Anesthesia & Analgesia has retracted 22 papers by Joachim Boldt, the discredited German anesthesiologist whose prolific career as a researcher has unraveled with stunning rapidity — and 67 more retractions are likely on the way from 10 other titles that have published his work.
The 22 retractions, announced Feb. 25 on the journal’s website, come less than a month after the state medical board overseeing an investigation into Boldt’s publications said that it was looking into more than 90 of his articles out of concern that he had failed to obtain proper approval from an institutional review board for the work.
The board, Landesärztekammer Rheinland-Pfalz (LÄK-RLP), investigated 102 articles. Investigators could not find evidence of adequate IRB approval for 89 papers; for the remaining, 11 had IRB approval and two did not require it, according to the A&A notice, which was signed by editor-in-chief Steven L. Shafer:
The retraction of the articles … for lack of IRB approval means that the research was unethical, and that IRB approval for the research was misrepresented in the published article.
The LÄK-RLP inquiry is ongoing — as Shafer notes with praise, it’s a small group with a meager office staff — as is an investigation by Boldt’s former employer, the Klinikum Ludwigshafen, which dismissed him late last year. The two bodies are tasked with looking at different aspects of Boldt’s behavior: the LÄK-RLP, with issues of IRB approval, the clinic with whether Boldt accurately represented his findings and research. As the notice states:
Klinikum Ludwigshafen has commissioned an investigating committee to systematically assess the veracity of the findings presented in Dr. Boldt’s articles against patient and laboratory records. We will communicate to our readers any finding of data fabrication, falsification, or misrepresentation identified by the investigating committee at Klinikum Ludwigshafen.
Although Germany and the United States have somewhat different structures for IRBs, Shafer notes that both systems matured in the aftermath of the 1945-46 Nuremberg trials, during which Nazi wartime atrocities were revealed. As he said:
They obviously take [ethical research] very seriously in Germany.
Should he be found guilty of violating the Code of Deontology, Germany’s medical ethics provision, Boldt could face a fine of up to 100,000 Euros, and even jail time if he broke any laws. (We have attempted to contact him recently several times by email for comment but have not received a reply.)
The articles in A&A spanned the period 1999 to 2009 and are available on the journal’s website. According to the retraction notice, the remaining 67 articles will likely be retracted this week, once the 10 journal editors “have had an opportunity to review the list and notify their readers.”
Here’s the list of the 22 articles A&A is retracting. The individual articles are not yet marked as retracted. The vast majority were cited in the double digits, according to Thomson Scientific’s Web of Knowledge, with #17 cited 99 times:
1. Riesmeier A, Schellhaass A, Boldt J, Suttner S. Crystalloid/colloid versus crystalloid intravascular volume administration before spinal anesthesia in elderly patients: the influence on cardiac output and stroke volume. Anesth Analg. 2009;108:650-4.
2. Boldt J, Brosch Ch, Röhm K, Lehmann A, Mengistu A, Suttner S. Is albumin administration in hypoalbuminemic elderly cardiac surgery patients of benefit with regard to inflammation, endothelial activation, and long-term kidney function? Anesth Analg. 2008;107:1496-503.
3. Mayer J, Boldt J, Wolf MW, Lang J, Suttner S. Cardiac output derived from arterial pressure waveform analysis in patients undergoing cardiac surgery: validity of a second generation device. Anesth Analg. 2008;106:867-72.
4. Mengistu AM, Röhm KD, Boldt J, Mayer J, Suttner SW, Piper SN. The influence of aprotinin and tranexamic acid on platelet function and postoperative blood loss in cardiac surgery. Anesth Analg. 2008;107:391-7.
5. Boldt J, Wolf M, Mengistu A. A new plasma-adapted hydroxyethylstarch preparation: in vitro coagulation studies using thrombelastography and whole blood aggregometry. Anesth Analg. 2007;104:425-30.
6. Mayer J, Boldt J, Schellhaass A, Hiller B, Suttner SW. Bispectral index-guided general anesthesia in combination with thoracic epidural analgesia reduces recovery time in fast-track colon surgery. Anesth Analg. 2007;104:1145-9.
