just recently resigned and VroniPlag was under full steam investigating other dissertations, the editor began a side-by-side comparison. Except for minor (and sometime error-inducing) changes, the general introduction to the topic was identical, down to the the line breaks. Then it got worse: there were even identical results, discussions, and the dedication - except the names were changed. The CVs were, however, different.

The editor was not sure what to do, consulted with some scientists. The unanimous opinion was: this must be reported to the authorities. So it happened, and the doctorate has been rightly rescinded from a practicing medical doctor in Westphalia.

I have often stated, as here in the Deutsche Ärzteblatt, that we need two kinds of doctorates for medicine: M.D. for the practicing doctors and Dr. med. for the researchers.

I'm glad the University of Münster was so quick in reacting.

Plagiarism Found by Chance

The Münsterländische Volkszeitung reports on a strange case of plagiarism. An author for the German version of the Wikipedia was cleaning up the article on prostate cancer and looking for a serious source for one statement. Doctoral theses are great places to find these, as proper disserations include an overview of the current literature on the topic.

As the author describes in the Wikipedia Kurier from May 28, 2011, while looking through the dissertation from 2006 a term showed up that was quite unfamiliar, although the author had been researching the topic for a while. A source was given, from 1996, but not feeling like going to the library, the Wikipedia author just asked the "omniscient garbage can" about the term - and found a few hits.

One was a dissertation from 2009 - from the same department of the same university. The author downloaded it, and started reading, and it was déjà vu all over again, in the immortal words of Yogi Berra. The author thought that perhaps the links had been mixed up. But no, they had different authors, different years, but even the same advisor.

But Diss 2009 had been slightly changed. For example, 2009 discovered that one source in 2006 was included in the bibliography twice by mistake - it was removed and the references renumbered. Even large portions of the acknowledgments are identical. The CVs are, however, different.

The University of Münster was informed in March, the committees are working, there is no word yet on their decision. These kinds of cases tend to be very hush-hush, just in case the charge of plagiarism is being lodged just to throw dirt at someone. If I hear of a result I will report it here.

German World Record in Retractions

Somehow this flew under my radar, so I'm picking up the pieces here. Much is already well documented in the Wikipedia and The Telegraph.

German anesthesiologist Joachim Boldt had a stellar career - he had published about 200 papers, many on the use of hydroxyethyl starch (HES) during anesthesia. As it turns out though, he did not actually have either the permission of the patients to do the research, nor did he have approval of the ethics board for this research. In one case, the ethics board flatly refused a proposed study.

He was a professor at the University of Gießen and mentored numerous dissertations there, at least two of which were conducted without explicit permission after the university set up explicit procedures in 2000, according to the Hessischen Rundfunk.

He has had his professorship withdrawn for not teaching and has had to retract an extraordinary number of his papers. Retraction Watch reported in November and now in March on the investigations into almost 90 of his papers. 88 studies published in 18 journals have had to be retracted, one turned out to be okay, as he could produce documentation of ethics committee permission for the study, although he had changed the title of the study. The studies are funded by the pharmaceutical company producing the HES drug.  The complete list of retracted papers is available online, signed by all the journal editors.

This, according to Retraction Watch, is a new world record, topping Jon Darsee with 82 retractions.

Luckily for patients in the Ludwigshafen area, he has also been fired from the clinic. The current professor for anesthesiology in Gießen, Markus Weigand, sent an internal email around the department denouncing the TV documentary on the case "defacto".  Weigand is said to have called the defacto story unscientific and only interested in scandal. He also outlined the procedure for obtaining ethics board approval for research. It seems much needed.

Anniversary Book Withdrawn

The Tagesspiegel reports this morning on a withdrawn book.

The prestigious Berlin university medical center Charité is celebrating its 300th anniversary in 2010. In honor of the occasion they put out a book about their history, and commissioned a journalist, Falko Hennig, to assist in producing the volume.

The historian of medicine, Philipp Osten, was looking forward to the book and immediately opened it to the chapter on orthopedics, his specialty. There he discovered about 8 pages lifted from his own book, Die Modellanstalt, without permission and with a different author listed.

He contacted the editors and the publisher, who immediately investigated the allegations. They soon found more plagiarism by Hennig in other chapters, and so they have decided to withdraw the book. The publishers are suing Hennig.

Update: Spiegel Online reports that the Charité's own medical history department did not want to produce such a book. The supposed "authors" of the chapter on orthopedics had no idea that they were authors, and the editors are doing a lot of hand-washing, as they were "only" editors. Spiegel Online also reports that Henning is looking for a good intellectual property rights lawyer, as he reports on his Twitter stream.  

Biomedical Text Similarity

Science Daily alerted me to this publication on PLoS

Systematic Characterizations of Text Similarity in Full Text Biomedical Publications
Sun Z, Errami M, Long T, Renard C, Choradia N, et al. 2010 Systematic Characterizations of Text Similarity in Full Text Biomedical Publications. PLoS ONE 5(9): e12704.doi:10.1371/journal.pone.0012704

The authors of eTBLAST, a text-similarity search engine, have expanded their work that at first investigated text- and author-similarity on PubMed abstracts (CSP article from 2008). They have now accessed full-text articles to dig deeper into text similarities.

