REFLECTIONS ON THE GEORGE ZIMMERMAN TRIAL

There is nothing like being timely. Then again, taking the time to reflect has its advantages as well. While the death of Trayvon Martin, like the pointless death of any person, black or white, was tragic, for a nation said to be a nation of laws, it is rather pathetic that most people have absolutely no idea what the law is, including, in this case, the prosecutors. At the time the verdict was delivered one of the prosecutors expressed her shock that George Zimmerman “got away with murder.” Why the shock? The way the law was written, it seems relatively easy to “get away with murder” by provoking someone and “standing one’s ground.” In addition, we have a presumption of innocence and a principle that it is better to let ten guilty people go free than to convict an innocent person. Frankly, I have always thought that latter policy was pretty dumb, considering that the ten guilty persons set free might do a heck of a lot of damage to more than one innocent person, but that’s the system. Having spent considerable time in courtrooms as an expert witness, I have found that juries actually listen to instructions from judges and care about upholding the law. Please remember, the prosecution indicted Zimmerman only because of public pressure. The initial opinion was that they didn’t have a winnable case. That opinion proved to be correct. All the protests by people who saw this in terms of race, and who demanded an indictment, and who got an indictment, didn’t make the case any more winnable when it went to a jury that took the time to listen to the law. As an aside, the NFL football player who suggested that the jurors should go home and kill themselves is part of the stupidity about which I am speaking by the way. I was in Florida when the controversy over indicting or not indicting Zimmerman started to rage and I had the opportunity to read the “stand your ground” law before Zimmerman was arrested. It was clear that while Zimmerman may have “acted like a vigilante,” because of the way the law was written, NOTHING that he did could be proven to be a crime beyond a reasonable doubt. When the prosecutor said that “this isn’t about standing your ground, it’s about getting out of his car,” I decided that a not guilty verdict was inevitable (if the jury held to the law). Zimmerman didn't stay in his car when he was advised to do so. Failing to follow a suggestion is not a crime. He made assumptions about Trayvon Martin. They were wrong. That is not a crime. He followed Trayvon Martin. Following someone is not a crime. He was carrying a legally registered gun. Then, there was a fight (the nature of which is and always will be unclear) during which a teenage boy was shot and killed. Since there is no way to exclude the possibility that George Zimmerman FELT he was in mortal danger, (he didn’t have to prove that he was in mortal danger), he had a right to use self-defense. When the law was intelligent, one could defend one’s self in one’s home (the castle theory) but outside one’s home, one has to back away. Under stand your ground, one can basically provoke a fight outside one’s home and then, when one is in mortal danger, (or when one thinks he is in mortal danger) justifiably use lethal force. Sounds dumb on the surface, but that’s the law. I keep hearing people say that Trayvon Martin didn’t do anything wrong. That is probably true but irrelevant under the law. If he picked a fight, that wasn’t very smart, but again, we have no reason to know if he did or didn’t. But the point is that Trayvon Martin wasn’t on trial for a crime. George Zimmerman was and not knowing what was happening in the fight, in view of conflicting versions of the fact, and under the presumption of innocence, there was no way under the law to convict George Zimmerman of a crime. Regardless of who started the fight or created the circumstances that led to a fight, there was no way to prove that George Zimmerman didn’t feel that he was in mortal danger. As has been noted by commentators, presumption of innocence does NOT mean that they arrested the wrong guy; someone else did it. Presumption of innocence means that unless one is certain, beyond a reasonable doubt, assume that a crime was not committed. If one doesn’t like the result, complain about the law regarding “stand your ground,” complain about the presumption of innocence in our system, complain about the fact that in criminal trials we demand proof beyond a reasonable doubt, but don’t complain about the jury. I have no doubt that racism exists and that George Zimmerman’s assessment of Trayvon Martin was based on race. However, that is not a crime. The police may not be able to profile, but a private citizen can think what he wants. The existence of racism means – as far as this case is concerned – that in our society a bad law regarding guns and self-defense is more likely to have disastrous consequences. The jury rendered the verdict that was consistent with the law, a bad law in my opinion, but still the law. Since the verdict was rendered, there has been more focus on how the law enabled it to happen. One of the jurors even came forward and said that she felt that George Zimmerman was getting away with murder, but that it was the only verdict she could render considering the judge’s instructions. Don’t blame the jurors. Blame the legislators. When the legislature makes murder legal under certain circumstances by giving people the right to provoke and then use lethal force to protect themselves, put the blame where it lies. (Required self-disclosure: Based on its performance in recent years I have to believe that the Tennessee legislature is far worse than the Florida legislature, but since there are no established criteria, there is no way to judge.) And by the way, for people considering OJ, where the families of the victims took to the civil courts after the criminal case led to a not guilty verdict, please read the Florida law on the right to request immunity from civil suits under the “stand your ground” law before advocating that position. It sounds good to say, “Take it to civil court,” where one only needs a reasonable degree of certainty instead of having the criteria be “beyond a reasonable doubt,” but the Florida law undermines that position. In the time since the verdict was delivered two of the most intelligent comments I heard came from a black minister (whose name I did not catch) and from someone whose politics are nowhere near mine, Newt Gingrich. They both pointed out that while people had a right to be upset about the death of Trayvon Martin, if they are truly concerned about young black boys being shot and killed they should recognize the simple fact that in the overwhelming majority of the cases it is other black boys who are doing the killing.

