Should the chocolate-diet sting study be retracted? And why the coverage doesn’t surprise a news watchdog

Gary Schwitzer
Gary Schwitzer

Note: This story has been updated to include the journal’s response. See below.

Yesterday, John Bohannon described in i09.com how he successfully”created” health news — he conducted a flawed trial of the health benefits of chocolate, gamed the data to produce statistically significant results, and published the findings in the International Archives of Medicine:

It was terrible science. The results are meaningless, and the health claims that the media blasted out to millions of people around the world are utterly unfounded.

Given that the author himself says the study is meaningless, clearly, the journal will retract it, yes? 

Not necessarily, given what we’ve seen in the past. Yes, Bohannon provided a false first name (“Johannes”) and affiliation, but to many journals these would be simple corrections; we’ve seen far worse “errors” that don’t rise to the level of retraction. No, he and his colleagues never received approval from an Institutional Review Board to conduct their research on human subjects, but Bohannon told Retraction Watch the journal never asked him to do that. While failing to document IRB approval that you say you’ve gotten, or lying about it, is certainly a reason for retraction, Bohannon isn’t guilty of either of those things. (We’ve contacted the journal’s editor in chief for comment, and will update with anything we learn.) Update 5/28/15 2:46 p.m. eastern: The journal appears to have pulled the paper from its website. Update 5/28/15 3:37 p.m. eastern: The journal’s Facebook page includes a statement from publisher Carlos Vazquez claiming the paper was published by mistake and was only live for a few hours:

Disclaimer: Weeks ago a manuscript that was being reviewed in the journal “Chocolate with High Cocoa Content as a Weight-Loss Accelerator” appeared as published by mistake. Indeed that manuscript was finally rejected, although it went online for some hours.
We are sorry for the inconvenience. We are taking measures to avoid this kind of mistakes happens again.

Unfortunately, here at Retraction Watch we see many flawed studies, whether intentionally so or not; that’s not going to change anytime soon. So how should we deal with such problematic research? In Bohannon’s case, the media ran with his findings without conducting any of the simple due diligence that would have uncovered the major issues. And that, to us, is where the meat — or chocolate — of this story is. Here’s Gary Schwitzer, publisher of HealthNewsReview.org, on why that really matters:

John Bohannon claims he “fooled millions into thinking chocolate helps weight loss.”

But he may have directly fooled only a few – not millions. And those few – whom I will politely call “journalists” – did the rest of the fooling for him.

And they do it all the time, gobbling up crumbs from a steady diet of weak, hyped studies.

When you critique (and try to improve) health news every day, as we have on HealthNewsReview.org for more than 9 years, you find broad, deep problems with the way science is communicated to the public.

And it’s not just on “terrible science” that is “fairly typical for the field of diet research,” as Bohannon frames the problem. It happens in stories about cancer, heart disease, diabetes – you name it. And then we really are impacting millions.

Here are just a few of the notes I took from Bohannon’s article on io9.com:

…for reporters who don’t have science chops, as soon as they tapped outside sources for their stories—really anyone with a science degree, let alone an actual nutrition scientist—they would discover that the study was laughably flimsy.

Well, he found out how likely outside sources were to be tapped.

Not a single reporter seems to have contacted an outside researcher. None are quoted.

This isn’t a surprise to me. Only about half of the 2,000 news stories we’ve reviewed received satisfactory grades for using independent sources and for identifying conflicts of interests in sources.

You can’t absolve journals of some of the responsibility – and not just the “fake journals” Bohannon has targeted with his stings. He writes:

Almost no (journal) takes studies with fewer than 30 subjects seriously anymore.

I beg to differ. Here’s a chocolate-related nutrition journal article on a study of just 24 women. Topic: a particular kind of antioxidant-rich cocoa protects the skin from sun damage caused by UV exposure. Really? The Minneapolis Star Tribune, one of the biggest newspapers in the country, posted a fluff piece on it on their website.

Earlier this month, we reviewed a university news release that we felt exaggerated the findings from a journal article summarizing a study of just 27 men.

We’ve found that it’s not unusual for reputable journals to publish papers on studies with fewer than 30 subjects. And that’s certainly not the only — or the biggest flaw — in what journals publish.

Talk about cancer, and some journalists will hint at “cure” even when reporting on a study of 22 people, half of whom died. And they don’t need a journal article or a news release prompting them.

