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Machiavelli's Laboratory

Machiavelli's Laboratory
A Satire
© 2010 Jules J. Berman
Version 1.0 created April 13, 2010
Version 1.0 last modified January 25, 2010



TABLE OF CONTENTS

Chapter 0 Preface

0.1 About me

0.2 Nota bene

0.3 Book cover

Chapter 1 Falsification And Fabrication Of Data

1.1 Lessening the guilt: retractions, scapegoats, and clueless conspirators

1.2 Elite liars

1.3 When you are caught

1.4 Advice for evil scientists

Chapter 2 Improving The Truth: The Art Of Scientific Misinterpretation

2.1 All statistical studies are open to misinterpretation

2.2 Introducing biases into your study

2.3 Falsification of conclusions

2.4 Misrepresenting progress in the war against cancer

2.5 Advice to evil scientists

Chapter 3 The Evil Writer

3.1 Co-authors

3.2 First credit

3.3 Evil books

3.4 Altering the past

3.5 Plagiarism

3.6 Plagiarism in a computer world

3.7 The acknowledgment section

3.8 Advice for evil scientists

Chapter 4 Evil Editors And Reviewers

4.1 Advice for evil scientists

Chapter 5 Grantsmanship

5.1 True funding means never having to say you're sorry

5.2 Your failure is my success

5.3 Investing in science

5.4 Advice for evil scientists

Chapter 6 Rejection

6.1 Applauding bad science

6.2 Progress? what progress?

6.3 The consequences of rejection

6.4 Advice to evil scientists

Chapter 7 Complexity: The Devil Is In The Details

7.1 Lazy data

7.2 Complex decisions

7.3 Advice for evil scientists

Chapter 8 Scientific Globetrotting

8.1 Advice for evil scientists

Chapter 9 Evil Intellectual Property

9.1 Advice for evil scientists

Chapter 10 Evil Standards

10.1 What the standards development organizations never do

10.2 Advice for evil scientists

Chapter 11 Abusing Power

11.1 The department chief

11.2 Carl linnaeus and his immortal cronies

11.3 Advice for evil scientists

Chapter 12 Governments And Evil Science

12.1 Government cover-ups

12.2 Government against the people

12.3 The power of bureaucrats

12.4 Advice for evil scientists

Chapter 13 Corporations And Evil Science

13.1 Erbitux and the brave new world of gene targeted therapy

13.2 It pays to advertise

13.3 Scientific organizations are instruments of large corporations

13.4 Advice for evil scientists

Chapter 14 Universities And Evil Science

14.1 Academic freedom is the freedom to lie to your students

14.2 The fertile ground excuse

14.3 Advice for evil scientists

Chapter 15 Ethics, And The Avoidance Of Same

15.1 Consent and unconsent

15.2 Conflicts of interest

15.3 Betraying confidentiality

15.4 Evil patients

15.5 Harming animals

15.6 Advice for evil scientists

Chapter 16 Clinical Trials On Trial

16.1 Biases in survival data

16.2 Advice to evil scientists

Chapter 17 Scientific Disasters

17.1 What is the maximal amount of damage that can be credited to a single person?

17.2 Other disasters

17.3 Advice for evil scientists

Chapter 18 Belief And Disbelief

18.1 Mathematics is neither science nor religion

18.2 Statistics and other pseudo-mathematical fields

18.3 Advice for evil scientists

Chapter 19 Sex And Gender

19.1 Where the boys are

19.2 Advice for evil scientists

Chapter 20 Greed

20.1 To understand the practice of medicine, just follow the money

20.2 Man-made diseases

20.3 The physician jobs program

20.4 Fast care and slow care

20.5 Cashing in on cancer

20.6 Off-label physicians

20.7 Ghost writers

20.8 Advice for evil scientists

Chapter 21 The Future Of Evil Scientists

21.1 Advice for evil scientists

Chapter 22 Final Exam

Chapter 23 Glossary

Chapter 24 References







CHAPTER 0. PREFACE

"God did not make us perfect. To compensate, he made us blind to our faults."

-Anonymous

This is a satirical book about science and ethics. All of the advice offered in this book is bad advice. Nothing in this book should be taken seriously. Literal-minded readers are urged to stop reading NOW.

Serious books cover the deep issues: the obligations of scientists to individuals and to society, general principles of ethical conduct, human dignity and human rights, etc. These ethics books tend to be a bit sanctimonious, and boring. This book is focused on the commonplace, petty, and venial misdemeanors that shape scientific culture. Thoughtless crimes are committed by every scientist. Cumulatively, they do more damage than the actions of rare, sociopathic scientists.

When we think about scientific misconduct, we tend to focus on the problem of data falsification. We are told that these cases are rare, but nothing can be further from the truth. Misconduct creeps into every scientific endeavor. The reason for this is that scientists and physicians are humans motivated by the typical human goals: financial security, social approval, and the pursuit of pleasure. When the selfish goals of scientists and physicians conflict with the selfless goals of of science and medicine (the advancement of knowledge and the reduction of the suffering and death due to disease), the selfish goals of scientists always win out.

Here are just a few banal evils committed every day by respected scientists:

1. Boastfulness. Touting the positive qualities of your research, while omitting the problematic aspects.

2. Jealousy. Writing manuscripts that fail to cite the relevant and precedential work of your competitors.

3. Irresponsibility. Receiving a large federal grant but barely working on the project, preferring to spend your time garnering additional grants.

4. Arrogance. Refusing to release your research data to the public, insisting that others will misinterpret your findings.

5. Laziness. Co-authoring papers you haven't even read.

6. Deception. Hiding your financial conflicts of interest from your research subjects, colleagues, and editors; and profiting from your deceit.

7. Intimidation. Getting your way through an exercise of authority, rather than through scientific persuasion.

8. Cronyism. Using your influence to help your allies (by inviting them to speak at meetings, or by placing them in powerful positions), while you surreptitiously work to isolate or discredit scientists whose opinions or agendas conflict with yours.

9. Influence peddling. Using your authority and power to alter the course of scientific advancement, in accordance with the wishes of a paying entity.

10. Rationalization. Justifying your actions through the self-serving use of a seemingly scientific argument that is illogical and wrong.

You may be thinking that there must be some exceptions; scientists and physicians who are altruistic. Actually, no, there are no exceptions. I have been involved in dozens of research efforts through the decades, working closely with hundreds of different scientists. I have attended countless meetings and have spoken with thousands of dedicated scientists who I admire and trust. But I have never met a scientist who is driven by altruism, and I have never met a scientist who is capable of being objective on the subject of his own research. The hypothetical altruistic scientist would not last very long in an environment where competing ideas are marketed (promoted in grant applications), bought (through licenses and royalty payments and technology transfer agreements), sold (as high-priced pharmaceuticals and laboratory tests), banked (patented) and destroyed (by competition).

Every scientist and physician has moments when they are asked to forgo some personal reward for the sake of scientific integrity. This book takes a fresh approach at examining such moments. Instead of moralizing on the virtues of scientific integrity, I try to explain the selfish motives that make every scientist and physician act the way they do.

Society tends to assume that scientists and physicians are somehow different from the rest of us. This book will prove that this is not so. Scientists are just like everyone else, only more so.

Through the book, I recount hundreds of well-documented cases of scientific misconduct. In many instances, the names of scientists involved in scandal or crime, are omitted, and replaced with vague epithets, such as "the investigator," "the junior colleague", and so on. I see no reason to hold scientists to public ridicule. I assume that most of the scientists involved in scandal have moved forward with their lives, and deserve some degree of anonymity. Actual names appear in situations that rise to the level of notoriety, or for which the person involved is a public figure (e.g., a leading bureaucrat in a federal agency, a Nobel prize winner, the CEO of a corporation, etc.). I would have preferred to exclude all names, but I'm certain that readers would construe these omissions as sloppy journalism.

Curious readers, who insist on knowing the identities of the scientists involved in any particular scandal, may find them in the cited references. There are over 300 references to this book; most are publicly available documents. I tried to make this book the most comprehensive and accessible treatise ever written on the subject of professional pettiness.

Indented paragraphs, printed in italics, are fictional stories or hypothetical situations. These stories are drawn from my own experiences, or they were told to me by other scientists, and they all have some loose connection to reality. I have changed the names and locations of institutions to spare anyone embarrassment. Attempts to deduce specific real-life events, from stories in this book, will be futile. All of these stories have occurred many times, with different casts of characters.

Here's an example:

You have been working on a key scientific problem for the past 8 years: finding the gene mutation responsible for a terrible disease. You are on the verge of a breakthrough. Success will come in a week, a month on the outside. Three other laboratories are on the same path. At meetings, you discuss some of your results, but you only divulge enough information to confuse your close competitors. You have worked longer and sacrificed more than anyone else. If there is any justice in the world, you will soon prevail. Your graduate student rushes into your laboratory. You glance at him, unsmiling. "What does he need from me now?" you wonder. He has just heard that your chief competitor has isolated the disease gene, and found its mutation. His paper was accepted and will be published in next week's issue of Nature. Your graduate student asks how this news will impact on his thesis timeline, but you have already stopped listening to him. You turn white, and slump deeply into your chair. Fame and riches will not come to you. The past eight years of your life were wasted. Your research will no longer be supported. You will not receive tenure. Your graduate students and post-docs will move to other laboratories. Hatred and jealousy fill your soul. The world has just received another miracle of science, and it is the worst day of your life.

0.1 ABOUT ME

"A highbrow is a person educated beyond his intelligence."

-Brander Matthews (1852 - 1929)

After receiving two bachelor of science degrees (mathematics and earth sciences from MIT), I entered the graduate program in pathology at Temple University, where I began my thesis work within the Fels Cancer Research Institute. I spent the final year of my graduate studies at American Health Foundation in Valhalla, New York, before beginning my post-doctoral studies in the Laboratory of Experimental Pathology at the U.S. National Cancer Institute. I earned a medical degree from the University of Miami, followed by a pathology residency at George Washington University Medical Center in Washington, D.C. I became Board Certified in Anatomic Pathology and in Cytopathology, and served as the chief of Anatomic Pathology, Surgical Pathology and Cytopathology at the Veterans Administration Medical Center in Baltimore, Maryland. While working at the Baltimore VA Medical Center, I held appointments at the University of Maryland Medical Center and at the Johns Hopkins Medical Institutions. In 1998, I became the Program Director for Pathology Informatics in the Cancer Diagnosis Program at the U.S. National Cancer Institute. In 2006, I became President of the Association for Pathology Informatics. My name has appeared as a co-author on hundreds of scientific contributions, and I have written, as first author, more than 100 publications. Today I am a free-lance author and have written extensively in my three areas of expertise: medical informatics, computer programming, and cancer biology. At this stage in my career, I have witnessed just about every kind of deceitful activity known to science.

0.2 NOTA BENE

"Things that are new are wont to be set forward rudely and formlessly, and then must be polished and perfected in succeeding centuries."

-Pappus (circa 350 - 300 B.C.), one of the last Helenistic mathematicians

This book is a work of satirical fiction and has no value or purpose other than as a work of literature. It is distributed at no cost to the reader, but copyright law applies. If you find any mistakes, please send corrections to me, via the book's blog site.

0.3 BOOK COVER

"Don't judge a book by its cover."

-Anonymous

The cover illustration was prepared from Wikipedia's public domain photograph of an oil-on-canvas painting of Niccolo Machiavelli (1469 - 1527), by the artist Santi di Tito (15361603). The painting currently appears in the Palazzo Vecchio, in Florence, Italy. The photograph was tiled, and pasted onto a globe suspended on an infinite rippled plane, using Pov-Ray rendering software.





CHAPTER 1. FALSIFICATION AND FABRICATION OF DATA

"A clear conscience is the self-assured feeling that no one has found out about you yet."

-attributed to Ambrose Bierce

Each year in the U.S., about 28,000 science and engineering doctorates are awarded, along with about 75,000 Masters' degrees and about 400,000 undergraduate degrees (1), (2). This is a lot of competition. How can you distinguish yourself when you know from the outset that just about everyone is better than you? Cheating is the only practical solution.

You are in your seventh year of graduate school. You have watched as other graduate students came into the department, completed their coursework, wrote and defended their theses, and graduated with their PhD. You are now in debt to the tune of $150,000. You have no respect in the department. Your thesis advisor has hinted that the Ph.D. may not be a realistic option for you. You tell him that you have finished all your coursework and that the only obstacle preventing you from collecting your Ph.D. is the thesis. Your advisor indicates that a thesis project cannot continue indefinitely. Perhaps it would be better if you settled for a Master's degree. You could assemble your preliminary work into a Master's thesis and collect the degree by June. For many, the Master's degree is the perfect prelude to a successful career in industry or academia. For those who have labored four years, or longer, as Ph.D. candidates, the Master's degree is a bitter consolation prize, and the mark of a loser. You leave your advisor's office dejected. In the evening, you go to your shabby apartment to contemplate your options. No soulmate awaits you. Your girlfriend abandoned you months ago, when she realized that you had no viable job prospects. You begin to obsess over the unfairness of life. You are so much smarter than the others. You have so much to offer to the world. All you need is one break, and if the world won't give you that break, you will give it to yourself. You pull out your lab book, and you begin the task of fabricating the data that will earn you the respect and credibility that comes to every doctoral scientist.

In the U.S., allegations of research misconduct are investigated by the The Office of Research Integrity (ORI). Other U.S. agencies, and funding agencies in other countries have similar watchdog institutions. The ORI makes its findings a matter of public record. You can visit their web site and read the individual reports of misconduct (3). Here are just a few examples:

1. "[A] research program coordinator in the Oncology Center, The Johns Hopkins University School of Medicine, engaged in scientific misconduct by fabricating patient interview data for a study of quality of life measures in cancer patients. Further, the same research program coordinator, "engaged in scientific misconduct by falsifying patient status data by failing to update the status of treated breast cancer patients and misrepresenting data from previous contacts as the updated status for a study." (4)

2. An Assistant Professor in the Department of Psychology at Harvard University was found to fabricate data in a number of different experiments that were described in journal publications. The doctor retracted the published papers in a letter that included the following language, "because I improperly excluded some participants who should have been included in the analyses and that this exclusion affected the reported results. Moreover, the improper exclusion of data was solely my doing and was not contributed to or known by my coauthors." (5)

3. An Assistant Professor in the Yale University School of Medicine "committed scientific misconduct by plagiarizing and intentionally misrepresenting research in an application for Public Health Service (PHS) funded research supported by grant application 1 R24 RR05358-01" (6).

Between the years 1993 and 1997, the vast majority of Office of Research Integrity cases involved data falsification (modifying the true data to suit your own purposes), data fabrication (inventing data from thin air) or both. Less frequently, allegations of plagiarism were investigated. Of 150 cases investigated, all but one case had an alleged component of data falsification, fabrication or plagiarism (7). In 2007, of the 28 investigated cases, 100% involved allegations of falsification, fabrication, or both (8).

What can we infer from this revelation? If you commit a type of misconduct other than falsification and fabrication of research data, it will almost certainly be ignored by the ORI. Here are just a few of the kinds of misconduct that you can commit with impunity:

1. Stealing ideas from students, post-docs and coworkers.

2. Stealing all the credit for a project where your participation was marginal.

3. Selling another person's or another entity's property, as though you owned it (i.e., piracy).

4. Excluding co-workers from the author list of the publications.

5. Not citing prior work that would reduce the importance of your contribution.

6. Failing to complete your funded grant research.

8. Making mistakes. Scientists are expected to make mistakes, even when those mistakes have terrible consequences for others. ("True science means never saying you're sorry").

9. Embellishing your research papers with self-serving misinterpretations.

You do not need to worry about the ORI, so long as you confine your dishonest activities to areas outside their purview. Moreover, you need not worry too much about being detected by your colleagues. Experience has shown that many instances of data fabrication go unnoticed for a very long time.

Walt Bogdanich, in a New York Times article, recounts six years of non-stop medical misadventures occurring at the Philadelphia VA Hospital (9). In 2002, the VA funded an ambitious brachytherapy clinic for patients with prostate cancer. Brachytherapy involves the implantation of radioactive seeds in the prostate, at the site of cancer. The localized seeds deliver a toxic dose of radiation directly to the tumor, sparing normal tissues and adjacent organs. Performed correctly, brachytherapy is a very good method for treating cancer confined to the prostate. The administrators at the VA turned to the prestigious University of Pennsylvania to provide the professional staff for its brachytherapy unit, ensuring, they thought, the highest possible level of care for VA patients.

Over the next six years, systemic problems arose involving the way that the brachytherapy unit conducted surgeries, implanted radioactive seeds, visualized the seeds, measured the success of the seed implantations during surgery, reported the outcomes of surgery, and handled external review of unit procedures and activities. The unit botched 92 cases, out of 116 cancer treatments, over a period of six years. Among the most common errors, seeds were implanted into organs other than the prostate (e.g., bladder and rectum), and prostate cancers were under-seeded. Questions were raised regarding a cover-up; specifically, alterations in records and protocols intended to hide errors. When the case finally broke, the brachytherapy unit was shut down, a Senate hearing was called, and VA policy changes were recommended (10). The complete medical and legal consequences of activities at the former VA brachytherapy unit will unfold in years to come.

Scientists produce errors all the time, and at great frequency. The Institute of Medicine reports that between 44,000 and 98,000 people, die each year in U.S. hospitals from preventable medical errors (11). The astonishing feature of the brachytherapy unit is that a remarkably high rate of systemic errors occurred in a crucial medical setting, without any hint of public scandal for six long years (9).

A little digging uncovers scientific scandals that have endured much longer than six years, often extending beyond the death of the perpetrator.

John Seabrook chronicled the efforts of ornithologist Pamela Rasmussen (born 1959), who uncovered a fraud, committed throughout the first half of the twentieth century, involving numerous bird specimens collected through the latter half of the nineteenth century (12). The culprit was Colonel Richard Meinertzhagen (l878 - 1967). He stole bird specimens from historical collections and annotated them with fabricated data (Figure 1-1). The scientific mischief came to light in the early 1990s by Pamela Rasmussen and Robert Prys-Jones, who found inconsistencies in curated bird specimens. There were bird species reported to come from areas where the bird species did not exist, and there were were bird specimens prepared with materials consistent with collections that predated Meinertzhagen, using techniques that were different from those employed by Meinertzhagen himself. After the investigation, dozens of taxa had to be removed from the British list. Meinertzhagen was a soldier, intelligence officer, diarist, nature writer, and ornithologist. Throughout his long life, his many scientific fabrications went undiscovered.



Figure

Figure 1-1. Richard Meinertzhagen. Source: Wikipedia, public domain.

Gregor Mendel (1822 - 1884), the father of genetics, studied inherited traits in hybridized peas (Figure 1-2). His seminal work, published 1865, was received with underwhelming enthusiasm by the scientific community (13). Mendel lived out his days as an Augustinian priest, in near-total scientific obscurity. In the twentieth century, his work was rediscovered, and Mendel attained immortality, though posthumously. In 1936, RA Fisher, the celebrated statistician, published a paper in which he questioned the accuracy of Mendel's data: specifically, the data were much too accurate to be true (14). Mendel's data showed a near-exact proximity to the theoretically expected trait ratio of 3 to 1. Statistical sampling theory and experience with actual modern measurements suggest that Mendel almost certainly tweaked his data to best fit his hypothesis. This popular and ancient practice of self-serving data manipulation is known under a variety of names: fudging, cooking, forging, trimming, or fiddling (15). Though subsequent studies have fully validated Mendel's central hypotheses, it is widely believed that Mendel, like most other scientists, served his data cooked.



Figure

Figure 1-2. Gregor Mendel. Source: Wikipedia, public domain

In 1912, Charles Dawson (1864 - 1916) , a solicitor and an amateur archaeologist, announced the discovery of a jawbone in the digs at Piltdown, England. The jawbone, estimated to be about 500,000 years old, when matched with other bone fragments from the same site, was assembled into a humanoid skull (Figure 1-3). The skull was promoted as the missing link between earlier primates and humans, and given the scientific eponym Eoanthropus dawsoni (Dawson's dawn man); also known as Piltdown man. Though the Piltdown man had detractors, it also had powerful champions, including Arthur Keith (1866 - 1955), an influential anatomist and anthropologist, and Pierre Teilhard de Chardin (1881 - 1955), a famous philosopher and Jesuit priest. Dawson died four years later, enjoying celebrity and scientific respect. In 1921, Arthur Keith received British knighthood.



Figure

Figure 1-3. From the reconstruction by J. H. McGregor. Source: The Outline of Science by J. Arthur Thomson, Putnam and Sons, New York, 1922.

In 1949, 37 years following the discovery of Piltdown man, Dr. Kenneth Oakley (1911 - 1981) used newly developed dating to determine that the age of the Piltdown skull was only 50,000 years. Further tests showed that the bone fragments had been exposed to potassium dichromate, an agent that made the fragments seem ancient. The molar teeth of the skull had a non-human appearance. On close review, the non-human appearance resulted from someone deliberately filing the crowns. A visit to the Piltdown site indicated that the type of soil at the site could not have formed and preserved fossils. In 1953, the Piltdown man was declared a hoax. Today, nobody knows who perpetrated the hoax, but everyone can agree that it had a good run.

If you're looking for data to falsify, there's no better place to start than with your own history. Improving your past can lead to a better future. Concentrate on the four credentials you will need if you want to be hired into a high-level scientific position:

1. You will need an advanced academic degree (usually a Ph.D. or a D.Sc. or a Master's Degree), or a Medical Degree.

2. You will need a substantial number of publications. Some should appear in high impact journals, and some should list you as the first author.

3. You will need to establish a relationship of trust with a person in power at the institution where you wish to be employed. This is best achieved by displaying some kind of loyal and obsequious behavior towards a member of the search committee. If you come with a strong personal recommendation from someone trusted by the search committee, you might squeak by. Don't worry about better qualified competitors. The most qualified candidate, with no friends on the search committee, cannot compete against the pleasant fool who plays golf with the department chief.

4. You must be physically attractive. Scientists, like other varieties of people, are as shallow as piss on concrete. Lose the pounds. Dress for success. When you walk, heads should turn towards you, not away from you. Seek the services of a plastic surgeon, if necessary. Keep in mind that we must make certain sacrifices for Science.

If you have these four credentials, the job will be yours for the taking. Other characteristics (e.g., competence, intelligence, curiosity, strong moral character) are seldom helpful and may actually work against you if your interviewers are envious, insecure, or easily intimidated.

If you are lacking an academic degree, you may choose to lie on your job application. A former Dean of Admissions at MIT had lied on her job application (28 years earlier), when she reported that she had earned bachelor's and master's degrees in chemistry and biology from Rensselaer Polytechnic Institute, Albany Medical College, and Union College (16). She landed the job, thanks to her false credentials. Once employed by MIT, she rose through the ranks to become the Dean of Admissions. Twenty-eight years later, the lies were discovered. The dean was forced to resign, but this cautionary tale certainly has an up-side. Here is a woman, without formal credentials, who had the opportunity to become a dean at one of the most prestigious institutions in the world, thanks to a small personal embellishment. The sweet ride lasted twenty-eight years. Two and a half years after the scandal broke, she was back in the game, running her own college admissions consulting firm in New York City (17). She owed her success to a lie.

If you are going to lie about your college credentials, make it difficult for the human resources to discover the crime. It is sometimes impossible to verify credentials claimed on an application. Colleges can close, professors can retire or die, whole record departments can be destroyed in fire or flood. A list of defunct universities and prominent, deceased professors can be very helpful for anyone who chooses to fake college degrees and recommendations.

An alternative plan is to pay for a degree from a college or university with low standards. Most employers will require you to hold a degree, but very few employers will care where it came from. Try to find an on-line, off-shore college with matriculation standards that are closely aligned with your ability to pay their tuition.

Padding your curriculum vitae with fabricated citations is another task that can be achieved without much effort. Most human resource departments will only check to see if you've listed publications; they don't check to see if the listed publications actually exist. To be safe, when you list your publications, cite them as being "in press". An "in press" publication has been accepted for publication but has not yet appeared in print and does not have a publication volume, page, or date. Because "in press" publications have not yet appeared in print, there is no easy way to determine whether the citation is legitimate.

When listing a fictitious manuscript on your CV, it is best to assign yourself as the second author. The first author should be an ally, or a made-up name, or the name of a deceased scientist, or someone who would be difficult to find. This way, if anyone questions you about the likely date of publication for the paper, you can simply say that the first author is dealing with the publication process, and that you are out of the loop. If, after you land the job, people persist in asking when your "in press" papers will be published, just shrug your shoulders and say that you are as baffled as they. Indicate you have placed several calls to the first author and to the editor, with no reply. Strange as it may seem, your colleagues will believe this concocted story, because thoughtless behaviour is commonplace among scientists.

A young medical researcher came to America, from Italy, in search of an academic position. Unfortunately for him, he lacked prior publications. Fortunately for him, his uncle was a prominent researcher in Italy; he and his uncle shared the same initial of their given name, and the same surname. The younger scientist larded his own CV with recent publications of his uncle, including the surname and first initial of the given name in each citation. The search committee mistakenly attributed the publications to the applicant, and was impressed that a young researcher could have accomplished so much. He got the research position, and soon started to apply for grants. Soon, he had his own funding, and was doing quite well in the department. A few years later, his deception was found, but by this time, he was bringing substantial grant money into the department. The department leadership decided to keep him, though they knew he had cheated on his application. Perhaps they felt that he had proven himself the only way that real scientists every prove themselves; by getting funded. Perhaps they felt that if they could fire him at any time; why would they want to fire him when he was bringing in grant funds? Perhaps they wanted to avoid a scandal that would diminish the department's ability to bring in future grants? Perhaps they felt that they could hold the secret over his head, keeping him as a virtual slave to the department, forever. Most importantly, the department knew that they would be required to return the grant funds to the granting agency, if his secret got out. The lesson learned here is that even a feeble deception on a job application can lead to a successful career in science.

It may seem counter-intuitive, but lying works best when the competition is fierce. Good jobs may have hundreds of applicants for a single position. With so many applications to review, you can be certain that nobody will be making a thorough check on your accuracy.

One of the most competitive types of positions are medical specialty fellowships. Such fellowships almost always lead to highly lucrative careers. Studies have been conducted to gauge the honesty of medical specialty applicants (18), (19), (20). Not surprisingly, about 30% of applicants for gastroenterology fellowships were found to misrepresent their accomplishments. Misrepresentations included citations of nonexistent articles in actual journals, articles in nonexistent journals, or articles noted as "in press," that were not published.

