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The Israel Medical Association says that in future it will take action against academic fraud by investigating complaints and discouraging the relatively widespread phenomenon of “gift authorship,” in which the names of doctors not involved in research are included in the list of authors.
Its announcement comes after a recent case where a surgeon, who was presenting details of a study to a conference, claimed that six doctors had been involved in the research when in fact he had been the sole researcher. Moreover, the surgeon claimed that it was a prospective study and that informed consent had been obtained from the participants, whereas actually it had been conducted retrospectively and without informed consent.
Oleg Avrutis, a surgeon at the Bikur Holim Hospital, Jerusalem, was found by Shimon Glick, the public complaints officer at the Israeli Ministry of Health, to have falsely claimed that he and five others conducted a randomised prospective trial on nearly 1000 patients between 1992 and 1996.
The aim of the study, claimed the authors, was to compare two methods of inguinal hernia surgery: the laparoscopic approach and the Lichtenstein technique. The authors concluded that laparoscopy was superior.
The study, written by Dr Avrutis, was not published as a full article in any journal but was presented as an abstract at a conference of the European Society for Endoscopic Surgery in Barcelona in 2004. Dr Avrutis claimed that all the patients had given informed consent to be included in the study.
A surgeon who was at the conference and who had previously worked as chief of surgery at Bikur Holim during the relevant years complained to the Israel Medical Association's ethics bureau, saying that no such study had taken place. The association asked Professor Glick to investigate.
Professor Glick questioned the doctors and others and concluded, on the basis of medical records, that the study was not prospective but retrospective. In addition, he wrote, the documentation showed clearly that no one had given informed consent in advance and that some follow-up forms had been destroyed.
A disciplinary hearing awaits Dr Avrutis, but action has been postponed because he is ill, and letters of reprimand have been sent to the other five “authors” who allowed their names to be used even though they had not been involved in the study.
The health ministry said that it has acted and will continue to act to ensure purity of academic research and that anyone suspected of fraud would be investigated and punished.
The vast majority of Israeli medical research, said the ministry's director general, Avi Israeli, is carried out according to the strictest criteria.
He said, “It is distressing there are rare cases that place a shadow over the whole system, which usually functions very well.”
The management of Bikur Holim Hospital said it could not comment beyond the fact that all clinical research there must receive approval of its Helsinki committee for clinical experimentation and that patients must give their informed consent in advance.
Four of the doctors released a statement saying that the “data presented in the research were carried out solely on the basis of operations that were actually performed … When the study was carried out, it was not common practice to demand approval for routine treatments that are not innovative.”
Israeli researchers regard as fierce the pressure to “publish or perish” so as to advance academically and professionally—leading to the not uncommon occurrence of gift authorship, which violates rules on ethics but is not illegal. The only punishment the medical association can mete out is to suspend or cancel membership. Doctors have said they hoped this case would discourage the practice.
The BMJ was unable to contact Dr Avrutis for comment because he is seriously ill and is unable to communicate.