You don’t have to create a spoof to lure journalists. Chocolate claims of any sort seem to work every time.

We also reviewed a Mars , Inc. (the chocolate company) news release that claimed “mounting evidence demonstrates improved cognitive function from cocoa flavanol consumption.” Our reviewers said that the release did “not include a single number related to the benefits, and notes merely that there was ‘significant’ improvement with some dosages of flavanols.” Devoid of data. Even so, some news stories bit the bait. This is similar to the Bohannon spoof, except it wasn’t a spoof and it came from a chocolate company. An unholy wedding of marketing, public relations and journalism.

Bohannon writes:

We don’t even have to leave home to do any reporting. We just dip our cups into the daily stream of scientific press releases flowing through our inboxes.

Even esteemed medical journals’ news releases are complicit in the chocolate hype.

We criticized a BMJ news release for sensationalizing an observational study with the headline, “It’s official: chocolate linked to heart health.” Many news organizations followed like sheep. NBC News was laughable with lines such as “Bona fide science. A real study of a lot of people.”

It was a university news release that led influential news organizations to report that “a new study indicates” that “drinking iced tea raises kidney stone risk.” Only problem is, there was no study.  

With that as a backdrop, should we really be surprised to see journalists fooled by tricks related to statistical significance, as Bohannon writes? P-values? P-hacking?

When we have journalists reporting on studies that never existed?

When we have news releases from industry, academic medical centers and medical journals misleading journalists who then mislead the public?

I don’t know if Bohannon’s latest stunt will have any positive impact. Journalists and bloggers have already moved on to the next, much-quicker-than-24-hour, news cycle. Here at HealthNewsReview.org, we are doing our best to help readers see through the hype of health news. By publishing reviews continuously, we hope to help more people understand, do a better job communicating, and make better decisions.

The health and science news food chain that feeds the consuming public is contaminated by different players at different stages along the way. The problem is much worse than a publishing prank that fools millions. It’s a credibility crisis for science and for journalism. And consumers at the end of the food chain will be – indeed, already are – poisoned.

Gary Schwitzer is the publisher of HealthNewsReview.org, Adjunct Associate Professor at the University of Minnesota School of Public Health, and the Director, Center for Media Communication and Health, UMN SPH.

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44 thoughts on “Should the chocolate-diet sting study be retracted? And why the coverage doesn’t surprise a news watchdog”

  1. I browsed the latest issue of the journal to better understand the target journal that Bohannon had selected (I do not see any rationale anywhere for his selection):
    http://imed.pub/ojs/index.php/iam/index
    I was amazed to find that one individual (and others associated with him), Modesto Leite Rolim Neto, has published over 20 papers in ONE issue. How is this individual able to be so productive (considering that these are not letters or notes, but full-blown research papers)?

    1. I believe that he was only seeking to publish it as quickly as possible in any type of relevant sounding journal, even if it had questionable review practices, as he notes in the io9 article:

      “We needed to get our study published pronto, but since it was such bad science, we needed to skip peer review altogether. Conveniently, there are lists of fake journal publishers (This is my list, and here’s another.) Since time was tight, I simultaneously submitted our paper—“Chocolate with high cocoa content as a weight-loss accelerator”—to 20 journals. Then we crossed our fingers and waited. Our paper was accepted for publication by multiple journals within 24 hours. Needless to say, we faced no peer review at all. The eager suitor we ultimately chose was the the International Archives of Medicine. It used to be run by the giant publisher BioMedCentral, but recently changed hands.”

      Also, I would venture a guess that since the International Archives of Medicine was previously ran by BioMedCentral, he may have thought that this particular journal, as opposed to the other seemingly predatory ones which responded, could offer the greatest name recognition. Of course, this is just speculation. It is possible that they simply offered a lower publishing fee or whatnot.

      Finally, since this journal is flagged as potentially predatory in nature, it is reasonable to find that one man could easily publish upwards of 20 papers.

  2. “Almost no (journal) takes studies with fewer than 30 subjects seriously anymore.”

    I think this is a really unhelpful comment. Whether or not 30 subjects is sufficiently powered entirely depends on the design of the study. For instance, testing 30 subjects in a within-subjects study that investigates something with small individual differences (visual search, say) would just be a waste of resource.

    If we’re going to have sample size guidelines they need to be MUCH more nuanced than “if you don’t have more than 30 participants its not a serious study”.