Among 280 applicants for orthopedic fellowships, 151 claimed that they had authored journal publications. It was found that 16 (10.6%) of these 151 applicants had misrepresented their citations (19). The results were similar among the applicants for radiology fellowships. A minimum of 16% (14/87) of applicants to the body and breast/body imaging fellowship programs who cited publications misrepresented their publication record (20). A similar pattern of dishonesty was found among the applicants for Emergency Medicine residency positions, the very same breed of doctors glorified in the TV show, ER (21).

What happens when a dishonest applicant is discovered? Does the university contact other universities, warning them the doctor has falsified his application? Apparently not. The authors of the study found no instances wherein the National Residence Matching Program (NRMP), the clearinghouse for residency applications, was apprised of falsified applications (21). Once a falsification has been found, why wouldn't the University notify the NRMP? Institutions fear that reporting a falsification would violate the ethics and rules of the National Residency Matching Program (NRMP) match, which prohibit schools from sharing information that would alter the applicant's standing in the selection process. In addition, the applicant might actually have a plausible defense for what would seem to be a blatant case of cheating. You wouldn't want to be sued for ruining an innocent medical student's chance to earn a living.

Suppose you were a medical student who was caught falsifying his residency application. What would you do? You would simply claim that any error was unintended. If you credited yourself with a fictitious journal article, you would simply say that you thought that the paper had been published, and that you were never informed by the co-authors that the paper was rejected. This kind of thing happens all the time.

The key thing to remember about false credentialing is that it has a single purpose: to give you an advantage over your stronger, more deserving, competitors. It should never be used to establish a completely false persona. The full-time imposter destroys his own identity, and this is simply not in the interests of any self-respecting evil scientist. A story that unfolded at the Stratton VA Medical Center, in Albany, NY, demonstrates the point (22). The Stratton VA hired a man for a cancer research position despite his prior felony conviction for forging a medical license application. Once hired, the cancer researcher, with no medical degree to his name, presented himself to patients as a physician, and participated in their care. By modifying medical records, he contrived to enroll patients in cancer studies inappropriately, and without informed consent. These nefarious activities fed patients into a financed arrangement between the VA and the pharmaceutical companies that paid a fee for each subject entered into clinical trials (23).

Two Stratton researchers complained that patients were being placed at risk. Nobody likes a tattle-tale. The institution ignored their warnings, and retaliated against the two whistleblowers. Affairs came to a head when a decorated and popular veteran died two weeks after receiving an experimental cancer drug. There was a trial, and the fraudulent researcher was sentenced to nearly six years in prison after pleading one count each of mail fraud and criminally negligent homicide (22).

1.1 LESSENING THE GUILT: RETRACTIONS, SCAPEGOATS, AND CLUELESS CONSPIRATORS

"Everybody lies, every day; every hour; awake; asleep; in his dreams; in his joy; in his mourning."

-Mark Twain (1835 - 1910)

How often have you heard a scientist admit that he was mistaken? There is hardly a single scientific area that is not steeped in controversy. For every scientific hypothesis, there is an equal and opposite hypothesis promoted by a rival scientist. You would think that the progression of scientific knowledge would inevitably result in a never-ending parade of retractions from those scientists who championed discredited ideas. This is simply not how science works. Scientists are not morally superior beings; they seldom confess to their mistakes. In almost all instances, retractions occur only after the scientist has been proven wrong decisively and publicly.

Dr. Kilmer McCully's scientific career was built on his hypothesis, first proposed in 1969, that homocysteine played an important role in heart disease. Dr. McCully's hypothesis predicted that by reducing the blood levels of homocysteine, with B vitamin supplements, the incidence of heart disease would decline. Clinical studies failed to validate his hypothesis. An evil scientist would have dissembled, suggesting that the clinical study was poorly designed and would require a much larger, lengthier study to test his hypothesis. Alternatively, an evil scientist might choose to tweak the hypothesis slightly, requiring new tests. Procuring funding for another clinical test, poorly conducted and analyzed by allies with a stake in the success of the original hypothesis, is the kind of subterfuge that usually meets with some measure of success.

Dr. McCully, in a stunning act of honesty and scientific humility, responded "The evidence is clear that this type of vitamin therapy is really not effective in reversing or benefiting advanced vascular disease" (24), (25).

All hypotheses are tentative propositions. It is the scientist's job to develop and objectively test hypotheses. The perfect scientist does not really care whether the hypothesis is proven to be true.

Dr. McCully is a rare exception to the general rule that scientists never admit when their hypotheses are wrong. Most retractions occur when something goes terribly, terribly wrong, and the best course of action is a public apology.

Here is an example, reported in Nature under the banner, "Agony for researchers as mix-up forces retraction of ecstasy study." (26) A group of scientists at the Johns Hopkins University School of Medicine had reported in the journal Science that the drug ecstasy, in small doses, damaged the dopamine-producing brain cells in monkey. As it turned out, the Science article was retracted when it was determined that the wrong drug had been injected during the experiment (i.e., no ecstasy) (26). How could such a mistake occur? We would all like to believe that scientific experiments are repeated over and over, with fresh reagents, and with results scrutinized by every member of the scientific team. We tend to forget the basic truth that scientists are no different than any other people. Nobody questions findings that confirm their own beliefs. If your original hypothesis is that ecstasy is toxic to dopamine-producing cells, a normal person will most likely accept results that validates his hypothesis.

Some retracted papers are highly cited. The journal Science retracted one of its published papers when it was discovered that an author had fabricated data (27), (28). The paper had been cited 227 times. Most research papers are never cited by anyone other than the authors. To be cited 227 times is an indication that the scientific world had fully embraced the conclusions of the bogus paper. In 2006, the Office of Research Integrity came to the conclusion that the same author had falsified data in four grant applications and in eight publications and one published manuscript. In addition to the Science paper, retractions appeared in other highly influential journals, including Mutation Research, the Proceedings of the National Academy of Sciences (PNAS) and Molecular and Cellular Biology. This indicates that serial fabricators can have a pervasive influence within a field, by planting pseudo-facts into the scientific literature, and by tainting works, written by other scientists, that were predicated on false findings.

One of the greatest cultural inventions was the scapegoat, an animal to which human sins can be transferred. When the transference is completed, the scapegoat is sacrificed to the gods, and the humans are absolved from guilt.

In October, 1996, Dr. Francis Collins, a well known genetics researcher, retracted five papers that he co-authored with a junior colleague. A New York Times article reviewed the events leading to Dr. Collins' revelation (29). Earlier that year, one of Dr. Collins' co-authored papers had been submitted to the journal Oncology. The reviewer for the journal found problems with some of the submitted data, and raised suspicions that the data had been deliberately falsified. When Dr. Collins was notified of the problem, he reviewed other papers co-authored with the same colleague and found a trail of falsified data. When confronted, the colleague confessed. Much to his credit, Dr. Collins immediately retracted the papers and sent notifications to about 100 scientists in the field. This quick and decisive action far exceeded the cryptic notices that characterize most scientific retractions. Eventually, seven papers were retracted, and the final deliberations of the Office of Research Integrity are now public record (30). Full blame for the deceptions was placed on the junior colleague.

There are a number of puzzling details concerning this episode. One of the falsified papers was a two-author work written by Dr. Collins and the junior colleague. When a paper has 30 authors, it is easy to see how some of the authors might be unaware of every detail found in the final manuscript. In a two-author paper, it is difficult for one author to hide the experimental details from the other author. In his interview with the New York Times reporter, Dr. Collins was quoted as saying, "My bottom-line answer is very unsatisfying, but there is no fail-safe way to prevent this kind of occurrence if a capable, bright, motivated trainee is determined to fabricate data in a deceptive and intentional way, short of setting up a police state in your laboratory. (29)" If this were the case, how was it possible for the journal reviewer to find the deception in the data?

This short episode in Dr. Collins' career illustrates the venial character of data fabrication, when there is a scapegoat. Nobody will push very strenuously for reforms in the way that group efforts are conducted. Nobody will require every author on a multi-author work to take full responsibility for the data included in their manuscript. If you have a scapegoat, you have an alibi. Parenthetically, today Dr. Collins is the head of the National Institutes of Health (i.e., the top medical researcher in the U.S. government).

In another case, Charles Turner, an NIH funded investigator, used interviewers to collect sociological data on 1800 Baltimore residents (31). Eleven months into the study, Turner was informed that one of the staff interviewers was much more productive than the others. Turner investigated and found that the overproductive worker had been fabricating data. A grueling six months of data review followed, during which Turner discovered multiple instances of data fabrication, committed by several staff members (31). After the incident, the investigator could have shrugged away the problem, insisting, that it would be impossible to prevent fraud without setting up a research police state. The investigator, in this case, owned up to the problem, and affirmed that researchers, must validate, for themselves, the work they delegate to others (31).

If you are the first author of a paper, and you have falsified the data in your manuscript, how might you protect yourself? One approach is to add a lot of superfluous co-authors. If the paper is discredited, the blame can be diffused over a great many people. If the paper is well-received, you can claim full credit for yourself. So-called "big science" projects can produce manuscripts with over 100 co-authors (32). In these cases, it becomes meaningless to blame every co-author for a falsified study.

In the late 1990s, Dr. Wu Suk Hwang was a world-famous cloning researcher. He was the pride of South Korea, and a commemorative stamp was issued to celebrate his laboratory's achievements (Figure 1-4). Hwang's status drastically changed when fabrications were discovered in a number of the manuscripts produced by his laboratory. Dr. Hwang had a habit of placing respected scientists as co-authors on his papers (33). When the news broke, Hwang pointed his finger at several of his collaborators.



Figure

Figure 1-4. South Korean stamp celebrating Dr. Hwang's research, depicting the direct route from stem cell cloning to the cure of disease.

A remarkable aspect of Dr. Hwang's publications was his ability to deceive the coworkers in his own laboratory, and the co-authors located in laboratories around the world, for a very long time. Dr. Hwang used a technique known as compartmentalization; dividing his projects into tasks distributed to small groups of scientists who specialized in one step of the cloning process. By so doing, his coworkers never had access to the entire project. The final achievement of the research, new embryonic cells, was never examined by the majority of scientists involved in the project. (34), (33).

For several years, South Korean politicians defended Dr. Hwang, labeling his critics as unpatriotic. Over time, additional violations committed by Dr. Hwang were discovered. In 2009, Hwang was sentenced in Seoul, S. Korea, to a two-year suspended prison sentence for embezzlement and bioethical violations; but he was never found guilty of fabrication.

1.2 ELITE LIARS

"The best is the enemy of the good."

- Voltaire

Every night, throughout the world, parents go to sleep dreaming that one of their sons or daughters will get an education in Harvard, or MIT, or CalTech or Johns Hopkins. They know that when someone receives a degree from a top U.S. University, a bright future is guaranteed. Respect, wealth, and happiness always come to these lucky graduates.

If that were the case, why does it seem that the most contemptible acts are committed at the best universities? Here's an example. On January 23, 2009, the Office of Research Integrity made public their findings of scientific misconduct concerning a doctor who fabricated data for several grants projects funded by the NIH (35). The doctor was a former graduate student in the Department of Pathology, Harvard Medical School, a former research fellow and Instructor of Pathology, at Brigham and Women's Hospital in Boston, a former postdoctoral fellow in the Department of Biology, at the California Institute of Technology, and a former Associate Professor in the Department of Biology and the Center for Cancer Research at the Massachusetts Institute of Technology. He had worked on numerous NIH grants, and was found to have fabricated data supporting applications for five NIH grants.

It is difficult to imagine a person better prepared for a life of scientific integrity. From his pre-doctoral training, through his post-doctoral research and his academic appointment, he was nurtured in the finest environments, by some of the most respected scientists on the planet. Throughout this book, we will be shocked by the most respected universities and corporations (36), (29), (30), (37), (38), (39), (16), (40), (41), (42), (43). The reason is obvious: if you want prestige and money, you go to the places where the prestige and money are found.

1.3 WHEN YOU ARE CAUGHT

"Of all the thirty-six alternatives, running away is best."

- Chinese proverb

Most scientists who falsify data never get caught. If you are one of those few cheaters unlucky enough to be discovered, use one or more of the following tried-and-true methods to avoid punishment:

1. Deny that any offense was committed. You will be surprised that most dishonest or otherwise unethical behavior is permitted under the law. Furthermore, most institutions never bother to write regulations, policies, or even guidelines that cover the vast majority of the offenses covered in this book. The logic works like this: if it's not illegal, it must be legal, and if it's legal, it can't be wrong. Characterize your accusers as ineffectual whiners. Remind them that America is a free country, and that you will not allow them to abridge your freedoms.

2. If, in fact, you actually broke some law, deny that the statute has legitimacy. Argue that the law is unfair, archaic, ambiguous, and never enforced on your colleagues. Say that you are a victim in a ruthless plan to promote an unfair and unnecessary law that would never have been approved by a responsible legislature. Appeal to the public to overturn the law.

3. Deny knowledge of the law. They say that ignorance of the law is no excuse. Nonetheless, it is always worth a try. If the average person has never heard of the law, you can gain public sympathy.

4. Impugn the integrity of your accusers. Say that your accusers have themselves broken the same law, among many others.

5. Assert that you are the victim of a personal vendetta. If you can show that your accuser has a personal agenda, you can undermine his credibility, his moral superiority, and his authority. You can take advantage of the situation by transforming yourself into the victim.

6. Blame someone else. If you were smart, you have maneuvered someone else into committing the actual offense.

7. Share the blame. If there are fifteen co-authors on a falsified report, particularly if some of those co-authors are powerful authorities in the field, it is unlikely that punishment will fall on any one participant.

8. Get a lawyer. Lawyers are trained to help guilty people get off free. Sometimes it is best to let the professionals do their job.

9. Lie your head off. Lying often helps. It is best to confine yourself to a few carefully chosen lies that will hold up under scrutiny. Be careful not to include lies that contradict other lies. Once you've settled on a set of lies, stick to the script. The more you improvise or embellish, the less likely the lies will hold.

10. Use one of these general-purpose excuses:

a. "I did it for my kids." This works for almost everyone, even those with children from former marriages whose child support is in arrears.

b. "I did it for my family." Almost everyone has family: a mother, father, sibling, or cousin. Even if you are completely estranged from all of your relatives, you can use this excuse. Nobody will bother to check.

c. "I had to pay the mortgage." This excuse can summon a vision of the destitute scientist, with his wife and children, shivering, in the night, in a Chevy.

d. "I was under enormous pressure from my supervisor." This often-used excuse works if everyone believes the premise. Should anyone point out that your pressures were par for your profession, and that thousands of your peers manage to conduct themselves with integrity, the excuse evaporates. If everyone knows that your supervisor is a major head case, go for it.

e. "I was not myself." This completely irrational excuse is remarkably effective. It requires an external object (drugs, alcohol, drugs and alcohol, video games, twinkies) that transforms the person into someone with a different personality, for some convenient length of time. Dr. Jekyll cannot be held responsible for the actions of Mr. Hyde.

f. "I infiltrated the group of conspirators and was collecting evidence on them." Though this excuse is almost never credible, it is sometimes hard to disprove.

g. "I would have been destroyed if I did not cooperate." This excuse works best if you can demonstrate that other scientists, who did not cooperate, were actually destroyed.

h. "I'm no fool. I just played the game like everyone does." This excuse builds the guilty party into someone who is a realist (not an idealist), and who follows a set of rules imposed by harsh reality.

If all this fails, don't sweat it. In virtually all cases of simple data fabrication, the worst that might happen is that you will lose your job. It seems that nobody is ever asked to repay the federal government for the cost of a grant. Nobody goes to jail for writing bad manuscripts. Throughout this book, you'll see numerous examples of scientists, tainted by misconduct, who emerged from the ordeal to become powerful leaders in their fields. Don't be surprised. If we disposed of every blemished scientist, all scientific activities would come to a screeching halt.

1.4 ADVICE FOR EVIL SCIENTISTS

1. Truth is an over-rated commodity. If truth had any value, we'd get paid to be honest.

2. When you think about it, there are so many risk-free ways to be a successful evil scientist, data falsification is seldom worth the peril. Remember, being an evil scientist should not involve gambling with your own career. Being an evil scientist involves gambling with the careers of your competitors.

3. When you absolutely positively must falsify your data, there are a few common sense precautions that you should take. First and foremost, get someone else to do the dirty deed. Find someone who is insecure, lazy and dishonest. Never order anyone to cheat; let your subordinates figure it out for themselves. In the unlikely event that you are caught, immediately apologize for the unauthorized and regrettable actions of the guilty subordinate. The scientific community will forgive you, so long as your apology is sincere. Sincerity, like everything else, can be faked.

4. A job application is an advertisement for yourself. All advertising is rife with hyperbole. Anyone who reviews job applications should expect serious applicants to exaggerate their accomplishments. When applying for a job, do not hesitate to pad you CV with fictitious accomplishments.

5. Do not worry about institutions putting you on some kind of black-list, if they catch you falsifying your CV. Such black-lists do not exist. Most institutions are content to let some other institutions hire bad scientists. Moreover, some institutions have a very short memory for these kinds of things. After a change in department chairs, you can re-apply to the very same institution that caught you lying on your CV. You can even include the same falsifications. Just because they caught you once, doesn't mean they'll catch you a second time.





CHAPTER 2. IMPROVING THE TRUTH: THE ART OF SCIENTIFIC MISINTERPRETATION

After a crushing defeat at the hands of their arch-rivals, the local newspaper displayed the following banner headline, "Home team takes second place. Visitors finish next to last."

-Anonymous

You are the chief scientist for a major cigarette manufacturer. You have devoted your career to developing a safe cigarette. You knew, going into the project, that your task was impossible. But the pay was excellent, and your company offered an excellent retirement package. Although you might never produce a safe cigarette, you might one day produce a cigarette that is safer than other brands. Today, you are testifying for a Congressional committee investigating your employer. As chief scientist, you are asked some very blunt questions about the biological effects of cigarettes. A particularly self-righteous congressman asks you THE QUESTION: "Is cigarette smoking addictive?" You pause, for a moment, to think. You know that some people quit smoking permanently by going cold turkey, without suffering withdrawal symptoms. These people had no addiction; smoking was just a habit, for them. Thinking this way, you answer, without perjury, "No, smoking is not addictive."

All scientists demand the unadulterated truth; from other scientists. They tend to set a much lower bar for themselves. When truth interferes with fame, fortune, or vanity, the most focused scientists somehow draw on inner-strength, opening their minds to a rich variety of dependable, truth-independent alternatives.

Every observation can be misinterpreted, and no scientist has ever been found guilty of any criminal or ethical offense because his interpretation was incorrect. If you want to eliminate any chance of punishment, stick with falsifying your conclusions, not your data. Many a research career has been fueled by drawing stunning conclusions from the flimsiest of data. At worst, some of your competitors will say that your are a bad scientist. Counter by saying that your accusers are losers who are jealous of your hard-earned success.

Though many books have been written on data interpretation, no evil scientist has tackled the broader question: "What is the best way to misinterpret data?" Each new generation of scientists have been forced to master the subject of data misinterpretation anew, through trial and error. This chapter is designed to rectify this omission and to shed new light on a dark area of scientific gamesmanship.

2.1 ALL STATISTICAL STUDIES ARE OPEN TO MISINTERPRETATION

"There are three kinds of liars - liars, damn liars and statisticians."

-Attributed to Mark Twain and to Benjamin Disraeli

It is said that you can prove almost anything with statistics. This is not an exaggeration. Statistics, at best, summarize some aspect of the truth, leaving you to commit mayhem with other aspects of your data. Every statistician learns the parable of the mathematician who drowned in a lake of average depth two feet!

Consider the analysis of vaccination effectiveness. Brisson has shown, quite convincingly, that you can statistically demonstrate that vaccinations are effective in a population, or ineffective, without altering your data (44). It's done by modifying the model, choosing a different analytic question (e.g., examining cost-effectiveness or cost-benefit), and introducing a bit of uncertainty in the results. The results can be anything you desire.

Simpson's Paradox (published 1951) is named after the British mathematician Edward H. Simpson (45). Simpson provided an example wherein two sets of data, considered separately, supported a particular conclusion, whereas the two sets of data, combined, supported the opposite conclusion. Here is how Simpson's paradox operates. Let's say that a drug trial shows that drug A is effective in 10 out of 100 patients (10 per cent), and drug B is effective in 200 out of 1,000 patients. (20 per cent). We conclude that drug B is more effective than drug A. In a second trial, drug A is effective in 400 out of 1,000 patients (40 per cent), and drug B is effective in 60 out of 100 patients (60 per cent). Again, drug B proved more effective than drug A. When we combine the results of both trials, drug A is effective in 410 out of 1,100 (37 per cent), and drug B is effective in 260 out of 1,100 (24 per cent). The combined data indicates that drug A is more effective than drug B; the opposite result from either of the individual trials.

Statistics is the most malleable of the analytic sciences, and statisticians are highly adept at interpreting data to suit their own agendas. In a just world, when a man drowns in a lake of average depth two feet, that man will be a statistician.

2.2 INTRODUCING BIASES INTO YOUR STUDY

"A mathematician is a person who says that, when three people are supposed to be in a room but five came out, two have to go in so the room gets empty"

-Origin unknown

Every evil scientist must carry a bag of tricks. Statistical biases will be among your most trusted deceptions. For the sake of brevity, the biases are listed here. In-depth explanations are found in Chapter 16 (Clinical Trials on Trial).

Accrual bias, Apples-oranges bias, Cherry-picking bias, Co-morbidity bias, Confounder bias, Demographic bias, Diagnosis bias, Eligibility bias, Income bias, Lead-time bias, Marketing bias, Meaningless bias, Measurement bias, Medical record bias, Negative study bias, Population bias, Prayer-based bias, Re-abstraction bias, Record bias, Second trial bias, Stage bias, Stage treatment bias, Statistical method bias, Under-reporting bias, and Zipf bias.

How are these biases used in experimental studies? Lead-time survival bias serves as an example. Suppose there were a cancer, Y, that is uniformly deadly. Once it is diagnosed, the average survival, after the best available treatment, is three years. Nobody who has this cancer lives beyond five years.

Dr. Detecto is a pathologist who has invented a very sensitive method for detecting cancer Y at a very early stage. Dr. Detecto can detect cancer Y a full four years earlier than any previous method of detection. Unfortunately, there is no effective treatment for cancer Y, even when it is detected early. All patients with cancer Y will die. Because cancer Y patients are now detected four years earlier, the natural course of disease results in an expected death 7 years (3 years plus the 4 years lead time) later. When we study 5-year survival after diagnosis, we find that the five year survival is now 90%.

The newspaper headline reads, "New, improved detection technique for cancer Y improves 5-year survival from 0% to 90%."

Of course, detecting the cancer four years earlier only increased the time between diagnosis and death. It did not extend, by even a single minute, the age at death of patients with cancer Y.

Has Dr. Detecto made a useless discovery, and is the survival data fraudulent? No. Tumors are best treated when they are detected early. In the case of cancer Y, there was no immediate benefit for early detection. Nonetheless, the set of early cancers provides cancer researchers with a group of tumors that might have an improved response (compared to late-diagnosed cancers) to newly developed cancer therapies.

2.3 FALSIFICATION OF CONCLUSIONS

"If any question why we died, Tell them because our fathers lied."

-Two-line poem, by Rudyard Kipling, commemorating World War I

"if one reads the literature, one often discovers that a finding reported in the Results section studded with asterisks implicitly becomes in the Discussion section highly significant or very highly significant, important, big!"

-Jacob Cohen (46)

Everything in life can be improved, including the truth. The easiest way to improve the truth is to interpret your results to support the outcome you prefer. Nobody in the history of science has ever gotten into any serious trouble for misinterpreting their research results. In fact, misinterpretation is the most prevalent form of falsification in science. If your data is collected honestly, and you draw conclusions that are not strictly supported by your own data, the most likely results (in descending order of probability) are:

1. When your conclusions support the current popular paradigm of your field, they will be accepted for publication, even when your data does not support your conclusions. There was a time when blatant racism, the belief that some races were superior to other races, was accepted as established scientific fact. Racist papers sailed through peer review and were published in professional journals. Eugenics seemed like a quite reasonable method to improve the racial stock. Between 1921 and 1964, over 33,000 Americans deemed unfit for procreation, were sterilized against their will (47). Most scientists today recognize that these respected journal articles, written by respected scientists, and published in respected journals, were all nonsense; nonsense that conformed to a paradigm that was once popular.

2. After your paper is published, nobody will read your paper or care that your conclusions are nonsensical. Yes, the vast majority of journal articles will be totally ignored by your peers. The scientific literature serves as a vast cemetery, where dead ideas are buried.

3. The publication, though of no scientific merit, will establish your credentials in the field. Yes. Every publication adds two centimeters to your Curriculum Vitae.

4. Your conclusions will stir controversy among a small minority of the scientists in your field, who have nothing better to do than to discredit your feeble contribution. This might draw some small amount of attention to you, but in the long run, it will have no negative consequences.

The Discussion section of any manuscript is always the dumbest section, because it includes all of the subjective, prejudiced, dogmatic, self-serving, and unscientific thoughts that motivate the authors. You might be wondering why reviewers do not delete such comments. Reviewers never delete comments that support the general scientific paradigm held by the reviewer. Suppose that your are an astronomer who believes that bacteria grow on mars. You are charged with reviewing a paper indicating that meteorites contain microscopic shapes. The author of the paper indicates that the shapes might be bacterial fossils and that this indicates that bacteria may grow on planets, such as mars. What is the likelihood that you will insist that the author delete such remarks on the basis that they are purely speculative? More likely than not, you will accept the paper, and you will use the "findings" to promote your own scientific agenda.

In many cases, you will learn that no useful conclusions can be drawn from your work. Your data can neither establish or abolish a hypothesis. Basically, you have wasted time and money working on a project that has produced no meaningful results. Do not despair. Here are a few standby conclusions that you can apply to the flimsiest of findings, without any serious challenge:

1. "These findings indicate that it is feasible to...." Comment. Demonstrating feasibility is a low hurdle. Just about everything is feasible.

2. "These findings demonstrate the enormous potential of...." Comment. Every idea has potential. So what?

3. "One possible interpretation of these findings is...." Comment. You cannot go wrong by offering a possible explanation.

4. "These findings raise several important questions..." Comment. When your findings provide no answers, perhaps they raise some questions.

5. "These findings cannot be explained using the prevailing paradigm...." Comment. This technique will work if your reviewer is an opponent of the prevailing paradigm.

