Investigation results in disciplinary action against researchers, retraction of articles

Article Abstract:

A controversial case of questionable ethics occurred in 1986 which has stimulated a great deal of discussion within the scientific community. An investigation by the National Institute of Mental Health (NIMH) resulted in disciplinary action against two researchers and the retraction of a number of articles, including two that were published in American Medical Association journals. The incident which prompted this investigation involved a study concerning the physical aspects of mental illness, conducted by the Mental Health Clinical Research Center at Stanford University. The improprieties that were discovered involved both financial misconduct and the use of questionable research. The question of ethics arising from the misuse of data has created the greatest repercussions. The NIMH found that 14 subjects were improperly identified for a control group and all work resulting from the use of this data was voided, including several published papers. The investigation concluded that a judgment error occurred, but fell short of claiming actual fraud. Some of the authors acknowledged responsibility for error but felt that the label of ethical misconduct was too harsh. All of the authors involved were held accountable. A question arises concerning the extent to which authors should be held accountable for all information published in articles credited to numerous individuals who have differing areas of expertise. Whether one researcher is accountable for the work of another, especially when that contribution is in a field in which the author has no professional expertise, has come under discussion. This case has brought up the question of how far members of the scientific community should go in policing themselves. Editorial considerations and the responsibilities of the publisher have also been examined. Some scientific journals have taken measures to strengthen their criteria for authors prior to publication. The issues of ethical responsibility, as well as the overall maintenance of credibility and integrity within the scientific community, remain the topics of much discussion.

Cases, Medical research, Fraud, Fraud in science, Science fraud, Medical ethics, United States. National Institute of Mental Health

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Individualized care, as well as intensive care, may reduce morbidity among premature infants

Article Abstract:

Although great strides have been made in improving the survival of premature infants, concern about the health of the surviving infants has mounted. One recent study found that only 65 percent of infants with extremely low birthweights performed normally on cognitive tests at the age of 19 months; the babies' motor skills were also reduced. In addition to medications and educational programs aimed at these infants, an approach that provides individualized care is being evaluated. Heidelise Als, an Associate Professor of Psychology at the Harvard Medical School who developed the approach, stresses the importance of developmental care for newborns. Her Preterm Infants' Behavior Scale evaluates the function of behavioral subsystems (nervous, motor, and organizational systems). An individualized care plan is then developed that includes the apparent goals of the infant's behavior and ways its strengths can be supported. Parents work with the primary care team to implement the care plan. To reduce stress, lights are dimmed, noise is reduced when possible, and infants may be placed in special positions. Care is planned to allow the infant to be stabilized, with attention to timing of feeding and blood tests. A review is presented of the few published studies on individualized care. In general, infants treated in this way needed less time on mechanical ventilators and oxygen, began breast- and bottle-feeding earlier, and gained more weight than infants treated conventionally. Their developmental scores were also better, and this continued to be true of children older than three who had received individualized care as newborns. Studies on the results of individualized care using other groups of infants, and at other institutions, are underway. When such a program is started, staff training in its methods is essential and can consume considerable resources. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Infants (Premature), Premature infants, Neonatal intensive care, Infant development

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Synthetic vascular graft trials start; endothelialization seen as possible

Article Abstract:

Synthetic vascular grafts, which are sewn into patients' damaged blood vessels, have a failure rate as high as 25 percent, primarily because blood clots develop in them. Blood is prevented from clotting in normal vessels because the endothelial cells which line blood vessels prevent it. Thus, if endothelial cells could be induced to grow over a synthetic graft, an antithrombotic (anti-clotting) effect should result. A review of recent research with this aim is presented. James Stanley, Professor of Surgery at the University of Michigan, summarized research results at a meeting. Teflon and Dacron grafts were made largely clot-free (91 and 86 percent, respectively) by a process of ''seeding'' with endothelial cells in animal experiments; moreover, the seeded grafts remained open after they had been implanted. The use of Goretex grafts was considered. One complication of vascular grafts may be activation of platelets (blood cells essential for clotting), leading to clots in distant vessels. The seeded grafts, however, were associated with lower levels of platelet activation than unseeded grafts. Studies of seeded grafts in humans, begun in the mid-1980s, have been encouraging. An endothelial cell seeding kit, created in cooperation with the Gore Company, is in use in clinical trials of seeded vascular prostheses at three medical centers, under a strict protocol that makes progress slow. Results from a study in Germany will appear soon. Future developments may include the use of genetically engineered endothelial cells that produce clot-dissolving substances. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Innovations, Prevention, Design and construction, Endothelial seeding, Vascular grafts, Graft occlusion, Vascular, Vascular graft occlusion, Stanley, James

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