BLACKHAWKS WIN

BLACKHAWKS WIN!  And why the Bruins lost.

Congratulations to the Blackhawks!

As anyone with more than a passing interest in sports likely knows, Monday night the Chicago Blackhawks, trailing 2 to 1 in the sixth game of the Stanley Cup Finals, scored the tying goal with only a minute and sixteen seconds to go in the third period. With the game headed to overtime, they followed it up with another goal seventeen seconds later avoiding sudden death overtime, avoiding a Game 7 showdown, and winning Lord Stanley’s Cup on the road in Boston. Sports radio and sports journalism have been calling it one of the greatest turnarounds in the history of sports. Hyperbole aside, it was an incredible seventeen seconds of ice time, and an incredible one minute and seven seconds of real time.

My son Glenn had come over to watch the game with me. He was wearing his Blackhawks #9 Bobby Hull jersey; I was wearing my #88 Patrick Kane jersey. The comeback was shockingly surprising to me at the time. In fact, with six minutes to go in the game, I was ready to walk my dogs and stayed to watch only because my wife asked me how I could possibly give up when there was a chance. As she said, “These are the Blackhawks, not the Cubs.”

I have always imagined that I am a curse to the Chicago Cubs. They last played in the World Series in 1945. I was born in 1946. Sixty-eight futile years later they haven’t been back. In 2003 they came close. In Game 6 of the NL Playoffs against the Marlins, they were five outs from the World Series, leading 3-0 when a fan, the infamous Steve Bartman, interfered with a foul ball and the mood of the ballpark went from ecstastic to funereal. With the crowd chanting “asshole, asshole, asshole,” and the fans waiting for the proverbial roof to fall in, Alex Gonzalez kicked a double play ball, and by the time the inning was over, the Cubs were losing 8-3.

A mathematical analysis of the probability of scoring runs as a function of the number of men on base and the number of outs showed that BB (Before Bartman) the Cubs had a 98% chance of winning. AB (After Bartman) it was 96%. The drop in the chance of winning occurred after only Gonzalez booted the double play ball. But baseball players are not APBA or Strat-o-matic cards, to name two statistical baseball games of my generation. Baseball players are people whose performance is mood dependent. Gonzalez’s error turned the game around, but Bartman’s act changed the mood of the ballpark and of the players and – one will never convince me otherwise – played a role in Gonzalez’ blowing the double play. Yes, baseball players are professionals. They are also people. And so are hockey players.

I grew up in Chicago as a Blackhawks’ fan, as was my father. While I played baseball, I couldn’t even skate. However since the Cubs, playing under the motto “Anyone Can Have a Bad Century” always lost, being a Blackhawks fan was easy. Since there were only six teams, at one time I actually knew the rosters of every team in the NHL. It was simple since the only games on television were the Saturday hockey games, which meant a steady diet of Gordie Howe, Maurice Richard, Jean Beliveau, Frank Mahovlich, Andy Bathgate, Johnny Bucyk, and, our own Bobby Hull and Stan Mikita.

In 1961, the Blackhawks won the Stanley Cup. In 1962, my father took me a Stanley Cup Semi-final game. The Blackhawks, down in the series two games to none, won the game and upset Montreal in seven games. They lost to Toronto in the finals, but I have never felt that I was a curse to the Blackhawks, they tended to win most of the time that I saw them play.

Monday night, the tying goal was simply a matter of the Blackhawks pulling their goalie for an extra attacker and executing a great play in the offensive zone. The winning goal was a matter of one team playing with their egos deflated and completely flat while the other team was sky-high. The announcers were saying that the Bruins’ bench was yelling for the team not to be back on their heels. They were not only back on their heels they were playing with their heads down. The Blackhawks scored before they got back in the game. Had the game gone to overtime, I suspect the Bruins would have been ready.

The Blackhawks gave up a tying goal in the final seconds of the final game of the series against Los Angeles, but the period ended before their depression could hurt them. They played tough in an evenly played overtime and won.

After the Blackhawks tied the score, the Bruins were playing with an attitude of “Seventy-six seconds until regulation time runs out and we regroup and go to overtime.” The Blackhawks were playing hockey. I have watched the last seconds of the game over twenty times on DVR in the last thirty-six hours and it is amazing to watch.

