Malcolm Pearce was an obstetrician and lecturer based at St George’s Hospital Medical School who in 1998 was struck off the medical register for fabricating research data. One of his fake papers published in the British Journal of Obstetrics and Gynaecology claimed that he had removed an ectopic foetus, successfully re-implanted it and the mother had delivered a healthy baby. He also published a randomized controlled trial which purportedly used 200 patients with polycystic ovary syndrome who had already had three miscarriages in early pregnancy; even a major referral would have taken a decade to recruit such a large sample of this very specific and rare group of subjects. Professor Geoffrey Chamberlain who was Pearce’s boss accepted co-authorship of the ectopic pregnancy paper without participating; he felt obliged to resign all of his academic positions when details of the deception became public. This case study is illustrates the practice of so-called gift authorship which in this case ended an otherwise distinguished medical career.
The fraudulent publications that ended two careers
In 1994, Malcolm Pearce was a successful 40-year-old obstetrician and senior lecturer based at St George’s Hospital Medical School with close to a hundred scientific publications to his name. He was a member of the editorial board of the British Journal of Obstetrics and Gynaecology and over a quarter of his publications had been published in this respected journal with a number of others published in other high impact medical journals like the Lancet and the British Medical Journal. His head of department, Professor Geoffrey Chamberlain, was editor of this obstetrics journal and president of the Royal College of Obstetricians and Gynaecologists who published it. In the August of 1994 Pearce published two papers in this journal which brought about the end not only his own career but also that of the well-respected Professor Chamberlain.
In the first of these papers, Pearce and two co-authors, including Chamberlain, claimed to have successfully removed a five-week old ectopic embryo and re-implanted it in the womb of the 29-year-old African mother who subsequently delivered a healthy baby. Ectopic pregnancies are those where the embryo develops outside of the womb, usually in a Fallopian tube. Many of these embryos die and are re-absorbed but some grow and, if not detected and treated by surgical removal or chemical destruction, they can rupture the tube, leading to a potentially life-threatening internal haemorrhage. This two page report by Pearce caused interest around the world because other surgeons had tried to do this but none had thus far succeeded.
The second paper was a report by Pearce and one co-author of a randomized controlled trial of the use of Human Chorionic Gonadotrophin (HCG) to try to reduce the risk of miscarriage in women with polycystic ovarian disease. HCG is the hormone that is produced early in pregnancy from the developing placenta and its detection is used as the basis of pregnancy tests. Pearce claimed to have recruited almost 200 patients who had polycystic ovarian syndrome and who had already had three miscarriages in their first trimesters. These women were randomly allocated to receive HCG or a placebo from around the time of ovulation until the tenth week of their pregnancy. In this paper it was claimed that this HCG treatment reduced the rate of miscarriage by more than three-quarters and thus that the treatment was highly beneficial for pregnancy outcome in this specific group of women.
A whistle-blower made accusations to the authorities at St George’s that the results of these two studies had been fabricated (see piece by Owen Dyer in the BMJ) . A subsequent investigation found that the 29 year-old woman whose ectopic embryo was claimed to have been successfully re-implanted in her womb had in fact miscarried. Pearce tried to deflect these accusations by claiming that this was not the real patient reported in the study but he had used this woman’s details to protect the anonymity of the real patient. This real patient was found to have been created by an amalgamation of falsified and altered records including that of a woman who was actually dead when she was supposed to have been pregnant. Mr Pearce’s colleagues at St George’s later said that they had initially been very surprised that he could have carried out this internationally significant procedure and managed the woman through to term under their noses without them being aware of it.
The second paper reporting the results of the HCG trial aroused suspicions because of the large number of women with very specific and quite uncommon inclusion criteria that he had managed to recruit especially without any of his colleagues being aware of what he was doing. Even major referral centres would have taken a decade to accumulate the almost 200 patients that Pearce claimed to have used in his trial. When questioned about these accusations, Pearce was unable to produce any patient notes, consent forms or indeed anything to corroborate the existence of these women. He had clearly fabricated the results.
The aftermath of the accusations
A committee under the chairmanship of Sir Robert Kilpatrick, at a formal disciplinary hearing of the General Medical Council (GMC), found Pearce was found guilty of fabricating research studies. He was struck of the medical register making him unable to practice medicine in the UK. A total of four articles co-authored by Pearce in 1994 in the British Journal of Obstetrics and Gynaecology have to date been retracted along with a 1990 article in the British Medical Journal. In the retraction notice in the BMJ it was reported that a letter from the Dean at St George’s in 1995 said that there were reasons to doubt the veracity of the paper. The paper had apparently been written by the co-author using summary data supposedly generated by Pearce before her arrival at St George’s. The summary data sheet did not give patient names or hospital numbers and so the data could not be directly corroborated.
