2Singh RB,Rastogi SS,Verma R,Bolaki L,Singh R.An Indian experiment
with nutritional modulation in acute myocardial infarction. Am J Cardiol
Singh RB, Rastogi SS, Niaz MA, Ghosh S, Singh R, Gupta S. Effect of fat
modified and fruit and vegetable enriched diets on blood lipids in the
Indian Heart Study. Am J Cardiol 1992;70:869-74.
Lock S, Wells F. Fraud and misconduct in biomedical research. London: BMJ
International Committee of Medical Journal Editors. Retraction of
research findings. BMJ 1988;296:400.
Singh RB,Ghosh S,Niaz AM,Gupta S,Bishnoi L,Sharma JP,et al.Epide-
miologic study of diet and coronary risk factors in relation to central
obesity and insulin levels in rural and urban populations of north India.
Int J Cardiol 1995;47:245-55.
Singh RB, Niaz MA, Ghosh S. Hypolipidemic and antioxidant effects of
Commiphora Mukal as an adjunct to dietary therapy in patients with
hypercholesterolemia. Cardiovasc Drugs Ther 1994;4:659-64.
Singh RB, Niaz MA, Ghosh S, Singh R, Rastogi SS. Effect on mortality
and reinfarction of adding fruits and vegetables to a prudent diet in the
Indian experiment of infarct survival (IEIS). J Am Coll Nutr 1993;12:255-
Singh RB, Ghosh S, Singh R. Effects on serum lipids of adding fruits and
vegetables to prudent diet in the Indian Experiment of Infarct Survival
(IEIS). Cardiology 1992;80:283-93.
10 Singh RB,Rastogi SS,Singh R,Ghosh S,Niaz MA.Effects of guava intake
on serum total and high density lipoprotein cholesterol levels and on
systemic blood pressure. Am J Cardiol 1992;70:1287-91.
11 Singh RB,Rastogi SS,Sircar AR,Mehta PJ,Sharma KK.Dietary strategies
for risk factor modification to prevent cardiovascular diseases. Nutrition
12 Singh RB, Verma R, Mehta PJ, Rastogi SS. The effect of diet and aspirin
on patient outcome after myocardial infarction. Nutrition 1991;7:125-9.
13 Singh RB, Rastogi SS, Mehta P, Mody R, Garg V. Effect of diet and weight
reduction in hypertension. Nutrition 1990; 6: 297-302.
14 Singh RB, Rastogi V, Niaz MA, Ghosh S, Sy RG, Janus ED. Serum choles-
terol and coronary artery disease in populations with low cholesterol lev-
els: the Indian paradox. Int J Cardiol 1998;65:81-90.
15 Singh RB, Rastogi V, Singh R, Niaz MA, Srivastav S, Aslam M, et al. Mag-
nesium and antioxidant vitamin status and risk of complications of age-
ing in an elderly urban population. Magnes Res 1996;9:299-306.
16 Singh RB, Niaz MA, Sharma JP, Kumar R, Rastogi V, Moshiri M.
Randomized double blind placebo controlled trial of fish oil and mustard
oil in patients with suspected acute myocardial infarction: the Indian
Experiment of Infarct Survival—4.Cardiovasc Drugs Ther 1997;11:485-91.
17 Rice RD. Clinicians must promote value of diet containing oil-rich fish.
18 Al-Marzouki S, Evans S, Marshall T, Roberts I. Are these data real? Statis-
tical methods for the detection of data fabrication in clinical trials. BMJ
19 Singh RB,Dubnov G,Niaz MA,Ghosh S,Singh R,Rastogi SS,et al.Effect
of an Indo-Mediterranean diet on progression of coronary artery disease
in high risk patients (Indo-Mediterranean diet study): a randomised sin-
gle blind trial. Lancet 2002;360:1455-61.
20 Hu FB. The Mediterranean diet and mortality—olive oil and beyond.
N Engl J Med 2003;348;2595-6.
21 Singh RB, Beegom R, Mehta AS, Niaz MA, De AK, Mitra RK. Social class,
coronary risk factors and undernutrition, a double burden of diseases, in
women during transition in five Indian cities. Int J Cardiol 1999;69:
22 Soman CR, Kutty VR. Methodological errors uncovered? Int J Cardiol
23 Smith R. Investigating the previous studies of a fraudulent author. BMJ
24 Meguid MM. Retraction of Chandra RK Nutrition 2001;9:709-12. Nutri-
Investigating the previous studies of a fraudulent author
This year, the journal Nutrition retracted a study by R K Chandra, and questions have been raised
about the integrity of the rest of his work. Who has the responsibility for investigating previous work
and if necessary punishing the researcher and correcting the scientific record?
