Throughout the history of medicine, advancements frequently have been made by people who pioneered research, inventions, and methods of treatment and who had the strength, conviction, and fortitude to persist, regardless of the opposition.
One such individual who made enormous contributions during my lifetime is Sir John Charnley. When his total hip was first introduced in the United States on an experimental basis (you needed an identification number to use methyl methacrylate), I was a resident and my “chief” emphatically stated, “That will never work.” Being the follower that I am, I repeated that belief for the next decade. Now, several decades later, I have a total hip. (I may often be wrong, but never in doubt!)
I—and the hundreds of thousands of people around the world who have had total hip arthroplasty—am forever indebted to Sir John Charnley, one man who made a difference, changed the course of medicine, and improved patients’ lives.
Conversely, this issue’s cover story reports on one man—Scott S. Reuben, MD—whose research influenced the course of medicine and changed treatment regimens—but in a negative way.
I categorize research as “good, bad, and ugly.” Good research is research that is properly done, and published regardless of the outcome. Bad research, while honestly performed, is set up with a faulty proposition, has an inadequate protocol, does not test the hypothesis, or is generally technically poor and does not scientifically eliminate variables and bias, but—I repeat—it is honest research.
The worst part of ugly research is that it is the hardest to detect. According to peer reviewers and editors, without taking on the impossible task of reviewing each patient’s records, one cannot detect fraudulent research. A good impostor can make the results “fit,” and make it difficult to prove otherwise.
When ugly or fraudulent research occurs and is published, about all that can be done is to retract the article. The journal that originally published the article makes an announcement stating that the article has been retracted because the research is “tainted.” In today’s litigious environment, this may not be an easy task. AAOS Now would like to applaud two editors who have already taken this step—James D. Heckman, MD (The Journal of Bone and Joint Surgery) and Steven L. Shafer, MD (Anesthesia & Analgesia).
In preparing the article on Dr. Reuben, AAOS Now found more than 70 peer-reviewed, published manuscripts that he authored or coauthored. Many of these articles focused on the subject of COX-2 inhibitors used as a perioperative analgesic and anti-inflammatory medication. These articles were, in turn, cited by more than 700 subsequent articles by other authors, many of whom based their use of COX-2 inhibitors on Dr. Reuben’s studies. Ugly research spawned bad research based on faulty, fraudulent data.
Just as Dr. Charnley influenced orthopaedic surgery in a positive way, it appears, if the allegations against him are correct, that Dr. Reuben has influenced orthopaedic surgery and other medical specialties in a negative way. These revelations call into question the role of COX-2 inhibitors in the treatment of perioperative pain, and, perhaps unjustly, give COX-2 inhibitors another black-eye. As orthopaedic surgeons, we no longer know what to believe and are increasingly confused about their use.
It will take time to clear up the spoilage from this ugly research. Perhaps a panel of experts, including journal editors, should be assembled to review the multiple studies infected by this ugly research and to determine whether any consensus can be reached on the use of COX-2 inhibitors as anti-inflammatories. I’d volunteer to help, because I know that one person can make a difference—and I’d rather make a difference for the good, than the ugly!