6. "Prior studies have overlooked these and similar observations...." Comment. Most poorly executed experiments produce results that have not been observed previously. Try to turn your ineptitude into a virtue by drawing the reviewer's attention to the mysterious quality of your data.

7. "Whereas further research is needed before this technique can be applied...." Comment. One of the most useful qualities of bad research is that it always requires further study.

If you are a journalist, assigned to report on research that has no real significance, try one or more of these encouraging mischaracterizations:

1. "Scientists are one step closer to finding a cure for..." Comment. You need not burden the reader with the total number of steps needed to find a cure.

2. "Scientists hope that future clinical trials will confirm...." Comment. Scientists are a hopeful bunch.

3. "If these preliminary findings are validated in clinical..." Comment. You need not point out that unvalidated preliminary findings have no value.

4. "Exciting new research promises that relief may be close at hand for millions of patients suffering from..." Comment. Relief may also be distant, but it helps to be optimistic.

5. "New hope for sufferers of ...." Comment. Nobody will ask what might have happened to the old hope.

2.4 MISREPRESENTING PROGRESS IN THE WAR AGAINST CANCER

"Adverse alike to ethical propriety and to medical logic, are the various popular delusions which, like so many epidemics, have, in successive ages, excited the imagination with extravagant expectations for a cure of all diseases and the prolongation of life beyond its customary limits, by means of a single substance. Although it is not in the power of physicians to prevent, or always to arrest, these delusions in their progress, yet it is incumbent on them, from their superior knowledge and better opportunities, as well as from their elevated vocation, steadily to refuse to extend to them the slightest countenance, still less support."

-The American Medical Association Code of Ethics of 1847

It is difficult to pick up a newspaper these days without reading an article proclaiming progress in the field of cancer research. Here is an example, taken from an article posted on the MedicineNet site (48). The lead-off text is: "Statistics (released in 1997) show that cancer patients are living longer and even "beating" the disease. Information released at an AMA sponsored conference for science writers, showed that the death rate from the dreaded disease has decreased by three percent in the last few years. In the 1940s only one patient in four survived on the average. By the 1960s, that figure was up to one in three, and now has reached 50% survival."

Optimism is not confined to the lay press. In 2003, then NCI Director Andrew von Eschenbach, announced that the NCI intended to "eliminate death and suffering" from cancer by 2015 (49). The book you are now reading was written in 2010. If you believe the Director of the National Cancer Institute, people will stop dying from cancer just five years from the publication date!

These optimistic reports on our progress against cancer are grossly misleading. There is ample historical data showing that the death rate from cancer has been rising throughout the twentieth century, and that the burden of new cancer cases will rise throughout the first half of the twenty-first century (50). If you confine your attention to the advanced common cancers (the cancers that cause the greatest number of deaths in humans), we find that the same common cancers that were responsible for the greatest numbers of deaths in 1950 are the same cancers killing us today, and at about the same rates (51), (52). Furthermore, the age-adjusted cancer death rate, the only valid measurement of progress against cancer, is about the same today as it was in 1950 (53). According the the U.S. National Center for Health Statistics, the age-adjusted cancer death rate in 1950 was 194 deaths per 100,000 population (54). In 2004, the death rate was the same, 194 per 100,000 population (54). There has been no net reduction in cancer deaths in more than 50 years, despite decades of effort!

In 1971, President Richard M. Nixon signed the National Cancer Act into law, marking the year that the United States launched its War on Cancer. For the next two decades, the U. S. cancer death rate rose steadily. Then in 1991, the U. S. cancer death rate began to decline, incrementally. It is tempting to conclude that 1991 marked the beginning of victory in our war against cancer, and that the steady, incremental declines in U. S. cancer death rates will continue in future decades, until cancer is fully eradicated. The decline in the cancer rate since 1991 is counter-balanced by the rise in the rate of cancer deaths between 1975 and 1991. What accounts for the rise in cancer deaths after 1975 and the restoration of the 1975 rates following 1991? There's no mystery here. The rise was due to smoking; the fall was due to smoking cessation (50). As we have already seen, the post-1991 drop in the U.S. cancer death rate has only served to bring us back to our 1950 cancer death rate.

You may conclude that cancer is a difficult problem, but at least the U.S. is working on the leading edge of cancer care. If cancer is a problem for us, it must be must worse for all the underdeveloped countries in the world. Nope. The U.S. has a high cancer death rate when compared to other countries (55). Kuwait, Panama, Ecuador, Mexico and Thailand have a much lower cancer death rate than the United States (Figure 2-1). American citizens intent on lowering their cancer death rate would be better off immigrating across the border, to Mexico, than waiting for the U.S. win its war against cancer.



Figure

Figure 2-1. The U.S. has a high cancer death rate compared to many other countries.

Despite the many billions of dollars spent on research and treatment for cancer, we have made negligible progress toward reducing the number of people who die each year from cancer. The reason that cancer organizations can announce major gains against cancer and can promise to eliminate cancer deaths by 2015 is due entirely to the magic of data misinterpretation!

To see how the deception works in the cancer field, you need to start with the definition of "survival." To a layperson, the term "survival" indicates avoidance of death. For example, the survivors of a plane crash are the people who did not die in the crash. To an oncologist, survival is the time interval between diagnosis and death. The difference between survival (to an a layperson) and survival (to an oncologist) is the difference between winning and losing the War on Cancer.

Suppose that oncologists announce that a new treatment of pancreatic cancer produces a 1% increase in survival. Layman will interpret this to mean that a person with pancreatic cancer will have a 1 in 100 chance of being cured of his cancer above and beyond his chances for cure with the older treatment. To most people with cancer, that 1 in 100 improvement, though small, is worth any price. Unfortunately, this is not the case at all. To the oncologists who made the announcement, a 1% increase in survival indicates that if the life expectancy following diagnosis of pancreatic cancer is 100 days, then the life expectancy following diagnosis with the new treatment is 101 days. In either case, virtually every patient with advanced pancreatic cancer will die. The patients receiving the new treatment may reasonably expect to live an average of one day longer.

You may be asking yourself about the validity of claims that we can now cure many childhood cancers that could not be cured in prior generations. This is absolutely true. Many children with cancer can now be cured. However, the overall incidence of childhood cancers has risen 36% since 1976 (56). This rise in childhood cancer incidence has erased about half of the overall benefits from the rising cure rates.

We've seen some real progress made in curing a few rare cancers, such as gastrointestinal stromal tumors (GISTs), chronic myelocytic leukemia, and Hodgkin Disease. Is it reasonable to hope that these advances will carry over into the treatment of the common cancers? Not really. Recent advances in cancer genetics point to an opposite conclusion. Research into the genetics of tumor cells has shown us that some cancers are characterized by simple genetic errors. It turns out that the tumors with simple genetic errors coincide with the rare tumors of childhood and certain rare tumors of adults. The small number of gene alterations in these rare tumors permits us to target chemotherapeutic agents against a single vulnerable metabolic pathway. The successes against childhood cancer and other rare cancers are due, in no small part, to the simplicity of the gene alterations that characterize rare tumors. However, the common cancers of adults are characterized by thousands of complex genetic and epigenetic alterations. The genetic complexity of common cancers would suggest that treatments that work against rare tumors will have limited effect on the common cancers. The lesson we learn from the genetic analysis of cancer is profoundly discouraging.

Cancer projections provided by the NCI's SEER program (the National Cancer Institute's Surveillance, Epidemiology, and End Results), indicate that between the years 2000 and 2050, the number of new cancer cases per year will more than double, from 1.3 million new cases in 2000 to 2.8 million new cases in 2050 (57). The projected yearly increase in cancer cases, if unchecked, will put additional strain on the wobbly American healthcare system.

After hundred of billions of dollars spent on cancer research and cancer treatment, with almost nothing to show for the effort, why do we believe claims that the dying will stop by 2015? Humans live in hope; we would rather believe a hopeful lie than a hopeless truth.

2.5 ADVICE TO EVIL SCIENTISTS

1. If you think about it, you'll realize that every paper is misinterpreted. Sometimes misinterpretations result from stupidity. More often, they result from efforts to bend the truth. Sometimes, misinterpretations occur because everyone as their own unique interpretation of reality. Whenever you misinterpret your data, be sure to provide a conclusion that people want to hear.

2. Daniel Moynihan once said, "People are entitled to their own opinions, but not their own facts." So long as you stick to opinions, and keep your distance from facts, you can get away with saying anything.

3. Misinterpretation is safe. Nobody has ever been prosecuted for misinterpreting data. If you are a serious evil scientist, searching for a risk-free escape from the unproductive efforts in your laboratory, the burgeoning field of data misinterpretation will be your salvation.

4. The person who interprets the data determines the outcome of the study. Never let others interpret your data. They will always misinterpret your data to suit their own agenda (just like you do).

5. There are no rules that specify what must be included in the results section of a scientific paper. That being the case, feel free to include only those findings that support your own agenda. Any data that might an opposing hypothesis can be omitted from your results section.

6. There are no rules that limit the number of experiments performed by a scientist. When your data does not support your preferred hypothesis, repeat your experiment over and over again, until the data is more to your liking. In the unlikely event that a co-worker, with access to your lab reports, notices the omitted experimental data, simply indicate that the earlier experiments (the ones with the non-supportive data) were not included because they were flawed.

7. In the Discussion section of your papers, you will be expected to compare and contrast your results with the results of other contributors to the field. You can selectively cite works that support your findings, while omitting any mention of opposing works. You can misrepresent the conclusions found in the works of others. You can bolster your discussion with citations that bear no relevance to your assertions. Nobody will check the citations against your statements.

8. Every field of science has jargon terms that mean something very specific to the people within the field. The same words will mean something very different to laypersons. To a layman, survival is an indication of cure. To an oncologist, survival indicates the interim between diagnosis and death. An evil scientist can play one meaning against another to manipulate the way data is interpreted.

9. Nobody will doubt your misinterpretation of the data, if you tell people what they want to hear.

10. Your job, as an evil scientist, is to make the world believe that your research is more important and more fundable than everyone else's research. Over 99% of research has no real value, and your research is certainly no exception. All of your creativity, effort, and cunning should be focused on promoting your own work; data misinterpretation will be one of your most useful tricks.





CHAPTER 3. THE EVIL WRITER

"I try to leave out the parts that people skip."

-Elmore Leonard

"A metaphor is like a simile"

-Anonymous

Here is a popular story passed down from generation to generation of scientists:

A renowned biologist dies and finds himself in a mist-enshrouded world, bathed in an ethereal, opalescent light. Next to him stands a tall, hooded figure garbed in a monk's robe. Further on, a young, beautiful blond woman, in a bikini, sits at a desktop covered with journal articles. The hooded figure nods in her direction and says, "Go see what this woman is doing." The dead scientist walks to the woman, who is deeply absorbed in her reading. He picks up one of the articles from the stack, and sees that it is a scientific journal that he had published, many years ago. With growing excitement, he thumbs through the other articles and sees that they are all his works. Turning to the hooded figure, he says, "Ah. I understand now. I'm in heaven, and my reward is to have a beautiful, adoring woman spending eternity reading the products of my earthly endeavors." The hooded figure responds with undisguised exasperation and contempt, "Fool. I have not shown you your heaven! I have shown you this woman's hell!".

Publication is a topic that cannot be avoided. If you are planning on an academic career, you must publish manuscripts in science journals.

Preparing a journal article is much like filing your income taxes. Lots of boilerplate, a list of hastily assembled numbers, a disappointing conclusion, and a choice of post office or electronic submission.

If you lack a creative spirit, and are worried that you will have trouble writing your paper, do not be alarmed. No creativity is involved. The stylistic restraints imposed on journal articles, by editors and reviewers, have removed all of the attributes you would normally associate with stimulating prose.

Every journal has an "Instructions for Authors," page, providing a manuscript template, and a list of commonly encountered features that the editor would prefer not to encounter. The template usually takes the following form:

Title - Always in the form of a specific topic, not as an assertion of your findings. It's best to keep them guessing.

Authors - If you're under 35 years old, take the first author spot. Otherwise, take the last author spot.

Abstract - Two-sentence condensation for the Background, Methods, Results, and Discussion section. This is the part of the paper that will pop up with a PubMed search, and is the only part of your manuscript that anyone is ever likely to read.

Background - This section is intended to contain the conceptual information that justifies your hypothesis, and an explanation of the experiment that will test your hypothesis. In actuality, the Background section is used to impress upon the readers that the topic you have chosen is important, and that anything written on the topic, no matter how trivial, deserves to be published.

Methods - This is the easiest part of the manuscript to write. It consists of references to a few standard papers that describe precise steps for complex techniques known to everyone in your field. Of course, you have modified the techniques to produce the results you desired, but nobody needs to know that.

Results - No doubt, while conducting your studies, you and your colleagues performed many experiments that failed to yield the correct results (i.e., the results that confirm your hypothesis). You can safely ignore this data, selecting only confirmatory data for the precious space allotted to Results. Within your confirmatory data, there will be some data points that do not "fit" with the other data points. This data can be omitted. Prepare a table that contains your favorite data points, overlaid with statistical ranges that appear to confirm your conclusions. Convert your table into a pie chart or some visually misleading graphic that distracts your readers from the actual data. In the textual portion of the Results section, interpret the pie chart to suit your own agenda.

Discussion - Use this section to explain how your now-proven hypothesis confirms the currently popular paradigms in your field. Be sure to cite prior works that complement your findings. Cite your own publications freely, even if they bear no relevance to your current paper. Never cite papers written by your competitors.

Summary or Conclusion - This is the section where the author includes exculpatory language, such as "Awaits clinical trials in humans," "Requires confirmation in an in vivo system," and the old stand-by, "Further study is needed."

Once the paper is prepared, in draft form, you can begin the humiliating process that leads up to submitting the final version to a journal. Send a copy of the first draft to each of your co-authors and ask them for constructive feed-back. Only one of the co-authors will provide a quick turn-around with helpful suggestions. The others really do not care about you or your paper, and will not reply. Wait two weeks, make a few of the changes suggested by the single respondent, and send the second draft to all of the co-authors, with a cover letter thanking them for their input on the first draft. Repeat the process one more time. Send all of the co-authors a copy of the final draft, indicating that you have incorporated all of the changes requested by all of the co-authors. Remember to thank them for their guidance and indicate that working with them was a privilege and an honor.

You are now ready to send three copies of the final manuscript to the editor.

Here are a few tips for enhancing the likelihood that your paper will be accepted for publication:

1. Be sure to include an ingratiating cover letter with your manuscript. Indicate that the topic of the paper has great importance to the readers of the journal.

2. Use the Background section of your manuscript to sell the paper to the reviewers. If you are publishing in the cancer field, be sure to include the number of people who die each year from cancer. Readers will subconsciously transfer the general topic (e.g., cancer research, saving lives) to your manuscript. This trick works well, even when your study has no merit and adds nothing to the sum of knowledge on the topic.

3. From time to time, you'll choose a field of study that has been thoroughly plowed by your betters. If your results agree with the results of prior studies, then you must pose your paper as a validating study. If your results disagree with prior studies, then you must promote your paper as a controversial re-examination of an important research question. If the prior work was done in the remote past, then you must promote your work as a historical investigation, that brings new techniques to bear on an topic of enduring interest. If the only justifiable reason for your paper is that it answers a previously unsolved problem, then it's best to simply ignore the preceding manuscripts. Odds are, nobody will notice that it was all done before.

4. In every field, there are some journals that have a backlog of accepted papers waiting their turn to be included in a forthcoming issue. Never submit your papers to these journals; the editors are looking for an excuse to reject papers and reduce their backlog. Submit your paper to a journal that can barely assemble a sufficient number of papers to justify the next issue. Editors of these journals are desperate and will accept almost any submitted paper. A sure sign of desperation is the "Call for Papers," often sent by editors who are beating the bushes for fresh material. Never hesitate to answer the "Call." On a lark, Philip Davis and Kent Anderson sent a patently ridiculous paper, from a fictitious institution (Center for Research in Applied Phrenology, or CRAP), under pseudonyms, to a journal that had solicited papers. The paper was accepted (58). After the hoax was publicized, the journal's editor resigned (59).

5. Be certain to include a co-author who is respected by the readers of the journal or by the editor of the journal. Scientists, just like non-scientists, will believe anything, if it comes from a trusted authority.

6. Include a statistician as a co-author. Most editors and reviewers are unfamiliar with statistical methods. Adding a statistician to the author list adds a comforting layer of credibility to your dubious results.

7. Include elegant graphics. For editors and reviewers, style beats substance.

8. When writing your conclusions, interpret your results in such a way that they support the journal's agenda. For example, if you have a manuscript on the topic of capital punishment, and you are submitting the paper to an ethics journal that has published numerous research articles and editorials on the evil of the death sentence, you should interpret your data to suggest that capital punishment is without societal value, or (better yet) detrimental to law enforcement efforts.

9. If your paper is rejected, re-submit your rejected paper to another journal. Eventually, you will find an editor who will publish your paper (58), (59).

10. When it seems as though no journal will ever publish your paper, just put the paper aside for a time. Eventually, an editor will invite you to submit a paper on a topic related to the rejected manuscript. Invited papers are often reviewed in-house (by the editor or by a colleague of the editor) and the reviews, no matter how negative, are never taken as a serious impediment to publication. In many cases, invited papers are not reviewed at all. Use the invitation as an opportunity to publish your otherwise unpublishable manuscripts.

Let's jump ahead. You've just gotten your first paper accepted for publication. Your evil work has finally come to a successful close. Or has it? Once your paper has been accepted for publication, it enters publication limbo. Some journals are severely backlogged, having accepted many more papers than can fit into their print issues. In this case, a paper can wait for more than a year before the print version appears. This backlog problem is alleviated somewhat when journals publish an electronic version of the article that appears prior to the release of the print version. However, there is a limit to number of months that an e-publication can precede the print version. The problem remains that after acceptance, a journal article can languish for a very long time before its official publication date. During this time, a number of unfortunate events may occur that crush the hopes and careers of the hapless authors.

1. The editor may decide not to publish your paper (60). Yes, acceptances can be revoked. This can happen when the editor who accepted your paper vacates his position, and a new editor arrives who wants to move the journal into a new direction. Specifically, the new editor may specifically want to exclude papers such as yours.

2. The publisher may discontinue the journal. Yes, journals that are unprofitable can die. Backlogged, unpublished papers will fall into a dismal void.

3. The editor may be forbidden to publish your paper, by the marketing department. This can happen when your paper criticizes a journal advertiser (61).

4. The editor may stop or delay publication of your paper if he likes your competitor more than he likes you. If others in your field become aware of the imminent publication of your paper, they might prevail upon the editor to delay publication until their own paper has been published in the same journal or in another journal. The first publication of a scientific finding confers discoverer status on its author. By delaying publication, editors can determine who gets the credit for a scientific breakthrough. The competitors who are in the best position to learn about your pending publication are your reviewers, who are almost always working in your field, and the editor himself, who often conducts research in one or more of the areas covered by the journal. Reviewers have been known to plagiarize findings taken from the works they review (62). It is quite possible for your reviewer to duplicate your work, write a manuscript, and have the manuscript accepted and published before your manuscript appears in print.

You might be wondering how editors get away with treating authors so badly. The reason is simple. Journals, like all businesses, exist for the purpose of attaining wealth and perpetuating their own existence. Journals attain wealth by attracting subscribers, and all journals are focused on increasing the number of paid subscribers. Authors are pathetic people who beg editors to publish their papers, and who foolishly sign away the copyright for their work, without asking for any compensation. Authors are so stupid that they will often pay thousands of dollars to publishers to have their papers published. Is it any wonder that authors are treated with contempt by editors?

To add insult to injury, remember that most published papers are totally ignored; never cited, never read, by anyone. One of the most effective ways of burying a scientific discovery is to publish it in a scientific journal.

3.1 CO-AUTHORS

"I love being a writer. What I can't stand is the paperwork."

-Peter De Vries

One of the more delicate tasks in journal writing involves the selection of co-author. Once selected, you will need to assign the order of appearance of their names, under the title banner. If you complete these tasks correctly, you will gain new allies, and you will be virtually assured that your paper will be accepted for publication. Choosing the wrong co-authors, or placing their names in the wrong order, may ruin your career.

It is customary for authors to include a collection of co-authors who are barely aware of the project. The compulsory co-author list includes the principle investigator of the grant whose funds were used in your research, and any high-ranking professionals who provided any assistance toward the final product, no matter how small. If you are part of a team whose members are have not directly helped you with your work, be sure to list all of these people as co-authors. Otherwise, they will omit listing you as a co-author on their papers. If you had helpful conversations, or email exchanges with influential scientists, add them to the list of co-authors. Influential co-authors increase the likelihood that your manuscript will be accepted. If there are any fellow scientists who have included your name on a paper, undeservedly, be sure to return the favor. With luck, you can build of network of allies who list each other on papers, for no justifiable reason. Your love interests or spouses can be co-authors as well.

By this point, you must be asking yourself whether adding bogus co-authors to your manuscripts will have negative consequences. Don't worry; this never happens. Though editors love to write strict guidelines for the inclusion of co-authors on manuscripts, they basically don't care what you do. Here is an example of a universally ignored instruction from the International Committee of Medical Journal Editors: "Acquisition of funding, the collection of data, or general supervision of the research group, by themselves, do not justify authorship (63)." If you check against published papers in the biomedical field, you will find that just about every paper includes co-authors whose only contributions were data collection, supervision, or funding acquisitions.

Few if any scientists follow authorship guidelines. In a study by Flanagin and coworkers, 1 in 4 articles assigned authorship inappropriately (64). Their findings were similar to those of Shapiro and co-workers, who found that 26% (268/1014) of co-authors listed in research papers fail to merit authorship (65). These analyses are grossly underestimate the prevalence of non-meritorious co-authors. Basically, there is no way to identify every non-performing co-author.

Nobody really cares if the co-author list includes bogus names. Editors don't want to get involved in fruitless investigations to identify deadbeat co-authors. Who would benefit from the effort?

The flip side of the co-authorship issue involves choosing the names of valid co-authors who you must exclude from attribution in your manuscript. Sometimes, you will find it necessary to drop from the author list a colleague whose efforts were instrumental to the completion of your project. This happens when the head of your laboratory, or someone of even higher influence, indicates that he does not want particular names to appear on the final manuscript. He may be holding a grudge against the person in question, but more often, he simply doesn't want the person to take a job at another laboratory. If this person were included as a co-author, it might help him find an alternative position in another laboratory. Can scientists be this petty? Of course they can. When a good technician or scientist leaves a laboratory, they take their expertise with them. In many cases, an important technique will be lost, or a secret technique will be acquired by a competing laboratory. When you drop a co-author from a publication, you will need a false but credible reason. Here are a few options:

1. Assign responsibility to un-named conspirators. Tell the excluded co-author that you wanted to include him, but there was pressure to keep him off the paper.

2. Tell the excluded co-author that the editor insisted that the author list was too long and had to be reduced.

3. Tell the excluded co-author that the omission was an oversight, and that he will be included on the next paper.

4. Tell the excluded co-author that he has so many publications in quality journals, you didn't think he would want to be included on this paper.

5. Tell the excluded co-author that he had not indicated that he wanted to be included on the author list.

6. Don't tell the excluded co-author anything. It may take several years before the paper appears in print. By that time, the matter may be forgotten.

After you've selected the co-authors on your paper, how do you determine the order in which their names appear? Many different ways have been suggested. Perhaps the most common is to list the person who wrote the paper as first author; the head of the laboratory as last author, and every other co-author is listed by the relative sizes of their contribution, in descending order. Some groups list the co-authors in strict alphabetic order. In this case, it might be worthwhile to change your name, early in your career, to Dr. Aaaaa. Authors and tenure committees all agree that the order of authorship is meaningless (65), (66). Editors provide no real guidance in the matter. The International Committee of Medical Journal Editors passes the problem back to the authors: "The order of authorship on the byline should be a joint decision of the coauthors (67), (68)."

In these days of collaborative science projects, it is not unusual to find papers with over 100 listed co-authors. When scientists create their Curriculum Vitae, they routinely list every paper on which they appeared as a co-author, regardless of the number of co-authors listed on the paper. A person who is one of 100 co-authors on each of ten published papers, will have the same number of publications to his credit as the person who wrote 10 single-author papers. Does this make any sense? Does each construction worker who helped build the Golden Gate Bridge take full credit for building the bridge? No. If there are 100 co-authors on a paper, each co-author should claim credit for writing 1/100th of a paper.

Many scientists spend their entire careers without every writing a single full-length, peer reviewed, original research manuscript. They are content being one co-author among many. They take some comfort in knowing that search committees and tenure committees have never devised a satisfactory method of determining who, among a list of co-authors, played a key role in the development of a scientific advancement.

3.2 FIRST CREDIT

Stigler's law of eponymy, "No scientific discovery is named after its original discoverer."

-SM Stigler (69)

"If you want to make an apple pie from scratch, you must first create the universe."

-Carl Sagan

According to Stigler, credit always goes to the wrong person, and this is the essence of Stigler's law of eponymy (which, according to Stigler, must have been invented by someone other than Stigler). Stigler provides numerous examples of credit going to the wrong scientist (69). "Laplace employed Fourier Transforms in print before Fourier published on the topic, that Lagrange presented Laplace Transforms before Laplace began his scientific career, that Poisson published the Cauchy distribution in 1824, twenty-nine years before Cauchy touched on it in an incidental manner, and that Bienayme stated and proved the Chebychev Inequality a decade before and in greater generality than Chebychev's first work on the topic."

Yes, misleading eponymous terms are commonplace in medicine. Marcello Malpighi (1628 - 1694) was an Italian physician who was one of the earliest scientists to use the microscope to describe tissues and their diseases (Figure 3-1).



Figure

Figure 3-1. Marcello Malpighi. Source: Garrison FH. History of medicine. WB Saunders, Philadelphia, 1921.

Malpighi was the first to describe lymphoadenoma, the lymphoma known today as Hodgkin's disease. More than a century later, Thomas Hodgkin (1798 - 1866) wrote a manuscript and credited Malpighi with the first description of the disease. Nonetheless, the eponym for the lymphoma went to Hodgkin (Figure 3-2).



Figure

Figure 3-2. Thomas Hodgkin. Source: Garrison FH. History of medicine. WB Saunders, Philadelphia, 1921.

Likewise, the Wheatstone bridge, introduced in 1843, was not invented by Charles Wheatstone (1802 - 1875). Wheatstone, working from the prototype, improved and popularized the device. The eponym was bestowed on Wheatstone, despite his protestations. The original bridge was invented by Samuel Hunter Christie (1784 - 1865), in 1833.

