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Research in the NHS teaching series. Thank you for joining me today. Um Our topic for this session is fraud in medical research. So medical research has always aimed to advance our knowledge, improve the treatments that we're giving and build trust within the healthcare setting. However, sometimes fraud within research can some can mislead these sort of goals and can lead to serious harm. So today, we will be discussing about what research fraud is why it happens and how it uh impacts our health care and what can be done to prevent fraud in research. So let's start off with the basic definitions. What is research fraught? So fraud and medical research happens, you know, when a researcher intentionally manipulates the data or the result or the process of it for personal gains, whether it's reputation or whether they want to advance their career or whether to just get some financial incentives and fraud can take in various forms. So I've got a picture here of a pyramid that shows the different levels in which research frauds can happen. And it's also important to remember that most researchers, they do work honestly, but only it only takes a small amount of fraud to have a huge co uh consequence on our healthcare treatment. So coming back to the types of sort of research frauds and our pyramid here, you can see that the top of the pyramid, you can see that research fraud is based on falsification of data. So what that basically means when researcher they invent data that actually wasn't collected. So you know, this could be a patient data or it could be a patient form or even some kind of other types of measurements. Now, data that's called fabrication falsification is when the researchers would completely alter the data to make the results look better than they really are. And if you look at the deception of conductors, when they basically failed to follow the method that was planned out for them, they failed to follow the study blueprint or sometimes they just have a very poor measurement tools or the methods. Um And it can also include things like fail to obtain consent from participants. Another type at the bottom of the pyramid you can see is plagiarism. So this involves basically using someone else's work or idea without giving them credit. Um There's one more also that I would like to add, which is the undisclosed conflicts of interest. So that's also considered as fraudulent, which is basically researchers will be hiding some sort of a personal or financial interest. And because of the financial interest or personal interest in that study they always take that study at a biased way, they completely change it, the their work and they give you a biased outcome because they want, they're getting some kind of a money from it. We look into a bit more of what it means. So why does it all happen? So why, why are they all different types of frauds and fabrications? Well, there are many pressures that can lead to someone doing fraud within research. Firstly, researchers actually very commonly have the pressure to publish and the publication has to be in very highly reputed, highly prestigious journals. And because when you publish in those journals, you know, it can give you a job promotion. Uh you will get a lot more recognition as a person. Um your team will get more recognized within your current society. And another thing is grants. So the more you publish, especially within these uh well known journals, you'll get more grants and more money to do more research. Another reason could be financial incentives. So many pharmaceutical companies, they will fund your study so that you can tell them, you know, that you've done research on their product and you think that their product is much better than the product that's already in the market. So in sometimes pharmaceutical companies can, you know, basically buy researchers, make them do research, manipulate that data so that they can so that you know, makes the product look better and it will do much well in the market. And a third reason why someone would want to commit fraud within research would be mainly for competition and career advancement. Um I think we're in an era at the moment where all doctors, clinicians, physicians are all requested or required to do some form of research within our career. So because it makes us look as better doctors, but sometimes um it's that mere pressure that causes doctors, researchers to manipulate the data so that they can get papers out, they can finish researches on time or they can have a nice outcome. So these are maybe some of the common reasons why fraud, you know, happens in the first place. Now, what are the consequences? What really happens when you uh you know, do a lot of fraud is a uh sorry. I think someone's just said that my microphone isn't working. Let me quickly have a look to see if my microphone is walking. Can everybody hear me? Yeah. So what, what are the main consequences that can happen when there's a lot of fraud in medical research? First and foremost, it, it harms the public trust. So people are relying on scientific research to make their healthcare decisions. So when a fraud is exposed, people start questioning the reliability of our research and they start questioning our treatments. And secondly, that it's just waste of resources, whether it's time, money effort, all of this is being spent on a research that's now come out as FTS now for can also harm the patients. So when you end up giving them ineffective or even dangerous