Summa cum fraude or Scientific fraud

It’s been over a month since the last post. You be the judge if the time was well spent

Thomas A. Hennebry, interventional cardiologist Oklahoma Heart Hospital, called it “the most blatant example of scientific fraud encountered in my academic career.” A group of esteemed Italian cardiologists speaks of it as the “worst scam ever associated with an international journal of medicine,” and describes the facts as “shocking and shameful”.

In order to request the removal of the director of the scientific journal, that is held responsible, if nothing else for “negligence”, 23 cardiologists had to voice their intention to quit the Editorial Board.
As a result of the scandal, three issues of the journal should have been withdrawn because poor scientific standards. It has not been done, perhaps for economic reasons.

Above all, the case hasn’t been brought to court to investigate alleged wrongdoings and potential responsibles.

Not a single line appeared on the scientific or the general media. . Today, two years later, the choice has proven to be extremely short-sighted (see box SCIENTIFIC FRAUD OFFENCES AGAINST THE COMMUNITY at the end of this post).

Since November last year, the position of Head of Cardiology at Policlinico S. Orsola Malpighi in Bologna is vacant; the role was provisionally assigned to an associate professor .

Conversely, the editor of the Journal of Cardiovascular Medicine, who is a full professor, never held accountable for any liability and possible damage caused during his direction, has recourse to the courts to have it awarded by the judiciary.

Which might find the details we are going to report here of some use.

THE FACTS. Back to our story. Between July and August 2012 a number of strange letters were received by the staff of the scientific journal Journal of cardiovascular medicine, or JCM (see below box magazine). The clearest sign of alarm came from the United States, it was signed by Thomas Hennebry, at that time a researcher at the University of Oklahoma: it reported significant faults in the review system. In particular the email pointed out that “there were large differences between the version of the article that the researcher had sent and had been approved for publication, and the version published in the July issue of the magazine” (the problem would be continued in the files August and September).

All complaints highlighted the same anomalies, namely the addiction of bibliographic citations to the texts.

The review sequence of a scientific paper always follows the same standard procedure. During the editing, a reviewer may suggest or require the addition of a quote blatantly missing. But usually these additions are made before the final copy is submitted to the author for approval.

Also, the citations suggested by the reviewers have to be pertinent to the specific research field, mentioning authors who made a significant contribution to the scientific literature around the issue.

Hennebry stressed that “more than ten” added quotes were not only irrelevant to the article’s topic, but had been added without his approval after his final review of the text, just before publication.

BOX JOURNAL OF CARDIOVASCULAR MEDICINE The Journal of Cardiovascular Medicine is the house organ of the FIC, the Italian Federation of Cardiology, which includes the SIC, the Italian society of cardiology and ANMCO National Association of Hospital Cardiologists.
Its first issue was published in January 2006. It’s ranked 49th among the existing 124 journals on heart and cardiovascular system and (according to the Journal Citation Reports, 2012, the world’s leading scientific journal, Circulation, an IF of 15.202) it has an impact factor of 2.657.
It is an Italian journal published in English. Since the end of 2012 the editor in chief is Livio dei Cas. In short, the management is different from the past one (July, August and September 2012). It is published by Wolters Kluwer Health and Lippincott Williams & Wilkin*
Who stands to gain? It has been reported in the past that editors of small magazines have asked the authors to include citations of works previously published in the same journal in order to increase the impact factor, namely its scientific authority, but that was not the case.


In fact, the American researcher emphasized that all harked citations referred to papers written by Raphael Bugiardini, full professor of cardiology at the Medicine faculty of Bologna, at that time Head of JCM.

At that point, someone started to browse past issues of the magazine and noticed that the first signs of this practice dated back to mid-2011, but had intensified in July 2012, to continue in August and September. With the persistence of such anomalies the papers authors’ continued to voice their concerns. In the September issue, seen in draft by staff members, the fraud had worsened: some quotes, added without following the standard procedure and unrelated to the article’s contents, harked back to publications by Peter J. Schwartz, at the time professor of cardiology at the University of Pavia. Schwartz, the highest h-index of the Italian community cardiology (93), had suggested that the use of his name was intended to muddy the waters.