Simpson's Paradox was named, in 1972, for Edward H. Simpson's work published in 1951 (45). Karl Pearson and colleagues, in 1899, made the same observation as Simpson, 52 years earlier (Figure 3-3).



Figure

Figure 3-3. Karl Pearson, the statistician who discovered Simpson's Paradox. Source: Wikipedia, public domain.

Karl Pearson, incidentally, was author of The Grammar of Science, first published in 1892, with an expanded second edition in 1900 (Figure 3-4) (70). Pearson's book described relativity, speculating that an observer moving at the speed of light would see an eternal now. The Grammar of Science was studied by Albert Einstein, whose annus mirabilis occurred in 1905.



Figure

Figure 3-4. Cover of the second edition of Pearson's The Grammar of Science, Adam and Black, London, 1900.

Antonie Philips van Leeuwenhoek (1632 - 1723) is sometimes credited with inventing the modern microscope (Figure 3-5). Not so. Leeuwenhoek improved the microscope with his superb lens grinding technique, but he did not invent the microscope and did not make any particularly important modifications to the design of the microscope.



Figure

Figure 3-5. Antonie Philips van Leeuwenhoek. Source: Garrison FH. History of medicine. WB Saunders, Philadelphia, 1921.

In 1595, fifteen year old fledgling Dutch lens grinder and part-time counterfeiter, Zacharias Jansen (1580 - 1638) placed two lenses in a tube, and created the first compound microscope (Figure 3-6).



Figure

Figure 3-6. Zacharias Jansen. Source: Garrison FH. History of medicine. WB Saunders, Philadelphia, 1921.

This amazing invention sat dormant until 1667, when Robert Hooke (1635 - 1703) studied insects and plant material with this 72-year-old invention. Hooke used the word "cell" to describe the complex, living structures that compose every organism. In 1675, with improved lenses, Leeuwenhoek studied micro-organisms in water and cells of the human body. Hooke and Leeuwenhoek kick-started modern microscopy, but Zacharias Jansen invented the microscope.

Smallpox was the first disease for which vaccination was successful. As early as 200 B.C.E. in China and 1000 B.C.E. in India, physicians knew that infection with smallpox conferred immunity against subsequent infection. Based on this observation, they were the first to develop a vaccination, administered nasally, of attenuated virus. Arabic doctors developed their own treatment, consisting of transferring material from an infected pox blister to another person via a small cut. Emmanuel Timoni (1670 - 1718) was a physician practicing in Constantinople. He introduced the Arabic vaccination process to the West, in 1717. In 1796, Edward Jenner (1749 - 1823) developed a new vaccine, from a bovine pox virus (vaccinia) that seemed to confer cross-immunity against smallpox (variola) (Figure 3-7). When you consider that the word, "vaccine", derives from Jenner's choice of inoculum (vaccinia), it seems reasonable to give Jenner the credit for developing the first effective vaccine. Incidentally, Jenner's paper describing his smallpox vaccine, was rejected, in 1796, by a peer-reviewed journal (71).



Figure

Figure 3-7. Edward Jenner. Source: Garrison FH. History of medicine. WB Saunders, Philadelphia, 1921.

If you want to give credit to the first person to save European lives by immunizing against smallpox, you would need to go 80 years earlier than Jenner; to Timoni. To be really fair, you would need to go back many centuries, to the Chinese, Indian and Arabic physicians to find the origin of human immune treatments.

Carl Wilhelm Scheele (1742 - 1786) lived a scant 46 years, but he found time to make several of the most important discoveries in the field of chemistry. Unfortunately, through a series of bad breaks, he lost first credit for every one of them (Figure 3-8). Scheele discovered Oxygen a full two years before Priestley, but Scheele sent his manuscript to a publisher who held the work for several years, during which time Priestley got his discovery into print. Today, Joseph Priestley (1733 - 1804) is widely held to be the discoverer of Oxygen. In 1774, Scheele laid the groundwork for the discovery of Manganese, but Johan Gottlieb Gahn (1745 - 1818) finished the task and received the credit. Also in 1774, Scheele isolated chlorine. Unfortunately, he failed to identify chlorine as an element, the credit for which eventually went to Humphry Davy (1778 - 1829).



Figure

Figure 3-8. Carl Wilhelm Scheele. Source: Wikipedia.

Johann Franz Encke (1791 - 1865) is given credit for the discovery of [Encke's] comet (1818), but Encke merely calculated the orbit, using a technique first developed more than a century earlier by Edmond Halley (1656 - 1742). In 1705, Halley applied Newton's laws of physics to correctly predict that a particular comet (known today as Halley's comet), observed in 1531, 1607, and 1682, would return in 1758. The comet known today as Encke's comet was named after a person who neither first-sighted the comet nor discovered the methodology to predict the comet's orbit (Figure 3-9). The person who made the first sight of the comet has descended into scientific obscurity.



Figure

Figure 3-9. Johann Franz Encke. Source: Wikipedia.

It often happens that a new discovery is made by multiple independent researchers, simultaneously. For example, sunspots were discovered by Thomas Harriot (England, 1610), Johannes and David Fabricius (Frisia, now parts of The Netherlands and Germany, 1611), Galileo Galilei (Italy, 1612), and Christoph Scheiner (Germany, 1612).

In the 1830s, Janos Bolyai (1802 - 1860), Johann Carl Friedrich Gauss (1777 - 1855) and Nikolai Ivanovich Lobachevsky (1792 - 1856) independently developed the field of non-Euclidean geometry, a quickly obscurated achievement. It was not until the late 1860s, after all three had died, that other mathematicians paid the slightest attention.

Louis-Paul Cailletet (1832 - 1913) and Raoul-Pierre Pictet (1846 -1929) independently manufactured liguid oxygen, the same year (1877).

Alfred Russel Wallace (1823 - 1913) and Charles Darwin (1809 - 1882) independently developed an equivalent theory of evolution, in the years preceding the 1858 publication of Darwin's Origin of the Species.

Sometimes synchronous discoveries can be calibrated against the lives of the inventors. Charles M. Hall (United States) and Paul Louis-Toussaint Heroult (France) were born the same year, in 1863. In 1886, when each man was only 23 years old, they independently made one of the most innovative and important advances in industry: the extraction of aluminum from bauxite. The process involved heating alumina (from bauxite) with cryolite, and passing an electric current through the molten product. Aluminum emerges. Aluminum is one of the most abundant metals in the earth's crust, but pure aluminum was virtually impossible to obtain, in any useful quantity, until Hall and Heroult arrived on the scene. They led lives separate but parallel. Both men died the same year, 1914, at the young age of 51.

Elisha Gray (1835 - 1901) and Alexander Graham Bell (1847 - 1922) both invented the telephone at the same time, and both filed their inventions in the U.S. patent office, on the very same day (February 14, 1876). As the story is told, Gray's patent was filed a few hours before Bell's, but Gray's sat at the bottom of the "in box" while Bell's was processed promptly. Bell took first credit.

Sometimes, credit falls on the person who least understands the significance of his own work. In 1771, Charles Messier (1730 - 1817) , selected 103 heavenly objects that have captured the rapt attention of astronomers for nearly two and a half centuries (Figure 3-10). Messier selected regions of space that were nebulous, thus obscuring his view of comets (his sole interest). He made a point of categorizing the Messier objects as areas of space that should be avoided by serious cometologists. In 1771, his chosen spots might have been accurately called the Messier non-objects.



Figure

Figure 3-10. Charles Messier. Source: Wikipedia.

Today, the Messier objects are credited with holding some of the most fascinating galaxies and cosmologic curiosities in the known universe (Figure 3-11). Though Messier was completely wrong, he achieved scientific immortality, just the same.



Figure

Figure 3-11. Messier object 51. Source: Wikipedia, public domain NASA image.

The first observation of a particular type of anemia associated with sickled red blood cells, was made by Ernest E. Irons (72). Dr. Irons was a young intern when he encountered a patient, Walter Clement Noel, and made his historic observation. He alerted his attending physician, James B. Herrick. Irons sketched the shape of the cells directly into the patient's hospital record. Herrick wrote the 1910 case report as a single author submission, excluding Irons (73). To this day, the disease sickle cell anemia carries the eponym, Herrick's disease (not Irons disease).

Sometimes first credit goes to the wrong species. Acetylsalicylic acid has been used as a medicinal by several different ancient cultures. In the western tradition, Hippocrates (5th century BC) claimed that a bitter powder extracted from willow bark could ease aches and pains. How did the ancients know that willow bark would relieve pain? Bears were observed rubbing against the bark of willow trees when wounded. Humans stole credit for an ursine discovery.

In the future, first credit may go to a non-living entity. Adam, a robot gainfully employed at Aberystwyth University, has made an independent discovery in the field of Saccharomyces cerevisiae genetics (74). We can expect much from our robot colleagues in their future endeavors.

3.3 EVIL BOOKS

"The person who does not read has no advantage over the person who cannot read."

-Mark Twain (Figure 3-12)



Figure

Figure 3-12. Mark Twain's library, in the Twain House, 351 Farmington Avenue, Hartford, Hartford County, CT. Photograph by Jack. E. Boucher, for the U.S. National Park Service.

You are a third year undergraduate biology major. You have just registered for Course 305, Molecular Biology Lab, required for all molecular biology majors. The coursebook is a 435 page book of protocols, with laboratory exercises at the end of each chapter. The book is in its sixteenth edition. A new edition comes out every year. All students must buy the latest edition of the book (the protocols are the same, but the exercises are somewhat different in the newest edition). The book costs $224.95, retail. It is impossible to buy a used copy of the book, because the required new edition was released the month before course registration. When the course it finished, you will not be able to re-sell your book, because the next group of students will be required to buy the forthcoming seventeenth edition. The author of the book is the course instructor and the head of the biology department. The book is used exclusively in your university. Biology departments across the world use a different book, sold at half the price of your book. You've had a chance to read the competing book, used by students in the other area colleges. It is a much better book than yours, with full explanations of the protocols, covering a greater range of techniques. You resign yourself to buying the instructor's book, rationalizing that it is an honor to be taught by the book's author.

Great science books are written for an intelligent audience of professional scientists; virtually guaranteeing financial disaster for the author. Do the math. The difficult disciplines of science are sparsely populated, with just a few hundred serious scholars in their ranks. This means that the publisher will only print a small number of copies of your book (maybe 600). Science books produced in low quantity invariably have big price tags. Most of your colleagues will not be able to afford the book. Sales will go primarily to university libraries. You'll be fortunate if 400 copies are sold. As author, your royalties may come to $20 dollars per book, bringing in a total of $8,000 income spread out over the three or four years for which your book is "in print." Figuring that you spent about 2,000 hours writing your opus, this comes to a salary equivalent of $4 per hour. The monetary reward does not justify the effort.

The solution, of course, is to write a not-so-great science book, and gear it to your students. Students are people who read what they are told to read, when they are told to read it. The only way to make money writing a science textbook is to make the book a course requirement.

Once a book has become a course requirement, you can milk the same book throughout your entire career by writing new editions that appear annually. It won't take much work. Most new and revised book editions are much like the old and un-revised editions. The key difference is the price of the book; it goes up with each minor version change. When the professor requires students to buy the newest edition of a book, he guarantees himself a stream of royalties to supplement his more-than-adequate staff salary.

3.4 ALTERING THE PAST

"It is an amazement, how the voice of a person long dead can speak to you off a page as a living presence."

-Garrison Keillor, essay in Washington Post Book World Dec 2, 2007

Sometimes publication is less a matter of making a new contribution to your field, and more a matter of altering the written past. There are moments in every scientist's professional life when he wishes he could travel back in time and retract, modify, or add text to the scientific record. Impossible, you say? Not for evil scientists. A surprisingly large portion of the scientific record is neither verified, authenticated, or time-stamped. This means that you can change the past, to produce a better future for yourself.

If you want to tamper with documents, you must understand three concepts: verification, authentication, and time-stamping. Verification means that the contents of a document have been verified to be true, according to a person who takes responsibility for the document. This usually means that somebody signs the document, indicating that it was read and the contents were approved by the signator. Authentication means that the document you're reading is really the document you intended to read, and not some other document that somebody else might want you to read. Time-stamping ensures that the document was created at a certain specified date and time.

When documents are not verified, authenticated or time-stamped, you can create bogus documents, changing the name of the author or the date on a pre-existing document. In the world of medical charting, doctors have been covering their errors, for hundreds of years, by deleting, modifying or inserting notes into the old patient record. A month-old doctor's order for a toxic dose of pain-killer can be changed into a less murderous dose, by moving the position of a decimal point.

Retro-noting is a time-tolerant tradition. A doctor who hasn't seen his hospitalized patient in a month can make a short visit to the ward, pull the patient's medical chart, and insert short notes, for each day that the patient was in the ward, indicating something such as, "Patient visited 8:20 a.m., no change in status, vital signs stable, continue current treatment plan." Retro-noting permits lazy physicians to comply with standards of timeliness, and to bill for "visit" fees.

Has the computerized medical record eliminated retro-noting and other efforts to alter the contents of personal records? Not really. It is not easy to build reliable computerized systems that guarantee verification, authentication, and time-stamping for complex transactions. The rare, well-designed hospital information system is often thwarted by the limitations of computer-human interactions. For example, it is difficult to force a doctor to complete a discharge summary on the same date that the patient is actually discharged. Consequently, hospital information systems may allow physicians to assign dates that are different from the true transaction times. Furthermore, doctors may delegate verification tasks to their assistants. When the system allows staff to alter verification, authentication and time-stamping protocols, the electronic medical record quickly becomes a work of fiction.

If you decide to manipulate the past, you may as well do it with a minimum of effort. With a computer, it is possible to paste a favorite block of text, or a template requiring minor customization, into many different records. In one study, instances of careless insertions into electronic medical records occurred in one in ten charts (75).

3.5 PLAGIARISM

"Imitation is the sincerest form of plagiarism."

-Oscar Levant (1906 - 1972), (Figure 3-13).



Figure

Figure 3-13. Oscar Levant, from Rhapsody in Blue trailer. Source: Wikipedia, public domain.

If you want author credit on scientific publications, but you want to avoid all the paperwork involved in writing, then plagiarism might be just the ticket. Plagiarism involves taking credit, through a literary device, for another person's intellectual contribution. Plagiarism is often confused with intellectual piracy. When you take an idea, developed in a book that someone else published, and you include it in your book, as though it were your original idea, without citing the published source of the idea, that would be plagiarism. Publication piracy is the copy-theft of a literary work. If your take someone else's book, re-print it, sell copies of the re-printed work, and keep the proceeds; that would be piracy. Perhaps the easiest way to distinguish these activities is: the plagiarist steals your name, while the pirate steals your money. As books go, scientific works have negligible value, and are seldom pirated. The ideas contained in published scientific works are the prized possessions of academic scientists, and good ideas are routinely plagiarized.

Any society can reach a point where the most corrupt activities are considered standard operating procedure. In 18th century European academia, casual plagiarism was routinely tolerated. In 1731, Carl Linnaeus (1707 - 1778) wrote the doctoral dissertation for Johan Olaf Rudbeck, for which Linnaeus was paid a customary fee (76) (Figure 3-14). Twenty-first century plagiarism is less blatant, but equally common.



Figure

Figure 3-14. Carl Linnaeus, posing in "Laplander" garb, to emphasize his credentials as an explorer/naturalist. It has been remarked that no Lapp would have been caught dead in the ridiculous costume that Linnaeus assembled for his portrait (76). Source: Wikipedia, public domain.

Everyone wants to know how powerful people achieved their success. When you study the lives of the most powerful people throughout history, you find that most were ruthless villains who seized power, often by brutal force, and who held onto power by murdering their challengers. No mystery there. Nonetheless, people remain eternally curious, and are eager to learn the particulars. The CEO of Raytheon, William H. Swanson, published a short, popular book, humbly titled, "Swanson's Unwritten Rules of Management." It turns out that Swanson's 2004 book is composed in large part of rules written over a half-century earlier, by W.J. King (77), (78). King's book was entitled, "The Unwritten Laws of Engineering." Here's just one of many examples of the remarkable similarity between the two books. Rule 21 (Swanson's book) states, "Don't get excited in engineering emergencies: Keep your feet on the ground." King's 1944 book states, "Do not get excited in engineering emergencies - keep your feet on the ground."

Mr. King's earlier book is not cited in Mr. Swanson's later work. According to the Boston Globe, Mr. Swanson, author of Swanson's Unwritten Rules of Management, said, "You should understand I'm not a writer. It's not my profession, and I don't know how to do it" (78). We have a situation where a person writes a book, on the rules of business management, assigns exclusive attribution of the book's contents to himself (in the title of the book), and later claims that he did not understand the rules.

It turns out that not all of the content in Mr. Swanson's book was taken from Mr. King's earlier work. Four of his rules came from an article written by Donald Rumsfeld, and one of the rules came from a book written by Dan Barry (79). Was Mr. Swanson guilty of plagiarism? We do not really know. He was never charged with plagiarism in a court of law. Mr. Swanson's employer, The Raytheon Corporation, applied Solomonic wisdom and ended the controversy by reducing Mr. Swanson's executive compensation (i.e., recycling some of Mr. Swanson's money by returning it to themselves) (79).

Plagiarists tend to be cavalier, greedily snatching text and ideas without fear of the consequences. For example, the Office of Research integrity found that an instructor at Harvard Medical School and the Massachusetts General Hospital, "engaged in 15 acts of scientific misconduct by plagiarizing and falsifying research data taken from another scientist's different experiment in a published journal article for use in a program project grant application submitted to, and funded by, the National Institutes of Health (NIH)" (80). At one point, the investigator's application was temporarily halted by a grants official. No problem. The Office of Research Integrity explains that he "forged the signature of the institutional official for the MGH Grants and Contracts Office" (80).

3.6 PLAGIARISM IN A COMPUTER WORLD

"Computers are like Old Testament gods; lots of rules and no mercy."

-Joseph Campbell

The computer is a fascinating tool for plagiarism. It's easy to copy text from existing articles and paste it into your own. It's just as easy to detect plagiarism, if you care to do a little research. Just read the text, and wherever you read an idea conveying more intelligence than you would credit to the author, paste the text into a Google search. If the text was lifted from any other published work, Google will find it. Many acts of scientific plagiarism are discovered through Google searches, launched by a suspicious colleagues.

If you're serious about detecting plagiarism, you might want to pursue your suspects with software designed for the task. In the early 1980s and 1990s, two NIH scientists, Walter Stewart and Ned Feder, invented a so-called "plagiarism machine (81)." Their software compared large volumes of literature against a chosen document. One of their targets was an historian who had written, in 1977, a book purported to contain numerous passages from another book, written in 1952. The accused plagiarist posed a thoughtful question: Why, he wondered, were NIH scientists investigating a somewhat dated, non-scientific work, that had been written without the benefit of government funding? Shouldn't NIH investigators be occupying their time with projects related to medical science? To the leadership at NIH, it seemed a compelling question. Stewart and Feder were told to stop annoying people.

A period of indignant acrimony followed, wherein Stewart and Feder asserted their academic rights. The NIH leadership countered that the researchers, both civil servants paid by taxpayers, were obliged to work on projects relevant to the NIH mission (i.e., conquering disease through research). Stewart and Feder were blocked, but not defeated. The crusading duo focused their attention on medical researchers, and, to this day, the two are exposing misconduct wherever found (82), (83).

In 2006 the novel "How Opal Mehta Got Kissed, Got Wild, and Got a Life," written by a Harvard sophomore, was pulled from stores after the author admitted plagiarizing portions of the book (84). Four years later, a similar act committed by another young writer, was perfectly acceptable to the book establishment. A 17 year old German prodigy wrote "Axolotl Roadkill," a book that swiftly rose to number 5 on the Spiegel's hardcover-seller list. A reader noticed that numerous passages in Axolotl Roadkill seemed to be plagiarized from another book, "Strobo." In one example, an entire page was lifted from "Strobo" (85). Nonetheless, Axolotl Roadkill was not pulled from the German bookshelves. Instead, the disputatious book was nominated for the fiction prize in the Leipzig book fair. One of the jurors noted that he was aware of the plagiarism accusations, but said, "I believe it's part of the concept of the book" (85). Plagiarism has became the "in" thing for young writers.

The most successful plagiarists are often self-plagiarists; people who re-invent the same idea in every paper they write. The scientific world cannot distinguish the scientist who publishes 500 research papers from the scientist who publishes one paper 500 times. You should follow the second path; it's much easier. Begin with one good paper, preferably published in a prestigious scientific journal. This paper must have your name listed as first author. Your actual contribution to the paper may have been small, even negligible, but this will not matter in the long haul. This paper will be the template for all future papers and future grant applications from your laboratory. Because every scientific contribution opens up new questions related to the original work, use those questions as the basis for all of your subsequent publications. Publish at least one paper each year on same variation of the original paper. Soon, you will be recognized as the world's leading authority in your field (your field being your original article). When discussing your work, express contempt for scientists who do not concentrate their energies on a single topic. You will find that narrowly focusing on your own work, staying oblivious to the external world of science, confers credibility. If you follow this popular pathway, you will be rewarded with the respected and comfortable life of an academic scientist.

There is a second strategy for self-plagiarism, that is somewhat riskier, but not without merit. It is based on the simple truth that stealing from yourself is not a crime. Basically, you take one of your publications and re-publish the same paper in a new venue. It is common practice to publish a paper in a Proceedings Symposium, and then re-submit the same paper to a journal publication (86), (87), (88), (89), (90), (91). Journal editors are well aware of this practice and have clarified their opposition: "Authors publish a preliminary manuscript as part of conference proceedings. Mistakenly believing that conference publications do not count as "official" publications (of note, several informatics conference proceedings, such as MEDINFO, MIE, and the AMIA Fall Symposium, are indexed in MEDLINE), the authors later submit the same work, with minimal alteration or expansion, to a peer-reviewed journal for publication" (92).

Publishers oppose re-publication, in part because they cannot claim copyright to an article that has been published previously. The submission guidelines for almost all journals contain language indicating that previously published material cannot be submitted for publication in the journal (92). This entanglement can be avoided. If you, as the author, hold copyright to the original paper, or if the original paper fell into the public domain (as happens with works by federal employees), or if the publisher happened to own copyright to both the original and the duplicate publication, then self-duplication would not rise to the level of a criminal offense.

In theory, a publisher could sue an author for the cost of the materials involved in re-publishing a previously published article. This never happens. Self-plagiarism occurs whenever authors copy and paste some of their previously published text into review articles and book chapters. Re-cycling publications as duplicate works in other languages is also common. Bruce Schneier has recounted instances where his works were pirated and re-published in other languages, under the authorship of blatant plagiarists (93).

Multi-lingual self-plagiarism occurs when an author translates a manuscript into several different languages, and submits it to multiple journals, worldwide, that publish in the corresponding languages. This practice violates the "one manuscript one journal" rule of scientific publication. Authors want to attain the greatest possible readership for their manuscripts. By publishing the same manuscript in different languages, they expose their ideas to groups of scientists who may not otherwise have access to their work. This is an example of a victimless crime, because neither author, reader, nor editor are hurt by the procedure. Still, it perverts the idea that journal manuscripts report "new" findings. Self-plagiarized articles never come with a warning label, "The information published in this article was published five years ago, in another language, and may have become obsolete in the interim."

In most instances, the stakes are small in scientific plagiarism. There is no crime, if nobody complains.

3.7 THE ACKNOWLEDGMENT SECTION

The Acknowledgment section of scientific manuscripts provides public recognition for those people who contributed to the manuscript. It's a sort of consolation prize for people who weren't included as co-authors.

For those who have never paused to read the Acknowledgment section at the end of a research manuscript, here is a typical example:

"For advice and discussion, we thank L.F. Cai, C. F. Kim, T. Motoi, R. Hobbs, J. Clohessy, T. Yung, A. Carracedo, K. Ito, Pandolfi lab members, B. Clarkson, members of the MSKCC Lung Cancer Oncogenome Group, and members of the DF/HCC Lung Cancer Research Program. We thank M. Asher, T. Matos, and A. Egia for histology services and immunohistochemistry. We thank the MSKCC, University of Iowa, and Dana Farber Cancer Institute flow cytometry core facilities for technical assistance. This work was funded by National Institutes of Health/NCI grants (CA-64593) to P.P.P., and Steps for Breath Fund by the Society of MSKCC and the Thomas G. Labrecque Foundation to M.N. (94)."

The authors acknowledged individuals, by name. They listed the laboratories and funding agencies that provided materials, funds, and other tangible support for the project. For their NIH grant, they listed the grant number, CA-64593. NIH expects grantees to reference grant numbers within their manuscripts. This permits administrators to track the research activities of their grantees.

All told, the typical Acknowledgment serves everyone but the authors. Certainly, an evil scientist should be able to turn the acknowledgment section into another opportunity for shameless self-promotion.

Let's look at a few Acknowledgment sections that serve the author.

"ACKNOWLEDGMENTS. I thank students, postdocs, and colleagues for critical discussion and encouragement. I am grateful to the National Center for Biotechnology Information for providing the earliest dates associated with each NR sequence (95)."

Here, the author has published an Acknowledgment wherein no person or persons are actually acknowledged. The Acknowledgment gives the impression that many people are vested in the success of the project, without giving credit to any individuals. By extending the effort to a large, anonymous group of professionals, the Acknowledgment adds a certain gravitas to the manuscript.

Here's an even better Acknowledgment.

"ACKNOWLEDGMENTS. We thank the patients, physicians, and investigators who have contributed to our understanding of these disorders, and apologize to our colleagues whose work was not highlighted due to space constraints (96)."

This Acknowledgment also fails to actually acknowledge any specific persons. Instead, it provides an emotionally charged list of anonymous participants that includes every physician and investigator who has ever worked in the field, and every patient who has ever been afflicted by the investigated disease. Well done, but further improvement is possible.

"ACKNOWLEDGMENTS. This work is dedicated to the many colleagues and patients who have contributed over the past several decades to advancing our understanding and treatment of amyloidosis, and to the staffs of the Amyloidosis Foundation and the International Myeloma Foundation whose work is ongoing and so often unheralded (97)."

From the first sentence, the authors deftly replace their Acknowledgment with a Dedication. It's brilliant, really. With one bold stroke, the Acknowledgment is transformed from a message of indebtedness to a message of giving. As in the previous examples, no specific persons are actually mentioned in the acknowledgment. The manuscript becomes a gift delivered to all of the unnamed little people out there.