Brief details of the Pearce case were compiled by Owen Dyer and published in the news section of the BMJ in June 1995. In a statement about what Pearce had done, Sir Robert Kilpatrick said:
“Mr Pearce not only sought personally to mislead others but to implicate colleagues, including junior doctors, in a web of deceit that has had incalculable consequences for public confidence in the integrity of research. Scientific fraud is dangerous. Medical knowledge worldwide is developed in part on the published results of previous research work”.
Pearce committed major research frauds which could have raised the hopes of women who had problems with recurrent miscarriage and influenced the way in which other doctors treated their patients. He also ended not just his own career but also that of a leading and well-respected member of his profession and tarnished the reputations of other unwitting co-authors who he involved in his deceptions. One can imagine some academics being delighted and even flattered to be offered the chance to be associated with publications in a respected journal that were likely to be highly cited and have high impact.
The GMC also sent letters to the three other people who had acted as co-authors for these two papers: Professor Chamberlain, Isaac Manyonda for the case report and Rodoel Hamid for the HCG trial. This letter reminded them of their responsibilities as co-authors; they had a duty to check the data that they were accepting credit for. Sir Robert Kilpatrick summed this up as follows:
“All individuals named in a research paper must have made an intellectual contribution and been able to verify the raw data. All researchers should be familiar with the declaration of Helsinki”.
This declaration of Helsinki is a set of ethical principles originally set out in 1964 at a meeting of the World Medical Association. These principles have been revised, amended and added to several times since then and the 2008 version consists of a series of 35 short bulleted paragraphs that are spread over 5 printed pages. The key issues that in my opinion would be particularly relevant to this case are:
- In statement 15 it says that a detailed research protocol for any research involving human subjects must be submitted to an appropriate and independent ethics committee for approval and comment before the research begins. Any modification to the protocol should require the agreement of this committee.
- In statement 19 it states that every clinical trial must be registered on a publicly accessible database before the enrolment of the first subject.
- Statement 20: physicians must be confident that any risks involved have been adequately assessed and can be satisfactorily managed. This would undoubtedly apply to all medical personnel involved in the study and not just the first author.
- Statement 30: “Authors have a duty to make publicly available the results of their research on human subjects and are accountable for the completeness and accuracy of their reports”.
When questioned after the GMC hearing Professor Chamberlain agreed that in hindsight gift authorship was a bad idea and says:
“I rubber stamped this paper out of politeness because he asked me to as head of department” adding that “this paper was peer reviewed twice, both medically and statistically. It never occurred to the referees that the whole thing might be a lie”. He is also quoted as saying “Obviously Malcolm has been extremely silly on this occasion, but in the past he has done a lot of good”.
Richard Smith who was at one time editor of the BMJ discusses this case in an online PowerPoint presentation entitled Editorial misconduct: time to act. This was posted in October 2003 and is one of a large series of lectures made available by the BMJ. Smith sums up Professor Chamberlain’s involvement thus:
“Chamberlain retired or resigned from all of his positions, a terrible end to a distinguished career. His crime was gift authorship, which was normal at the beginning of his career, scandalous by the end.”
There are issues relating to the way in which the papers were processed by the journal after submission. The ectopic pregnancy report was accepted within 3 days of submission. Pearce was a member of the editorial board and Chamberlain was the editor in chief of the journal. Even if in this case there was flawless handling of these papers, unless there were truly anonymous, the fact that two co-authors were fellow members of the editorial board could have affected the judgement and depth of the assessment of any reviewers and other editors. One must also ask why no expert involved in the review process questioned how Pearce could generate 200 patients for the clinical trial when it would have been relatively uncommon to find patients who met the inclusion criteria.
Professor Chamberlain died in 2014 at the age of 84 and an obituary by Sarah Gillam published by the Royal College of Surgeons gives details of his career. After leaving St George’s and the end of his obstetrics career he became Apothecaries’ lecturer in the history of medicine at Swansea University from 2000-2008. To give an indication of the esteem in which he was held, the Royal College of Obstetricians and Gynaecologists established the Professor Geoffrey Chamberlain Award in his memory.