Of course, if one wants a more mystical explanation, the Cubs lost in 2003 because I was there with my son Adam, in a grandstand seat on the first base side. That was a curse that could not be overcome.

The Blackhawks won because I stayed on the sofa, wearing my Kane 88 jersey, almost believing that the team could come from behind. Okay, not believing it because my years as a Cub fan had drained me of optimism for any team from Chicago, but at least not so totally skeptical that I got up to walk my dogs.

If a man sits on a sofa in Nashville, does it affect the possibility that the puck may go in the net behind Tuukka Rask in Boston. I doubt it. But if so, if so, if not for my wife, Game 7 would be tonight.

Go Blackhawks!  

ANGELS FROM RIKENNY

I just completed the third draft of a sci-fi novella entitled Angels from Rikenny. I first outlined this story in 1968 when I was a second year medical student at Harvard. The story was the product of two diverse forces, Rod Serling’s The Twilight Zone and the adoption of Medicare and it is a bit depressing to see that the novella is as timely today as it was then.

The basic story involves aliens who come to Earth with the cure for heart disease and cancer. The result is not a utopia, but a complete collapse of society as people live long but not well. That’s just the beginning, but I don’t want to spoil the story for people who want to read it by giving away too many details.    

Three episodes of The Twilight Zone made a special impression on me and led me to write my novella. In “The Monsters are Due on Maple Street,” typical small town Americans are exposed as fearful paranoids who turn on each other as various technological failures occur. In the end, we learn that their paranoia is justified. Aliens have landed in the distance, and by getting us to turn on ourselves, they have facilitated their conquest. The main lesson - in The Twilight Zone there is always a lesson - is that paranoia destroys and that disaster does not require physical weapons of mass destruction.

In the episode “To Serve Man,” apparently friendly aliens come to Earth, solve some our basic problems, and choose some fortunate Earthers to visit their home planet. Only at the end do we translate their language and find that their book, “To Serve Man,” is a cookbook. Oops! As Rod Serling says at the end, man has devolved from ruler of a planet to "an ingredient in someone's soup." Clearly aliens can be dangerous even when they seem benign.

To counter these tales, Serling produced a third episode entitled “The Gift.” In this episode, an alien is pursued and killed despite offering a gift to mankind. In the process, the vial he has brought with him is destroyed and its label is read. “Greetings to the people of Earth: We come...in peace. We bring you this gift. The following chemical formula is...a vaccine against all forms of cancer.”

When I first saw “The Gift,” I thought that the episode offered a balance to Serling’s two xenophobic efforts. Then, in 1968, I decided that the aliens in “The Gift” might have been the most dangerous aliens of all.

In 1965 the United States passed Medicare, a just system designed to prevent the elderly from going broke while dealing with the illnesses that they had collected over the course of a lifetime. I asked myself, “What could be better than seeing to it that elderly people did not lose their life savings spending money on their end of life illnesses?” I did not consider the question to be rhetorical. Imagine that one had to create a health care system from scratch and define priorities. How would we rank order the following?

1. Let’s guarantee that every child is able to grow up and reach his or her potential without being affected by illnesses that are treatable and curable.

2. Let’s guarantee that every working adult gets the care he or she needs to remain functional and provide for their family and that they are not compromised by treatable and curable disorders.

3. Let’s guarantee that every wanted pregnancy can be carried to term without disease compromising either the mother or the child.

4. Let’s devote money to research to increase the number of conditions that are treatable and curable.

5. Let’s protect the life savings of the elderly by providing them unlimited hospital care.

Considering that the death rate is, was, and always will be one hundred percent, option 5 is not at the top of my list. Sadly, it was the only aspect of health insurance on which we could agree at the time, since, as was pointed out, everyone either has a parent or grandparent or hopes to become one.

It was clear from the inception of Medicare that more and more health care resources were going to be devoted to individuals who couldn’t enjoy anything that would be considered health. Forty-eight years later, our health care system, more correctly our disease care and health insurance system, is little improved. While we don’t face the social disaster described in Angels from Rikenny, we don’t need aliens to destroy us when we are in the process of bankrupting ourselves. The only way in which the situation has changed, sadly, is that we have replaced benign neglect of the problem with partisan stagnation.

The original version of the tale was a story told by an American sniper in exile in Antarctica after having failed to follow orders to shoot the aliens. He heard the aliens’ description of their gift upon their arrival and he decided that we were on the brink of utopia. Not quite.

Richard Dinsmore, the staff at BHC-DEL, the American Party, TGB, The Dana Twins, Noraa, and the other Rikennians are new additions to the story. So is the idea of saving the world by making a movie. Obviously, the fact that Richard Dinsmore caused the Cubs to lose the critical game in the 2003 playoffs was not part of the original tale written in 1968. Having been at that game, and feeling that it is ridiculous to blame Steve Bartman, the fan who touched the fly ball, when it is Alex Gonzalez’s error that sank the Cubs, I wanted to blame someone else. I have not been back to Wrigley Field since and probably never will, unless I go to see an alien landing.

