Last August, a reader alerted the editor of a medical journal to a recent case report “riddled with irreconcilable contradictions, medically impossible claims, fictional terminology, and ethical lapses.”
The paper, about a woman who allegedly suffered an aortic aneurysm rupture three days after giving birth, stated that written “informed consent was obtained from the patient for publication.” But the woman died less than two hours after arriving in the emergency room, according to the report.
“If she did not survive, she could not have provided consent post-event,” the concerned reader pointed out in an email to Riaz Agha, editor-in-chief of Annals of Medicine and Surgery, which published the case report in April.
The email went on to list a litany of concerns, the most glaring of which perhaps was the report’s statement that, ”Cardiac monitoring revealed PEA [pulseless electrical activity] with a heart rate of 120 beats per minute, and with blood pressure of 90/60 mmHg.”
During PEA, the heart is unable to contract despite showing electrical discharges and so, by definition, there is no detectable pulse or blood pressure. “A blood pressure of 90/60 mmHg implies organized perfusion, which contradicts the diagnosis of PEA. This error reveals a profound misunderstanding of basic resuscitation physiology,” the email stated.
Other problems included contradictory timelines, an “implausible surgical narrative,” made-up medical terminology and irrelevant references.
“The combination of these flaws, especially the impossible consent, PEA with 90/60 BP, and conflicting timelines strongly suggests that the case is not a genuine clinical event, but rather a constructed narrative assembled from generic templates,” the email, sent under a pseudonym to both Agha and Retraction Watch, concluded.
The same reader previously alerted us to a report of a patient whose heart was in their abdomen, a case plagiarized from an April Fool’s joke. The paper, published in Wolters Kluwer’s Medicine, was retracted after our story ran.
Zatollah Asemi, the corresponding author of the case report in Annals of Medicine and Surgery and a nutrition researcher at Kashan University of Medical Sciences in Iran, did not respond to requests for comment. Asemi, whom we have written about in the past, has had more than 160 papers flagged on PubPeer and has earned 34 retractions, including nine last year, and several dozen expressions of concern, according to our database. Researchers notified publishers about concerns over 172 clinical trial publications from Asemi’s group in 2019.
Agha did not respond to our request for comment. But a spokesperson for Wolters Kluwer, the journal’s publisher, told us an erratum had been published in November, although it didn’t appear on the online version of the paper until after our inquiry.
The erratum states informed consent “was obtained from the patient’s legally authorized representative” rather than the dead patient herself. It also corrects “Feinstein incision,” a non-existent procedure, to “Pfannenstiel incision,” and replaces a reference.
But it makes no mention of all the other concerns in the email, including how a patient with no pulse could have had a blood pressure.
Wolters Kluwer did not respond to a follow-up email asking why it judged a short erratum sufficient in the face of the report’s many flaws.
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