Concern — in triplicate — arrives for Poldermans papers

Jacc1212coverThe Journal of the American College of Cardiology, or JACC, has issued expressions of concern for three papers by Don Poldermans, the Dutch cardiologist who was fired earlier this year amid allegations of misconduct.

Cardiobrief’s Larry Husten had the story first.

The, um, heart of the matter is that neither the investigators at Erasmus Medical Center, Poldermans’ former institution, nor the JACC editors, can say whether the researchers conduct rose to the level of fabricating data. As the Notice of Concern states:

Concern has been raised regarding the scientific integrity of several articles published in the Journal of the American College of Cardiology under the leadership of or collaboration of Dr. Don Poldermans. This concern has resulted in an extensive investigation both of papers published in JACC and other journals by an Investigation Committee of Erasmus Medical Center in Rotterdam, Netherlands. The Editors of JACC (Jeroen Bax recused himself) have carefully read the report of the Investigative Committee,, and have concluded that it was performed with rigor, accurately, and objectively. Therefore, we wish to report our concern regarding the scientific integrity of these articles based upon the conclusions of the Investigative Committee of Erasmus Medical Center. Poldermans D, Bax JJ, Schouten O, Neskovic AN, Paelinck B, Rocci G, van Dortmont L, Durazzo A, van de Ven L, van Sambeek M, Kertai MD, Boersma E, for the Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echo Study Group. Should major vascular surgery be delayed because of preoperative cardiac testing in intermediate-risk patients receiving beta-blocker therapy with tight heart rate control? J Am Coll Cardiol 2006;48:964–9.

In regard to this study the Investigative Committee was unable to confirm with certainty that the process of written informed consent was performed appropriately. In regard to the statement in the publication that patients were screened for several cardiac risk factors to classify them into three distinct categories, the Committee established several inconsistencies between source documentation and the patients risk factors as recorded on the Case Report Forms. The research protocol specified that study outcomes had to be assessed by an Independent Committee consisting of two cardiologists. The Investigative Committee concluded that no formalized arrangement with two independent cardiologists had been made and that an Adverse Events Committee did not exist. In practice, clinical data were collected by a junior researcher. Finally, the Committee noted an unreliable working procedure for collection of scientific data. The Case Report Form was not consistently used as the universal master document for data collection. As a result the Committee observed inconsistencies between the Case Report Form and the research data base.

In spite of the irregularities mentioned above, the Committee did not find evidence for any manipulation of the research results by the researchers in the sense of deliberate steering of results into a particular direction. Although the Committee found several irregularities in the execution of the study, the Committee had no evidence that the research conclusions as published in the above mentioned article are wrong. In view of the above findings, and since the manuscript was the report of a multi-center trial, it is impossible for the Editors of JACC to determine the effect of this breach of scientific integrity upon the overall conclusions of the manuscript. Biagini E, Elhendy A, Bax JJ, Rizzello V, Schinkel AF, van Domburg RT, Kertai MD, Krenning BJ, Bountioukos M, Rapezzi c, Branzi A, Simoons ML, Poldermans D. Seven-year follow-up after dobutamine stress echocardiography: impact of gender on prognosis. J Am Coll Cardiol 2005;45:93–7. The Investigative Committee indicated that there is doubt about the validity of the causes of death recorded in the data base. The Committee found that the source documentation in relation to the reported causes of death is missing. However, since the research was not subject to the Medical Research involving Human Subjects Act HS&A and was performed about ten years ago, the Committee categorizes the lack of source documentation as unfortunate but not as negligent. Because of these circumstances, the Committee was not able to investigate the validity of the reported causes of death, or deliver any judgment on the results and conclusions in the publications mentioned above. Again, the Editors of JACC could not determine how these facts influenced the conclusions of the manuscript. Poldermans D, Schouten O, Vidakovic R, Bax JJ, Thomson IR, Hoeks E, Feringa HHH, Dunkelgrin M, de Jaegere P, Maat a, van Sambeek RHM, Kertai MD, Boersma E, for the DECREASE Study Group. A clinical randomized trial to evaluate the safety of a noninvasive approach in high-risk patients undergoing major vascular surgery: the DECREASE V pilot study. J Am Coll Cardiol 2007;49:1763–9. The Investigative Committee found that the informed consent procedures was applied negligently. The Committee also considers the failure to preserve case report forms to be negligent, and the way in which data collection was done to be both negligent and scientifically incorrect. The Committee considers the way in which outcomes were determined to be scientifically incorrect. On the basis of available information, the Investigative Committee considered that it is not possible, in relation to the DECREASE V Study, to vouch for the reliability of the findings in the publications and for the validity of the conclusions. The conclusions of the Committee regarding the DECREASE II Study also applied to the DECREASE V Study. As was true for prior publications, the JACC Editors could not determine with certainty that the findings of the study were erroneous.

Since it is not possible for the Editors of JACC to determine with certainty that the findings in the above articles were erroneous, we have elected not to retract these manuscripts. However, given the uncertainty regarding the accuracy of the data, and the inability to validate the collection of data, readers should be cautioned in the application of the findings of these manuscripts to clinical practice.

The papers have been cited 130 times, 31 times, and 162 times, according to Thomson Scientific’s Web of Knowledge.

Coincidentally, one of us (AM) was at a medical meeting over the weekend during which the Poldermans case came up in two separate talks. In both instances, the presenters labeled him a fraudster — underscoring the evident confusion over the terms “misconduct” and “fraud.”

One thought on “Concern — in triplicate — arrives for Poldermans papers”

  1. May not have been confusion:

    There was *fictitious* data: see pages 19-23 of the English version of the report at

    The speakers may have been giving their scientific opinion in a Bayesian sense; in contrast Journals seem to drag their feet and expect proof of fraud, which can easily be prevented by an author by simply claiming to have lost the list of patients. That is a great get-out from any investigation, and hospitals are full of shredders.

    I myself am having extreme difficulty getting a journal to retract (or even express concern over) an article by a fraudster, that is a redundant publication, contradicting his prior claim of the study design and size (now shrunken and become non-randomized), contains numerous internal inconsistencies, obviously false statistical claims, incorrect arithmetic, falsified survival plots and much more: after over 2 years, 4 formal letters from me delineating the evidence, numerous emails, and 2 phone calls, the journal declared the case closed after darkly describing having discussed with “all stakeholders”.

    I use the article now when teaching on Fraud. In a way it is convenient that the students can see it as an an article in apparently good standing, and marvel at the madness of the situation. Last week’s class picked out 2 more discrepancies.

    Is there a competition somewhere for the article still standing in the biomedical literature with the most wrongitude?

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