  3. Unless I see evidence of human subjects clearance, the whole thing should be retracted for being unethical. There was no reason to enroll actual people in a study just to point out the effects of p-hacking.

  4. Never mind whether the paper should be retracted or not, that’s a secondary issue beside the far more serious business of doing a clinical trial without ethical approval.

    Let’s remember that a physician recruited human participants to a clinical trial. Where I come from in the UK, that’s a pretty damn serious breach of a physician’s professional code of conduct. I’m not so familiar with the rules in Germany, but I would be surprised if the physician involved in this wouldn’t find himself in serious trouble if his professional licensing body decided to get involved in this.

    1. That’s a very distorted notion of what constitutes “ethics,” Adam. Bohannon et al gave a handful of people chocolate bars, for three weeks, for Pete’s sake. And that’s unethical unless some sort of institutional review board okays it? That’s ridiculous.

      That confuses the process with the purpose. The process is not an end to itself. The purpose of the process is to protect patients.

      Bohannon et al obviously put no patients at risk, in my opinion.

      Approval by a review board doesn’t make anything ethical. The purpose is to prevent unethical research, and we all hope that the review process reduces the likelihood of unethical research, but review boards are not infallible. An unethical study which gets approved by a lax review board is still unethical, and a perfectly ethical study which is improperly rejected by a review board doesn’t thereby become unethical.

      Bohannon’s purpose was to expose shoddy, unethical publishing practices, which really do put people at risk, by inducing them to make health-related decisions based on bad information. He succeeded spectacularly, and he did so without putting anyone at risk. He’s the whistleblower. He’s not guilty of unethical practices, he’s guilty of exposing unethical practices. Let’s not kill the messenger.

      1. You are completely mistaken if you think that carrying out any kind of research involving human subjects (or any animal for that matter) without ethics approval is justified. Even if you only obtain a few mL of blood from healthy volunteers to isolate some cells, you are required to obtain written consent, after informing about the purpose of the study, how the data will be handled, how and where it will be stored etc etc.

        “No harm has ever come of a few chocolate bars” is a pretty dumb argument. It is an even more dumb argument to excuse Bohannon’s unethical research practices with his motivation to uncover unethical/unprofessional journailism. Did he inform his volunteers of the purpose of the study? Did he turn the into willing participants or are they now just caught up in it? I would be mightily pissed if I would learn that a study I volunteered for was intentionally set up to fail; to never actually yield any relevant data.

        Bohannon is just as guilty of unethical practices, as the journal which published the findings. The journalists are guilty of being lazy and blindly believing any media release that promises to be great click-bait.

        I actually think that Bohannon never had to involve any volunteers, or co-authors in this study. He could have just made all of the data up, made up all co-authors and would have still been able to find a journal and publish. But of course that would not have been as sexy as actually having some volunteers being examined by an MD for nice footage for the forthcoming TV report on this stunt.

        1. What you advocate would be unethical, Sebastian. In what sort of Orwellian world is fabricating data and making up fictional co-authors preferred to real data and real co-authors for “ethical reasons?”

          The obligation to obtain institutional review board approval before performing studies involving human participants derives entirely from the researcher’s contractual obligation to the institution with which he is affiliated. There’s absolutely nothing unethical about performing studies without IRB approval, if there is no such contractual obligation, and no such board.

          We’ve not yet come to the sorry state in which lone researchers, unaffiliated with any institution, or affiliated only with their own private companies and organizations, are prohibited from performing research. Unfortunately, many institutions have become so insular and bureaucratized that some people within them can’t even conceive of life outside the blob.

          1. Ethical review requirements also derive from the professional registration of Gunther Frank, the General Practitioner who “ran the clinical trial” according to the io9 story. This is covered in the (Model) Professional Code for physicians in Germany (see pp 13-14), English version here: http://www.bundesaerztekammer.de/fileadmin/user_upload/downloads/MBOen2012.pdf

            The io9 story suggests that participants were told only that they were participating in a documentary on dieting. There’s no indication that participants were ever told their medical data, collected by a physician, was actually for a story about p-hacking or poor peer review. This suggests that real medical data was collected from real people, by a real doctor, but used for purposes for which those people did not give voluntary and fully informed consent. It’s at best deceptive.