I once promised myself that I would never write a time travel story because the paradoxes gave me a headache.  For that reason, I concluded the story in such a manner that I did. Without giving too much away, anyone wishing to read a time travel story can simply stop before Warren Tanner yells ‘CUT’ for the last time, and leave the joke on Noraa.

Frankly, it really doesn’t matter if the joke is on Richard Dinsmore or on Noraa. With respect to the disorganization of our disease care system, and our failure to recognize that as we spend dollars on health care without considering the true costs and consequences, including opportunity costs, the joke, quite sadly, is on us.

The first ten sci-fi fans who find this blog post and request a copy of Angels from Rikenny will be sent an electronic version of the unpublished manuscript for their reading enjoyment.

Just e-mail me at richard.stein.050446@gmail.com or at richard.stein@vanderbilt.edu and I will get back to you.

TEXAS AND GEOGRAPHY

When I was a child, I had a puzzle map of the United States in which the states were scaled to size. Rhode Island was so small that it came attached to Connecticut and Massachusetts, Delaware was similarly attached to Maryland and perhaps also to Virginia.

Texas was the largest state, something that I have had reinforced in recent years when I have looked at an electoral map and seen all those electoral votes going Republican.

I suspect they don’t make puzzle maps like that any more. The words "DANGER : CHOKING HAZARD" come to mind. Keeping a few children from choking to death is worth a nation of geographically challenged individuals, which is the polite way of saying people who have no idea where the states are.

As I was writing this, I mentioned what I was doing to someone quite intelligent who told me that they had once claimed (incorrectly) that it was impossible to go from Texas through Oklahoma to Kansas because Missouri was there. Having mastered putting the states in the right place at a young age, I knew that right down the middle of the USA, from north to south, are North Dakota, South Dakota, Nebraska, Kansas, Oklahoma, and Texas.

Of course, instead of giving myself an ovation for this trivial piece of knowledge, I should point out my own answer to the question “In what direction does one travel to get from Vanderbilt (in Nashville, Tennessee) to Los Angeles?” My answer was “Southeast.” I then explained that one went Southeast to the Nashville airport and got on a plane, and what heck difference did it make where anything was.

I thought that my smug reply was useful until I was talking about my snarky approach to geography with a friend who told me about some relatives who came from Israel to visit them in California. They wanted to see the Grand Canyon and also the Grand Tetons. So they flew to Arizona and back. Then they flew to Utah and back. Thank goodness they didn’t want to see Miami and New York City.

Now, while I realized that Texas was big, I had no concept of how big it was until my wife and I and our two dogs drove cross country from Nashville to San Diego (December 2012) and back (March 2013). Because we had the dogs and had to stay at pet friendly hotels we only managed 350 miles a day. Our itineraries were as follows:

Nashville to Little Rock

Little Rock to Fort Worth

Fort Worth to Midland, Texas

Midland to Las Cruces, N.M. (just across the state line from El Paso)

Las Cruces to Casa Grande, Arizona

Casa Grande to San Diego (actually Del Mar)

That means two and a half days to cross Texas.

I suppose I should have had some sense of this in advance. Obviously, I knew where we were stopping each day, but it wasn’t until I was driving that the vastness of Texas became real. For those of you who have never driven across Texas let me share some observations.

When writers talk about the wind roaring across the Texas plains, they are not kidding. There were times when we were crossing Texas that I thought we were in a thunderstorm but without any rain.

Coming back east, we left El Paso, Texas, and saw a sign that read “Beaumont 784 miles” (at least that’s as best as I remember the sign) and Beaumont is still in Texas. Heck, it’s 450 miles from where I grew up in the Chicago suburbs to where I live in Nashville and that takes me through parts of four states : Tennessee, Kentucky, Indiana, and Illinois. Google maps says the short route from El Paso to Beaumont is 828 miles so if I’m wrong about the sign, I’m not wrong by much.

On the sad side, it was March, three weeks before spring, when we drove back east through Texas and we were more than 400 miles into Texas until we saw the first green, a very small field that looked smaller than the two acre lot on which our house stands. We were taking the southern route, but the drought has been terrible. It’s one thing to read about it but another thing to see it. When we turned northeast to head to Dallas/Fort Worth it was clearly spring.

By the way, both going west and coming back east we stayed in Midland Texas. I never thought that I would say this, but I now feel sorry for George W. Bush. He may have started a war with Iraq for no reason, and he may have claimed to be a "uniter not a divider" before starting us on the road to partisan stagnation, but he paid for it in advance by being born in Midland. How a town of 100,000 people can have absolutely nothing except for one new Japanese restaurant is beyond me. I thought that Kenton, Tennessee, the home of the major characters in “No Cause for Shame” was the middle of nowhere, but I was wrong.