In February of this year, Michael Meguid, the editor of
Nutrition,retracted a paper by the Canadian researcher
R K Chandra, that it had published in 2001.1 2The
paper claimed to be a randomised double blind
placebo controlled trial showing that physiological
amounts of vitamins and trace elements would
improve cognitive function in elderly people.1Meguid
gave eight reasons for retracting the paper and said
that Chandra had either ignored the reasons or failed
to give an adequate response.2
Chandra’s paper was submitted originally in 2000
to the BMJ, which had severe doubts about the paper:
one reviewer said that the paper “had all the hallmarks
of having been entirely invented.”3The BMJ asked
Chandra’s employers—the Memorial University of
Newfoundland—to investigate its anxieties about the
study.The university held an inquiry but found no seri-
ous problem. The BMJ was unconvinced by this
response and raised further questions about the study.
In August 2002 the university answered that Chandra
had taken unpaid leave for the first four months of
2002 and failed to respond to any of its inquiries,
including a request for raw data. Then in August 2002
Meanwhile,the BMJ had notified Nutrition about its
anxieties over the study. Unfortunately Nutrition had
already published the study. Chandra must have sent
the study to Nutrition as soon as the BMJ began
questioning it. The BMJ also notified the Lancet, which
had published a closely related study by Chandra in
1992.4Serious doubts were then raised about the 1992
study in a letter to the Lancet in 2003, which among
other criticisms pointed out that “some of the standard
errors were statistically impossible.”5There must be
grave doubts about the Lancet study, which has been
cited more than 300 times,6and about the other 200
papers published by Chandra, many of which are ran-
domised trials with him as sole author. Furthermore,
investigations by the Canadian Broadcasting Corpora-
tion have raised many other questions over the
integrity of Chandra, who is an officer of the Order of
Canada and holds a patent for the supplement that is
claimed to improve cognition.
R K Chandra’s paper in Nutrition was retracted; he resigned before
the Memorial University of Newfoundland could investigate his
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BMJ VOLUME 331 30 JULY 2005bmj.com
The Memorial University of Newfoundland has
said that it can do no more about investigating
Chandra and that responsibility for investigation lies
with the journals that have published the more than
200 articles. The Canadian Institutes of Health
Research have tried to hold an investigation,but Chan-
dra has refused to give research data.6
This sad story raises fundamental questions about
who has the responsibility for investigating allegations
of research fraud and particularly for considering
other studies published by a researcher who has been
shown to have written one fraudulent paper.
Investigating previous studies is
When the fraud squad discovers that somebody is
guilty of an act of financial fraud they assume—until
proved otherwise—that much else in the person’s
affairs is fraudulent. Yet within medicine we seem to be
inclined to believe the opposite: a fraudulent research
paper is often seen as a one off caused by the author
experiencing stress, mental illness, or difficult circum-
stances. It is perhaps to be expected that policemen,
who spend their lives associating with criminals, will
assume the worst, and doctors, who are agents of
mercy,the best.But it is clearly dangerous when we dis-
cover a fraudulent research paper to assume that there
were no problems with all previous work. The
safe—and right—thing to do is to assume the opposite
and start an investigation.
Patterns of misconduct
misconduct in medicine shows both how cases of fraud
are likely to be seen as isolated incidents but how
investigations often eventually show a history of previ-
ous fraud.7The modern story of fraud, writes Lock,
began in 1974 with William Summerlin, from the
Sloan-Kettering Institute in New York,claiming to have
transplanted human corneas into rabbits. He also
faked transplantation experiments in white mice by
blackening patches of their skin with a pen, an extra-
ordinarily crude form of forgery. Summerlin’s miscon-
duct was long ignored and once exposed was
attributed to a mental health problem.