treatments based on research data that has been completely fabricated or that has been completely changed, it puts the patient's safety at risk. And lastly, it's a huge setback to scientific progress. So many researchers waste their time trying to build on fraudulent findings or findings that are not true. It completely sets back our scientific pro progress in that particular field. So before we II talk about more about research and their fraud, I want to touch up on this very common concept that was very much er that was published by Doctor Carlisle. He's an anesthesia anesthetist in the UK. Now his exposure in fraud and research has created a huge impact into what fraud and research is about on how, how uh popularly popular it is and how commonly um you know, doctors are practicing misconduct and fraud and research. So John Carlo is an anesthetist from the UK and what he's been known for is basically analyzing clinical trial data very, very meticulously. So he looks into the different datas that different clinical trials publish and he analyzes them from point to point from decimals to decimals. And he actually sees whether it's quite reliable. Uh unlike other researchers who know who analyze data and they try to find out findings from it. He analyzes data from other researchers to see whether what they're trying to prove is correct. And he actually went on to analyze data of around 526 trials, clinical trials that was published in the journal Anesthesia. And his goal was to assess the reliability of the data in these trials. Now, when he looked at the 526 trials, he did, he made a ground breaking discovery to find that the statistical methods that was used to examine the pattern within the data were all in consistence. All the 526 trials had some sort of an error, some kind of an um fraud ongoing within the data that that was, that was, that was produced by these trials. And this wasn't a, a very typical, you know, study that he conducted because he was trying to look at the integrity of the data rather than trying to look for the scientific hypothesis. And another shocking finding that he found was 44% of the trial that he analyzed had unworthy, untrustworthy data. So that means almost nearly half of the studies that was published in this journal showed data that you could not rely on. And these findings, you know, were raised as a major concern because we're trying to look at, we're trying to look at these data, we're trying to look at those research results and we're trying to create treatment plans and policies here when the data that we have is not true is not reliable. And that was quite a very uh a shocking discovery that he made. And he also coined the term as a zombie trials to describe a subset of these studies. So he said that 26% of the clinical trials that was published in that journal Anesthesia were actually zombie trials, meaning that they actually never happened or they happen to a very small level, they completely lack credibility altogether. So these trials with data that appeared fabricated with no real world basis or with methods that were so flawed that they couldn't be trusted. And this means that over a quarter of the study and his review were either fictional or, or just had complete errors and flaws. He also went on to extrapolate his data and he said that 20% of all the clinical trials are false. So and that's a staggering number that you we need to consider because there's a waste of resource time, trust money and it's going into all this clinical research. And you can imagine if you know one in five clinical trials have unreliable data, then the healthcare providers, the NHS the patients, the policy makers, they could all be making decisions about, about treatment based on incorrect information, which is both dangerous and wasteful altogether. So that was about the discovery of John Carl and his objectivity. Now let's look into some of the examples of fraudulent studies that we actually discovered and there was, there are so many, but these are the co of common ones that I wanted to pick up on and they're quite latest as well. So the first one I want to talk about is Doctor Sato. So he actually is a researcher who studies uh fracture prevention. And his um the, the, the, the data that he published from his study on how to prevent fracture was actually used to make a lot of clinical guidelines. So say it does what he it it it it focused on treatment of preventing fracture. And it's very much important in fields of geriatrics and orthopedics. But it was only later that, that the discovery was made that some of his studies contained fraudulent data. So despite the fact that S ao's S AO findings were used to shape clinical guidelines, the recommendations that were made for patients became untrustworthy altogether. Another example, uh this is quite a famous one was admin was about administering steroids for C section deliveries in obstetrics and gynecology in pregnant women. So there were four randomized control studies, four RCT S that looked at the effectiveness of giving steroid injections for mothers who were going to have C section. And the four studies were one of them was conducted in the UK. And the other thing was in Egypt. And they all proved the point that if the mother receives steroids before having ac section, there will be a positive effect on the baby's breathing. That means that the baby will have no breathing issue, which has always been in a risk when a baby is born via C section. So initially, you know, these trials suggested, yeah, please give