          2. It’s not unethical because it didn’t have IRB approval. It’s unethical because it was unethical. The only reason I would want to see clearance would be to reassure me that they had stopped to think about whether the benefit of the study outweighed potential harm to respondents.

        2. I disagree with this approach. Although publishing a made-up study does not pose the actual ethical breaches as if real subjects were used, it still poses harm to human health because he false notion that eating chocolate contributes to weight loss could become an accepted idea among some people. A better way would be to prepare such a made-up study for use in workshops.

      2. Even minimal risk of harm to human subjects is unjustifiable when the same outcome could be produced without use of human subjects at all. He could have done exactly the same p-hacking/data-mining/breathless self-promotion with existing data or even fabricated data. Not to mention that he deliberately misled a number of journal editors and journalists, who are human subjects. Perhaps they deserved it, but that’s up to ethics board, not him.

        1. Liz,

          1. There was not a “minimal” risk of harm to human subjects, there was no risk of harm to them. In the terminology of the German MPC, their “mental or physical integrity” was not “invaded.” They were given no medications. They were subjected to no experimental treatments. They were given nothing to eat except with their consent and their full knowledge about what it was. They were just given a few free chocolate bars.

          2. Fabricating data, as you suggest, would have been unethical.

          3. It is common when performing research involving human subjects to keep them in the dark about the “real nature” of what being studied. That is not unethical. In many cases (including this one) it is essential, to avoid biasing the outcome.

          1. I’m not familiar with German medical research ethics requirements. However from the Australian perspective, “risk of harm” is far more complex and nuanced than your post suggests. Australian rules are here: https://www.nhmrc.gov.au/book/chapter-2-1-risk-and-benefit

            Risk of harm includes discomfort, which could arise from stress or anxiety associated with filling in surveys, having blood tests, reporting all their data every day. Participants also had two blood tests, and two groups were required to eat low carb diets. From an ethics perspective, this alone means there were risks of harm beyond only discomfort. The risks also include inconvenience (e.g. time for daily weigh-ins, visiting the GP before and after the trial, and filling in all the data collection). There is also an issue here of deception. Potential participants were told they were being recruited for a documentary on dieting. However their data was used quite differently, and it’s not clear if they were ever told about this. This has potential to cause mental harm to participants, particularly if they became distressed by the disclosure.

            It’s hard to see here how the potential risks of harm (including discomfort and inconvenience) were outweighed by the potential benefits of the study, especially when participants may not have been fully informed about how their personal medical information would be used.

          2. Dave Burton
            1. There was not a “minimal” risk of harm to human subjects, there was no risk of harm to them. In the terminology of the German MPC, their “mental or physical integrity” was not “invaded.”

            The participants had at least 2 blood tests (one before, one after the study). Their physical integrity was therefore “invaded”. Eating food specifically for a clinical trial also means their physical integrity was “invaded”.

            The io9 posts suggests potential participants were told there data was being collected for a documentary on dieting, and not a study on p-hacking. This is at best deception, and could be considered as an invasion of their mental integrity.

      3. OK Dave, let’s deal with the “process vs purpose” argument first.

        You obviously think that the way the human participants were treated in this study was OK. Obviously Bohannon thought that as well. But I and other reasonable people don’t think it was OK.

        So who gets to decide? Would you like to live in a world where any ethical questions about a piece of clinical research are resolved by the researchers themselves? Sounds pretty scary to me. Sure, independent ethics committees don’t make infallibly good judgements, but having an independent group of people look at the ethics of a study is a pretty good start.

        Now to the actual ethical issues. Yes, no-one in this study was put at any physical risk. But participants in this study were deceived. First, how do you think they are going to feel about that when they find uot what happened? I don’t know about you, but I’d be pretty angry about it.

        And second, to take a more consequentialist ethical position, what do you think something like this does to the trust between the medical profession and the general public? If you were someone in Germany being recruited to a clinical trial, how do you know you could actually trust the researchers to be doing what they told you they are doing?

    2. Yes, this is the part I find deeply troubling. The English version of the (Model) Professional Code for physicians in Germany is here (see pp 13-14). http://www.bundesaerztekammer.de/fileadmin/user_upload/downloads/MBOen2012.pdf

      Bohannon’s description of the “clinical trial” (his term) – http://io9.com/i-fooled-millions-into-thinking-chocolate-helps-weight-1707251800 – includes this:

      ” They used Facebook to recruit subjects around Frankfurt, offering 150 Euros to anyone willing to go on a diet for 3 weeks. They made it clear that this was part of a documentary film about dieting, but they didn’t give more detail.