Then again, my characters needed to be from a small obscure town, and Midland is neither small nor obscure.

Academic Fraud

Thirty years ago I wrote an unpublished medical novel, White Squirrel, some of which is in the process of being reworked into my third novel, The Dana Twins and Other Lies. One story line from White Squirrel which will not be worked into The Dana Twins and Other Lies involved academic fraud. When I set out to write fiction after a thirty year hiatus, I wondered whether or not this theme would resonate with readers of a novel, and decided that it might not.

The story of a drug company or a manufacturer falsifying research to make millions has become a staple of modern crime shows. Typically, in those dramas, a whistle blower is murdered to conceal the truth and the investigator-protagonist steps in at that point. Since the fraud involves huge amounts of money, the dishonesty is easily understood by even the most unsophisticated viewer.

Academic fraud, on the other hand, occurs on a much smaller scale. Real science is built in small pieces, one brick at a time, and the stakes in academic fraud are usually much smaller. Academic fraud often involves someone falsifying science in order to generate a series of publications, or to advance their career – gain tenure, or to please a mentor. To my knowledge, no one has ever been killed to conceal academic fraud, though lives and careers have been destroyed. The following tales happened approximately thirty years ago, and while they were known in the academic community at that time, they have faded into obscurity and a retelling seems appropriate, certainly more appropriate than creating a fictional fraud just to write a novel about it.

 

In the early 1980’s, Dr. John Darsee published an impressive series of papers while a medical resident at Emory. After becoming a research fellow in cardiology at a Harvard teaching hospital, Darsee was observed running a rhythm strip (EKG recording) on an animal, then breaking the recording into pieces and labeling them with different dates and times, making it seem that they were parts of different experiments. As reported in TIME magazine, and elsewhere, several hours of work appeared to be several weeks of data.

A preliminary investigation at Harvard found nothing out of the ordinary, except for what was apparently a single aberrant action. However, when the overall body of Darsee’s data was found to be inconsistent with results obtained by other investigators working on the same project, Harvard was criticized for claiming to have completely reviewed data which were – in essence – non-existent.

By the time the entire sham was discovered, Dr. Darsee had been offered a faculty position at Harvard based on his productivity. That offer was rescinded. Darsee was banned from receiving NIH research funding for a period of ten years. He left research, took a fellowship in critical care medicine, and, as best I could learn, is in practice as an internist in Indianapolis, Indiana.

One of the interesting themes of the Darsee story is that internal investigations are often flawed by the fact that the people who do the investigating are the people at the institution who are most familiar with the research issue in question, i.e. the people who should have been supervising the study. Finding a major problem in such a review would mean finding oneself guilty of not providing adequate supervision. Hence, since one is, in essence, investigating oneself, there is a vested interest in not finding academic fraud. That theme repeats itself in other stories of scientific fraud. Ironically, a NY Times article from December 15, 1981 praised Dr. Eugene Braunwald, Dr. Darsee’s supervisor at Harvard, for acting with speed and responsibility to perform a thorough investigation. That, of course, was before all the facts were known. At that time, the investigation had uncovered only the single aberrant act by Darsee at Harvard and had reached the conclusion that Darsee was a prolific and brilliant researcher whose work at Emory was not in question. That latter statement was true only until someone thought to look at Darsee’s previous work at Emory. Overall, it seems that Darsee learned at an early point in his career that it was easier to publish research data if one omitted the tedious step of actually doing the research. 

At the end of the Darsee affair, numerous papers from Harvard and Emory were retracted. Darsee’s supervisors were criticized for providing lax supervision, and the prestigious New England Journal of Medicine took the opportunity to criticize Darsee’s co-authors for attaching their names to work with which they were unfamiliar. While Darsee’s chicanery was not the only force behind a greater concern for assigning authorship on scientific papers, it was one of them.  

 

 Perhaps the most prominent fraud in medical science involved Dr. William Summerlin, working in the lab of the noted immunologist Dr. Robert Good, a scientist who had been on the cover of TIME magazine in March of 1973.

In 1973, Dr. Summerlin claimed that by growing cells in tissue culture he could graft incompatible cells into mice, the most dramatic example being a graft of cells from a black mouse into a white mouse. The work appeared to revolutionize transplant immunology. I remember being at the national presentation of Dr. Summerlin’s work in Atlantic City when my program director said, “That’s the most amazing thing I ever heard – if it’s true.”

The house of cards collapsed when an animal caretaker examining one of Summerlin’s mice found that the black color could be washed off with alcohol.  

