Links related to work published by Scott Reuben MD have been removed from the Foundation's web site

based on the information disclosed in the two articles printed below

Fraud Case Rocks Anesthesiology Community





ISSUE: 3/2009  |  VOLUME: 35:3


Fraud Case Rocks Anesthesiology Community
Mass. Researcher Implicated in Falsification of Data, Other Misdeeds  


In what experts are calling one of the largest known cases of academic misconduct, a leading anesthesiology researcher has been accused of falsifying data and other fraud in potentially dozens of published studies.

Scott S. Reuben, MD, of Baystate Medical Center in Springfield, Mass., a pioneer in the area of multimodal analgesia, is said to have fabricated his results in at least 21, and perhaps many more, articles dating back to 1996. The confirmed articles were published in Anesthesiology, Anesthesia and Analgesia, the Journal of Clinical Anesthesia and other titles, which have retracted the papers or will soon do so, according to people familiar with the scandal (see list). The journals stressed that Dr. Reuben’s co-authors on those papers have not been accused of wrongdoing.

In addition to allegedly falsifying data, Dr. Reuben seems to have committed publishing forgery. Evan Ekman, MD, an orthopedic surgeon in Columbia, S.C., said his name appeared as a co-author on at least two of the retracted papers, despite his having had no hand in the manuscripts. “My names were forgeries on the documents,” Dr. Ekman told Anesthesiology News.

Dr. Reuben has been an extremely active and visible figure in multimodal analgesia, particularly as an advocate for its use in minimally invasive orthopedic and spine procedures. His research has provided support for several mainstays of current anesthetic practice, such as the use of nonsteroidal anti-inflammatory drugs and neuropathic agents instead of opioids and preemptive analgesia. Dr. Reuben has also published and presented data suggesting that multimodal analgesia can significantly improve long-term outcomes for patients.

Incomprehensible Course

All of that is now in question, said Steven L. Shafer, MD, editor-in-chief of Anesthesia and Analgesia, which retracted 10 of Dr. Reuben’s articles. “We are left with a large hole in our understanding of this field. There are substantial tendrils from this body of work that reach throughout the discipline of postoperative pain management,” Dr. Shafer said. “Those tendrils mean that almost every aspect will need to be carefully thought through. What do we still believe to be true? Do the conclusions hold up to scrutiny?”

Dr. Shafer said that although he still believes “philosophically” in multimodal analgesia, he can no longer be absolutely certain of its benefits without confirmation from future studies.

Dr. Shafer called the scandal “a tragedy” for the profession, for patients and for Dr. Reuben personally. “I cannot begin to comprehend why a person would take this course,” he said of the research fraud.

Efforts to reach Dr. Reuben were unsuccessful.

Internal Inquiry Revealed Sweeping Misconduct

The retractions came after an internal investigation by Baystate turned up evidence of widespread fraud in Dr. Reuben’s research. Jane Albert, a spokeswoman for Baystate, said the inquiry was undertaken after an internal reviewer at the medical center had raised questions last year. Ms. Albert said the hospital’s investigation raised “no allegations concerning any patient care. This was focused on academic integrity.”

Dr. Reuben is on medical leave from his position as chief of the acute pain service at Baystate, Ms. Albert said.

Dr. Reuben, who was educated at Columbia University and received his medical degree from SUNY at Buffalo School of Medicine, is well-known among anesthesiology researchers for his studies of multimodal analgesia, the practice of combining several forms of pain relief to better control postoperative discomfort and promote faster recovery from surgery.

Rumors of a problem with Dr. Reuben’s research have been circulating among academic anesthesiologists for a year, according to people familiar with the matter.

"Interestingly, when you look at Scott’s output over the last 15 years, he never had a negative study,” said one colleague, who spoke on the condition of anonymity. “In fact, they were all very robust results—where others had failed to show much difference. I just don’t understand why anyone would do this or how anyone could pull this off for so long.”

A recent PubMed search for Dr. Reuben’s name turned up 72 citations, the most recent an article in the December issue of the Journal of Cardiothoracic and Vascular Anesthesia on preventing the development of chronic pain after thoracic surgery.

“Massive” Breach of Trust

Josephine Johnston, an attorney specializing in research integrity at the Hastings Center, in Garrison, N.Y., called the scope of the Reuben fraud “massive.”

"It’s usually just one article, not a body of work,” Ms. Johnston said.