The Acknowledgment section has gradually evolved to a point where it's primary purpose is to add credibility to the manuscript. Can we dare hope to raise the level of the Acknowledgment to a higher realm? Yes, with God's help, we can.

Consider this remarkable innovation, wherein the author acknowledges God's role in the manuscript.

"ACKNOWLEDGMENTS. I thank God for His grace and inspiration in this work..... (98)."

This tour de force continues by thanking a number of coworkers, by name. It ends by thanking the author's wife and his children "for the years of personal sacrifice that are their contribution to this project (98)". The final sentence of the Acknowledgment is another reference to God:

"May God bless them richly (98)."

How can any reviewer reject a manuscript that was inspired by God? To do so would be an act of heresy. Even the most hardened secular humanist will be moved by the years of personal sacrifice endured by the author's family.

So there we have it. The Acknowledgment section is much more than a simple afterthought, grudgingly included in the publisher's boilerplate. Remember that a well-turned Acknowledgment can save your next manuscript from the rejection it deserves.

3.8 ADVICE FOR EVIL SCIENTISTS

1. People will not read your papers. Even if your paper is cited by other papers, it is a safe bet that nobody has actually sat down and read your paper from beginning to end. You can be certain that your department chair, your close colleagues, even your co-authors, have not read your research papers. If you value your marriage, never ask your spouse to read your research papers.

2. Unlike just about every other competitive endeavor, being the first person to achieve a new idea, discovery, process, or invention, seldom means that you will be credited with the breakthrough. The more powerful laboratory, the more recognizable name, the splashier publication will take precedence over mere chronology. It is often more profitable to be the first person to commercialize another person's idea than to be the idea's creator.

3. Scientists do not need to publish. Some of the most influential scientists have made no scientific contributions, preferring to take credit for the work of their colleagues and subordinates. You will find these people running academic departments, occupying powerful positions within scientific institutions, and sitting on peer review committees.

4. Most of the scientific work attributed to you, will be the product of someone else's toil. In any collaborative effort, you must insist, from the very beginning, that your name must appear on any and all publications that result from the collaboration. The magnitude of your effort, compared to that of the other authors, must not be measured. The point is that you are a professional, and you must be rewarded for any professional contribution when the paper is published.

5. Every paper that you publish should be preceded by an abstract presented at a scientific meeting. The abstract establishes the date that the work was completed and adds to the number of publications in your curriculum vitae. Abstracts are much easier to publish than full-length journal articles. Abstracts provide an opportunity to present your work to influential colleagues. More importantly, abstracts provide an opportunity to present yourself to influential colleagues.

6. Divide your work into LPUs (Least Publishable Units, also known as MPU, Minimum Publishable Units). A journal manuscript must convince the reviewers that the work is original, and that it advances science. Just how much a journal article advances science is an unmeasurable quantity, though everyone assumes it is almost always very close to zero. Because advances typically require a collection of small observations and studies, it is often possible to split a paper into minipapers, each containing part of the total research product. When you split a paper into three or four LPUs, you enhance the chance that one or more will be published, and you ultimately increase the number of papers that you have published. Each LPU should include citations to the other LPUs in the series, and to your abstracts.

7. After you have published several LPUs within a project, you can combine your LPUs into a more extensive paper, submitted to a prestigious journal. Do what you must to ensure that your name appears as first author on the composite paper. With care, your can mix and match your LPUs into several composite papers in several different prestigious journals.

8. After you have published your abstracts, your LPUs, and your composite paper, publish a review paper that highlights the importance of your prior works. With luck, you can turn a mediocre research effort into publication empire.

9. When choosing co-authors on your papers, include the names of influential cronies. By doing so, you will increase the likelihood that your manuscripts will be accepted, enhance the prestige of the published product, and diffuse responsibility if the paper is discredited.

10. Don't expect much from co-authors, most of whom will not read the paper and will have only a vague idea of its contents.

11. When you prepare the bibliography for your paper, never cite the papers written by your competitors. This is particularly important when when your competitor has published the same conclusions, at an earlier date. In all likelihood, your reviewer is unaware of your competitor's publications. In the unlikely event that your competitor is your reviewer, cut your losses and re-submit to another journal.

12. When you submit your manuscript, do not hesitate to list several scientists who should not be invited as reviewers. This serves several purposes. It eliminates the people most likely to reject your paper. It makes the editor suspicious of your enemies; more likely to believe anything negative about them. It implants the idea that your paper has sufficient importance that others in your field will try to stop its publication.

13. Get to know editors of several different journals in your field. If you feel that the editor dislikes you, do not even dream about sending him a submission. It will be rejected, even when the reviews are generally positive. If the editor likes you, your paper will be accepted, unless the reviews are scathing. Give the editor a call before you submit the paper, indicating the subject matter, and ask the editor if he is interested in receiving articles such as yours, at this time. The editor will be flattered that you value his scientific opinion [you don't, really], and if he gives you the go-ahead, there is an excellent chance that the paper will be accepted.

14. If you want to re-publish one of your earlier papers in a second journal, use some common sense. Modify your title, and change a few words in each paragraph. Most importantly, change your conclusions [does not require any modification of your data]. Most papers live in obscurity, never read by anyone, and serve only to pad your Curriculum Vitae. It is exceedingly unlikely that anyone will discover your deception. If you are caught (by an editor or a reviewer) trying to republish one of your prior papers, insist that the paper builds on your earlier work, adding new and important conclusions. Though self-plagiarism angers editors, who have been duped into publishing material that has appeared in print elsewhere, it is a crime that has no punishment. If you stick to your guns and proclaim your righteous innocence, all will end well for you.

15. Career-wise, it is much better to publish one paper 100 times than to publish 100 different papers.

16. Behind every great scientist is an evil scientist, ready to take steal his credit. You can be that evil scientist.

17. In the long run, your scientific contributions will have no real impact. Don't dwell on this thought.





CHAPTER 4. EVIL EDITORS AND REVIEWERS

"Any fool can criticize, condemn and complain and most fools do."

-Benjamin Franklin

"La critique est la vie de la science."

-Victor Cousin

By far, the most powerful way to destroy the self-esteem of any creative person is by ignoring him. Basically, if no one listens to you, reads your work, or even glances in your direction, your mark on science will be small.

The second most powerful way of destroying a scientific career is with scathing, unrestrained criticism. Basically, all science is tentative and flawed. Any researcher can be ripped to shreds with a few cutting remarks.

When it comes to putting the kibosh on the dreams and aspirations of earnest, youthful scientists, journal editors are unequaled.

You read a fascinating journal article in the October issue of Science Life. The authors have discovered that galactic acid, secreted by tear ducts, increases the time that astronomers can stare through their telescopes without blinking. You find this article particularly interesting for two reasons; 1) in the March issue of The Science of Our Lives, you reported that galactic acid increased the time that birdwatchers could stare through their binoculars without blinking, and 2) the authors of the Science Life paper did not cite your work, that predated their work by 7 months. You write a letter to the editor of Science Life, indicating that yours was the earlier work, and that you would like to have a letter published in the very next issue of the journal, rectifying the oversight.

Three weeks later, you receive a letter from the editor's office indicating that your letter has been received and is being reviewed by an impartial referee. The letter indicates that you will be informed of the editor's decision once it has been made.

Two months pass. You call the editor's office. His assistant indicates that the editor is aware of your complaint, is working to reach a decision, and that you will be notified when a decision is reached.

A month later, hearing nothing, you call the editor's office again. This time, you reach the editor. The editor indicates that your complaint has been reviewed, and that the outside consultant had determined that the authors of the Science Life paper are innocent of plagiarism.

You inform the editor that you had not accused the other authors of plagiarism. You simply had accused them of being the second, not the first, laboratory to discover that galactic acid inhibits blinking. As such, your paper should have been cited in their paper.

The editor indicates that because there was no plagiarism, there was no scientific misconduct. If there was no scientific misconduct, there is no obligation to publish a retraction.

You indicate that you are not requesting a retraction. You are requesting that the editor publish a short statement indicating that you were the first to discover the effect of galactic acid on blink-avoidance.

The editor indicates that his journal does not embroil itself in disputations over precedence. He says that such arguments need to be settled among the authors.

You indicate that the problem is that the readers of Scientific Life were informed, incorrectly, that the October article was the first to observe the effects of galactic acid on blink-avoidance. You are simply asking for the mistake to be corrected.

The editor indicates that he is pressed for time, and the conversation ends.

Editors have their own biases and will summarily reject scientifically sound papers, if it suits them. There really is nothing that a scientist can do when an editor tells him that a flawless work, requiring years of hard work, is simply unsuitable for publication in the journal (47).

Editors have a lot of self-serving rules that they expect authors to obey. In a paper pompously titled, "On Exemplary Scientific Conduct Regarding Submission of Manuscripts to Biomedical Informatics Journals," a group of editors vented some of their frustrations with authors. Particularly vexing was a practice they call "journal shopping," occurring when "Authors submit a manuscript to one biomedical informatics journal, and, after peer review, it is not accepted for publication, and a critique is provided. The authors do not make any of the changes suggested by the previous review and instead submit the unchanged manuscript immediately to a second journal, without disclosing the existence or results of the previous review by the first journal."

Authors do not publish guidelines telling editors how to edit; editors should not publish guidelines telling authors how to write. If authors were to list some of the more egregious practices of journal editors, they might include the following points:

1. Accepting papers of highly questionable scientific merit when those papers come from an influential laboratory, or when those papers address a hot topic of great interest of their readers.

2. Failing to provide a timely review. Editors always blame the reviewers, but the reviewers are selected by the editor. A craftsman never blames his tools.

3. Not bothering to ask whether the reviewer or the authors have conflicts of interest. Or, asking reviewers and authors if they have conflicts of interest, but doing nothing to verify their response (99)

4. Relying on reviewers who routinely reject papers written by their competitors.

5. Failing to determine the competency of reviewers.

6. Failing to have any quality assurance program for rendered reviews. Editors should be able to show that that reviews have consistency. Editors should follow the destiny of rejected papers. If the journal's rejecta are published in competing journals, receiving praise and peer citations, then something went wrong with the original review process.

7. Failing to provide reviewers with guidelines for a fair review. When a reviewer flatly rejects a paper because it was prepared in a small font, then perhaps the reviewer could use some instruction.

8. Failing to determine if the study protected research subjects from harm.

9. Failing to determine if the paper was written by a ghost writer.

10. Failing to provide authors with the names of the peers who reviewed their papers. Criminals are allowed to confront their accusers; why don't scientists have the same rights.

11. Delaying publication of low-priority papers that have been accepted.

12. Yielding to pressure from the publisher regarding the content of the journal. For example, the marketing department may stop the publication of an accepted paper containing conclusions detrimental to the interests of advertisers (61).

Editors cannot seem to grasp the idea that scientists submit papers for the sole purpose of getting the paper published. Scientists do not submit papers for the purpose of learning the opinions of anonymous reviewers. When an editor forwards scathing reviews, requiring the author to repeat experiments, gather more data, provide more analysis, revise results, pay homage to competitors, and grovel to the delight of anonymous critics, authors will not comply without some bitterness. Editors should not presume that authors will adjust their behaviors to serve the interests of scientific journals.

Every author knows that editors routinely reject scientifically valid manuscripts if they are deemed to be of limited interest to the readers. Journals, like all publications, need to attract and maintain an active readership. Most scientists have received, at some point in their careers, the classic put-down for an otherwise adequate work of science, "Your manuscript is not of sufficient scientific interest to be published at this time." In truth, the editors are almost always correct when they deliver a "not of sufficient interest" notice. Most papers, whether published or unpublished, do not advance science. The problem is that we really have no method of distinguishing the important papers from the unimportant papers. There are many examples of Nobelists whose seminal work seemed uninteresting to editors (100). If editors had the power to stop the authors of rejected papers from submitting to another journal, scientific advancement would come to a standstill.

From the author's point of view, the problem with rejection distills down to time. After submitting a paper, an author can wait a year or longer before he receives his rejection letter (101). During that time, the author is prohibited from submitting his paper to any other journals. The editor, at his whim, can delay publication of a scientifically valid paper for reasons that are purely self-serving and without benefit to the scientific community.

Editors have a bad record of ensuring that the results published in their journals were not biased by financial interests (102), (103). Authors seldom volunteer their conflicts of interest, and editors seldom demand disclosures (104). You can never be sure whether the authors of any scientific paper have a financial interest in the results. Ensuring integrity is a time-consuming and thankless task. No editor has ever earned a dollar for his journal by uncovering a conflict of interest in a study, or a lapse in human subject protections. Basically, editors are in the business of selling journals, not advancing science.

Though editors loathe to scrutinize, they love to criticize. The chief vehicle for scientific criticism is the peer review process, and editors never miss a chance to heap praise on the process. Here is what a group of medical journal editors have said: "The peer-reviewed literature constitutes the main archival source of knowledge in biomedicine. Authors, editors, and publishers must respect reasonable, common-sense ethical and legal imperatives in order to maintain the integrity of the peer-reviewed literature as a vital and important resource. Peer review is conducted by busy professional colleagues who are experts in a given field and who are not compensated for their efforts" (92).

If these editors were asked to demonstrate the value of peer review, with the same scientific rigor they demand from the authors of journal articles, it is unlikely that their praises would be published. Peer review has not been shown to have merit (62), (105). Peer review does not seem to improve the clarity of the papers published in scientific journals, and peer review does not seem capable of finding or reducing scientific fraud and human subject abuses. In a recent test conducted by the British Medical Journal, eight errors were deliberately inserted into a paper and sent to 420 potential reviewers: 53% responded with a review, the median number of errors spotted was two, no reviewer spotted more than five of the eight errors, and 16% found none (106). We can say that peer review greatly lengthens the interval between a paper's submission and its' subsequent publication. Otherwise, peer review has no proven effect on scientific advancement.

The silliest section of the editors' statement is that "Peer review is conducted by busy professional colleagues". The reason that editors refer to reviewers as "busy people," may stem from the excuses they hear for tardy reviews. "It took me six months to review this paper because I've been very busy." Or, perhaps, "No, I haven't reviewed the paper. I've been very busy." Or, "Has a year gone by already? I really think it is important for me to offer the authors some instructive comments, and I want to make sure that I give the paper all of the time it takes to do a helpful review. Can I have a two month extension to complete my review?"

How long does a reviewer work on a review that takes two years to complete? About five hours; if you're working in the field it simply does not take much longer than this to read and comment on a paper. The procrastinator is not a "busy professional." He is simply a selfish person who places a higher value on five hours of his own time than on two years of the author's time. A procrastinating reviewer can easily delay the publication date of a paper by a year, two years, or even longer (101). Late reviews are almost always unfavorable reviews. After you have submitted a manuscript, each month that passes while you wait for the reviewer's comments reduces the likelihood that your reviews will be favorable.

If peer review were important, wouldn't you expect scientists to receive some training in the area. Wouldn't you expect peer reviewers to be held to a standard of conduct? It doesn't happen. When the reviewer receives your manuscript, he knows that he can handle the review exactly as he wishes. Most editors hide the identities of their peer reviewers with the same zeal that journalists hide the identities of their sources. A reviewer can kill the work of a competitor or a colleague, and nobody will ever know the name of the assassin.

As the number of journals increases, and the number of submitted papers increases, editors have an increasingly difficult time finding reviewers. If an editor asks you to review a paper, always accept. A review is your opportunity to hurt your competitors, and to stifle innovative ideas that threaten the status quo. Always remember the first rule of the journal reviewer: "Every manuscript can be justifiably rejected." If you take your job seriously, you can find a flaw in any research effort. In the event that one of the other reviewers supports the paper, over your objections, don't be discouraged. A reviewer has the power to delay the publication of any paper. If the editor instructs you to return your review in two weeks, you can take six months, without rebuke. The author will be required to submit new revision of his manuscript, responding to your criticisms. If you nitpick each successive revision of the manuscript, you can easily stretch the review process to 18 months. By the time the author has successfully responded to all of your criticisms, his innovative paper will be stripped of new ideas and transformed into a non-controversial fluff piece.

On rare occasion, you may be asked to review a truly excellent research paper. You can delay its publication for about two years. This gives you ample time to duplicate the experiment in your own lab, and publish the results in an electronic journal that offers quick publication. Don't worry about being caught stealing the author's ideas. Editors defend the anonymity of reviewers. Why do editors protect the anonymity for reviewers? The given reason for this practice is that a reviewer, fearing retribution, might be reluctant to criticize a paper written by a powerful colleague.

As a reviewer, you are the defender of your chosen field of science. It is your duty to reject any paper that challenges the integrity of your field. Simon LeVay, in his book, When Science Goes Wrong, recounts the story of fetal cell transplantation gone wrong (107). The researcher injected tissue from two sixteen-week old human fetuses into the striatum and the ventricles (of the brain) of a patient with advanced Parkinson's disease. The operation was performed by an American scientist, in China, where experiments using fetal tissue are legal. Two years later, the patient died. An autopsy showed no surviving fetal tissue in the striatum. However, the injected fetal tissue had grown into a teratomatous neoplasm, composed of bone, cartilage, skin and hair, filling the ventricles. The autopsy was restricted to an examination of the head, but the findings of teratoma in the ventricles seemed to be the logical cause of death. The pathologist who performed the autopsy submitted her findings to the New England Journal of Medicine, where her paper was rejected by a reviewer who happened to be a supporter of fetal tissue transplantation research. The manuscript was subsequently published in a neurology journal (108).

When you read a journal article, remember the following:

1. You can't assume that the paper was written by the listed author. The paper may have been written by a ghost writer paid by industry.

2. You can't assume that the co-authors contributed to the paper. They may have been listed for political or economic reasons, without contributing in any measure to the manuscript.

3. The listed authors may have undisclosed conflicts of interest, of a financial nature.

4. In the case of clinical trials, the study may have violated the rights of human subjects.

5. The conclusions may be based on falsified or fabricated data.

6. You will never have access to the raw primary data upon which the conclusions were based.

7. The Discussion section may misrepresent the data.

8. The Reference section may exclude important precedent work published by the author's competitors.

9. The paper may have been accepted for publication because it confirmed the biases held by the reviewers.

10. The research may have been submitted for publication several years prior to the publication date and has no current scientific value.

11. The work described in the article may bear no relevance to the intended area of research supported by the funding sources listed at the end of the article.

12. The article may have appeared in another place and another time, in another language, with a different title and conclusion.

13. You are probably the only person on the planet who has bothered to read the published manuscript.

4.1 ADVICE FOR EVIL SCIENTISTS

1. You must understand that journals exist to make money for the journal publishers. Journals that cannot bring profit will be discontinued. Editors work for the publishers, and their only job is to choose articles that sustain the economic viability of the journal.

2. Do not kid yourself into thinking that editors try their best to accommodate authors. Editors could care less about the authors.

3. Do not think that all valid scientific work will be welcomed by editors. Editors prefer poor scientific contributions that draws the readers, over good scientific works of limited interest to readers. Editors routinely reject flawless scientific papers.

4. Do not worry about whether your submission provokes an ethical dilemma for the editor. Editors do not care enough about the ethical issues related to journal publications to spend any serious time trying to ensure compliance.

5. Editors can make your life miserable as follows: 1) delaying your reviews, 2) sending your paper to toxic reviewers who will undoubtedly find many reasons to render a rejection, 3) rejecting your papers, even when the reviews are good, 4) ignoring your attempts to learn the status of your submission, 4) accepting your paper, but greatly delaying publication of the accepted paper, 5) accepting your paper, but stopping publication when the marketing department finds the paper to be critical of an important advertiser, 6) accepting your paper but stopping publication when he realizes that so much time passed in the review and publication process that the subject and contents of your article are no longer current.

6. After receiving a rejection letter from an editor, never call the editor to defend your paper. Editors routinely reject papers for reasons other than those listed in the rejection letter. Arguing the merits of your paper is a waste of time, and will almost certainly inflame the editor's smoldering animosity.

7. When you are given a submitted paper to review, never think of the task as a burden; think of it as a chance to get even. Don't worry about retribution; the editor will keep your identity secret.

8. The first rule for reviewers is, "Every manuscript can be justifiably rejected." Every manuscript has flaws, and it's your job, as a reviewer, to find them.

9. Always take at least three months to review a manuscript. Never turn in your review until the editor's office has sent you at least two reminders. All of your reviews must include requests for major revisions. If you do not find fault with the manuscript, the editor may question why you needed so much time to complete your review.

10. As a reviewer, your criticisms need not be fair, relevant, or even competent. Remember, the critic is not the one being judged.





CHAPTER 5. GRANTSMANSHIP

"[A]ny new writing, from reporting to reviewing to intellectual journalism, finds the easiest path to publication by seeking the consensus and falling into the deep groove of what's already written and held to be true."

-Paul Maliszewski (109)

Grantsmanship is the art of getting grants. Institutions hire new faculty and research staff based on grantsmanship skills, not research skills or teaching skills. The faculty member who brings in grants will be hailed as a consummate researcher and teacher, even if he is incompetent in both areas. A staff member may be a highly skilled and innovative researcher or a dedicated and competent teacher; nonetheless, he will be reviled as an incompetent researcher and teacher if he cannot win grants. Grants are the currency of science. Just as the pursuit of money is the root of all evil, the pursuit of grants is the basic imperative of every evil scientist.

Universities, like corporations, exist to accumulate wealth and to perpetuate their own existences. Open any University newsletter, and you will see headlines listing the awards received by the various departments and centers. The article will name the principle investigator, the size of the individual's award (usually 5 to 40 million dollars for the most prestigious universities), and a few words describing the general area of research. Newsletters focus on awards, not science; it's much easier to count money than comprehend new ideas.

It is ironic that the ascendancy of grantsmanship in universities comes at a time when the scientific value of most grants has steeply declined. The likelihood that any chosen NIH grant will advance the field of medicine is extremely small. The leadership at NIH understands this and has produced a an official definition of grant success that omits the expectation for scientific advancement. The official NIH definition for the grant success rate is "the percentage of reviewed grant applications that receive funding" (110). Success at NIH is determined by money spent (the award), not value received (the product of the award).

NIH receives between 40,000 and 50,000 grant applications each year. When you consider that NIH is just one of the many U.S. federal agencies that fund grant applications, and that science grants are funded by governments and private agencies throughout the world, you can see that grant applications represent a large industry. The effort wasted on rejected grants has increased, along with the number of grant applications. In the 1950s, grants were awarded to about 70% of the people who applied for a grants; this dropped to 30% by about 1980 (111). In 2008, NIH the grant award rate was 21.80% (112).

Writing a good grant requires a lot of hard work and scientific talent. An evil scientist avoids the task altogether. Grant writing is best left to the professionals. Most departments have someone on hand who is a good writer, who knows the rules of grant writing, and who cannot write his own grants, no matter how hard he tries. Such honored servants learn how to write a strong summary statement (the only part of the grant that is carefully read by the reviewers), how to prepare credible budgets, and how to lard an application with an impressive group of co-investigators. Well-funded institutes, centers and academic departments usually have a star writer who has prepared many funded grant applications. The ghost grant-writer, collaborating with your institution's grant administrator, and using template text from successful grants, will provide you with a grant application you can be proud to call your own.

If you can't weasel out of writing your grant, there are a few simple lessons that you must learn. When you look at grants, you quickly realize that the final product comes as the result of a small but frantic intellectual effort. Keep in mind that NIH receives about 50,000 grant applications each year. If grants were really hard to write, the number of grant applications would be much smaller. Much of the grant proposal is informational boilerplate; names of investigators, institutional grant administrators, addresses, telephone numbers, biographic data for the investigators and co-investigators. A large portion of the grant will be cobbled together from parts of similar grants written in your department. In many cases, the methods you will be using are the same methods that have been used by your co-investigators and that were included in prior grants. Such methods can be pasted into your grant. The background section, which usually begins with some unnecessary discussion of the history and magnitude of the problem addressed by the grant, can be used for all your grant applications. This assumes that the problem you are addressing will not be solved in your lifetime, a safe assumption in most cases.

The most important part of the grant is the abstract, which conveys a summary of the proposed work, and the rationale for doing the work. The study section needs to know what you plan to do, why you want to do it, and whether you can actually pull it off within your institution, with the specified personnel, equipment, and techniques. The typical grant reviewer gives your grant a perfunctory once-over, looking for answers to the following simplistic questions:

1. Is the applicant a bona fide scientist?

2. Does the applicant have a history of completing the grant awards that he has received?

3. Is the applicant known to the members of the study section?

4. Is the grant well written?

5. Does the grant address a real scientific problem that has not been previously solved?

6. Is the scientific hypothesis of any interest to the funding agency?

7. Does the grant application make any scientific sense?

8. Is the grant budget realistic?

Grants with these basic assets cannot be further distinguished from grants written by competitors. A Committee of Science and Public Policy report concluded that if you were to switch the review group for a set of grant applications, you would change the group of funded investigators by 25-30% (113). Agencies would save a great deal of money if they pooled the adequately written grants, and awarded funds by lottery. Deep down, everyone knows this.

Though writing grants is easy, scientists frequently commit three avoidable errors:

1. Procrastination. The most common cause of procrastination is self-doubt. You simply are not confident that you can complete the task. You lack the emotional maturity to develop and complete a set of steps that will lead to a finished product. You cope by procrastinating. You wait until the last possible moment to write your grant. Driven by panic, you feverishly produce a rather crude product. Your grant is not funded. When the next grant deadline comes, the same story unfolds. You are pathetic.

2. Thriftiness. It makes no sense to write a grant with a low-ball budget. Grants are judged on their scientific merit, not on the size of the proposed budget. Review committees cannot give a grant a low score because the grant is large; their job is to determine whether the funds requested are commensurate with the work proposed. If your budget is too small for the work proposed, the review committee will conclude that you don't know what you're doing.

3. Honesty. It makes no sense to write a grant proposal that faithfully describes your intended research. The review committee will be composed by your competitors, who will give your grant a low score, and steal your ideas. Under these circumstances, honesty is the worst policy. Most agencies publish the list of people who sit for the various grant review committees. It's best to pander to the biases that prevail in the committee. If your reviewers believe in global warming, and that the oceans will rise 18 inches in the next decade, then you must believe the same. Feel free to write ridiculous, misleading proposals; reviewers will not object so long as your hypothesis legitimizes their biases.

Once the grant is won, the next step is to work on the grant and fulfill the promises made in the grant application. WRONG!!! After a grant is obtained, the next step is to win another grant. Grants, and the money they bring to the researcher and his institution, are all that matters. Grantees have two options:

Option 1: Palm off the the grant work on a post-doctoral worker or on a grantless faculty member.