John Darsee worked in the department of cardiol-
ogy at Harvard and was seen falsifying data. His boss,
Eugene Braunwald, an eminent cardiologist, decided
that this misconduct was an isolated incident and so
did not fire him. A few months later, however, it
became clear that results he had taken in a study being
conducted in several places were very different from
those of the others. An investigation was started and
went back to when he was an undergraduate. Many of
his more than a 100 studies proved to be fraudulent
and had to be retracted. Darsee’s high profile case led
to congressional hearings. And Drummond Rennie
and Kristina Gunsalus have described how the first
witness, the president of the National Academy of Sci-
ences, “asserted that problems [of misconduct] were
rare—the product of ‘psychopathic behaviour’originat-
ing in ‘temporarily deranged’ minds.”8Unfortunately,
accumulating evidence shows both that they are not
Lock’s“imperfect history”of research
rare and are usually a pattern of behaviour rather than
isolated cases.9 10
Who should investigate?
An accusation of research misconduct is clearly a seri-
ous event. Such an accusation cannot be ignored, but
nor can the accusation be assumed to be correct.There
needs to be a process of screening the accusation,
investigating it if necessary,conducting a hearing,mak-
ing a judgment, and taking whatever steps may be
appropriate to punish the offender, to make changes
to reduce the chance of misconduct recurring, and to
correct the record. The process must be effective, fair,
and efficient, and it has to be conducted by a body that
has the legal legitimacy to do so and the means to
administer suitable punishment. Often accusations are
about a particular piece of research, and my argument
is that there needs to be a secondary process of investi-
gating previous work. The body that has responsibility
for the investigation of other research might also want
to examine financial and professional matters.
The investigation of an accusation can be difficult,
but I must acknowledge that the investigation of previ-
ous work is still harder. Examination of published
papers will rarely be adequate for deciding confidently
whether work was fraudulent. The research may have
been done 20 years previously—and so neither raw
data nor records may be available. Possible witnesses
may be dead or dispersed and may have to try and
remember events from long ago. Miscreants may have
published hundreds of papers, and there may be vast
quantities of data to examine. Unsurprisingly, institu-
tions may try to avoid having to investigate previous
One body that clearly has legal legitimacy to respond
to an accusation of research misconduct is the
accused’s employer, usually a university, a medical
school, or a hospital, in the case of a medical
researcher. Increasingly these institutions do have
declared, transparent, and legally sanctioned processes
for dealing with accusations of research misconduct—
not least because the funders of research require such
processes to be in place. But until recently, many insti-
tutions did not have satisfactory processes,and globally
it is still probably the case that many,even most,do not.
In many countries the problem of research misconduct
has not been confronted. Furthermore, every step of
the process is important, and my suspicion is that it is a
minority of employers that have processes that work
well at every stage. The investigation and collection of
evidence, for example, is something that is unfamiliar
to many institutions, which is why they may have to
hire an agency to do the work for them.
Employers face a clear conflict of interest with
accusations. To expose one of your employees as
fraudulent is unpleasant and does harm to the brand
of the institution.Often the miscreant will be a friend,a
respected colleague. The temptation is to bury the
whole thing,and Stephen Lock has produced evidence
that this did happen commonly.11Many, even most,
senior academics know of cases of misconduct, and yet
they reportthat rarely
investigated, the miscreant punished, and the scientific
were those casesfully
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BMJ VOLUME 331 30 JULY 2005bmj.com
record corrected. The miscreant may simply have been
encouraged to resign or take early retirement. In such
circumstances, the scientific record is not corrected—
and certainly there is no investigation of other research
studies by the miscreant.
As well as being unpleasant for employers these
cases can also be expensive, time consuming, and diffi-
cult. (I remember ringing a hospital in the United
Kingdom with an anxiety that one of its consultants
may have published a fraudulent study in the BMJ,
which I edited at the time.The hospital told me that the
consultant was already suspended because of anxieties
over his clinical work and that if the BMJ wanted an
investigation of his research it would have to pay.) Mis-
creants may well employ lawyers and challenge the
processes of the employers. Costs and complexity
immediately increase. Or the miscreant may resign—so
removing the legal legitimacy of the employer to inves-
tigate. Or, commonly, the miscreants may come from
several institutions,often in different countries,making
the organisation of an investigation and hearing
Institutions have great difficulty investigating accu-
sations against their employees—and attempts often
fizzle out. They do, however, in most countries
currently have more responsibility, capacity, and legal
legitimacy for conducting investigations and correcting
the scientific record than any other institution—as
emerges in what follows as I examine alternatives.
Funders of research
Funders of research will have a contract with those they
fund, and this contract will give them a legal basis for
investigating an accusation of research misconduct in
relation to the work that they have funded. They will
not, however, have legal legitimacy for investigating
research that they have not funded, and funders of
research usually require employers to investigate accu-
sations of fraud rather than attempt to do it themselves.