The motivations. Why adding irrelevant citations? In 2012, an important change in the selection criteria for examining board and candidate professors was introduced. To make sure the selection process was rigorous and to prevent scientists without a robust scientific output to achieve important positions in academia or control over the selection of new candidates, the Ministry of Education (Ministry of Education, University and Research ) had introduced an evaluation system for the quality of the scientific production, adopted all over the world. The method is based on the h-index, also called Hirsch index, which assesses the scientific output of researchers based not only on the number of published articles, but also on the number of citations from other authors . For example, an h-index of 3 means that the researcher has published three papers, each mentioned by at least 3 other authors. Papers not mentioned in the H-index do not count.

The JCM case shows how quotations can be manipulated to boost the h-index of an author, in this case Mr Bugiardini Raphael, editor of the journal.

The first letter. Between late July and mid-August 13 university professors of cardiology sent a letter to Massimo Volpe, professor of cardiology at University La Sapienza of Rome and president of the College of Professors of Cardiology. “In articles published in July and August 2012 issues of the JCM, the number of citations of papers published from the Editor and his collaborators exceeds 150 units, with an average of about 6 quotes for every paper … – original contribution, review papers, research letter, etc. – published in JCM! This number is in itself unusual for any author, and it appears even more anomalous and disproportionate when compared to the number of citations that the Editor work received on the rest of the scientific literature …

As a result of this editorial policy, the Hirsch index of the JCM Editor, ranking 17 in 2010, currently totals 28 (source: Publish or Perish). The 13 professors went on asking to “convene a Board … to agree on any action to be taken against this unfortunate situation.” Here linked the text (Lettera al Prof Volpe) of the Letter to Prof. Volpe which ditails the Hirsch index scores obtained from the Editor with the added quotes. Similarly, had been urged members of the board of the FIC, the National Federation of Cardiology owner of the magazine, and the publisher. But despite the legal implications nobody took action against the author or authors of the fraud.

The second letter. At this point, on August 23, 2012 at 17.29, another group of cardiologists sent an e-mail addressed to the board of the Italian Federation of Cardiology, the deputy directors, past directors of the magazine and publisher. Attached to the email, a document in English of two pages and a half densely typed, with the signatures of 23 Italian professors of cardiology (among them luminaries such as Attilio Maseri), gave an ultimatum: if Raffaele Bugiardini wasn’t suspended from the position of editor of the journal on August 31 the members of the editorial board present among the signatories would resign in group. (qui il testo originale dell’allegato)

Three days later, on August 26, in Monaco of Bavaria, during the ESC (European Society of cardiology) congress , the Governing Council of the FIC appointed a disciplinary committee formed by Francesco Fedele, Pantaleo Giannuzzi, Joseph Mercuro and Gian Luigi Nicolosi. The committee received various documents supporting the case, including this one (questo), signed by 33 cardiologists, summarizing the motivations of ‘”accusation”.

The investigation lasted exactly one month and on 26 September the four arbitrators signed the report (relazione) to the Governing Council of the Italian Federation of Cardiology. In two pages full of motivation responded to the question, “If there has been an abuse of position by the Editor prof. Raffaele Bugiardini, outside of the rules of national and international scientific publishing, with corresponding damage of the Italian Cardiology image. ”

In particular, wrote the arbitrators «The analysis of the above told facts shows: a) the creation of publishing conditions that favored, in a systematic and repeated way, the personal visibility of prof. Bugiardini, with potential personal positive professional impact; b) the search for a private interest and therefore an abuse of his position of Editor of the JCM, who should identify and correct this anomaly and c) the damage to the image of the JCM, journal under the direct responsibility of the FIC, which represent Italian Cardiology». They concluded that «the Commission considers that there has been an abuse of the position of Editor of prof. Bugiardini. This abuse determines its incompatibility with the conservation of this role, becouse of the decay of the fiduciary relationship with the Fic that is the basis for such a task.”
On JCM another Editor has now taken the place of Raffaele Bugiardini whose name appears among the Past Editors. But Bugiardini continues to benefit from the fraud. The three fake issues have not been withdrawn, hence he continues to enjoy the fraudulent quotes inserted to his advantage in the period in which he was director. He now aims to get from a Court the role of head of Cardiology of Policlinico S. Orsola Malpighi in Bologna. As for the journal, starting with the October issue no complains about counterfeit quotes arrived.