Gina Kolata wrote an investigative article for the New York Times, titled, "Labs, A Scientist's Foreign Country (114)." For this article, Kolata interviewed highly successful scientists, who agreed that success requires you to leave the labwork to others. One of the interviewed researchers indicated that he had not performed experiments in years. Dr. Shirley Tilghman, now President of Princeton University, admitted that, for some scientists, "the best thing that ever happened to them was to get out of the lab." As a successful scientist, your job is to bring money into your institution. Leave the work to others, but remember to take the credit for yourself.

Option 2: Use your grant to attain more grants, in quick succession; never completing your goals.

If you tell a lie, and people believe you, and you profit immensely from the lie, why would you ever want to stop? Among the most prominent financiers are life-long liars who understood that the value of an investment is buoyed by a belief system. With a little luck, you can suspend the disbelief of your investors indefinitely. Ivar Kreuger, once known as the "Match King", and credited as the inventor of derivatives, created an enormous Ponzi scheme that lasted for years, until the Great Depression spoiled his fun and brought his investors to financial ruin. Hard lessons learned by Kreuger's investors were soon forgotten. Another Ponzi schemer, Bernard Madoff, swindled billions of dollars from investors over several decades. Until the moment that the Ponzi scheme unraveled, Madoff was held in the highest esteem by his investors and by his colleagues on Wall Street and the Securities Exchange Commission. The wizards at Enron built a shell-game into one of the largest financial empires in the world, and enjoyed the adoration of biographers and colleagues, until the illusion finally collapsed.

Once you've been awarded a grant, you're considered to be superior to every scientist who has not been awarded a grant. This will hold true even if you never make any contribution to science. Use your prestige as a grant-winner to attract additional grants. Your colleagues will be glad to add your name as a co-investigator on their grant applications; your name will provide vicarious legitimacy to their application. When you apply for your next grant, the members of your review committee will see you as an established leader in your field, greatly improving your chances for additional funding. Grantsmanship is a never-ending Ponzi scheme. One grant parlays into many.

Ponzi schemes work well for academics, but they work best for small businesses. Federal funding agencies must award a percentage of their grants to small businesses, through the Small Business Innovation Research Program. A small business is usually a corporation, and holds all of the legal corporate advantages. One of the most useful rights of corporations is the right of re-incarnation. A corporation can simply kill itself on Monday and arise as a new corporation on Tuesday, with a different name, but with the same owners and employees. A small business can win a grant, spend the appropriated funds without producing any useful product, and apply for another grant, in the same scientific area, under a new legal identity, and a fresh slate.

5.1 TRUE FUNDING MEANS NEVER HAVING TO SAY YOU'RE SORRY

"He that increaseth knowledge, increaseth sorrow."

-Ecclesiastes 1:18

Artists must produce art, if they accept a commission. Writers must produce books, if they accept advances from publishers. But scientists need not produce science if they have grants. Why is this so? Funding agencies hold the act of scientific discovery in such awe and veneration, that they cannot sully the process by requiring funded investigators to produce results on command! The same delusion is preserved in academia. When applying for a staff position in a university, your success in getting grants will be closely scrutinized. Yet nobody will ask you what you have actually accomplished with your grant; such inquiries are considered crude and irrelevant.

Sometimes, after receiving grants for decades, and without any substantive scientific results to show for it, your funder might question your competence or your diligence. This is unlikely to happen, because funding agencies don't seriously expect much to come from any individual researcher. If you happen to have one of those rare, earnest Program Directors, who actually cares how taxpayer money is spent, you should be prepared to defend yourself. Here are a few retorts, of proven value:

1. "Over the years, I have trained dozens of graduate students and post-doctoral assistants."

The grad students and post-docs do the actual work of the grant. There is no way to verify that the principle investigator contributed to their training.

2. "I am currently a full professor and have won multiple awards."

This is basically a circular argument. Scientists attain tenure and earn awards in return for acquiring funding.

3. "I have a grant, not a contract. Grants have no expected deliverables."

Federal funding agencies have two general ways of funding scientific programs: contracts and grants. A contract lists the work that must be done by the contractor, and specifies a set of deliverables that the contractor must produce by the time the contract is finished. A grant is a gift. There are no deliverables. The funding agency can check to see that the grantee is using his grant funds for his research, but few grantees receive serious scrutiny. With very rare exceptions, a grant will receive continuous funding until it reaches its full term of expiration. This is true even in the event of death of the grantee; the funds simply transfer to a co-investigator or to an appointed surrogate researcher if no co-investigator is listed on the grant application.

4. "I completed the work described in the RFA that your agency provided me. What else do you want?"

An RFA (Request for Applications) is a public announcement for a federal grant funding initiative. RFAs differ from investigator-initiated grant applications. Investigator-initiated grant applications provide a mechanism whereby a researcher can receive funding for any project that interests him, provided he can convince a peer review committee (the so-called study section) that the research is important and feasible. In an RFA, the funding agency provides a specific research objective, and contains a list of the kinds of activities that are appropriate for the specified project. In general, RFAs are answered by a large number of competing proposals, all promising to adhere to the research objectives specified in the RFA.

After the RFA is awarded, it is common practice for funded investigators to veer sharply from RFA guidelines. There are several reasons for non-compliance. First, researchers think of themselves as free spirits, a notion reinforced by the culture of academic freedom fostered in most universities. Researchers are loathe to follow research plans developed by bureaucrats who work for funding agencies. Second, researchers like to follow tangential lines of research, even when the research diverts them from their primary mission. Third, and most important, researchers follow a modus operandi. Regardless of the project, a researcher will always return to the methods he mastered as a graduate student. Over time, the RFAs project will morph into the principle investigator's narrow field of study.

How do RFA recipients get away with ignoring the well-documented goals specified in the RFA document? It's easy. The principle investigator simply asserts that the RFA did not adequately specify the project. It is impossible to specify, in advance, every aspect of a research project. A crafty principle investigator will use the uncertain nature of research to excuse any and all breaches from the RFA.

5.2 YOUR FAILURE IS MY SUCCESS

Modern evil scientists understand that their success depends on their competitor's failure. You can confirm this assertion for yourself by visiting Google's ngram viewer (at http://ngrams.googlelabs.com/). Google collects an index of the occurrences of words and phrases (up to 5 words in length) found in its' collection of scanned literature. The lengths of phrases are ngrams (e.g., a 1-gram is a single word, a 2-gram is a two-word phrase, and so on). At the ngram viewer page, anyone can enter a comma-separated list of words and phrases, and Google will produce a graph plotting occurrence frequency over time. Most of their scanned books come from the period following 1800, and Google's default starting data is 1800. You can look at earlier years, or you can confine your search to shorter periods of time.

Let's look at the ngram that compares the frequency of "success" and "failure" (Figure 5-1).



Figure

Figure 5-1. The frequency of occurrence of the word "success" and "failure" in 19th and 20th century literature.

In the nineteenth century, "success" (the blue line) was about 6 times more frequent as "failure". By the end of the twentieth century, "failure" had overtaken "success" and is currently just shy of a tie.

What does this mean? It means that in the artifactual world of literature, our ancestors were somewhat reluctant to write about failure; not so today.

Are modern writers more honest than our predecessors? Have we evolved to the point where we can openly admit our failures? Of course not. Modern writers have simply learned that they can openly criticize their competitors without incurring the scorn of their peers.

Let's look at the occurrences of the phrases "his failure" and "my failure" (Figure 5-2).



Figure

Figure 5-2. The frequency of occurrence of "his failure" and "my failure".

The occurrence of "my failure" (red line) remains at a consistent and low level through the centuries. The occurrence of "his failure" (blue line) enjoyed a meteoric rise through the mid-twentieth century. Basically, modern writers made the important discovery that they could blame someone else when things went wrong. This discovery was a major advance for evil science.

5.3 INVESTING IN SCIENCE

"Don't gamble; take all your savings and buy some good stock and hold it till it goes up, then sell it. If it don't go up, don't buy it."

-Will Rogers

Here's a nifty idea for funding agencies: fund the really important research, and don't fund unimportant research. This simplistic approach, analogous to the stock broker's advice to buy low and sell high, never seems to work as hoped. Basically, when one powerful individual is permitted to choose the winners and the losers, the winners always seem to be the friends, allies, and loyal supporters of the person in power.

A series of headlines appearing in Science magazine in 2003 and 2004 convey one example of a perennial theme.

-April 25, 2003: Canceling Grants, VA Research Chief Shakes the System (115)

-July 4, 2003: VA Shaken by Plan to Cut Grants, Cultivate the 'Stars' (116)

-December 12, 2003: Defunded VA Grants Restored; Wray Returns to Texas (117)

-April 2, 2004: IG Report Faults Handling of Veterans Affairs Funds (118)

In 2003, the Chief of Research and Development for the VA over-ruled the peer-review process, and de-funded 17 projects (115). She was of the opinion that outcomes research, her own area of study, was more worthy of funding than some of the basic science projects slated for funding (116). Many scientists disagreed with Dr. Wray, particularly the de-funded ones. Before too long, the de-funded grants were restored, and Dr. Wray vacated her position at the VA (117).

The other shoe dropped in March, 2004, when the VA Inspector General's office issued a report on allegations that "Dr. Wray misused funds provided to VA by pharmaceutical companies; misused Government travel funds; unfairly hired, promoted, and managed staff; and did not act impartially or reasonably when approving and disapproving Research and Development Office projects." On the particular complaint pertaining to her approach to grant funding: "We further substantiated that Dr. Wray did not act reasonably when she re-evaluated and re-scored 130 research proposals that had previously earned fundable scores, less than a month before their effective funding date, and disapproved 15 of them." (119).

Nobody can determine which ideas are important and which ideas are not. When we look at the major advances in science and medicine throughout history, almost all of them were ridiculed from the moment of their conception. Picking future science winners is a sucker's game.

The peer review system for funding is a nasty business; about 80% of grant applications are denied funding. You might prefer to increase your chances of success by bypassing the grants review process entirely. Here are a few alternate roads to success:

1. NIH awards grants to applications that receive the highest scores in open competition, but not always. The Institutes have some discretionary money that can be applied to grants applications that did not compete well (i.e., did not receive a fundable score during the review process). These grants are called "exceptions," because they circumvent normal review. Exception funds can be assigned to research projects that received poor scores. In rare instances, exception funds can go to an idea that was never developed into a formal grant application. Exception funds invariably go to scientists who can motivate an NIH program director or high-ranking official to exercise influence on their behalf. Smart scientists cultivate allies at NIH.

2. Higher than the exceptions process is the direct appeal to the head on an NIH Institute. The office of an NIH director has a variety of methods for moving funding to a favorite supplicant. An NIH director can request his division chiefs host an NIH workshop to be chaired by the supplicant. The workshop lends authority to the supplicant and legitimacy to his area of interest; this builds enthusiasm for supporting his research. The NIH director can ask program directors to launch a new initiative along the lines of research of the supplicant. The NIH director can arrange collaborative efforts between funded NIH researchers and the supplicant, essentially piggy-backing the supplicant onto a funded laboratory.

3. If you are a physician seeking grant support, you really don't need to look any further than your own suite of examination rooms. Dying patients and their families can often be persuaded to leave their estates, in part or in whole, to further the research interests of their beloved family doctor. The request often takes the following form:

Isn't (name of disease) a terrible disease? It (may be, is, was, could be) too late to save (name here), but my lab is on the verge of a breakthrough. We are very close to stopping this disease, so that nobody else's (father, mother, son, daughter) needs to suffer like (name here). The NIH only pays for big science these days. They'll give millions of dollars to the big labs, but it is virtually impossible for a small lab to get a few hundred thousand dollars for an innovative project. You know better than anyone else how important it is to cure (name of disease). Can you help with a donation?

4. Earmarks are the only sure-fire way way of getting grant funding, while avoiding the risks that come from the peer-review process. An earmark is a budget expense, inserted by a congressman, for a designated recipient in his home state. In 2007, Congress spent $2.3 billion on earmark projects for universities and colleges (120). If somebody on Capitol Hill likes you, you can get millions of funding dollars for otherwise unfundable research projects (121).

In the past, science was done on-the-cheap. Today, science is big business, and requires generous support. The absolute requirement for funding has turned the culture of research upside-down. Prior to 1960, the purpose of funding was to achieve research. After 1960, the purpose of research was to achieve funding. Because funding lies at the heart of modern science, and funding comes primarily from large federal agencies, today's scientist is essentially a welfare recipient. Money goes from the state to the scientist; very little comes back in the form of scientific advancement.

Does it need to be this way? Of course not. We could substitute a cash-on-delivery policy for grants. Here's how it would work. A scientist submits a scientific proposal to a central repository. As examples, the proposal might be for an insomnia cure, or for an improved jet engine, or for the genetic sequence of an aardvark. Funding agencies and private corporations review the grants, and place a bid based on how much it would be worth to have the proposal completed. In each example, you might imagine that certain agencies or corporations might want to place a bid, while others might find any given proposal irrelevant to their missions.

Once the bids are placed, the proposal is awarded to the highest bidder. The scientist looks at the size of the bid. If it is too low, he simply informs the winning bidder that he won't be doing the work, and the bid is withdrawn. Otherwise, the highest bidder then puts the money for the bid into into an escrow account. The money will be given to the scientist when he delivers on the proposed research, within an agreed interval of time.

At this point, the scientist has no money for his research. He needs to secure a loan for the research, using the bid as a form of collateral, he find one or more investors willing to stake his research, in return for a negotiated portion of the money in the escrow account.

Basically, this method of research funding permits society to pay for what it receives, at a price that it is willing to pay. It is similar to a "completion bond" (122). Scientists who cannot deliver on their own proposals will receive no money. Because bids are not tied to the cost of the work, productive scientists will do very well.

5.4 ADVICE FOR EVIL SCIENTISTS

1. Science progresses as follows: many different areas of inquiry are funded. A small number of them may one day lead to an important advancement. We cannot tell in advance which areas will lead to advancement and which areas are a waste of time. Major advancements often come from ignored areas that had never received funding.

2. If you believe that the purpose of funding is to do research, you need to turn your thinking around. Evil scientists know that the purpose of research is to get funding. Department heads and university administrators understand that professors are hired for the sole purpose of bringing grants and other forms of revenue into their institutions.

3. Understand that there is no relationship between the a grant's merit and its funding success.

4. As an academic scientist, you are only as good as your next grant; focus your efforts on securing future funding.

5. Never write your own grant. Grant writing is best left to professional ghost writers employed by your department.

6. Never work on your grant. Time spent on your current grant is time stolen from securing the next grant. Research is something done by technicians, graduate students, and post-doctoral fellows. Successful scientists never step foot into their own laboratory.

7. Spend, spend, spend. The most successful scientists have the largest grants. If you write your grant thinking that the study sections will look favorably upon a low-budget project, you are sadly mistaken. A small budget grant is the calling card of the loser. Don't be afraid of asking for more money than you can responsibly spend.

8. When your grant has expired, abandon your work. The only people who will be inconvenienced are the technicians, graduate stuents and post-doctoral fellows who slaved over the project for the past half-decade.

9. Take credit for all of the work that comes from your laboratory. If you must list your subordinates as co-authors, be sure to stagger their names on your papers. Your name will be the only name that appears on every paper coming from your laboratory; and the only name that is associated with the laboratory's work.

10. Commercialize your research. If you find yourself to be the unintended inventor of a process, drug, or invention that can save thousands of lives, don't make the mistake of giving it all away.

11. Don't worry about scientific stagnation in your field. The public will pay and pay forever, if they believe that a breakthrough is near. You can hold society hostage for decades, if they really need a solution to a scientific problem.

12. The truly powerful scientist becomes independent of grant funding. Earmarks from government, grants from private corporations, grants from charitable institutions, and money received directly from wealthy donors can free you from the endless pursuit of grants.





CHAPTER 6. REJECTION

"That it will ever come into general use, notwithstanding its value, is extremely doubtful because its beneficial application requires much time and gives a good bit of trouble, both to the patient and to the practitioner because its hue and character are foreign and opposed to all our habits and associations."

-The London Times, 1834, reviewing a new medical device, the Stethoscope

The life of a scientist is full of rejection. Rejection is a judgment from your peer community that your work has no merit and should not be rewarded, or even acknowledged. It is an official indictment against your work, and your self-image. Though some creative persons seem to thrive on rejection, most whither.

Perhaps nobody has been as deeply ignored, during his short, obscure lifetime, than Vincent Van Gogh (1853 - 1890) . In the last decade of his short life, he produced over 2,000 paintings. He just kept getting better and better at his craft, producing many of his most beloved works in the last two years of his life. Though he had connections to a successful art dealer (his brother Theo), his paintings had no buyers. Rejected and depressed, he took his own life.

John Milton (1608 - 1674) received only 10 pounds, from his publisher, for the manuscript and the copyright to Paradise Lost (1667). Despite an examplary life, Milton died blind and impoverished. His epic poem would not achieve critical acclaim in his own country until 30 years post-mortem. Perhaps Satanic forces prevailed against Milton, much as they prevailed in Paradise Lost (Figure 6-1).



Figure

Figure 6-1. Satan, drawn for a nineteenth century edition of Paradise Lost, by Gustave Dore (1832 - 1883). Source: Wikipedia, public domain.

Herman Melville (1819 - 1891) finished writing Moby Dick in 1851. He considered it to be his greatest novel, but reviewers disagreed. His publisher printed a small number of first edition books; most went unsold. Melville's career delined after disappointing sales for Moby Dick. Melville was forced to take a job as a customs inspector to make ends meet. He died in almost total obscurity, leaving behind the unpublished manuscript of his last work, Billy Budd. Today, Moby Dick is considered one of America's greatest novels.

Emily Dickinson (1830-1886) wrote about 1,800 poems. Fewer than a dozen poems made it to print during her lifetime; these were altered by the publisher to suit the prevailing norms of poetic form, and were ignored by all but a few close friends. Death did little to enhance her reputation, until 1955, when a collection of her works were published. Today, Emily Dickinson is one of the most beloved poets of all time.

From the 1930s to 1960, publishers had little or no interest in Louis Zukofsky (1904 1978); he wrote with virtually no audience. His book "Barely and Widely" sold only 26 copies two months after release. Today, Zukofsky is considered to be one of the greatest poets of the 20th century (123).

David Oshinsky wrote an essay on book rejections discovered in the Alfred A. Knopf, Inc., archive (124). In 1950, Alfred A. Knopf Inc. rejected "The Diary of a Young Girl," by Anne Frank. The publisher found the work dull and "a dreary record of typical family bickering, petty annoyances and adolescent emotions." After 15 other publishers passed on the title, Doubleday published the book (over 30 million copies sold). In the same essay, Oshinsky reported that Pearl Buck's The Good Earth was rejected by Knopf (Americans are not interested in China), as was George Orwell's Animal Farm, (animal stories don't sell). Also rejected were Isaac Bashevis Singer (rich Jews again), and Sylvia Plath (not enough talent).

Art and literature are subject to personal taste. Science is tethered to objective reality. You would expect that scientific discoveries would be greeted with immediate acceptance because legitimate scientific assertions can be tested and verified. Such is not the case, and the history of discovery is filled with sad stories of great works rejected. A short chronology of scientific rejection follows (125):

480 B.C.E. Democritus (460 B.C.E. - 370 B.C.E.) invents atoms, a theory supplanted by the much more popular "Earth, air, fire, and water" school.

350 B.C. Aristotle (384 B.C.E. - 322 B.C.E.) recognizes that dolphins are mammals. The rest of the world disagrees, classifying dolphins as fish. After two thousand years of derisive laughter, the world eventually agrees with Aristotle.

325 B.C.E. Pytheas (350 B.C.E. - 285 B.C.E.) sails from Greece to Iceland. Pytheas watched the Atlantic tides (absent in the smaller Mediterranean sea). When he returned from his remarkable voyage, Pytheas described his voyages and his observations. Nobody believed him.

240 B.C.E. Eratosthenes of Cyrene (276 B.C.E. - 195 B.C.E.) working in Alexandria, computes the size of earth correctly. At the time, the preponderance of scientific opinion favored a flat earth, supported by a giant (Atlas) or possibly a turtle.

134 B.C.E. Hipparchus (190 B.C.E. - 120 B.C.E.) observes a newly appearing star (nova). The western world remains incredulous until Tycho Brahe's observation 1500 years later.

1705 Edmond Halley (1656 - 1742), calculates that his comet would return to the solar system in 1758. Nobody took him seriously, until 1758, when Halley's comet returned.

1747 James Lind (1716 - 1794) determines that citrus prevents scurvy. It takes another 50 years and hundreds, perhaps thousands, of deaths, before the British navy listens.

1796 Edward Jenner (1749 - 1823), writes paper on smallpox vaccination; rejected. Forced to self-publish research results (126).

1847 Ignaz Philipp Semmelweis (1818 - 1865) reduces rate of puerperal fever by hand-washing. Hand washing was soon abandoned by the hospital staff. Semmelweis eventually lost his sanity. To this day, many physicians and healthcare professionals neglect to wash their hands.

1884 Svante August Arrhenius (1859 - 1927) defends his PhD thesis on ionic dissociation. His professors thought it was all wrong, reluctantly passing him with the lowest possible qualifying grade. In 1903, the very same thesis earned Arrhenius the Nobel prize.

1869 One-armed civil war veteran John Wesley Powell (1834 - 1902) is denied federal funding to explore the Grand Canyon; his privately funded exploration is credited with many of the significant discoveries of the Colorado basin.

1892 Georg Ferdinand Ludwig Phillip Cantor (1845 - 1918) publishes the theory of transfinite numbers, to the immediate and vociferous condemnation of the religious, philosophical, and scientific communities. Mathematics, unlike the natural sciences, yields to logic. In 1904, the Royal Society bestowed its highest honor on Cantor.

1987 Fred Cohen, who introduced the term, "computer virus" in a 1984 paper, and who was one of the first scientists to predict the threat of computer viruses, asks the National Science Foundation for a grant to study countermeasures. His grant was denied; not of current interest (127).

Sometimes, the best works are found amongst the rejected efforts. In mid-nineteenth century France, the Salon de Paris, the official art exhibition sponsored by the Academie des Beaux-Arts, rejected works by Monet, Manet, Pissarro, Cezanne, and many others whose concept of art conflicted with prevailing sensibilities. Complaints reached the ears of Napoleon III, who allowed rejected words to be displayed in a Salon de Refuses (a gathering of the rejected people). These exhibitions of rejected art are credited with the rise of impressionism. Today, the term "salon des refuses" refers to any exhibit of works that were rejected by a juried show.

Mathematicians have their equivalent of a Salon de Refuses. Today, mathematicians can publish their rejected papers in Rejecta Mathematica, available online at: http://math.rejecta.org/about-rejecta-mathematica. Sometimes, great ideas are not rejected; they're just ignored. Hundreds of years can pass while a deserving idea is discovered, lost, re-discovered, lost again, and so on.

In 1668, the world was modernized, in many ways. We had the fundamentals of cryptography (Viete, 1589), Pi calculated to 20 decimal places (Ludolf, 1596), logarithms (Napier, 1624), Fermat's last theorem (1637), the fundamentals of probability (Pascal, 1654), and the ability to diagnose cancers by pathologic examination (Malpighi, 1659). Differential equations were understood (1662), and the last details of integral calculus were being written, independently, by Newton and Leibnitz. Despite all of these scientific advances, the world believed that the life of very small organisms arose spontaneously, from thin air, or possibly from inanimate particles of dirt. Otherwise rational intellects were comfortable with magical thinking, and believed that life could be explained by postulating forces acting in a realm beyond human perception.

Francesco Redi, in 1668, designed an experiment to test whether maggots arose through spontaneous generation (Figure 6-2). He incubated meat in flasks; some flasks covered to stop the entry of flies, and others left uncovered, permitting flies to enter. After some time passed, Redi examined the meat in both sets of flasks. Only the meat from the open flasks contained maggots. Redi correctly concluded that maggots do not generate spontaneously from dead meat. We now know that maggots generate from tiny eggs laid by flies.



Figure

Figure 6-2. Francesco Redi. Source: Garrison FH. History of medicine. WB Saunders, Philadelphia, 1921.

Redi's experiment had very little influence on the prevailing belief systems. Seventy-two years later, John Turberville Needham conducted his own meat-related test for spontaneous generation. He heated mutton broth in a closed container, and examined the contents a few days later. The container swarmed with micro-organisms, proving, to the satisfaction of many, that micro-organisms arise by spontaneous generation. In retrospect, we can assume that the broth was not heated sufficiently to kill all of the organisms initially present in the container, or that the container was not closed tightly. For some time, though, Needham's experiment vanquished lingering doubts regarding the validity of spontaneous generation.

In 1768, a full century after Redi's experiments, Lazzaro Spallanzani (1729 - 1799) repeated Needham's experiment, this time boiling the broth for forty-five minutes. No organisms grew in the closed container (Figure 6-3).



Figure

Figure 6-3. Lazzaro Spallanzani. Source: Wikipedia, public domain.

Spallanzani's experiment should have put the kibosh on spontaneous generation, but it did not. Ninety-two years passed before the controversy was revisited. In 1860, scientists knew enough about the biology of life to infer that spontaneous generation was a needless and absurd theory. At that time, Virchow, a highly influential pathologist, argued against spontaneous generation, observing that cells arise from other cells, through cell division. In 1860, Pasteur showed that dust particles in air carried micro-organisms. If boiled meat is exposed to purified air (without dust particles), bacterial growth does not occur. Nearly two centuries were required to convince the world that Redi's experiment, disproving spontaneous generation, was valid.

Back in 1668, just as Redi was trying to convince his colleagues that living organisms cannot generate from nothing, Richard Lower was putting the finishing touches on his Tractatus De Corde: Item De Motu Et Colore Sanguinis. Lower demonstrated experimentally that venous blood pumped from the heart, into the lungs, is transformed (from venous dark red, to arterial bright red) by aeration and returned to the heart, where arterial blood is pumped to the peripheral circulation. This seems obvious today; barely worthy of explanation. But it took 1600 years to solve the mystery of heart-lung circulation.

We need to be reminded that for about 1500 years, all medical thought in Europe was dominated by one honored physician. Galen (129 - 199 C.E.) was a Greek physician who lived in Rome, and Pergamum (Turkey), and retired early to live a life of scholarship. He wrote many books, including "On Prognosis," (177 C.E.), and produced a total of about 3 million bon mots before he died (128). For the subsequent 1500 years, his words were accepted on blind faith by virtually all European physicians. To reject Galen was a type of heresy, that almost always resulted in professional ostracism.