      After a round of questionnaires and blood tests to ensure that no one had eating disorders, diabetes, or other illnesses that might endanger them, (Gunter) Frank [the General Practitioner] randomly assigned the subjects to one of three diet groups. One group followed a low-carbohydrate diet. Another followed the same low-carb diet plus a daily 1.5 oz. bar of dark chocolate. And the rest, a control group, were instructed to make no changes to their current diet. They weighed themselves each morning for 21 days, and the study finished with a final round of questionnaires and blood tests.”

      Not only was apparently unapproved, but it involved deception, since the true nature of the study (exposing p-hacking and inadequate peer-review) was not disclosed to potential participants. Paying participants could also be considered coercion since it impacts capacity for voluntary, informed consent.

    1. Excellent. Next time I don’t feel like going through the IRB, I’ll just claim my article was a big prank.

  5. You don’t have to create a spoof to lure journalists. Chocolate claims of any sort seem to work every time.

    Remember when UCSD was pimping chocolate as the cure for mitochondrial failure?
    http://www.sciencedaily.com/releases/2012/03/120302132259.htm

    Google ‘chocolate + cure + “Daily Mail”‘ or ‘chocolate + cure + “Daily Telegraph”‘ if you want to lose all hope for future generations.

  6. “After a round of questionnaires and blood tests to ensure that no one had eating ”

    Blood tests? I am fairly sure that taking blood from volunteers requires ethical board approval. Firstly taking blood has a small, but definite risk of adverse consequences, and secondly there needs to be a plan in place to deal with the possibility of a donor being determined to have a previously undiagnosed illness.

  7. jake3_14:

    Perhaps you could point me to the paragraph in the Declaration of Helsinki that states that normal ethical rules don’t apply if a clinical trial is part of a practical joke?

  8. Adam Jacobs
    Now to the actual ethical issues. Yes, no-one in this study was put at any physical risk.

    I disagree. All participants had blood tests before and after the “clinical trial” according to the io9 post. This means there was a physical risk, as @PWK points out further down in the comments.

    1. Fair point, ELF. The physical risk was minimal, certainly in comparison to the psychological risk, but I concede it was not zero.

      And I would agree that any physical risk, no matter how tiny, is hard to justify ethically if participants have not given informed consent, which they clearly didn’t in this case.

      1. The study participants did give informed consent. The study wasn’t even blinded. Every participant knew exactly what he or she was eating, and they even knew that it was part of a journalistic endeavor, rather than a health study. There was no “psychological risk,” and the biggest physical risk was probably driving or riding public transportation to participate.

        1. Do you have evidence that the patients were told it was part of a hoax? That’s certainly not the impression I get from reading Bohannon’s description. This is what he says:

          “They made it clear that this was part of a documentary film about dieting, but they didn’t give more detail.”

          Now how do you infer from that that the participants knew the precise nature of the study?

          1. The volunteers gave their time and blood for a “clinical trial”. The authors knew it was deliberately designed to produce meaningless results. However there is no suggestion that the volunteers were told this was the case.

            I’d also like to know what happened to the data- if it’s been stored somewhere or destroyed. I wonder if Germany’s very strict privacy laws come into play?

          2. It wasn’t a hoax. It was part of a real experiment, which confirmed an important hypothesis.

            The hypothesis wasn’t a medical one (e.g., whether chocolate works as a diet aid), but it was nevertheless a real experiment, which succeeded in confirming an important hypothesis –about the shoddy standards of some academic journals, and lax journalistic standards of other publications.

  9. The PDF file at Scribd indicates the following authorship and affiliation:

    Johannes Bohannon 1, Diana Koch 1, Peter Homm 1, Alexander Driehaus 1

    1 Institute of Diet and Health, Poststr. 37. 55126 Mainz, GERMANY

    Contact information: [email protected]

    I have the following queries:
    a) Is the real first name of John, Johannes?
    b) Is this a real institute?
    c) If b) is yes, then are the other authors’ names veridic and are they also actual “members” of this institue?
    d) Is the e-mail provided real, or fictitious?

    Given Bohannon’s background with the 2013, there is reason to be suspicious. Perhaps Bohannon and the other co-authors could clarify.