What’s particularly surprising given the dimensions of the case, Ms. Johnston said, is that Dr. Reuben’s research managed to raise no alarms among peer reviewers. However, she added, “the peer review system can only do so much. Trust is a major component of the academic world. It’s backed up by the implication that your reputation will be destroyed if you violate that trust.”

House of Cards?

A cornerstone of Dr. Reuben’s approach has been the use of the selective cyclooxygenase-2 inhibitor celecoxib (Celebrex) and the neuropathic pain agent pregabalin (Lyrica), both manufactured by Pfizer. Dr. Reuben has received research grants from the company and is a member of its speakers’ bureau. However, a source told Anesthesiology News that Pfizer recently alerted its speakers to remove any reference to Dr. Reuben’s data from their presentations. Pfizer was unable to comment by the time this article went to press. The company has not been accused of wrongdoing in the matter.

Jacques Chelly, MD, PhD, MBA, director of the Division of Regional Anesthesia and Acute Interventional Perioperative Pain at the University of Pittsburgh Medical Center (UPMC), said that the Reuben episode has left multimodal analgesia “in shambles concerning many of the drugs we use”—particularly celecoxib and pregabalin. “The big chunk of what people have based their protocol on is gone.”

In light of the situation and economic concerns, UPMC has stopped giving celecoxib and pregabalin to surgery patients “until we have some very formal evidence that we should do something else,” Dr. Chelly said. “In this day and age, doing multimodal [therapy] is expensive. Any institution is going to look at evidence-based clinical decisions, and unless we have very strong data, it is a problem.”

One of the pillars of support for combining celecoxib and pregabalin was a 2006 study in Anesthesia and Analgesia—for which Dr. Reuben has been a reviewer—by Dr. Reuben and colleagues that found the approach effective in patients undergoing spinal surgery. That paper has been withdrawn. “If we take out [those] data in spinal,” Dr. Chelly said, “you really don’t have any evidence that the combination is working.”

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ISSUE: 3/2009  |  VOLUME: 35:3


Routine Audit Uncovered Reuben Fraud

Missing IRB Info Led To Discovery of Fabricated Data



Early April is an exciting time at Baystate Medical Center. That’s when the Springfield, Mass., institution prepares for its annual research week highlighting the latest studies by its 270 faculty members and other scientists.

But 2008 was different. In the run-up to the event, Hal Jenson, MD, Baystate’s chief academic officer, made an alarming discovery. During a routine audit of the summaries, Dr. Jenson found that two abstracts submitted by one of the hospital’s prominent anesthesiologists, Scott S. Reuben, MD, had a potentially critical flaw: neither of the studies appeared to have the approval of Baystate’s institutional review board. That wasn’t necessarily a breach of ethics; after all, multicenter trials often have IRB approval only from sites where patients are enrolled. But it was enough of a red flag that Dr. Jenson asked one of his colleagues to speak with Dr. Reuben about the missing information.

What ensued was the unraveling of what medical ethicists are calling one of the largest instances of research fraud ever reported, a massive scandal that has led to the withdrawal of as many as 21 journal articles (see list).

Virtual Patients

Investigators for the hospital reached a shocking conclusion. “It turned out that was not IRB approval because the data were fabricated because the data were partially or completely fabricated,” Dr. Jenson told Anesthesiology News. Simply put, Dr. Reuben had concocted the data—and in many cases the patients themselves—out of vapor.

Over the following weeks and months, Baystate investigators learned that Dr. Reuben had been falsifying his data for years. A “prolific” writer, according to Dr. Jenson, Dr. Reuben—who graduated from the State University of New York at Buffalo medical school in 1985—has at least 72 published studies to his name on the journal database PubMed, a large number for a relatively young scientist. Yet because of gaps in the record, “in many cases it’s impossible to validate the data for the older studies,” Dr. Jenson said.

Baystate, which earlier this year reached out to the journals involved to request retractions of the suspect articles, stressed that none of Dr. Reuben’s co-authors is believed to have been aware of the fraud. The hospital also insists that no patients were harmed in any way by the deception.  

Foundation Weakened

Dr. Reuben’s research helped lay the foundation for an emerging area of perioperative care known as multimodal analgesia. Due to the sheer scope of the misconduct, advocates said, this field now requires major bolstering to regain the confidence of clinicians and researchers. “We are left with a large hole in our understanding of this field,” said Steven L. Shafer, MD, editor of Anesthesia and Analgesia, which has retracted 10 of Dr. Reuben’s papers. “It will take a while for science and practice to sort this out.”