Galen, great as he was, labored under the somewhat limited scope of second century science. Some of his most far-reaching thoughts fell into the realm of superstition. For example, Galen believed that blood was embued with natural spirits by the liver, and vital spirits by the heart. Furthermore, Galen believed that blood moved through the septum of the heart through invisible pores. The concept of a closed circulation was unknown to Galen.

Every child who rides an escalator must wonder where the steps go when they reach the top. The escalator steps slink under the floor, where they must drop off into a hidden chamber. Meanwhile, another mysterious process creates new steps that emerge from the floor of the elevator, and rise upwards. The idea of a continuous belt of stairs seldom catches the imagination of very young children, who are comfortable with magical thinking. Basically, medieval physicians accepted Galen's magic stairs version of blood circulation. Blood was constantly replaced by the liver at a rate that equaled its issuance through invisible pores in the heart. It was just fantastic.

Anatomists who gave any thought to Galen's theory of blood circulation knew that Galen could not be correct. Still, to doubt Galen was clearly unacceptable. In frustration, Henri de Mondeville, the author of Cyrurgia (1312), an early textbook of surgery, wrote, "God did not exhaust all His creative power in making Galen (128)." Andreas Vesalius (1514 - 1564), a gifted anatomist, published "De Fabrica Humani Corporis," in 1543 (Figure 6-4).



Figure

Figure 6-4. Andreas Vesalius, on left. Source: Garrison FH. History of medicine. WB Saunders, Philadelphia, 1921.

Vesalius provided a detailed description of human anatomy that corrected some of the misconceptions and superstitions left by Galen (Figure 6-5). Vesalius' closest friends turned against him. Others in his profession condemned, mocked, or ignored his work. Die-hard Galen fans insisted that any discrepancies between Galen's second century human anatomy, and Vesalius' sixteenth century observations were due to changes in human anatomy that had occurred after Galen's epoch. Sylvius, Vesalius' teacher in Paris, grumbled, "Man had changed but not for the better (128)." Ridiculed by his peers, Vesalius fled Venice, and died alone, impoverished, and shipwrecked on the Island of Zante (Zakynthos) (128).



Figure

Figure 6-5. Vesalius' drawing of the base of the brain, demonstrating a thorough understanding of brain anatomy, including the crossing of the optic nerves, the origins and course of the spinal nerves, and the relationship of the cerebellum to the brain stem. Source: Wikipedia, public domain.

Ten years later, Michael Servetus (1511 - 1553) published Restitutio Christianismi, in which he noted that the pulmonary vessels deliver blood to the heart, after the blood has mixed with air in the lungs. That same year, Servetus was burned at the stake (along with most of the copies of his book) by Calvin for a poorly written sentence that seemed heretical at the time (Figure 6-6).



Figure

Figure 6-6. Michael Servetus. Source: Wikipedia, public domain.

By 1628, the world was ready to take a critical look at some of Galen's assertions. In this year, William Harvey (1578 - 1657) published De Motu Cordis, describing the circulation of blood from heart to lungs and back, and from the heart to the periphery and back. This brings us to back to Richard Lower (1631 - 1691) (Figure 6-7). In 1691, Lower published an explanation of the relationship between the peripheral and pulmonary circulations, and described the intrapulmonary aeration of venous blood. Lower's work was a complete anatomic and physiologic synthesis that has withstood the test of time.



Figure

Figure 6-7. Richard Lower. Source: Wikipedia, public domain.

The Italians credit Andrea Cesalpino (1524 - 1603), a professor of medicine at Pisa, for discovering the closed heart-lung circulation prior to Harvey. The point is moot. In 1242 C.E., the Arabic polymath Ibn an-Nafis (1213 - 1288) described the heart-lung role in circulation and aeration; four centuries before Cesalpino. At the time, nobody in Europe cared to listen. The moral of the story is that new ideas will be rejected if they contradict cherished beliefs.

As Galen dictated medieval medicine, so did Ptolemy dictate medieval science. Claudius Ptolemaeus (90 - 168), known in English as Ptolemy, was contemporary with Claudius Galenus (129 - 199), known in English as Galen. According to Ptolemy, the earth sat in the center of the universe, and the size of the universe has a radius equal to 20,000 times the radius of the earth. Wrong or right, European scientists held Ptolemy's judgment inviolate for nearly fifteen centuries.



Figure

Figure 6-7. Ptolemy, pointing away from the center of the universe. Source: Wikipedia, public domain.

Reality is the thing that can kill you whether you believe in it or not. For centuries, navies refused to believe that citrus can cure scurvy (Vitamin C deficiency disease). Most animals can synthesize ascorbic acid (Vitamin C), and do not require a dietary source of the vitamin. Humans and guinea pigs must acquire the vitamin in their diets, or they will die. Without Vitamin C, the body cannot properly synthesize collagen, the fibrous protein that braces connective tissues in animals. The first known large epidemic of Vitamin C deficiency occurred in 1497, when Vasco da Gama sailed from Lisbon to Calcutta. About three-fifths of his crew died. Prior to the age of European sea explorations, voyages were shorter, or they involved foraging for food along the way. The Europeans set larder on their ocean-going ships with provisions for the full journey. Unfortunately, their stored foods lacked sufficient Vitamin C, resulting in death by scurvy, a particularly nasty condition marked by a general collapse of the body's structural integrity, often ending with stroke due to vascular hemorrhage.

In 1593, Sir Richard Hawkins demonstrated that scurvy could be prevented and cured by eating oranges and lemons. If citrus fruits were not to a sailor's liking, a type of salad cress was shown, in 1597, to work just as well. It would seem that by 1597, one century after the medical disaster aboard Vasco da Gama's ship, scurvy was eliminated as a threat to naval adventurers.

Not so. Soon after the cure for scurvy was found, it was abandoned. Scurvy resumed its killing spree on the British navy. It was up to James Lind to re-discover, in 1747, that citrus prevented and cured scurvy. Lind's re-discovery was lost on some explorers. A century later, in 1848, the ships Erebus and Terror, while navigating through the Northwest Passage, became trapped in ice. Citrus was absent from their provisions. The crew died of scurvy.

The basic theory of asepsis is simple and effective; keep wounds clean, and avoid contaminating your patients with infected materials. The limitation of asepsis, as a medical procedure, are three-fold: 1) humans are dirty; 2) humans are lazy, and 3) no physician has ever been paid to wash his hands.

Asepsis is another idea whose time had come and gone and come and gone. Hippocrates (460 - 377 BC) irrigated wounds with wine or boiled water. Galen (130 - 200 A.D.) knew enough to boil his surgical instruments. In 1266 A.D., Todorico Borgognoni taught aseptic wound treatment.

In 1847, Ignaz Phillipp Semmelweis was working at the Vienna General Hospital's maternity clinic, on a three year contract (Figure 6-8). Through much of human history, mothers commonly died of infections arising immediately following childbirth. As many as forty percent of mothers contracted and died from puerperal fever, also known as childbed fever. The cause of these deaths would have been obvious to Hippocrates, Galen or Borgognoni. Doctors scurried between sick patients and healthy patients without washing their hands. Semmelweis saw the problem, and contrived an experiment; Doctors and medical students would wash their hands between patient examinations. The staff doctors were skeptical, but they agreed to humor Semmelweis, if only to prove him wrong. The death rate from puerperal fever dropped precipitously. Unfortunately for the women at Vienna General, staff doctors abandoned the hand washing ritual when Semmelweis's contract expired. Hand washing was an annoying diversion. All told, physicians preferred the filth and the high death toll to the incessant hygienic obligations. The patients sided with the hospital staff. The sick were annoyed to see doctors washing their hands after touching them; it made them feel dirty.



Figure

Figure 6-8. Ignaz Phillipp Semmelweis, wedding diptych. Source: Wikipedia, public domain.

Have you ever wondered why Jewish doctors are held in high esteem, even among patients who are openly anti-semitic? Do Jews make the best doctors? The answer may lie in the ancient Hebraic hand-washing obligations. Observant Jews wash their hands often, and thoroughly. Ritualistic hand-washing is a carefully conducted procedure, requiring clean water, and repeated hand immersions. It comes as no surprise that a doctor who carefully washes his hands will save more patients than a doctor whose hands carry infection from patient to patient.

Today, nobody doubts the effectiveness of a clean environment for patients, but hand washing is still a lot of work. Doctors, even in the best hospitals, neglect washing their hands (129). For physicians, not hand washing is the perfect crime. It can kill as easily as a bullet, but no doctor has ever been punished for having dirty hands. As Dr. Robert M. Wachter, an expert in patient safety has said, "I can lose my hospital privileges if I fail to sign a dictated discharge summary or operative note. But if I don't clean my hands for the next 10 years, nothing will happen to me" (130). Every evil scientist understands that doctors will not wash their hands for free. The same careless disregard for cleanliness extends from their hands to their examination equipment. In a New Jersey Hospital about one in three stethoscopes was found to be contaminated with potentially lethal MRSA (methicillin-resistant Staphylococcus aureus) (131). When cleanliness becomes a billable procedure, its scientific value will be re-discovered, again.

Sudden Infant Death Syndrome (SIDS) is a disease known to every parent. Typically, the baby is left to sleep. When the parents check in on the baby, they find that it is dead. Moments of temporary sleep apnea are common in babies and adults. In SIDS, the process of breathing simply stops, and does not resume. Autopsies on SIDS patients have never shown any consistent conditions in organs that may have caused death. Many bright medical researchers have devoted their careers to SIDS. The obvious suspects (respiratory controls in the brain and lungs) were examined in hundreds of studies, with little to show for the effort. These expensive but fruitless research efforts were conducted in a time when an effective method to prevent SIDS was known; and ignored.

As early as the 1940s, the observation was made that many victims of SIDS were found in the prone position on pliant bedding (132). Similar observations were made again and again, and by the 1970s, people began to wonder whether babies could breathe adequately under these conditions (133). New Zealanders are credited with showing that the incidence of SIDS drops precipitously when infants sleep in a supine position, on a firm mattress. Numerous population studies have confirmed these observations. Currently, the "back-to-sleep" campaign is a worldwide effort whose goal is to spread awareness of a breakthrough in SIDS prevention, discovered more than six decades ago.

Scientists will reject observations that challenge their beliefs. No story better exemplifies this than the tale of seventeen centuries of night-blindness experienced by European astronomers. Hipparchus (190 B.C.E. - 120 B.C.E.) was an early Greek astronomer (Figure 6-9). In 150 B.C.E., he correctly calculated the distance from the earth to the moon (250,000 miles). Some years later, in 134 B.C. Hipparchus looked in the night sky and saw a new star (a nova). He was certain that the star was new because he had just finished mapping the known heavens when the new star appeared.



Figure

Figure 6-9. Hipparchus, the first to discover and record a new star appearing in the sky. Source: Wikipedia, public domain.

The next European to see a new star in the sky was Tycho Brahe, in 1572. The curious thing about this dark interim is that nova occur frequently. Several dozen nova, visible from earth with the naked eye, occur each year (134). Moreover, in the year 1054, the Crab Supernova was recorded by Chinese, Japanese, Persian/Arab and Indian astronomers. The Europeans, who were literally in the dark ages, somehow missed the event.



Figure

Figure 6-9. The Crab Nebula, shown here in a NASA image, contains the remnants of the 1054 supernova, carefully recorded for history by every civilization in the Northern hemisphere, with the exception of Europe. Source: Wikipedia, public domain NASA image.

The reason that no nova were observed in Europe, over a period of seventeen centuries, is very simple. The Europeans believed in the fixed heavens. If you believe that the heavens are the same now as they were when the universe was created, and will stay the same until the universe ends, then you will not see new stars twinkling in the night sky.

For many, the purpose of science is to confirm a set of preconceptions. When something new comes along that contradicts a previously held belief, it is ignored or rejected.

6.1 APPLAUDING BAD SCIENCE

"Intellectuals can tell themselves anything, sell themselves any bill of goods, which is why they were so often patsies for the ruling classes in nineteenth-century France and England, or twentieth-century Russia and America."

-Lillian Hellman

It is often easier to believe a bad idea than a good idea. Bad ideas can be carefully designed to provide people with something they want to believe, unconstrained by reality.

Geocentric heavens - Aristarchus of Samos (310 B.C.E. - 230 B.C.E.) correctly reasoned that the earth orbits the sun. Four centuries later, Ptolemy (90 - 168) inserted the earth into the center of the universe. Ptolemy's vision prevailed for about 1500 years. In 1543, Nicolaus Copernicus (1473 - 1543), published De revolutionibus orbium coelestium (On the Revolutions of the Celestial Spheres), proving that Aristarchus was correct. Even so, renasissance cosmographers continued to put earth in the center of things, as depicted in a 1568 chart by the Portuguese cosmographer Bartolomeu Velho (Figure 6-10).



Figure

Figure 6-10. The Ptolemaic Universe, by the Portuguese cosmographer and cartographer Bartolomeu Velho, in 1568. Source: Wikipedia, public domain.

Titius-Bode Law - In 1766, Johann Titius (1729 - 1796) found that the distances of the planets from the sun, in astronomical units, were determined by a simple formula: double the number of each planetary orbit (after the first), add 4 to each number, and divide by 10. The law predicted a missing planet between Mars and Jupiter. The presence of asteroids in this location prompted speculation that the missing planet had exploded in the distant past. Johann Bode popularized Titius' work in his 1772 astronomy textbook. Alas, discoveries of Neptune (in 1846, at a location predicted by Le Verrier, not Titius), and Pluto (1930) violated the Law. Today, The Titius-Bode Law (often incorrectly called Bode's Law, a sterling example of Stigler's Law in action), is considered a vacuous exercise in numerology, with no basis in theoretical or observational science.

Canals on Mars - Well into the twentieth century, scientists believed that there were canals on the planet Mars. Optical lines criss-crossing Mars were first observed by the Italian astronomer Giovanni Virginio Schiaparelli (18351910), in 1877. The observations stirred the imagination. Here was irrefutable evidence that a riparian civilization thrived on an alien-created canal system. We now know that the canals are an optical illusion, and do not represent any physical structure, water-filled or otherwise (Figure 6-11).



Figure

Figure 6-11. Schiaparelli's map of mars, showing canals. Source: Wikipedia, public domain.

Status thymicolymphaticus - In the late nineteenth and early twentieth centuries, doctors attributed childhood asthma and crib death (now known as sudden infant death syndrome) to enlarged thymus glands; they named the condition status thymicolymphaticus. In the 1920s, doctors radiated enlarged thymus gland of children as a preventive measure against crib death. It is estimated that about 20,000 - 30,000 people died from cancers produced by "therapeutic" radiation for this and other real or imagined disorders (135). We now know that status thymicolymphaticus is not a disease. Some children are born with larger thymus glands than other children, but no disease syndrome results from this anatomic disparity.

Stomach cancer produced by a worm - The 1926 Nobel prize for medicine went to Johannes A.G. Fibiger, who discovered a cause of cancer that that was eventually shown to be an artifact. According to Fibiger, a larval parasite caused stomach cancer in rats. Years later, scientists concluded that the tumors must have been caused by some other factors. Humiliated by their mistake, the Nobel Assembly waited four decades before they awarded the prize to another cancer researcher.

Frontal lobotomies - The frontal lobotomy was invented by Dr. Antonio de Egas Moniz in 1935 and popularized by Dr. Walter Freeman. For the procedure, Dr. Freeman applied local anesthetic, then inserted a gold-plated ice-pick just above the eyeball, and shoved it into the brain. The Doctor gingerly scraped the ice-pick through the frontal lobe, the presumed site of unrestrained emotions. Apathy and mental impairment often followed the procedure, and this was considered an improvement in most cases. Dr Freeman performed over 3,500 procedures; his disciples, performed about 40,000 more. The procedure has since been largely discredited, but not before Dr. Moniz received the 1945 Nobel prize in medicine, honoring his dubious gift of frontal lobotomy.

Polywater - In the 1960s, soviet researcher Nikolai Fedyakin introduced polywater to the world; a polymerized form of water with a higher boiling point, lower freezing point, and higher viscosity than ordinary water. Other workers seemed able to repeat and extend Fedyakin's early observations. After many years of wasted effort, the scientific community finally conceded that polywater experiments were unrepeatable and that polywater does not exist.

Phrenology - Phrenology is the pseudoscience that predicts personality by inspecting the surface features of a person's skull. Phrenology was invented by the German physician, Franz Joseph Gall, in 1796, but was practiced well into the twentieth century. Phrenologists believed that personality, the aggregate expression of many different brain functions, could be predicted by measuring protrusions of the skull overlying brain regions lifted by high levels of activity or depressed by atrophy (Figure 6-12). Nineteenth and twentieth century discoveries in brain science provided a theoretical basis for phrenology by assigning specific cognitive functions to specific anatomic locations of the brain. It was a nice idea, but completely wrong.



Figure

Figure 6-12. Phrenologist's skull chart. Source: Wikipedia, public domain.

Cold fusion - Stars are fueled by fusion. For decades, physicists have been trying to develop a controlled fusion reactor that would provide unlimited energy, from hydrogen; without much success. In 1989 Martin Fleischmann and Stanley Pons held a press conference to announce that they had produced fusion in a tabletop experiment involving electrolysis of heavy water and a palladium electrode. Fleischmann and Pons did not fully specify the theoretical basis for their success, but physicists throughout the world were only too happy to fill the void with theories of their own. Several laboratories reported that the observations of Fleischmann and Pons were repeatable! Meetings, seminars, and workshops were hastily assembled and attended by the top minds in physics. Lectures were delivered explaining how cold fusion worked. As time went by, despite early declarations of success, other laboratories could not achieve cold fusion. The theoretical works explaining cold fusion have been discredited. The long, frustrating quest for free, unlimited fusion energy continues.

6.2 PROGRESS? WHAT PROGRESS?

"The progress of man is based on disbelief of the commonly accepted."

-J. Frank Dobie

Much of what we call modern science was actually discovered by a few dozen Greek thinkers in a span of about 300 years. Most of the important events in human history seemed to play out in a very short time, in a very small country.

460 B.C.E. Hippocrates used boiled water when irrigating wounds (first use of asepsis)

460 B.C.E. Zeno of Elea proposes his "Dichotomy" paradox; basically, you need to traverse half a distance before you traverse a whole distance, but there an an infinite number of half-distances in any traversal, so how can you traverse any distance?

460 B.C.E. Pericles leads Athens into golden age.

440 B.C.E. Democritus invents "atoms."

429 B.C.E. Plague in Greece, also known as Plague of Athens.

420 B.C.E. Hippocrates observes that each side of the brain controls the opposite side of the body.

404 B.C.E. Athens capitulates to Sparta, ending Peloponnesian Wars. Sparta wisely spared Athens; simply added it to Sparta's province.

399 B.C.E. Socrates is condemned to death for corrupting the minds of Athenian youth (Figure 6-13).

380 B.C.E. Plato finishes The Republic.

350 B.C.E. Aristotle determines that earth must be round.

350 B.C.E. Aristotle classifies animals. His assignment of dolphins with mammals was received with derision for about two millennia, when he was belatedly proven correct.

337 B.C.E. Philip II of Macedon creates League of Corinth and essentially becomes the commander of the all-Greek army, set to attack the Persian empire. After Philip's assassination (in 336 B.C.E.), his son, Alexander, picked up the gauntlet.

331 B.C.E. Alexandria founded in Egypt (by Greece), grafting Grecian culture (itself highly influenced by Egyptian culture) back into Egypt.

331 B.C.E. Alexander captures Mesopotamia and Babylon.

326 B.C.E. Alexander captures the Punjab, and his long, exhausting campaign for world domination stops at the River Hyphasis.

323 B.C.E. Alexander the Great (356 B.C.E. - 323 B.C.E.) dies.

320 B.C.E. Theophrastus classifies 500 plants (de Historia Plantarum). He divided plants into two larg categories: flowering (angiosperms) and non-flowering (gymnosperms) and recognized that flowers were specialized leaves.

300 B.C.E. Euclid's Elements written in Alexandria. Becomes geometry standard for over 2,000 years and counting.

300 B.C.E. Pytheas sails from Greece to Iceland. Nobody believes him.

300 B.C.E. Pytheas describes Atlantic tides (absent in Mediterranean). Nobody believes him.

280 B.C.E. Aristarchus reasons that the sun is the center of the universe.

260 B.C.E. Archimedes describes principles of levers.

260 B.C.E. Archimedes calculates Pi as 3.142.

240 B.C.E. Eratosthenes, working in Alexandria, computes size of earth correctly.

150 B.C.E. Hipparchus calculates distance to moon correctly, 250,000 miles.

146 B.C.E. Corinth (Greece) plundered, essentially marking the end of the free Greek city states and increased Roman influence in Greece and Macedonia. Rome benefitted by the absorption of Greek philosophers, physicians and scientists.

134 B.C.E. Hipparchus finds a newly appearing star (nova). The next recorded nova in Europe was made by from Tycho Brahe, in 1572.

134 B.C.E. Hipparchus makes first star map (includes about 850 of the 2500 stars visible to the naked eye).



Figure

Figure 6-13. Death of Socrates, by Jacques-Louis David, 1787. Source: Wikipedia, public domain.

Our modern triumphs are puny compared to those of a few men, several thousand years ago.

By 1960, industrial science reached the level that we see today. In 1960, we had home television (1947), transistors (1948), commercial jets (1949), computers (Univac, 1951), nuclear bombs (fission , fusion in 1952), solar cells (1954), fission reactors (1954), satellites orbiting the earth (Sputnik I, 1957), integrated circuits (1958), photocopying (1958), probes on the moon (Lunik II, 1959), practical business computers (1959), lasers (1960). When you watch a movie circa 1960, and you look at streets and houses, and furniture, and clothing, do you see any differences between then and now? Not much. Nearly all the scientific advances that shaped the world today were discovered prior to 1960.

These engineering and scientific advancements pale in comparison to the advances in medicine that occurred by 1960. We had the basic principles of metabolism, including the chemistry and functions of vitamins; the activity of the hormone system (including the use of insulin to treat diabetes and dietary methods to prevent goiter), the methodology to develop antibiotics and to use them effectively to treat syphilis, gonorrhea, and the most common bacterial diseases. We had effective vaccines that protected us from deadly viruses, such as smallpox. Sterile surgical technique was practiced, bringing a precipitous drop in maternal post-partum deaths. We could provide safe blood transfusions, using A,B,O compatibility testing (1900). X-ray imaging had improved medical diagnosis. Civil engineers prevented a wide range of common diseases using a clean water supply and improved waste management. Safe methods to preserve food, such as canning, refrigeration, and freezing saved countless lives. In 1941, Papanicolaou introduced the smear technique to screen for precancerous cervical lesions, resulting in a 70% drop in the death rate from uterine cervical cancer in populations that implemented screening. By 1947, we had overwhelming epidemiologic evidence that cigarettes caused lung cancer.

When we entered 1950, Linus Pauling had essentially invented the field of molecular genetics by demonstrating a single amino acid mutation accounting for the the defective gene responsible for sickle cell anemia. In 1950 Chargoff discovered base complementarity in DNA. Also, in 1950, Arthur Vineburg routed an internal mammary artery, in place, to vascularize the heart. In 1951, fluoridation was introduced, greatly reducing dental disease. Then came isoniazid, the drug that virtually erased tuberculosis (1952). Also, in 1952, Harold Hopkins designed the fibroscope, heralding fiberoptic endoscopy. In 1953, Watson and Crick showed that DNA was composed of a double helix chain of complementary nucleotides encoding human genes. John Gibbon performed the first open heart surgery using a cardiopulmonary bypass machine (1953), and D.W. Gordon Murray used arterial grafts to replace the left anterior descending coronary artery (the coronary artery bypass graft). Oral contraceptives (birth control pills) were invented in 1954. That same year, Salk developed an effective killed vaccine for polio, followed just three years later with Sabin's live polio vaccine. Thus, in the 1950s, the two most dreadful scourges of developed countries, tuberculosis and polio, were virtually eradicated.

Don't believe those reports announcing longer life expectancies for Americans. The people who are living longer today are the people who were born in the twentieth century and benefited directly from the advances in medicine occurring prior to 1960. Nobody has any way of knowing whether children born in the twenty-first century will live longer lives than their twentieth century predecessors. But their chances for long lives do not look very good. Here are some of the medical reversals that have occurred since 1960.

1. The worldwide spread of AIDS, a virus-spread disease that could have been eradicated with a few simple precautions, but was not.

2. The emergence of multiple drug-resistant tuberculosis. The root cause of the rise of resistant TB is the incomplete treatment of identified patients.

3. The emergence of multiple antibiotic resistant strains of Staphylococcus aureus.

4. Global warming, loss of the ozone layer, and other consequences of atmospheric pollution.

5. Mass starvation.

6. Reduced access to potable water, affecting the vast majority of humans, and resulting in epidemics of diarrheal diseases.

7. Planetary scale deforestation and desertification.

8. Monoculture of a few favored crops, and the elimination of agricultural biodiversity.

9. Large scale emergence of invasive and destructive species of plants and animals.

10. Increases in the total number of U.S. deaths from cancer.

11. The re-emergence of resistant insect and other vectors carrying viral and parasitic diseases.

12. Astronomical costs of new medications for chronic diseases, unaffordable to all but a small percentage of the world population.

13. The rising worldwide incidence of obesity and its sequelae.

14. The rapid geographic spread of outbreaks of new strains of influenza and other evolving viruses, including HIV and hemorrhagic fever viruses.

If the rate of scientific accomplishment is dependent upon the number of scientists on the job, you would expect that progress would be accelerating, not decelerating. According to the National Science Foundation, 18,052 science and engineering doctoral degrees were awarded in the U.S., in 1970. By 1997, that number had risen to 26,847, nearly a 50% increase in the annual production of the highest level scientists (136). The growing work force of scientists failed to advance science very much, but it was not for lack of funds. In 1953, according to the National Science Foundation, the total U.S. expenditures on research and development was $5.16 billion, expressed in current dollar values. In 1998, that number has risen to $227.173 billion, greater than a 40-fold increase in research spending (136).