7. Boldt J, Schölhorn T, Mayer J, Piper S, Suttner S. The value of an albumin-based intravascular volume replacement strategy in elderly patients undergoing major abdominal surgery. Anesth Analg. 2006;103:191-9.
8. Mayer J, Boldt J, Röhm KD, Scheuermann K, Suttner SW. Desflurane anesthesia after sevoflurane inhaled induction reduces severity of emergence agitation in children undergoing minor ear-nose-throat surgery compared with sevoflurane induction and maintenance. Anesth Analg. 2006;102:400-4.
9. Suttner S, Lang K, Piper SN, Schultz H, Röhm KD, Boldt J. Continuous intra- and postoperative thoracic epidural analgesia attenuates brain natriuretic peptide release after major abdominal surgery. Anesth Analg. 2005;101:896-903.
10. Boldt J, Brosch C, Lehmann A, Suttner S, Isgro F. The prophylactic use of the beta-blocker esmolol in combination with phosphodiesterase III inhibitor enoximone in elderly cardiac surgery patients. Anesth Analg. 2004;99:1009-17.
11. Suttner S, Piper SN, Kumle B, Lang K, Röhm KD, Isgro F, Boldt J. The influence of allogeneic red blood cell transfusion compared with 100% oxygen ventilation on systemic oxygen transport and skeletal muscle oxygen tension after cardiac surgery. Anesth Analg. 2004;99:2-11.
12. Boldt J, Brenner T, Lang J, Kumle B, Isgro F. Kidney-specific proteins in elderly patients undergoing cardiac surgery with cardiopulmonary bypass. Anesth Analg. 2003;97:1582-9.
13. Lehmann A, Karzau J, Boldt J, Thaler E, Lang J, Isgro F. Bispectral index-guided anesthesia in patients undergoing aortocoronary bypass grafting. Anesth Analg. 2003;96:336-43.
14. Boldt J, Haisch G, Suttner S, Kumle B, Schellhase F. Are lactated Ringer’s solution and normal saline solution equal with regard to coagulation? Anesth Analg. 2002;94:378-84.
15. Lehmann A, Boldt J, Thaler E, Piper S, Weisse U. Bispectral index in patients with target-controlled or manually-controlled infusion of propofol. Anesth Analg. 2002;95:639-44.
16. Piper SN, Röhm KD, Maleck WH, Fent MT, Suttner SW, Boldt J. Dolasetron for preventing postanesthetic shivering. Anesth Analg. 2002;94:106-11.
17. Lang K, Boldt J, Suttner S, Haisch G. Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery. Anesth Analg. 2001;93:405-9.
18. Haisch G, Boldt J, Krebs C, Kumle B, Suttner S, Schulz A. The influence of intravascular volume therapy with a new hydroxyethyl starch preparation (6% HES 130/0.4) on coagulation in patients undergoing major abdominal surgery. Anesth Analg. 2001;92:565-71.
19. Piper SN, Maleck WH, Boldt J, Suttner SW, Schmidt CC, Reich DG. A comparison of urapidil, clonidine, meperidine and placebo in preventing postanesthetic shivering. Anesth Analg. 2000;90:954-7.
20. Suttner SW, Schmidt CC, Boldt J, Hüttner I, Kumle B, Piper SN. Low-flow desflurane and sevoflurane anesthesia minimally affect hepatic integrity and function in elderly patients. Anesth Analg. 2000;91:206-12.
21. Suttner S, Boldt J, Schmidt C, Piper S, Kumle B. Cost analysis of target-controlled infusion-based anesthesia compared with standard anesthesia regimens. Anesth Analg. 1999;88:77-82.
22. Suttner SW, Boldt J, Schmidt CC, Piper SN, Schuster P, Kumle B. The effects of sodium nitroprusside-induced hypotension on splanchnic perfusion and hepatocellular integrity. Anesth Analg. 1999;89:1371-7.