Some professional regulatory bodies may respond to
accusations of research misconduct, and the General
Medical Council (GMC) in the United Kingdom, for
example, has dealt with many cases.12
these have been brought to the council by pharma-
ceutical companies, and most had already been
investigated by a professional team that included a
One reason that bodies such as the GMC cannot
provide a full answer to the problem of who should
respond to accusations of fraud is that they usually
cover only particular groups—the medically qualified
in the case of the GMC. And most medical research is
done by people who are not medically qualified. Other
problems are that such bodies usually deal with
individuals not teams and consider particular cases
Colleges and professional societies
Professional societies—such as the Royal College of
Physicians or the European
Rheumatism—might seem to be obvious bodies to
investigate research misconduct within medicine, but
usually they do not have either the legal legitimacy or
the means. Furthermore, the worst they can usually do
in terms of punishment is expel the miscreant.
It is journals that publish the studies that may be
deemed fraudulent, so are they not the obvious bodies
to investigate accusations? Unfortunately, they cannot.
The fact that an author has published a study in a jour-
nal does not give the journal the legal legitimacy to
investigate even that particular study.Nor can a journal
apply due process. A journal making a judgment on
whether a paper was fraudulent would be nothing
more than “trial by media.” The journal clearly,
however, has a duty to notify its readers if the paper
proves to be fraudulent.It must depend on others,usu-
ally employers, to hold an investigation and hearing
and reach a conclusion on the status of the work.
Journals are privileged whistleblowers—privileged
because they are hard to attack and whistleblowers
because they, their reviewers, or readers are often the
first to suspect research misconduct. Reviewers or
readers might choose to contact employers rather than
journals, but they rarely do so—perhaps because as
individuals they are more vulnerable than journals.
The job of the journals is to ask another body—usually
an employer—to investigate. But they also have a duty
to make sure that the responsible body stays with the
case. If all else fails (as, sadly, it does) then the journal
may have to “tell the whole story,” but their lawyers will
advise them against it unless they have undertaken an
unusually thorough investigation.
One difficulty for the journals is to decide the
amount of evidence that is necessary to blow the whistle.
It is best not to spend too much time building up
evidence but rather to quickly transfer the responsibility
for investigation to the employer. When as an editor I
first dealt with possible cases of fraud, I spent a lot of
time gathering evidence, but this backfired on me on at
least one occasion when the story leaked out. Journals
can ask for access to the raw data behind a study, but
analysing raw data is by no means straightforward. It
requires special skills and can be expensive.
I applaud Michael Meguid for working so hard to
question the study of Chandra published in his journal
Nutrition, and the BMJ is in this issue publishing a
paper that describes doubts over another researcher
that go back at least 10 years.13But we are left not
knowing the true status of large numbers of research
papers by these authors.
The criminal justice system
Alexander McCall-Smith has made the interesting
suggestion that the criminal law might be used to man-
age research misconduct.14Such cases will often
involve misuse of funds—perhaps grants from public
bodies—and so research fraud may be seen as an
example of financial fraud.I do not know of this having
happened, and the immediate reaction of most
academics and researchers is that this would be an
extreme step. But the great advantage of such a devel-
opment would be that the criminal justice system is
used to dealing every day with problems that often
overwhelm academic institutions.
Some countries—including the United States and the
Scandinavian countries—have national bodies that can
deal with accusations of research misconduct. They
may either conduct the whole process or advise and
oversee employers.Theyhave legallegitimacy,
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BMJ VOLUME 33130 JULY 2005bmj.com
established processes, and growing experience, and Download full-text
where they exist they may be the obvious organisation
not only to lead on particular cases but also to take on
the difficult task of examining previous studies.
Unfortunately, such bodies do not exist in most
countries, including the countries of the United
Kingdom. They can also have difficulty dealing with
cases where the possible miscreants come from several
different countries, which is increasingly the case in
The media should not be the bodies to investigate accu-
sations of research misconduct, but they often are—
because of the failure of formal legally legitimate bodies.
This seems to be the case with Chandra, where the
Canadian Broadcasting Corporation has taken the lead.
An international body
Ideally—because medical research is increasingly an
international activity—an international body could take
the lead on responding to particular accusations of
research misconduct and
research studies. Establishing the legal legitimacy of
such a body would take time, and there would be inevi-
table argumentsover funding, governance, and
geographical positioning. But such a body could
potentially overcome the problems that rule out most
other possible contenders for the job of responding to
accusations of research misconduct. Interestingly,
physicists—who have come
researchers to the problem of research misconduct—
have started with the assumption that they need an
Should we mark suspicious studies?