  10. liz
    It’s not unethical because it didn’t have IRB approval.

    Agreed.

    It’s unethical because it was unethical.

    It wasn’t unethical. Bohannon did what was necessary to expose shoddy, unethical publishing practices, which put public health and welfare at risk, and which sorely needed to be exposed.

    The only reason I would want to see clearance would be to reassure me that they had stopped to think about whether the benefit of the study outweighed potential harm to respondents.

    It is clear that they thought about that, because they took steps to make sure that the study volunteers had no health conditions which could put them at risk from a daily chocolate bar or low-carb diet. There’s no need for IRB approval to confirm the obvious.

  11. Adam Jacobs
    Would you like to live in a world where any ethical questions about a piece of clinical research are resolved by the researchers themselves? Sounds pretty scary to me.

    Why is it “scary” to trust someone to behave ethically in his interactions with other people?

    There’s nothing special about research, per se. If it scares you to let a researcher hand out daily chocolate bars without first getting permission from a bureaucratic body, then does it also scare you that people are allowed to make far more momentous decisions affecting other people, without anyone else’s permission?

    Doctors prescribe medications, without IRB approval. Parents make medical and educational decisions for their children, without IRB approval. Manufacturers and artisans decide what sorts of products to create, without IRB approval. Drivers and pilots decide whether the weather is too stormy for a safe departure, without IRB approval. Are those things scary, too?

    Almost every profession requires ethical judgments. That doesn’t scare me. What scares me is the collectivist impulse to distrust individual initiative and judgment.

    1. All of those decisions are subject to bureaucratic oversight. Doctors are overseen by medical boards; parents are subject to investigation by child protective services; and manufacturers must report to all sorts of regulatory bodies. Plus all of these people are subject to the broader laws of the land, many of which prohibit unethical conduct.

      Also, you haven’t answered my question: do you actually have an experience with or training in human subjects research.

      1. There’s no bureaucratic oversight for those things, Liz. if someone does something harmful, there’s the potential for sanctions after the fact, but there’s no necessity for a bureaucracy to review the action before the fact (nor after the fact, unless harm is alleged).

        So, for example, if a child suffers harm, and there’s reason to believe that the harm might be due to parental neglect, the parent may get in trouble with the law. But there’s no “review board” to pre-approve (or reject) the parent’s choices for the care of his child, before the fact. At least not where I live.

  12. Does the German scientific code of conduct indicate if all data to a medical study must be made publicly available? Perhaps a German scientist could clarify this and provide the text of the code that makes this aspect clear. If data needs to be made publicly available, then can the raw data be demanded from “Johannes” et al., even post-“retraction”/”publication”?

  13. Dave Burton: “It wasn’t unethical. Bohannon did what was necessary to expose shoddy, unethical publishing practices, which put public health and welfare at risk, and which sorely needed to be exposed.”

    If any aspect of the study involved a lie, deceipt, or deliberate intent to do harm, then this is equivalent to a lack of ethics. As I read this whole sage, there was a deliberate intent to deceive the journal and its readers. If so, why did Bohannon specifically target this medical journal and not any other on Beall’s list of hundreds?

    The bottom line, a submission to a journal involves truthful claims. I could not find anywhere on the publisher/journal’s web-site that there are ethical guidelines to submission, but overall, submission to any journal must respect the ethical guidelines of that journal/publisher. So, is there a conflict here, and has the submission itself been a breach of publishing ethics?

    1. Apparently they submitted it to twenty journals simultaneously, but only paid the fee to actually get it published in one. Perhaps they chose the first journal which accepted the paper, or the one with the lowest fee, or perhaps the one with the highest Impact Factor.

  14. I have no doubt that this journal has a somewhat shady publishing code. There are no instructions to authors that describe any code of publishing ethics. Secondly, the archive is non-existent, and lists only volume 8 (where can one find volumes 1-7?): http://imed.pub/ojs/index.php/iam/issue/archive

    Has anybody reported this journal to Jeffrey Beall for examination and possible inclusion on his list?

  15. I find many reasons to explain why what Bohannon and his associates did was unethical. But first, I summarize the episode, based primarily on Bohannon’s account.