steroids, it reduces breathing problems in newborns. And this was a very uh a uh uh this finding was had a huge implication. And because of this promising results, the review of this study was cited over 200 times and it was incorporated in a lot of clinical guidelines and it started influencing the way obstetricians and midwives were practicing all over the world. But a later analysis of these four trials found that the three Egyptians trials were all fraudulent data. So the dra from these trials were not, couldn't even be trusted, they were either altered or the data, the way that they gathered, the data was quite questionable. And this was a huge blow because it means that the large portion of the evidence that a supportive steroid use for C section is now unreliable. So when we've got that, when we look at the RCT evidence as a whole, with three Egyptian clinical trials have been knocked out, that's just n and we were just left with one of the clinical trials in the UK when they analyzed that they found that it was quite a trustworthy, but it wasn't, you know, it, the, the evidence wasn't strong enough. We just have one clinical trial that said, yes, you can use C SEC, you can use steroids in C section. But with that one clinical trial, we've never made a huge change, a huge uh changes to our guidelines and treatments. So you can see how when a data gets released, we change the guidelines and treatments. And later on, we find out that the data was actually a fraudulent data. It's now starting to question the way we are practicing medicine and how much of an impact that it's it's actually have, it's a having on patient safety and apart from patient safety, you know, it sort of erodes the trust we have within the medical research community. So, uh a lot of things are, are involved and and a and a number of um issues are here at uh numerous levels. But that's the effect of having fraud and um fraud, fraudulent data within our uh medical research evidence that we have. Now, the next part I wanted to talk about was what can actually go wrong again. So when you have limitations of having fraud research, it could be the trust based systems can completely fail. So now the systems will start to question our medical research whether we're, we're actually producing any enough true data. Second will be the the main limitation for finding out whether this research fraud is that we don't actually have any kind of quantifiable measure for fraud and the nature and of research and the necessity of publication. The career is also questioned here and Another thing is with the ongoing um advancement in A I Artificial Intelligence fraudulence is now becoming much more easy. It's very easy to fabricate data. A I will do it all for you. So because of this increase in technology, although it favors us in one extent, it's now becoming very easy to generate very false information, false research data as well. So what can we do now? Because of the reasons? Uh because of all the consequences, fraud in research can happen. I think it's important to understand its implications and its consequences as a physician, as a doctor, uh or as someone who's working in the healthcare system. And it's important that we are aware of why these reasons happen, why, why people do fraud and research and to just challenge ourselves. Uh by saying, uh you know, it's, it's unethical. Um it challenges our um goals and our ethics towards duty as a human being and as a doctor towards our patients. So it's important to just have that self conscious and not to give into doing food and research. And second of all, you can, you know, be aware of the trust based systems that is medical research and the uphold that trust for patients families and yourself as well. Just being honest with yourself, being honest with your team and being honest with the treatment that you're practicing and you're giving to your patients. And lastly when you come across different clinical trials and the data, there are various tools that you can use or checklists that you can use to see whether the data is quite reliable. Uh, and a common one is known as the repressed checklist. It's something that you can go away and read upon. So it's a checklist that you can use to see whether the, the clinical trial data is reliable or not. But there's a, er, we're still, uh, there, there's still a lot of gray areas within fraud and research and I think a lot of the areas are not exposed but, um, the, the amount of fraud and the way it's now increasing is quite a staggering number. And we need to understand that, although 90% of the research is quite true and honest, if we only have a small percent of fraud, it still causes a big consequence. Um, it still completely changes the way we practice medicine. So it's important to be honest to ourselves and to the, to the work that we do in order to make sure that we don't fall into the trap of practicing fraud when, when we're working as researchers. So that brings us to the end of uh this session. Thank you for listening. If you have any questions, I'm happy to answer them. Please feel free to pop them in the chat box if you have any other questions uh later on in the day, uh feel free to email me, email me and I'm also gonna put up the feedback form link which you can find um at the bottom of the of the video or also in the chat box. Uh Please do fill that out. So it's a bit useful for us to see whether we're on areas that we can improve as well. Uh Thank you for your time today and I hope to see you in another teaching session. Bye.