One of the most important reasons for investigating all
the studies of fraudulent researchers is to correct the
scientific record. Ideally fraudulent studies will be
retracted and so excluded from the systematic reviews
that are becoming ever more important sources of evi-
dence.It may well be,however,that it will be impossible
to work out the true status of many studies, particularly
those done long ago. Should we therefore have a
system of marking such studies as “dubious”?
This article has arisen from a dispute between the BMJ
and Memorial University of Newfoundland over who
has responsibility for investigating accusations of
research misconduct against Chandra. In the absence
of national or international bodies, I believe that the
responsibility lies with the Memorial University of
Newfoundland. It certainly does not lie with the BMJ,
which blew the whistle on one of his papers (without
publishing it) and published only a couple of short
pieces from Chandra a long time ago.
Ideally, however, there would be an international
body to take the lead—on this and other cases that are
left unaddressed. Furthermore, although we lack effec-
tive mechanisms for dealing with such cases we
perhaps need a means of marking studies that are
under suspicion in databases such as PubMed.
Contributors and sources: RS is now chief executive of United-
Health Europe but for 13 years was editor of the BMJ. He was a
cofounder of the Committee on Publication Ethics and has dealt
with about 100 cases of research misconduct—both in his role as
editor of the BMJ and chief executive of the BMJ Publishing
Group, which meant that he advised editors of the 25 or so spe-
cialist journals of the group. He also served on the committee of
inquiry set up by the Royal College of Obstetricians and Gynae-
cologists into the United Kingdom’s highest profile case of
research misconduct and on a committee set up by the Danish
Committee on Scientific Dishonesty. This article arises mainly
from his direct experience but also from his reading around the
subject. RS is the sole contributor.
Competing interests: RS was editor of the BMJ for 13 years and
a founder member of the Committee on Publication Ethics. He
spent many hours battling over issues of research misconduct,
including with the Memorial University of Newfoundland, RK
Chandra, and RB Singh.
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Chandra RK. Effect of vitamin and trace-element supplementation on
cognitive function in elderly subjects. Nutrition 2001;17:709-12.
White C.Three journals raise doubts on validity of Canadian studies.BMJ
Chandra RK. Effect of vitamin and trace-element supplementation on
immune responsesand infection
Carpenter RK,Roberts S,Sternberg S.Nutrition and immune function:a
1992 report. Lancet 2003;361:2247.
Payne D. Nutrition retracts 2001 paper. Scientist 2005 Mar 3.
www.the-scientist.com/news/20050303/02 (accessed 14 July 2005).
Lock S. Research misconduct 1974-1990: an imperfect history. In: Lock
S, Wells F, Farthing M, eds. Fraud and misconduct in biomedical research. 3rd
ed. London: BMJ Books, 2001.
Rennie D, Gunsalus CK. Regulations on scientific misconduct: lessons
from the US experience. In: Lock S, Wells F, Farthing M, eds. Fraud and
misconduct in biomedical research. 3rd edition. London: BMJ Books, 2001.
Lock S, Wells F, Farthing M, eds. Fraud and misconduct in biomedical
research. 3rd ed. London: BMJ Books, 2001.
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11 Lock S. Misconduct in medical research: does it exist in Britain? BMJ
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ceutical industry action. In: Lock S, Wells F, Farthing M, eds. Fraud and
misconduct in biomedical research. 3rd ed. London: BMJ Books, 2001.
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14 McCall Smith A. What is the legal position? J R Coll Physicians Edinb
2000;30(suppl 7): 22.
(Accepted 13 July 2005)
in elderly subjects.
Once a piece of work is proved to be fraudulent,
the integrity of other studies by the author should
An effective, fair, and efficient process to
investigate and if necessary, hold a hearing, mete
out punishment, and correct the scientific record
Employers are best able to conduct this process,
but it is not easy—particularly with studies
conducted years ago
Because employers and others often cannot cope
and because many studies include authors from
many countries there may need to be an
international body to take the lead
A mechanism for marking studies as “dubious” on
databases such as PubMed is necessary because it
is often impossible to reach a confident
conclusion on the integrity of previous studies
Education and debate
BMJ VOLUME 331 30 JULY 2005bmj.com