Letter at issue. We asked Professor Bugiardini a contribution to this post. He said he was “old and tired”; attributed the facts recounted here to denied allocation of beds for patients to his role of full professor. He also sent us a controversial letter (Lettera prof Puddu) dated August 18, 2012 and directed by Professor Paolo Emilio Puddu, University La Sapienza of Rome, to the President of the College of Professors of Cardiology. He said president Massimo Volpe is the same mentioned in the text . The letter suggests that he and other members of the Italian cardiology may have taken advantage of their editorial role to keep publishing their papers on scientific journals , regardless of the conflict of interest. We link the Letter of Professor Puddu with a caveat: the practice described here is widespread; in fact traditionally in these cases, in order to avoid conflicts of interest, the most respected journals rely on the revision of the papers to a guest editor unrelated to the editorial board. From the letter of Prof. Puddu it is not clear whether this practice was not applied in the cases he lists. So far the facts.

OPINIONS. In the absence of a judgment of a Court, and even though he was the beneficiary, Raffaele Bugiardini can not be held responsible for the scam. For this reason, we are convinced that the scams of scientific research must be judged in court. The problem in fact, as we explain in the box below, is not just about science.

BOX SCIENTIFIC FRAUD, CRIMES AGAINST SOCIETY Scientific fraud is a crime against the scientific community, as it affects research standards; but from the point of view of the citizen it is primarily a crime against society. To hide fraud, as often the Italian scientific community does, means to prevent civil society to develop antibodies and means of defense. Society attributes to the scientific world the task of assessing the value of individual scientists: researchers publish on scientific journals that accept or reject their work according to the decision of other researchers; they get a score (h-index), based on the approval of magazines, more or less prestigious, that hosted their scientific production.
But that score has economic aspects for society and not only: it allows the researcher to win competitions and to boost their “career” in the scientific world, with teaching responsibilities: that is, they will be responsible for the education of future generations and for their job they will be paid by the Ministry of Research with taxpayers money .
The h-index will also allow them access to public research funds ; if doctors they will have access to positions of responsibility because departments, wards or beds are equivalent to flesh and bone of patients under his care. That’s why researchers who commit fraud   affect the whole community, appropriate money which they is not entitled to, and may also endanger citizens health.
The Italian organization is particularly weak against scientific fraud. A recent editorial in the scientific journal Nature explains that foreign countries such as USA or Germany have “an admirable system of self-regulation, arming universities with clear guidelines on good scientific practice, procedures for investigating allegations of misconduct and an ombudsman system to which whistle-blowers can turn “; that “all systems are designed to protect the deep gorge and the accused during the investigation… all the systems aim to protect the whistle-blower and the accused during investigations ” But, as Nature well explains ” Italy has no scientific-misconduct procedures in place, so last year, a frustrated whistle-blower presented his allegations of inappropriate duplication against a cancer researcher to the police. The police seem to be carrying out a serious, detailed and thoroughly pro­fessional investigation.”
And only 20 months after the start of the investigation some details were leaked to the press. This is the well known case of Alfredo Fusco, Professor of Pathology, Director of the Institute of Endocrinology in Naples and Experimental Oncology of the CNR and member of the Accademia dei Lincei.
He says that the police do not have the tools to survive in the complicated maze of scientific research. The editorial in Nature answers, “Really? Police forces worldwide routinely deal with financial and computer crimes, the details of which can seem equally impenetrable” … But that’s not all. Nature writes “any external inquiry has a distinct advantage: it cannot be hindered by the intrinsic threat of conflict of interest that comes when any community sits in judgement on its own members.” In fact, the investigation of the judiciary would be revealing a market for studies of computer graphics useful to falsify the images of “scientific” studies.

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