‘Deeply troubling’: Pediatric journal’s fictional cases affect more than 2,000 studies

Dr. David Juurlink says the case studies are 'fabrications, full stop.' Photo by Matthew Sherwood /Postmedia

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More than 2,000 academic papers have cited or based some of their content on fictional case studies that have now been retroactively corrected by Canada’s leading pediatric journal, the Investigative Journalism Bureau (IJB) has found.

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Paediatrics & Child Health, published by Oxford University Press for the Canadian Paediatric Society, publicly announced in February the blanket corrections of 138 articles, following a New Yorker investigation that reported on outrage in the academic community over fictional cases being presented as verifiable research.

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Among them was a notorious fictionalized case study backing a controversial theory that babies could overdose on codeine through breast milk.

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“This is a huge stain on medical literature,” said Dr. David Juurlink, head of the clinical pharmacology and toxicology division at Sunnybrook Health Sciences in Toronto. “They are fabrications, full stop.”

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But the problem didn’t stop with those 138. These articles were cited at least 117 times in peer-reviewed publications. Those papers were, in turn, cited at least 2,194 times in academic research.

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The fictionalized articles have had practical and far-reaching impacts on academic literature.

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“It is deeply troubling to discover the scale of the citations and downstream impact associated with a fabricated case report,” said Dr. Farah Abdulsatar, an assistant professor of pediatrics at Western University in London, Ont.

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“This represents a serious lapse in academic integrity and raises important concerns regarding the journal’s editorial standards and academic reputation.”

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Journal editors did not respond to questions from the IJB beyond the public statement the journal released in February about correcting the reports.

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The 138 case reports now labelled as fictional were never originally presented or declared as such.

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Dr. Farah Abdulsatar: ‘This represents a serious lapse in academic integrity.’ (Photo: Holly Goncalves) Photo by Dr. Farah Abdulsatar

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From 2001 through at least 2012, case reports published in the Paediatrics and Child Health series — called CPSP Highlights — were framed as “short clinical examples” drawn from pediatric survey findings. That wording suggested these were real patient cases, not invented ones.

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Only in 2015 did author submission guidelines explicitly start mentioning “fictional” cases.

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None of the so-called case studies has been retracted; instead they have been corrected to make it clear the examples used are fiction.

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In its February statement, the Paediatrics & Child Health journal acknowledged that assumptions about the veracity of the case studies were “understandable given the columns had no disclaimer to indicate the cases are fictionalized.”

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The fallout from fiction

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Perhaps the most compelling example of the fallout such fictionalized cases can have involves the work of former SickKids hospital researcher Dr. Gideon Koren and his co-author, Dr. Michael Rieder.