They investigated over 70.000 full papers, and determined that abstract similarity is a good predictor of full text similarity. They caution, however, that the automatic identification of possible cases of plagiarism must be checked by hand to determine if indeed plagiarism is present. They only uncovered 34 highly similar papers, and all were updates or multi-part articles that did indeed share larger sections of text.

However, they note that many of the currently uncovered plagiarized publications, for example in Chile and Peru [1], were translations and these are not included in the PubMed database.



[1] Sources given in the article about the Chilean and Peruvian cases:

1. Arriola-Quiroz I, Curioso WH, Cruz-Encarnacion M, Gayoso O (2010) Characteristics and publication patterns of theses from a Peruvian medical school. Health Info Libr J 27(2): 148–154. 
2. Salinas JL, Mayta-Tristan P (2008) [Duplicate publication: a Peruvian case]. Revista de Gastroenterologia del Peru 28: 390–391. 
3. Rojas-Revoredo V, Huamani C, Mayta-Tristan P (2007) [Plagiarism in undergraduate publications: experiences and recommendations]. Revista Medica de Chile 135: 1087–1088. 
4. Reyes H, Palma J, Andresen M (2007) [Ethics in articles published in medical journals]. Revista Medica de Chile 135: 529–533.

Advertising and Peer-Review in Medical Journals

The German online news site Telepolis reports in October 2010 about the pharmaceutical company Wyeth, which belongs to the Pfizer concern, hiring a public relations company (DesignWrite) to inject ghostwritten advertising into peer-reviewed articles that appear in closed-access medical journals.

The PR company carefully wrote articles that in diction and appearance seemed to be scientific articles that surveyed the literature on the topic of hormone replacement studies for menopausal women. The surveys downplayed the negative side effects, which include a higher risk of breast cancer, and praised the positive side effects, such as lowering the probability of dementia, of the substances. Later studies have shown that these hormone replacement medicines actually increase the probability of dementia. These surveys were given to researchers, who "edited" the articles and submitted them for publication to peer-reviewed journals.
 
This blog noted the article published in 2009 in the New York Times. Adriane J. Fugh-Berman, an associate professor for Complementary and Alternative Medicine at Georgetown University, has now published her study of the incident in the open-access journal PLoS: The Haunting of Medical Journals: How Ghostwriting Sold “HRT”.
Fugh-Berman has published a meticulously linked and documented article that demonstrates the depths of this relationship between the ghostwriters. One sample:

One co-author seemed puzzled by the concept that she was to author, but not write, an article [34]: “From what you have written, I would be more of an ‘editor’ rather than the major writer—that is, you guys would be writing the versions—with me ‘altering, editing, etc.? Is that correct?’” 1This query was in response to an e-mail from Karen Mittleman (a DesignWrite employee who supervised medical writers) that stated: “The beauty of this process is that we become your postdocs! … We provide you with an outline that you review and suggest changes to. We then develop a draft from the final outline. You have complete editorial control of the paper, but we provide you with the materials to review/critique” [34].

This would also suggest that the "normal" way of writing is to have the postdocs do the work and the PI publish the paper. And even when a peer review tried to question a paper, documents show that DesignWrite responded to the reviews (and not the supposed authors), at times scolding the reviewers for misusing the peer-review process! 

Fugh-Bermann summarizes:

Acceptance of ghostwriting, euphemistically termed “editorial assistance,” may be so widespread that it is considered normal. This could explain why several authors of ghostwritten articles have defended their involvement.

As a researcher for complementary and alternative medicine, it is of course to her advantage to demonstrate that what we have considered to be "hard science" in the area of medicine up until now has degenerated into an advertising circus. But her results are not based on just a single case - the list goes on and one. Fugh-Bermann: "Medicine, as a profession, must take responsibility for this situation. Naïveté is no longer an excuse."

Paper by former vice-president of Iran retracted

Nature reports that a "review paper by Massoumeh Ebtekar, the former vice-president of Iran and an immunologist at Tarbiat Modares University in Tehran, is to be retracted from an Iranian journal following allegations that it was almost entirely stitched together from other scientists' papers."

NatureNews: Butler, Declan. Iranian paper sparks sense of deja vu - Allegations of plagiarism prompt journal to retract report. Published online 22 October 2008 | Nature 455, 1019 (2008) | doi:10.1038/4551019a (http://www.nature.com/news/2008/081022/full/4551019a.html)

The plagiarism is one of more than 70,000 entries in the Deja Vu database. Powered by a tool called eTBLAST, it collects similar articles from the various scientific journals indexed by Medline. It takes an abstract, searches for similar ones, and then compares them, determining which one was published first. This blog noted a previous case in January 2008.

There are a shocking number of papers that are exact duplicates (but published in different journals), or have the same abstract but are published in different languages, or are identical but have different authors. Deja Vu is run by the University of Texas Southwestern Medical Center at Dallas and is funded by the Hudson Foundation and the National Institutes of Health.

This is a great service to the community!