A ‘very cautious’ process: Journal retracts reviews by anesthesiologist found to have committed fraud a decade ago

A journal has retracted three review articles by Joachim Boldt, the German anesthetist who currently occupies the second spot on the Retraction Watch leaderboard with 103 retractions. 

The reviews, which appeared in Intensive Care Medicine, cover articles by Boldt that were published both well before and the same year as his scandal broke in 2010. 

One article, from 2000, was titled “Volume therapy in the intensive care patient – we are still confused, but.” According to the retraction notice:

The Editor-in-Chief has retracted this article [1] because a number of studies included in this review [2, 3, 4] (originally cited as references 98, 128, 129) have since been retracted. Consequently, this has rendered the content of the review unreliable.

Author Joachim Boldt has not responded to any correspondence from the publisher about this retraction.

The paper has been cited 21 times, according to Clarivate Analytics’ Web of Science — including once this March.

Another, “PRO: hydroxyethylstarch can be safely used in the intensive care patient—the renal debate,” appeared in 2009. That paper has been cited 20 times. Its notice reads similarly, as does the one for the 2010 paper “The impact of fluid therapy on microcirculation and tissue oxygenation in hypovolemic patients: a review” — which has been cited 35 times, including thrice in 2019.

Clinical impact

The retractions were prompted by a 2019 guest editorial in Intensive Care Medicine by intensivists Christiane Hartog and Anders Perner. Hartog, of Charité hospital in Berlin, and Perner, of the University of Copenhagen, argued that journals should retract “narrative reviews” by Boldt about hydroxyethelstarch. According to the editorial: 

Boldt published numerous narrative reviews. We previously found that he alone authored 21 of all 124 reviews supporting the use of hydroxyethyl starch (HES) published between 1975 and 2010. From the 1990s onwards, favourable reviews increased from two to eight per year and HES’s share of the artificial colloid market tripled from 20 to 60%. We believe this association implies that narrative reviews contributed to the increasing use of HES.

The authors identified 23 narrative reviews by Boldt: 

Closer scrutiny reveals that all reviews cite retracted studies and contain misleading statements supporting the use of a substance that is less effective and clearly harmful in some patient groups. The misleading messages can also be found in reviews written by leading medical officers from a manufacturing company. Boldt admitted to financial payments from the fluid manufacturer to himself and his department. However, the sheer multitude of reviews is astounding (not counting the numerous clinical studies by Boldt) as is the fact that several reviews contain the results from different MEDLINE searches, complex graphs and reference lists with more than 100 references. It may therefore be questioned whether Boldt wrote all these reviews himself.

Despite widespread knowledge of Boldt’s misconduct in the field, and FDA requirements for labeling: 

HES is used widely outside Europe, and Boldt’s narrative reviews continue to be cited. Web of Science Citation reports show 591 citations overall and 238 since 2011.

‘Legal issues’

The editorial appeared in February of 2019. Toward the end of the year, however, nothing had happened. Even Intensive Care Medicine had not followed up with any action. 

Hartog told us that she contacted the editor of the journal, Giuseppe Citerio, who earlier had supported retraction of the three Boldt reviews she and Perner had cited that it had published. Citerio, she said, told her: 

the delay was due to ‘legal issues’. I do not understand legal issues but my personal opinion is that institutions should be held responsible to follow up matters of scientific integrity and not leave it to individuals. As you can see in the ICM editorial, there are a number of other journals which should follow suit and retract Boldt reviews.

Citerio told us that the delay resulted from: 

a long internal evaluation with the publisher … The internal Springer process is very cautious and it took months.

Citerio added that he requested that Nature Springer initiate retraction “the day after” Hartog asked him to do so, but he couldn’t recall when that was. 

A longstanding problem

Meanwhile, the editorial wasn’t the first time ICM had published commentary calling for more movement on the Boldt front. In 2018, it published “The Boldt scandal still in need of action: the example of colloids 10 years after initial suspicion of fraud,” which reviewed the case and noted that:

With regard to studies published from 1984 to 1998, ethical issues and possible fraud by Dr Boldt remain unclear because IRB documentation was checked only for studies published from 1999 onwards.

About that list of journals. One in particular sticks out. Hartog and Perner cite Anesthesia & Analgesia, whose editor at the time, Steven Shafer, led the effort to reveal Boldt’s fraud and clean up the literature. So far, the journal — which is now under different leadership — has retracted none of those reviews. 

We emailed the current editor of the journal for comment but have yet to hear back.

Update, 5/27/20, 1400 UTC: We received a response from journal editor Jean-Francois Pittet after this post went live:

Thank you for your email. We will look into your information and take the appropriate steps to deal with these issues.

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