Fall from grace: Questions about prominent researchers raise bigger questions about ethics in medicine

Editor's note: This article has been updated since it was originally published.

It was another bad day on Wednesday for Brian Wansink, Ph.D., the disgraced Cornell University scientist whose studies about food consumption made him something of a celebrity, attracting funding from government agencies and industry trade groups.

JAMA Network, which includes several top medical journals, retracted all six studies that included Wansink as author since Cornell was not able to provide assurances of their scientific validity, said Howard Bauchner, M.D., editor-in-chief of JAMA, in an editorial published online.

On Thursday, Cornell University announced that Wansink has resigned and will retire from the institution at the end of the academic year, after being removed from all teaching and research activities. In a statement, university provost Michael I. Kotlikoff said that for more than a year the university has been reviewing allegations of misconduct against the professor and a faculty committee concluded Wansink "committed academic misconduct in his research and scholarship, including misreporting of research data, problematic statistical techniques, failure to properly document and preserve research results and inappproriate authorship."

The news of the JAMA retraction of Wansink's studies, came days after the resignation of the chief medical officer of Memorial Sloan Kettering Cancer Center, José Baselga, M.D., a physician with a reputation as one of the foremost breast cancer researchers in the world. Baselga resigned a week ago after it was reported he failed to disclose millions of dollars he was paid by drug and healthcare companies in dozens of research articles published in recent years.

José Baselga
José Baselga, M.D. (Memorial Sloan
Kettering Cancer Center)

While the particulars of the cases are much different—Wansink is accused of bad science—the fall of the two prominent researchers raises far-reaching concerns about how medical journals enforce conflict-of-interest disclosures and assure the validity of research.

“One thing that pulls them together is the question of what can we trust in the scientific literature and that’s a big question,” says Adriane Fugh-Berman, M.D., of the department of pharmacology and physiology at Georgetown University Medical Center, where she directs Pharmed Out, a project that advances evidence-based prescribing and educates healthcare professionals about pharmaceutical marketing practices. 

Baselga told ProPublica in an interview that the omissions were unintentional and in his resignation letter said he takes full responsibility for failing to make appropriate disclosures in scientific and medical journals and at professional meetings.

But Baselga said the issue of disclosures is a problem the entire medical research field must resolve.

“It is my hope that this situation will inspire a doubling down on transparency in our field,” he said in his resignation letter, adding that he hoped the medical community would work together to develop a more standardized disclosure process for reporting industry ties.

Fugh-Burman says medical and scientific journals should not be counting on researchers to make their own disclosures and that they must take responsibility to check those disclosures. For physicians, that information is available on the government’s Open Payments database and is available to anyone, she says. 

She also says academic medical centers should disclose the conflicts-of-interest of their researchers and make the information publicly available, perhaps most easily via their own websites. Memorial Sloan Kettering knew Baselga’s disclosures, she says, which included ties to pharmaceutical and biotech companies, as well as consulting work, a fact the doctor pointed out in his resignation letter. Fugh-Burman called for changes in an essay published Thursday by The Hastings Center. 

Questions raised about study results

In the case of Wansink’s research, JAMA opened an investigation after concerns about the studies were raised in May. The retraction of articles in JAMA, JAMA Internal Medicine and JAMA Pediatrics came after it received word from Cornell University that it could not verify Wansink’s research.

“Cornell University has notified JAMA that based on its investigation they are unable to provide assurances regarding the scientific validity of the six studies,” Bauchner wrote. Cornell told the journal that since the institution does not have access to the original data, it could not confirm the results of the studies are valid.

Brian Wansink
Brian Wansick, Ph.D. (Cornell University)

RELATED: Study finds 1 in 12 doctors received payments from opioid makers that totaled $46M

Wansink’s studies dealt with food, nutrition and behavior and resulted in headline-grabbing results such as that people eat more if their plate is bigger and that hungry grocery shoppers buy more calories.

His work notably inspired a $22 million federally-funded school lunch program aimed at pushing healthy eating strategies in tens of thousands of schools. He gained funding from government agencies and convinced Kraft Foods to start packaging foods in smaller portions.

Starting last year, questions were raised about his research and his use of p-hacking, which occurs when someone influences the data collection process or statistical analysis in order to produce a statistically significant result—essentially allowing a researcher to make the data say what he or she wants it to say. Critics of his work say his research was aimed at going viral and gaining media attention rather than solid science.

Six of his lab's studies have been retracted and corrections issued. 

Thursday, Cornell's provost called the situation "painful" and said Wansick will be obligated to spend the time before his retirement begins cooperating with the Ivy League school in its ongoing review of his already published research.

Failure to report disclosures

Just how widespread is the problem of researchers failing to report potential conflicts of interest? Baselga is not the only guilty one. According to a research letter published in JAMA Oncology shortly before the allegations surfaced against Baselga, 32% of doctors in a sample of cancer trials did not fully disclose their payments from trial sponsors. “Our study found that financial relationships between oncologist authors and the pharmaceutical industry may be common, expensive and frequently undisclosed,” the authors wrote.

And a separate study published in JAMA Surgery last month, found nearly two-thirds of the 100 physicians who rake in the most money from 10 device manufacturers failed to disclose a conflict of interest in their academic writing in 2016.

Ties between research, industries

The problem isn't reserved for academics. 

The National Institutes of Health has come under the microscope because of ties between research and industry funding. The NIH is actively working to ensure it is vetting projects funded by private donations more thoroughly in the wake of several controversial studies, its Director Francis Collins, M.D., told a Senate committee last month.

RELATED: NIH’s Collins to lawmakers—Agency is addressing conflict of interest concerns

He acknowledged the potential conflict of interest and ethics concerns that can arise when NIH is setting its research priorities. The problem came into stark focus earlier this year when the agency canceled a study on the potential benefits of moderate alcohol consumption on cardiovascular health, which was funded in part by the beverage industry.

In April, NIH officials dropped a plan to accept $200 million from the drug industry toward research on pain and addiction treatment. 

The problem of conflicts also isn’t strictly an American one. The BMJ reported that a senior adviser to the United Kingdom government on alcohol policy quit after voicing concerns over Public Health England’s relations with the alcohol industry.

Ian Gilmore resigned from his advisory role after the public health agency entered into a partnership with Drinkaware, an alcohol education charity that receives funding from the industry, which he argued would undermine efforts to protect public health.

Links between payments, doctors

Plenty of attention has been paid to the link between payments from pharmaceutical companies and the drugs a doctor prescribes, including opioids. Doctors and teaching hospitals received $8.4 billion in payments from drug companies in 2017, according to the latest Open Payments data released by the Centers for Medicare & Medicaid Services last summer.

In what could be the biggest fraud case in California’s history, California Insurance Commissioner Dave Jones earlier this week filed an insurance-fraud complaint (PDF) against drug maker AbbVie Inc., alleging a series of kickbacks to providers to prescribe its drug Humira.

According to the complaint, AbbVie conducted a "far-reaching scheme including both 'classic' kickbacks—cash, meals, drinks, gifts, trips and patient referrals—and more sophisticated ones—free and valuable professional goods and services to physicians to induce and reward Humira prescription." Jones said private insurers have paid $1.2 billion in Humira-related pharmacy claims.