As documented in the book The Patchwork Mouse, Summerlin was involved in a series of “interesting” experiments. For example, corneas can be transplanted from one individual to another because the site is protected from the immune system. This is not true when the corneal transplant involves the limbus, the area where the cornea joins the sclera. In addition to the black/white mouse experiments, Summerlin was running a study in which one eye of a dog allegedly had a corneal transplant involving the limbus without the tissue culture step. As expected that eye became cloudy. The other eye, the control, had a limbus type corneal transplant, allegedly with the tissue culture step. That eye was clear. There was just one problem. The clear eye was actually an eye that had not had any surgery and the cloudy eye was an eye that had undergone a transplant. In essence, Summerlin’s entire body of work was apparently fraudulent.

Summerlin’s background was in dermatology, not immunology, and he claimed that he was “under pressure” to produce good results. One is left to wonder why such an important group of experiments was entrusted to a dermatologist without formal training in immunology.

What I have found most interesting is the scene described by the authors of The Patchwork Mouse in which one of the animal caretakers brought the mouse to a young surgeon at Sloan-Kettering and showed him how the color “washed off.” Without hesitation, the surgeon, one of my medical school classmates, Dr. John Raaf, brought the animal to Dr. Good’s office. Informed by a secretary that Dr. Good was meeting with the Board of Directors, or some equally important group of functionaries, Dr. Raaf allegedly responded, “Get him out of there; this is important.”

The Summerlin story illustrates the critical point that if you give too much responsibility to an untrained individual, he may have to choose between failing or fabricating data. He may choose the latter option. That theme is echoed in the story below.

The last tale of academic fraud that I wish to share is my favorite because, as the story has been reported, no one listened to the female whistleblower. Thus, the tale is not only one of academic fraud, but also a case of the “old boy’s network” versus a woman who was intellectually wronged. I personally think that this tale has potential as a stage play. Unfortunately, as the case played out in real life, the ending was too abrupt to be optimally dramatic, but, with a little literary license, it might work.

In essence, the story is this. Dr. Helena Washslicht-Rodbard (hereafter referred to as Dr. Rodbard) and her supervisor, Dr. Jesse Roth, at the NIH performed a study measuring insulin receptors in women with anorexia. The women were restudied after they had been treated with behavioral therapy and had clinically improved. The details and the results of the study are not critical to this discussion.

The Rodbard and Roth paper was submitted to the New England Journal of Medicine (NEJM). As is the policy of all journals, the NEJM sent the paper to reviewers, in this case three reviewers. One of the reviewers was Dr. Phil Felig of Yale, who, as per relatively standard practice, gave the paper to Dr. Vijay Soman, an investigator in his lab, to review.

Dr. Soman recommended rejection of the Rodbard and Roth paper; the other two reviewers recommended acceptance after revision. Shortly thereafter, Soman and Felig submitted a similar paper to the American Journal of Medicine and, since the work was in a somewhat esoteric field, it was sent to Dr. Roth to review. As might be expected, he shared the manuscript with Dr. Rodbard, and a major scandal was brewing.

Dr. Rodbard immediately recognized that the Methods Section of the paper seemed to be taken word for word from her manuscript. Obviously, there was an issue of plagiarism. Since the methods section tells how something was done, the excuse was offered at some point, that Dr. Soman “borrowed” Dr. Rodbard’s description of her techniques since they had done the same thing and her description was “perfect.” The second issue was one of propriety. Dr. Rodbard guessed, correctly, that since Soman and Felig had “borrowed” her Methods Section, they had, obviously, seen her paper. Clearly, they had been one of the reviewers. In fact, they had given the review which recommended rejection to the Rodbard and Roth paper which presented work similar to their own work. 

In science, primary discovery, even in a very limited field, has intellectual if not monetary value. By recommending rejection of the Rodbard and Roth paper, Soman and Felig increased the chance that their work would be published first. The question was raised as to whether Soman and Felig should have notified the editors at NEJM of this potential conflict. Since Felig (at Yale) and Roth (at the NIH) were long-time friends, (not only professional acquaintances, but actually boyhood friends), they agreed to meet and review the two papers. When that was done, the plagiarism was obvious. To resolve the problem, an agreement was worked out whereby priority would be resolved in favor of Rodbard and Roth. The Rodbard and Roth paper would be published; the Soman and Felig paper would be published after Rodbard and Roth had published, and it would cite the work by Rodbard and Roth.

Things might have ended simply at this point, except for one thing. On further review, Dr. Rodbard became suspicious that Dr. Soman had done more than “borrow” her methods section. Her suspicions had a major impact on the careers of several individuals and on two major academic institutions.