In addition to the charges that he falsified data, Dr. Reuben has been accused by at least two of his co-authors of putting their names on his papers without their consent. One, Evan Ekman, MD, an orthopedic surgeon in Columbia, S.C., told Anesthesiology News that Dr. Reuben “forged” his name as a co-author on two articles in which he had absolutely no involvement. Jane Albert, a spokeswoman for Baystate, said the institution had received a complaint from another researcher who maintains he was not a co-author with Dr. Reuben.  

17-Year Career Undone

Dr. Reuben, who began working at Baystate in February 1991, is now on medical leave from his position as director of the acute pain service at the medical center, a private, nonprofit facility affiliated with Tufts University. He also has been stripped of any research and educational activities involving the institutions for a minimum of 10 years, Dr. Jenson said. Under the terms of the hospital’s guidelines for academic integrity, “I have precluded him from presenting the suspect data without my written permission,” said Dr. Jenson, who added that Baystate “does not have any intention of bringing criminal proceedings” against Dr. Reuben in the matter.

Paul F. White, PhD, MD, the Margaret Milam McDermott distinguished chair in anesthesiology at the University of Texas Southwestern Medical Center in Dallas, called the Reuben case “unprecedented in our specialty.”

Dr. White, an editor of Anesthesia and Analgesia, said that given the retracted (and likely-to-be withdrawn) papers and those that are unsullied by the affair, practitioners of multimodal analgesia are now confronted with several significant problems.

Giving patients cyclooxygenase-2 (COX-2) inhibitors such as celecoxib (Celebrex, Pfizer) after surgery has consistently been shown to relieve pain, reduce side effects related to use of opioids and improve the quality of recovery in the early and intermediate postoperative periods. However, Dr. White said, any long-term benefit of these drugs on patient outcomes is unconfirmed.   

Another question mark, he said, now looms over “preemptive analgesia” with COX-2 inhibitors and nonsteroidal anti-inflammatory drugs, a component of multimodal therapy that Dr. Reuben strongly advocated.  Similarly, doubt has been cast on the alleged lack of adverse effects of COX-2 inhibitors on bone fusion—such as at the spine—an effect Dr. Reuben’s data had supported (although this claim already had been an area of considerable controversy, Dr. White told Anesthesiology News). And finally, he said, whether multimodal analgesia can prevent patients undergoing major orthopedic surgery from developing chronic pain, as Dr. Reuben had argued, remains “unproven.”

Anesthesia and Analgesia will be publishing a series of editorials on the fraud in its May issue.

Because of the layered nature of scientific research and publishing, the scandal “compromises every meta-analysis, editorial, systematic review of analgesic trials”—as well as every lecture and continuing education course—that cited the fraudulent findings, added Dr. White, a member of the editorial board of Anesthesiology News. “Clearly, it’s time get back to the hard work of conducting clinical analgesic studies to address important issues in perioperative pain management and patient outcomes.”

Like many anesthesiologists, Dr. Reuben technically was employed not by the hospital but by a private practice—in this case, Springfield Anesthesia Service, a group of about 50 doctors that contracted with Baystate to work in its operating rooms.

The scandal has left Springfield Anesthesia reeling and embittered. “We’re all very upset about how he strung us along,” said Steven Dunn, MD, a doctor in the practice. “Our group paid him extra money and gave him nonclinical time. We all worked long hours in the OR so that he could do his research.”

Dr. Dunn said he was a co-author with Dr. Reuben of one study, but because he collected the data on that paper himself, the results have not been challenged. However, he said, the nature of the fraud was surprisingly simple—and difficult to detect. “You can see how easy it was to get away with,” he said. “If someone comes to you and says, ‘Here are data on seven patients,’ how do you say, ‘No, I didn’t see you treat those patients’? You assume that a physician would have the integrity not to lie in this way.”

Dr. Dunn, who has neither seen nor talked with Dr. Reuben since the fraud was discovered, said he hoped the scandal would not diminish the reputation of Baystate, which he called an “excellent quality” institution. “Baystate has handled this situation in a forthright and proper manner since the initial discovery. It’s disheartening for us that some guy would do this,” he said. 

The most alarming aspect of the episode for him, Dr. Dunn said, was that as a skeptic of multimodal analgesia, he would frequently find himself in debates with Dr. Reuben about the approach. During one of those exchanges, Dr. Reuben presented his colleague with a study whose data were so convincing that Dr. Dunn began to doubt his stance. That paper, he recently learned, was on the list of articles to be retracted. “I was appalled that someone could take a paper based on fraudulent work and try to change my practice,” he said. 




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