    Bohannon explained what happened in an io9.com blog entry, “I Fooled Millions Into Thinking Chocolate Helps Weight Loss. Here’s How” (http://io9.com/i-fooled-millions-into-thinking-chocolate-helps-weight-1707251800). He had been contacted by a German television reporter and a collaborator who were working on a documentary film about the junk-science diet industry. They wanted Bohannon “to help demonstrate just how easy it is to turn big headlines behind diet fads.”
    Enlisting the participation of a German physician to run the study and of a financial analyst to “massage the data”, Bohannon and his collaborators set up an actual clinical trial, but whose design and findings were “such bad science”.

    They published this study under the names of four authors from the Mainz, Germany, “Institute of Diet and Health”, whose existence is nothing more than the website (http://instituteofdiet.com). The first of the authors, “Johannes Bohannon”, was identified as the institute’s research director. Bohannon’s summary does not state if the other three authors also were also made up, but none had the same name as the collaborators named in the summary.

    The study, under the title, “Chocolate with high Cocoa content as a weight-loss accelerator, was published during late March 2015 in an actual journal, the International Archives of Medicine, and is available with free sign-up at . The journal removed the article from its own website, as Retraction Watch reported: http://retractionwatch.com/2015/05/28/chocolate-diet-study-publisher-claims-paper-was-actually-rejected-only-live-for-some-hours-email-however-says/

    Then Bohannon and the others “cooked up” press releases (http://instituteofdiet.com/2015/03/29/international-press-release-slim-by-chocolate) that were sent around the world, and waited for media reaction. The resulting extensive coverage included big headlines.

    “I felt a queazy mixture of pride and disgust as our lure zinged out into the world”, Bohannon stated in his io9.com blog entry. “It was terrible science. The results are meaningless, and the health claims that the media blasted out to millions of people around the world are utterly unfounded” he wrote. Bohannon was critical of journalists and media outlets for their uncritical reporting.
    In the next post, I explain why what they did was medically ethical, and in the post after that, why what they did was journalistically unethical.

  16. The study by John Bohannon about chocolate as an aid to weight loss additional medically unethical in its involvement of actual participants.
    The most important stakeholders in a clinical trial are the participants. Their welfare must be assured.

    Consider the Nuremburg Code, which has been the blueprint for subsequent ethical codes in medical research. The Nuremburg Code is reprinted in an article by Evelyne Shuster, PhD, “Fifty later: the significance of the Nuremburg Code”, in the New England Journal of Medicine (November 13, 1997, Volume 337, Number 20; pages 1436-1440). Free full text is available at .

    Principle 4 states, “The experiment should be so conducted as to avoid all unnecessary physical and mental suffering and injury.” he study participants underwent unnecessary risks of harm.

    The study posed harm to public health. Principle 2 states, “The experiment should be such as to yield fruitful results for the good of society….” The study was deliberately poorly designed so as not to yield fruitful results about its purported subject, chocolate as an aid to weight, for the good of society. Besides being unethical with respect to involvement of human participants, the article also poses a harm to public health because physicians and patients might have be led to eat chocolate as a way to lose weight.

    The false notion that eating chocolate contributes to weight loss could become an accepted idea among some people. That some people are willingly misled, even foolishly on their part, does not justify perpetrating a hoax such as this one.

  17. Now I refer to ethical codes for journalists to explain why what John Bohannon did as a journalist is unethical.

    Code of Ethics for Science Writers,
    National Association of Science Writers (NASW; http://www.nasw.org/code-ethics-science-writers)
    “One of the principal aims of the National Association of Science Writers, according to its constitution, is to foster the dissemination of accurate information regarding science and technology in keeping with the highest standards of journalism.”

    SPJ Code of Ethics (Society of Professional Journalists; http://www.spj.org/ethicscode.asp)
    “Ethical journalism strives to ensure the free exchange of information that is accurate, fair and thorough.”
    “Journalists should: Take responsibility for the accuracy of their work.”
    “Journalists should: “Balance the public’s need for information against potential harm or discomfort. Pursuit of the news is not a license for arrogance or undue intrusiveness.”

    Statement of Principles of the Association of Health Care Journalists (AHCJ; http://healthjournalism.org/principles)
    “Association members know that readers and viewers may make important health care decisions based on the information provided in our stories. We embrace the Society of Professional Journalists’ code of ethics with its emphasis on seeking truth, providing fair and comprehensive accounts of events and issues, minimizing harm, acting independently and being accountable.”

    This episode makes for a teachable moment that ought to include considering medical and journalistic methods in addition to “how to lie with numbers”.

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