Both the paper by Rodbard and Roth and the paper by Felig and Soman studied anorexic women at baseline and after their anorexia had improved. The subjects at the NIH had been part of an intense psychotherapy program which was responsible for their clinical improvement. The therapist was a co-author on Rodbard and Roth’s paper. Soman and Felig’s subjects had “improved” to a similar degree. However no statement was made as to what had been done from a psychiatric point of view to lead to the improvement. Also, there was no co-author from the Department of Psychiatry on their paper. Dr. Rodbard brought her concerns to a Dean at Yale and also to the New England Journal of Medicine.

The Dean at Yale (Dr. Robert Berliner) accepted reassurances from Dr. Felig that all was well with the work published under his name and Dr. Soman’s name. The Dean informed Dr. Rodbard of that fact. Not surprisingly, Dr. Rodbard was less than pleased with the results of the investigation. 

Somewhere during the process, Dr. Rodbard’s supervisor (and co-author), Dr. Roth, essentially told her to cease and desist, and not to use NIH stationery in promulgating her complaints – which he seemed to regard as a personal vendetta. There is of course no way to know how his opinion was biased by his long term friendship with Dr. Felig at Yale. 

When I write fiction, I tend to see scenes, and I imagine Dr. Roth telling Dr. Rodbard to calm down, and Dr. Rodbard replying that important principles were involved and that instead of her calming down, he should be getting excited. Considering that he is in a senior position, and male, and she is the junior person and female, one can imagine the rest of the dialogue on one’s own.   

In any case, with a controversy smoldering, and legitimate questions about the adequacy of the Yale internal review, the New England Journal of Medicine sent an associate editor (Dr. Jeffrey Flier) to Yale to interview Dr. Soman, the junior faculty member who had seemingly duplicated the work of Rodbard and Roth. Almost as soon as Dr. Flier began his review, he became suspicious of Dr. Soman’s work. Data appeared to be missing, and where there was data, it looked too good to be true. Stated simply, in laboratory studies, points may lie near a straight line, but not exactly "on the line."

Dr. Flier challenged Dr. Soman about the data and Dr. Soman quickly confessed that he had “made up” some of the results due to a tremendous pressure to produce results and publish quickly. Flier had uncovered in a few hours what an internal Yale review had failed to find in a year. 

The fallout from the fraud brought the scandal to the public eye, leading to the telling of the tale in the prestigious journal Science. Prior to Soman’s confessing to the fraud, Dr. Felig, who was Chief of Endocrinology at Yale, had been hired as Chief of Medicine at Columbia. Felig had recommended that Dr. Soman be appointed a member of the faculty at Columbia. With the fraud revealed, Felig informed Columbia about what had happened and told Columbia that Dr. Soman could not be offered a position. He did not mention, at that time, the failure of the previous internal Yale investigation to uncover the fraud.

When all the facts came to light, Columbia became aware that an outside auditor quickly found what the internal Yale review (by Dr. Felig and one of the Yale Deans) had not uncovered. Dr. Felig was asked to resign as Chair of Medicine at Columbia since it was felt that the entire affair tarnished his ability to lead by example. Dr. Soman had, by this time, resigned from his position at Yale and returned to his native India. Twelve papers that Dr. Soman had published, eight of which had been co-authored by Dr. Felig, were retracted. Dr. Felig returned to Yale as a tenured Professor but without a named chair. (Since I am a professor, but do not have a named chair and do not aspire to one, I cannot say how much of a penalty that represents.)

Dr. Rodbard left the NIH. However, she was, as best as I can determine, in the midst of her training and not in a permanent position. She went into private practice in endocrinology. When I taught about academic fraud in the History of Medicine course at Vanderbilt, Dr. Rodbard was one of the heroes and I was happy to learn that in the intervening decades she went on to serve as president of both the American College of Endocrinology and the American Association of Clinical Endocrinologists.

Dr. Jeffrey Flier, the external investigator who uncovered the fraud, also has had a distinguished career. He went on the become Dean of the Faculty at Harvard Medical School.

The cases of Dr. Summerlin and Dr. Soman are examples of a junior person functioning without adequate supervision and illustrate why internal reviews often fail to detect obvious problems. Whether academic fraud is more common or less common now as compared to thirty years ago is unknown. Academic fraud is hard to measure.

 

People have attempted to measure academic fraud by counting "results which cannot be replicated." However, as scientists know, we generally take a probability level of 0.05 (1 in 20) as a level of statistical significance. This means that if a finding is positive at a level of 0.05, there is a 1 in 20 chance that the finding is random. Failure to replicate a result does not mean that something untoward was involved. It may simply mean that the initial observation was random.

We do know that academic fraud has not disappeared. Fifteen years ago, the most common condition for which a stem cell transplant was done was breast cancer. The value of the procedure was unclear as all of the studies showing a benefit for high dose chemotherapy in conjunction with stem cell transplant involved historical controls which were not truly similar to the patients undergoing the transplant procedure. Since there was legitimate concern over the value of the procedure, several randomized concurrent studies were performed to demonstrate whether or not stem cell transplant in breast cancer was of clinical value. All but one of the studies showed no benefit; the doctor conducting the study showing a positive result confessed to manipulating his data.

