In a medical world where ethical standards are constantly evolving as we face unprecedented issues, it is a matter of intense interest when someone is accused of acting unethically. What on earth could they have done to cross the line from ethical "dilemma" (a word that covers a multitude of risky propositions) to ethical transgression?
In the case of Barbara Sherwin, a professor of psychology at McGill University in Montreal, it was the sin of putting her name to an article the original draft of which she did not write. What apparently happened was this: nearly a decade ago, a ghost-writing firm in New Jersey approached her with an article based on her research on hormone replacement therapy (HRT) in older women. The company, it turns out, was paid by drug giant Wyeth to produce such articles. Professor Sherwin made numerous editing changes and the article was published under her name only.
This fact has come to light only because lawyers taking a class-action suit against Wyeth for women claiming they were harmed by HRT -- a therapy whose fortunes seem to have risen and fallen like the proverbial roller coaster over the past decade or so -- dug it up. A medical scandal with women’s health as a major side issue has naturally made for much shock and horror commentary in the media.
I was shocked, too, on reading the headlines, but not for the reasons that you might at first assume.
In 2001 a medical publisher approached me and asked me to write an article on ethical dilemmas surrounding the decision to treat patients who want a prescription for medications, but who are unwilling to make lifestyle changes. These patients want treatment that is not medically necessary, but they believe it would enhance their lifestyle -- for example, a non-obese woman wants a weight loss drug. I replied that I did not have time to write such an article. The publisher said that they could help.
They offered to have a researcher go through my relevant publications and, using what I had written, patch together an article that I could change as I pleased. It never occurred to me that accepting their offer would be unethical -- and I'm an ethicist. I thought of this offer as equivalent to having a research assistant, which is a universal practice in academia.
As matters turned out, the draft I was sent was completely unacceptable to me -- it is still filed as "original bad version". However, having agreed to contribute an article, I felt obliged to produce one, which I did. But, had the original article consisting of my previous work been acceptable, I would not, at that time, have thought it unethical to publish it. (I would have regarded it as more or less the equivalent of a republication of one of my articles, an occurrence that has happened hundreds of times.)
The key words here are "at that time". Lord Denning, the famous House of Lords judge whose judgments are studied by most law students in the Anglo-American world, once famously said that "you can't look at 1956 events with 1964 glasses". He meant that, when a judge sets the legal "reasonable standard of care", falling below which constitutes actionable negligence, the judge must look at what was regarded as reasonable care in 1956 when the event occurred, not what is seen as reasonable care in 1964.
Just as the law evolves and science evolves, so too ethics evolves and something we now rightly regard as unethical might not have been so characterised in the past.
Much has changed in the past few years with respect to the ethics of academic publishing. Practices that were considered normal just a few years ago, such as placing on research articles the names of people who did not participate directly in the research (for instance, a principal investigator whose only connection with the research was that his research grant supported it) are now considered unethical.
All of the above having been said, there is conduct that should always have been and was seen as unethical. Examples include publishing fraudulent data or, its first cousin, "massaged data" (unethically finding an "excuse" to drop data that make the results less convincing); falsifying results; signing off on an article that gives the impression that the famous researcher author has done the research, when that is not the case -- and, in some cases that have recently come to light, where the famous researcher had not even read the article to which his name is attached. (To be clear, none of these offences have been raised in relation to Sherwin's work.)
Leading medical and science journals have taken steps, including adopting a code of ethics, to try to ensure the authenticity of the research that they publish, even going so far in some cases as repeating the research before publication. These steps also have goals of ensuring that credit is given only where credit is due; that credit is not wrongfully withheld; and that conflict of interest is not present or, at the very least, is disclosed.
Good ethics depend on good facts and we should not rush to judgment, but wait and see what the facts are in Sherwin's case. She has said that "she made a mistake" in having her name on this article, but she might be looking at the situation with 2009 glasses.
Finally, I have written this because I had one of those "there, but for the grace of God, go I" moments, in relation to the article of mine that I describe above, when I read the articles about Sherwin. Also, if the facts in her case are as I am guessing they will be, I think we would find many similar cases in all our big research universities and it is not fair if she becomes the scapegoat.
I should add that, although I work at McGill University myself, to the best of my knowledge I have never met Barbara Sherwin; that no person at the university has spoken to me about her case; and that the university had no prior knowledge that I was writing this article.
Margaret Somerville is director of the Centre for Medicine, Ethics and Law at McGill University.
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