 

Joe Paterno and Lance Armstrong

Today is the first anniversary of the death of Joe Paterno, a man whose failings, revealed in the final months of his life, erased a reputation built over a lifetime. The issue of image as opposed to substance, seems more relevant than ever. We are only five days removed from Lance Armstrong’s confession to Oprah that he was all image, and no substance. He was just another rider violating the rules in a sport where, in essence, nearly everyone violates the rules.

His manufactured image is that of a heroic cancer survivor. In truth, all of his victories were tainted; his titles have been stripped. In truth he is just a guy who had cancer and never won a major race after that point in time. Whether Armstrong used EPO to win races, to support his foundation, or to create a heroic image of himself really doesn’t matter. To me the saddest parts of the Armstrong travesty are the lies and lawsuits aimed at people who dared to tarnish the phony image of “the one honest cyclist” in a tainted sport.

“Everyone” may cheat and use drugs in cycling. Not everyone goes out to destroy other people who shout that the emperor has no clothes. Lance Armstrong looks the part of a handsome hero, and the image has enabled him to get away with a great deal. To me, it’s the vindictiveness with which he went after his detractors, more than the drug use, or the titles albeit tainted) that defines Armstrong as a person.

While Armstrong’s lies enriched him, the lies were in a good cause. As a physician I have numerous patients who wore their yellow “Livestrong” bracelets with pride, symbolic of their ability to bounce back. I doubt that Armstrong’s admissions make them feel that recovery is impossible. After all, if they could become competitive athletes, even if they couldn’t win without cheating, that would be a substantial win. And, just as Armstrong’s legion of followers are willing to admire the good in the man, there are tons of Penn State alumni who still need to see the good in Joe Paterno, and with Paterno, as in all of us, there is good and bad.

Having helped my wife with her doctoral dissertation on the topic of abuse, and having written a novel about a woman who is raped and uses the notoriety to create a foundation to help other victims – and make herself a media superstar in the process – I followed the Paterno story with great interest. On the anniversary of JoePa’s death, I offer a few observations, none of which are original or profound. Athletic programs should not exist just so the alumni and fans have something for which to cheer. They should exist because they can have a positive impact on the students who come into the program. Whether we call that building character or creating a sense of teamwork doesn’t matter. When an athletic program becomes counter-productive because people in the program are more concerned with image (“We run a clean program.”) than they are with substance (“We are enabling a pedophile.”), that is a disaster beyond measure.

The serious points have been made elsewhere and are obvious. Sex abuse is bad. We should prevent it if we can. The perpetrators need to be punished. Victims need our sympathy.

However, to keep the mood from this posting from being totally depressing, I want to conclude with two comments that would have been made by my character, Amibeth, if only one of my novels had been set in the period of 2011-2012.

Having a “clean” program does not mean allowing a suspected to pedophile to soap up and shower with children.

Penn State debated whether or not to remove the Paterno statue. They finally had the decency to repudiate his phony image of integrity and place it in storage. However, while the debate was ongoing, someone advanced an idea that was as insightful as it was sad. Instead of removing the statue, someone suggested that Penn State should leave it up, but should rotate it one hundred and eighty degrees so that, symbolically, Paterno would be remembered not as a leader but for “looking the other way.”

Welcome to my blog

Greetings from San Diego where I am on extended vacation avoiding the Nashville winter and concentrating on my writing. We are three houses from the ocean. The good news is that it's a short walk to the beach - which the dogs seem to love. The interesting news is that cars pull up in front of the house, people wrap themselves in a towel, strip off their clothes - under the towel, and put on a wet suit to go surfing. That doesn't happen on Lynmont Drive back in Nashville.  

 

My second novel, Reasonable Degree of Certainty went to the publisher today and should be available from Amazon.com as an e-book, softcover, or hardcover within a couple of weeks. Why anyone other than my mother would buy the hardcover is beyond me, but I get a hardcover copy as part of my deal.

 

My first novel, No Cause for Shame, continues to get favorable responses. No Cause for Shame is the title of my blog, and the title of the charity run by one of my characters, Amibeth. From time to time I will let her rant on this page since real radios have trouble picking up her show and she deserves an audience. Some people have described her as being to survivors of abuse what Lance Armstrong is to survivors of cancer. Amibeth and I would like to take the opportunity to state that she did it without performance enhancing drugs and only with the benefit of the Brandenburg-Aaron Agency, which, if you have read the book, you will have to admit is a far far greater form of cheating.   

 

That's it for now. Buffy (the cocker spaniel) and Layla (the spirited shih-tzu) say "Hello." It's a tough life being a writer, but better than telling people that they have leukemia.