Unproductive scientists always promise a breakthrough just around the corner. What else would you expect them to say? Humans live in hope, but funding agencies are expected to calculate the future based on measurements of past performance. The U.S. Department of Health and Human Services has published a sobering document, entitled, "Innovation or Stagnation: Challenge and Opportunity on the Critical Path to New Medical Products. (137) " The authors note that fewer and fewer new medicines and medical devices are reaching the Food and Drug Administration. In the past few years, only a handful of important drugs have entered the market, and most are molecular variations of previously available drugs (138). For example, following Simvastatin, five new statins have been brought to market (Mevacor, Lipitor, Pravachol, Lescol, and Crestor). Each new drug is sold at high cost, while under patent, but does each new drug bring innovation beyond that offered by Simvastatin, now sold as an inexpensive generic? Significant advances in genomics, proteomics and nanotechnology have not led to significant advances in the treatment of diseases. Extrapolating from the level of scientific progress in the past half century, there's not much reason to expect great improvements in the next 50 years. The last quarter of the 20th century has been described as the "era of Brownian motion in health care" (139). Wurtman and Bettiker, in their review of medical treatments, commented that, "Successes have been surprisingly infrequent during the past three decades. Few effective treatments have been discovered for the diseases that contribute most to mortality and morbidity" (140).

Meanwhile, science has become irrelevant for many people (141). A growing number of Americans (perhaps the majority), do not believe in global warming, do not believe in evolution, and do not believe that vaccines are safe and effective. A large number of people, without much evidence to support their fears, believe that vaccines cause autism, that water fluoridation is harmful, and that AIDS was invented by government scientists as a genocidal agent to be used against black populations. These days, scientists are met with suspicion, if not outright hostility, by a large percentage of the world.

Among the many shortcomings of modern science, cancer research sits high on the list. Scientists tell us that they are making great advances in the treatment of cancer. Anyone can see that this is not so. The total U.S. age-adjusted cancer death rate today is about where it was 60 years ago (142). Though deaths from some types of cancer have dropped, these drops have been offset by the rise in other cancers. Of the cancers that have dropped the most: stomach cancer and cancer of the uterine cervix, improved mortality is due to a drop in cancer incidence, not due to any progress in treating advanced cancers. The reduced incidence of stomach cancer is generally credited to refrigeration and improved methods of food preservation. The drop in cervical cancer has been due to effective Pap smear screening for precancerous lesions (small lesions that precede the development of invasive cancer). The HPV vaccine will, in all likelihood, prevent many additional cases of cervical cancer.

Cancer death rates that have increased since 1950 include: esophageal cancer, liver cancer, pancreatic cancer, lung cancer, melanoma, kidney cancer, brain cancer, non-Hodgkins lymphoma, and multiple myeloma. The list includes some of the most common types of cancer. If cancer research were effective, we would expect to have ways of preventing the rise in incidence of these common cancers.

With the exception of curing a few types of rare tumors, cancer research has yielded none of the dramatic advances seen in the 1950s, with diseases such as polio and tuberculosis.

Over the decades, clever cancer researchers have discovered a successful strategy for attracting millions and millions of dollars of research funding for diseases that they cannot cure. Each year, they point to the number of people who will die from cancer, and they say, that cancer is a terrible diseases, causing untold suffering, and killing hundreds of thousands of Americans each year. Certainly, they argue, research to cure this dreadful disease must be funded. They fail to mention that the reason that hundreds of thousands of people die each year from cancer is that the scientists who received money to cure cancer failed to deliver the cure. Every year, the bulk of cancer funding is delivered to the very same institutions and laboratories that failed to produce any reduction in the cancer death rate.

6.3 THE CONSEQUENCES OF REJECTION

"The purpose of life is to be defeated by greater and greater things."

-Rainer Maria Rilke

Scientists live in a pervasive culture of rejection. Recent and past history provides ample proof that good science is not exempted from the withering effects of rejection. It would also appear that scientific advancement is stagnating, despite access to unprecedented funding largesse and a huge workforce of highly trained scientists.

There are many factors that contribute to the slowdown in scientific progress. Some claim that we have made most of the scientific discoveries that will ever be made; that there's not much left to do. Some might suggest that we have shifted into a new era of collective intelligence (e.g., twitter, facebook, social networking via texting) that transcends outmoded notions of scientific advancement. Regardless, it is impossible to avoid the conviction that unrelenting, spirit-crushing rejections take their toll on our societal effort to advance science. Rejections follow a scientist throughout his/her career: disappointing SAT scores, rejections to college of choice, poor grades, rejections to graduate schools, scornful treatment in graduate school, cold reception of research ideas, rejection of manuscripts, lack of any peer response to published manuscripts (i.e., research papers that nobody bothers to read), grant rejections, tenure rejections, and so on.

Many scientists cope by taking the path of least rejection throughout their careers: non-innovative grant applications (grant reviewers tend to approve applications that they can easily grasp, for work that can be easily accomplished), blind devotion to existing paradigms, group research projects, narrowly focused research (less likely to be rejected by reviewers), delegation of risks (let somebody else get rejected), demise of the single author research paper (dozens of co-authors decrease rejection rate).

6.4 ADVICE TO EVIL SCIENTISTS

1. Any scientific work can be justifiably rejected.

2. People only believe what suits them. If it is not in their perceived interest to believe in global warming, evolution, the health benefits of vegetarianism, the hazards of nuclear proliferation, the irresponsibility of corporations, the dangers of aggressive or distracted driving, the dwindling availability of oil, the value of public health interventions, they will not believe any findings that support these hypotheses. Don't waste your time trying to convince people to believe something they do not want to believe.

3. People will not accept ideas they cannot grasp, unless they directly benefit from the belief. For example, religions that promise an eternal afterlife, in paradise, have more followers than religions that promise a brief life filled with sorrow and persecution, followed by eternal non-existence.

4. Join a famous laboratory. Scientists are highly xenophobic and will ignore work from scientists they do not know. They will review your grant applications with thinly disguised hostility, judging you instead of your proposal ("This applicant has made no recognized contributions to the field."). When you join a respected laboratory, you work will be respected, regardless of its merits.

5. Don't try to discredit the research of powerful people in your field. Your papers will be rejected. Your grant proposals will not be funded. Your research will be never see the light of day.

6. Jump on the bandwagon; restrict your curiosity to well-funded fields of research. Cancer is well-funded; diarrhea is not (though more lives have been saved from diarrhea research than from cancer research) (143).

7. Conduct tabloid-ready research. A diet pill is news. An improved method for solid waste treatment is not news.

8. Work on sure things. Lots of well-funded projects have no serious hypothesis. The Human Genome Project (sequencing all of the DNA in the human genome) had no hypothesis. DNA sequencing methods were available to the scientists who launched the project. The effort more closely resembled a long, expensive chore, rather than an exciting scientific investigation.

9. Get backing from funders who are fully invested in the project. When your funding organization wants your project to succeed, they will do everything in their power to publicize your findings and exaggerate the importance of your work.

10. Stop setting yourself up for a fall. Rejection comes when you seek the approval of others in your field. Get someone else to do your research, draft your papers, prepare your grant proposals, write the chapters in your book. Rejections are easy to take when someone else has done the work.

11. In science, failure is the norm; success is the exception. If you want to be right more often than any of your colleagues, always predict failure. If you want to be popular, always predict success.

12. The key to dealing with rejection is to stop caring. If you don't care what other people think, rejection is just a minor nuisance.

13. Don't think of rejection as a bad thing. You can be quite certain that, at any moment, somewhere on this planet, a great idea is being ridiculed, and a great scientist has abandoned all hope of success. This is nature's way of making room for evil scientists, who are equipped to survive in a stupid and hostile environment.





CHAPTER 7. COMPLEXITY: THE DEVIL IS IN THE DETAILS

"Any informatics problem can be solved by adding an extra layer of abstraction."

-Anonymous, often referred as the golden rule of computer science

"There are 10 kinds of people...those who use binary annotation and those who do not."

-Anonymous

In the prior chapter, we discussed scientific progress, or, more precisely, the lack thereof. Is it possible that in the past half century, we have made no medical progress whatsoever? Well, maybe there were a few bright moments. Here are just about all of the the major breakthroughs in medicine occurring since 1960.

1. Zinc drastically reduces childhood deaths from diarrhea, a disease that kills 1.6 million children under the age of five, every year (143).

2. Helicobacter pylori causes gastritis, gastric ulcers, and some stomach cancers (144). A simple antibiotic treatment cures gastritis and reduces the incidence of stomach cancers (145). This work earned the two discoverers, Barry Marshall and Robin Warren, the 2005 Nobel prize

3. When babies sleep on their backs, instead of their stomachs, the incidence of SIDS (sudden infant death syndrome, or crib death) plummets (133).

4. Daily aspirin ingestion seems to reduce deaths from cardiovascular disease and colon cancer (146).

All of the significant medical advances in the past few decades (and there haven't been many) have been simple measures. All of the great debacles in medicine have been complex. This is because scientific methods have reached a level of complexity that nobody can understand.

Gone are the days when a scientist could describe a simple, elegant experiment that could be replicated by his peers. When several laboratories perform the same experiment, using equivalent resources, and producing similar results, it is a safe bet that the research is valid (111).

Today, much of research is conducted in a complex, data-intensive realm. Individual studies can cost millions of dollars, involve hundreds of researchers, and produce terabytes of data. When experiments reach a high level of cost and complexity, repetition of the same experiment, in a different laboratory, becomes impractical.

In the late 1990s, a variety of data-intensive methods were developed for molecular biology, all of which required complex and sophisticated algorithms to convert the raw data into measured quantities. One such method is gene expression microarrays. In these studies, RNA molecules in tissue samples are converted to DNA and incubated against an array of pre-selected DNA samples. Identical sequences will, under precise conditions, anneal to form double-stranded molecules. The number of matches can be semi-quantitated, and a profile of the relative abundance of every RNA species in the original sample produced. RNA profiles in one specimen can be compred with the profiles of other specimens. Using these comparisons, medical researchers have tried to identify profiles (of diseased tissues) that predict responsiveness to particular types of treatment. In particular, researchers have tried use cancer tissue profiles to predict the likelihood that a specific tumor will respond to a specific type of treatment. Since the late 1990s, an enormous number of studies have been funded to produce the tissue microarray profiles for many different diseases, in many different clinical stages, and to correlate these profiles with treatment response.

Because there are so many different variables in the selection of patients, the selection of tissues, the preparation of tissues, the selection of microarray reagents, the collection of data, the conversion of data to a quantifiable measure, and the methods of analyzing the data, it is impossible for different laboratories to faithfully repeat microarray experiments. Michiels and co-workers have shown that most microarray studies could not classify patients better than chance (147). Still, the field of microarray profiling continues, as it should, because every field has its obstacles. Continued efforts may resolve seemingly intractable problems. Or the field may collapse, a victim of its own complexity. Experience suggests that it takes at a few decades to thoroughly discredit a well-funded idea.

Artificial intelligence is the field that employs computers to make decisions that humans cannot. Computers can perform millions of computations in a second, and can store and search huge quantities of technical data. Computers have earned their place in every space launch, surely computers will prove themselves indispensable to physicians, faced with tough diagnostic problems. Despite decades of funded efforts, artificial intelligence has made very little headway among practicing physicians. In a 2002 review of a computerized decision support system, the authors found that "The computerised decision support system had no significant effect on consultation rates, process of care measures (including prescribing), or any patient reported outcomes for either condition. Levels of use of the software were low (148)." Today, computers play an essential role in every field of science, including medicine. Still, medicine is a subtle and complex art, that cannot be reduced to a set of algorithms, no matter how much funding is thrown at the task. Every attempt at modeling the medical decision-making process has met with failure. Irrational as it may seem, when it comes to making life-or-death decisions, humans prefer to make their own mistakes.

In general, computers cannot perform tasks where the operational rules are in constant flux. Here is a case in point. The U.S. Veterans Administration Medical System operates about 175 hospitals. This is an immense undertaking, but the work is accomplished fairly well, using a rather simple algorithm. The VA hires a bunch of doctors, nurses and healthcare workers, gives them a set salary, and houses them in hospital buildings. When registered patients appear in their clinics, the VA pays for the supplies necessary to treat the patients. Each year, the Congress appropriates the funds to keep the VA going the next year. One of the greatest benefits of the VA system is the lack of billing. Patient visits, medical procedures, diagnostics, pharmaceuticals, and other medical arcana are absorbed into the general budget. If you were to compare the level of complexity of the VA healthcare system with the level of complexity of 175 privately operated hospitals, you would find the VA system to be a model of simplicity.

Then one day, somebody asked, "Should the VA pay for medical services rendered on veterans who have their own private insurers?" Having no affirmative answer, the VA undertook an effort to pry reimbursements from the private insurers of veterans treated at VA hospitals. Suddenly, billing and expense records became important to the VA, an institution with no experience in fee-for-service care.

The VA planned a $472 million software system to track billing and other financial transactions. The pilot site was the Bay Pines VA, in Florida. After preliminary testing at Bay Pines, the system, known as the Core Financial and Logistics System, or CoreFLS, would be rolled out to all of the VA hospitals nationwide. Unfortunately, the system could not be implemented at Bay Pines. Neither the software nor the humans were up to the job. In 2005, the VA decided to pull the plug on a $472-million system at because it did not work (149).

Four years later, in 2008, the Government Accounting Office reviewed the billing performance on just 18 of the 175 or so VA hospitals. It found that these 18 hospitals, in fiscal year 2007, failed to collect about $1.4 billion that could have been paid by private insurers. The report from the Government Accounting Office concluded, "Since 2001 we have reported that continuing weaknesses in VA billing processes and controls have impaired VAs ability to maximize the collections received from third-party insurers. (150)"

Why, after so many years, has the VA not succeeded in billing private insurers for VA care delivered to privately insured veterans? The reason can be distilled in one word: complexity. When the VA tries to collect from third party payers, they must deal with insurers across fifty states. Private insurers have their own policies, and their own bureaucracies, that are constantly changing those policies. The job of collecting the money was simply too complex to succeed.

Hospital information systems are among the most complex and most expensive software systems. The cost of a hospital information system for a large medical center can easily exceed $200 million. It is widely assumed that hospital information systems have been of enormous benefit to patients, but reports suggest that 75% of installed systems are failures (151). Software crashes that bring hospitals to their knees are not uncommon. A November, 2002 crash at Beth Israel Deaconess Hospital in Boston disabled computer systems for four days (152). Common complaints include systems that never attain full functionality, poor vendor support, restricted access to system source code, and vendor bankruptcies (153).

If Hospital Information Systems worked well, why does the cost of healthcare continue to rise? Has information technology eliminated the fragmentation of medical care or reduced the complexities of health payment plans? Evidence for the value of implementing complex health information technology in community hospitals is scant. Implemenation failures are easy to find (154), (155), (151). Most of the credible reports on the benefits of Hospital Information Systems come from large institutions that have developed their own systems incrementally, over many years, correcting mistakes as they occur, and assembling a a staff with expertise in the system (156).

Much can be learned from documented technology disasters. A 2003 article in the British Medical Journal described a failed effort to deploy a computerized integrated hospital information system in Limpopo (Northern) Province of South Africa (151). This poor province invested heavily to acquire the system. The article describes what went wrong and provides a list of factors that led to the failure of the system. There was an underestimation of the complexity the undertaking and insufficient appreciation of the length of training required by the hospital staff.

One of the most challenging features of many Hospital Information Systems (HISs) is computerized physician order entry (CPOE). The intent of CPOE is to eliminate the wasteful hand-written (often illegible) doctor's orders that need to be transcribed by nurses, pharmacists, and laboratory personnel before they're entered into the HIS. Having the physicians directly enter their orders into the HIS has been a long-awaited dream for many hospital administrators. In a fascinating report, patient mortality was shown to increase after implementation of CPOE. In this study, having CPOE was a strong, independent predictor of patient death. Somehow, a computerized service intended to enhance patient care had put patients at increased risk (157).

High-tech medical solutions seldom achieve the desired effect when implemented by low-tech medical staff. Introducing complex informatics services, such as CPOE, requires many hours of staff training. There needs to be effective communication between the clinical staff and the hospital IT staff and between the hospital IT staff and the HIS vendor staff. Everyone involved must cooperate until the implemented system is working smoothly. This is virtually impossible. Hospital personnel know that a wide range of standard practices (such as complex tests, tests using specialized imaging equipment, procedures that require patient preparation or transportation, timed-interval dosage administration, expert consultations, interventions that require close attending staff supervision) become very iffy on weekends, holidays, and after about 4:00 PM on weekdays. It is difficult to get shift workers to interface seamlessly with a computer system that never sleeps.

When it comes to hiding in the safe shadow of complexity, nobody does it better than software designers. They will take a problem, such as computer-aided diagnosis, or computer-aided medical decision-making, and produce a software application that purports to provide an answer. We fool ourselves into thinking that the designers of complex software systems must understand how the system works. Computers allow us to design complex, interdependent, systems that are unknowable and unpredictable.

Software failure is a sensitive indicator of the limits of complexity. It is very easy to create software that works at a level of complexity beyond anything found in physical systems. The weakest programmers tend to fix bugs with layers of subroutines. Stronger programmers will simplify the problem and re-write their code, eliminating unnecessary subroutines. A 1995 report by the Standish group showed that most software projects sponsored by large companies are failures. Only 9% of such project are finished on time and within budget, and many of the finished projects do not meet the required performance specifications (158).

Each year, in the U.S., approximately 400 million radiologic procedures are performed that expose patients to nuclear radiation (159). In many cases, complex software helps to determine and control the location, spread, intensity and total amount of radiation delivered to patients. Are mistakes made? You betcha. Probably the most famous medical software disaster involved the Therac-25 (160). Between 1985 and 1987, at least 6 patients received massive overdoses of radiation due to a software error in a radiation therapy device. A review of the incidents uncovered numerous errors in the engineering and in procedures for detecting and correcting software problems. Software errors in radiation devices did not stop with the Therac-25. In 2005, a Florida hospital reported that 77 cancer patients were overdosed with radiation due to a software error that went undetected for a year (161). At Cedars-Sinai Hospital, in Los Angeles, 260 patients were exposed to as much as eight times the proper radiation from diagnostic CT scans. The errors were found when patients complained that their hair was falling out (162).

Medical software errors are not rare. The FDA analyzed 3140 medical device recalls conducted between 1992 and 1998 reveals that 242 of them (7.7%) are attributable to software failures. Of those, 192 (or 79%) were caused by software changes made after the software's initial production and distribution (163).

The National Reconnaissance Office is the U.S. agency that handles spy satellites. In 1998, the agency offered a contract to build a new generation of satellites. The contract went to Boeing, which had never built the kind of satellite specified in the contract. According to an investigative article written for the New York Times, the Boeing engineers designed subsystems of such complexity that they could not be built (164). Because the workforce was inexperienced in assembling satellites, they included parts that could not work in space. Most noteworthy was their use of tin parts, which deform in space, sometimes leading to short circuits. Seven years later, the project was killed, after running costs estimated as high as $18 billion dollars. Experts reviewing the failed project indicated that it was doomed from the start. Basically, the level of complexity of the project exceeded Boeing's ability to fulfill the contract, and exceeded the government's ability to initiate and supervise the contract (164).

There are some projects that seem to hover just outside human reach: sending men to mars, commercializing supersonic transport jets, long-term stock market predictions, introduction of species to a foreign ecological environment, tamper-proof computerized voting machines, planned tactical warfare, etc. It is not as though the world does not contain complex, and functional, objects. Jet planes, supercomputers, skyscrapers, telecommunication satellites, butterflies, and humans are just a few examples. These highly complex objects all arose from less complex objects. Butterflies and humans slowly evolved, over billions of years, from an early life form. Jets and other complex machines were built by teams of humans, working from a collective experience, adding improvements incrementally, over decades. Good complexity takes time to develop.

The savvy evil scientist understands that incompetencies, blunders, frauds, and assorted crimes can all be buried under scientific complexity. If you are a bad scientist, and you cannot do anything right, and you know that anything you try to do will produce unrepeatable results, the safest strategy is to confine your efforts to a complex realm of well-funded research.

7.1 LAZY DATA

In the complex realm of modern medicine, where life and death lies in the balance of clinical decisions, catastrophes occur when data gets lazy.

If you should ever have the opportunity to leaf through the pages of a medical chart, you're apt to come across the abbreviation: WNL. WNL is intended to indicate that an observation or measurement was "Within normal limits". More often than not, WNL really means "We never looked." A busy doctor or nurse will often find it inconvenient to measure respirations (inspirations per minute), blood pressure, pulse rate, and temperature, the so-called vital signs, on every patient, on every round. If you look at a patient's chart, and you find that every entry for the vital signs is entered as: "Respirations: 12, Blood pressure: 120/80, pulse 72, temperature 98.6," you can be certain that the values were obtained without the aid of a measuring device. Nobody in a hospital has perfectly normal vital signs, without variation, on every set of measurements. This is an example of WNL.

The introduction of "WNL" provided medical staff with yet another time-saving innovation. No longer must caregivers feel the need to invent a set of fictitious numbers. By applying WNL, the chart will indicate that the vital signs, whatever they might be, were within normal limits.

Hospitals provide staff with numerous opportunities to seem professional, on paper, without really doing much of anything. In 1994, Betsy Lehman, an award-winning health columnist for The Boston Globe, was treated for breast cancer at the world-renowned Dana Farber Cancer Institute. While there, she received four times the intended dose of the cancer drug, Cytoxan, over four consecutive days, and died. At Dana Farber, treatment protocols are always reviewed by pharmacists and caregivers. None of the people who checked-off their approvals had actually looked at the dosage and perceived that it was wrong. After the wrong dosage was given, and the patient reacted by vomiting blood admixed with sheets of intestinal lining cells, the staff failed to take immediate action (165). At the time, it seemed that Ms. Lehman's reaction was WNL ("Within normal limits"), but it was much closer to WNL ("We never looked").

Tragic as the Dana Farber incident may be, it pales in significance to the scale of carelessness exhibited at Harlem Hospital in New York (166). Echocardiograms are very specialized ultrasound tests that measure the functionality of the heart muscle and the heart valves. They're not cheap, costing up to about $500. Doctors only order the test when they are concerned that the patient might have a heart problem. At Harlem Hospital, about 4,000 echocardiograms were ordered, but the doctors never read the reports. The tests were performed, and the patients were billed, but the results were not delivered to the chart or to the doctors who ordered the tests.

Now, you might think that a doctor who ordered an electrocardiogram would insist on seeing the results. But no. The backlog of unreported results was found during a routine review of records by staff affiliated with the hospital's corporation (not by the doctors who treated the patients).

Each year at Harlem hospital, about 2,500 electrochardiograms are ordered. This means that the 4,000 backlogged cases occurred over a period of nearly two years. None of the doctors who ordered those tests seemed to notice that they never got the results. WNL in action!

7.2 COMPLEX DECISIONS

In a recent New York Times Article, Stephanie Saul told the story of a woman who had been given the diagnosis of DCIS (ductal carcinoma in situ, or non-invasive breast cancer), who subsequently received treatment (surgery, radiation and drugs), and who was later informed that the diagnosis was incorrect: she never had breast cancer (167).

The diagnosis of DCIS was rendered by a pathologist who was not a breast cancer specialist, but who had gone to the trouble of soliciting a second opinion, from another pathologist. The consulting pathologist, who worked at a nearby hospital, agreed with the first diagnosis of DCIS.

The misdiagnosis came to everyone's attention when the woman transferred her follow-up treatment to another hospital. Her records and pathology slides were sent to the transfer hospital, where a staff pathologist reviewed the pathology material. He found no evidence of cancer in the original biopsy or in the portion of breast that was subsequently removed at surgery. The slides were sent to several expert consultants, all of whom agreed that no tumor was present.

Not surprisingly, the case became the subject of legal action. The lawyer for the plaintiff indicated that the original pathologist [who misdiagnosed the case] could have easily sent the slides to an expert consultant [not to a non-expert pathologist from a nearby hospital.] It is likely that, should this case ever reach a courtroom, debate will center on whether the first pathologist exercised standard of care by seeking a second opinion from a pathologist who had no special expertise in breast cancer pathology.

Setting aside the specifics of the case described in The New York Times article, the broader question of expert consultants deserves the scrutiny of every evil scientist. As you shall see, the issue of choosing expert consultants has ramifications far beyond the small world of pathology.

First, you must understand that getting a second opinion is a lose-lose proposition. If your consultant agrees with your original opinion, nothing was gained. Everyone will assume that the diagnosis must not have been very challenging. You will learn that your opinion was actually superfluous. Only the consultant's opinion carries any real weight. Eventually, after a number of consultations, your employer may wonder why you are needed at all. Why not just pay the consultant to render diagnoses on all your specimens; in which case, your position can be terminated.

Of course, if the consultant disagrees with your opinion, your life will deteriorate rapidly. Everyone will assume that you are wrong, and that the consultant is correct. Your credibility will be destroyed. You may become the center of attention in a lawsuit. You will become a pariah among your co-workers. You may lose your job. Your permanent record will be blemished. You may become unemployable.

As an evil scientist, with no great competence, and prone to committing errors, you must learn to defend yourself. Follow the following recommendations, without deviation.

1. Pick a consultant that you trust to watch your back. This will almost always be someone who asks you to be his consultant when he needs a second opinion. A reciprocal consultation agreement virtually guarantees a non-threatening opinion.

2. In any field, most tasks are routine. In the specialty of pathology, 90% of cases are trivial and can be rendered correctly, and with complete confidence, by the most marginal pathologist. The remaining 10% of cases can be handled with equivocations ("The biopsy is consistent with but not definitely diagnostic of..."), temporizations ("A final diagnosis will be rendered after special stains and molecular tests are completed."), supplementations ("A few atypical cells are noted, but there is insuffficient material for an unequivocal diagnosis. I suggest re-biopsy."), and consultations ("We are waiting for a consultative report").

3. It is best for the marginal professional to eliminate the concept of a final diagnosis, entirely. Restrict yourself to vague pronouncements. On the official report, in the space normally reserved for the "Diagnosis" field, you must substitute the heading, "Diagnostic Impression." For example, "Diagnostic impression: Neoplastic process suggestive of invasive ductal carcinoma." Astrologers and palmists have perfected this dodge. Remember that the official tree of the evil scientist is "the hedge."

When you've picked your trusted consultant, you will need to be prepared to prove that he is an expert. This really is not very difficult, because nobody really knows how to determine whether any person qualifies as an expert. If you doubt this, try to answer the following:

1. Are experts infallible? Of course not. Experts are human and can make diagnostic errors.

2. Do experts make fewer errors than non-experts? Nobody really knows. In the medical field, there is no mechanism by which the diagnoses of experts can be evaluated.

3. Do experts routinely send their difficult cases to other experts? No. People who consider themselves experts tend to have high confidence in their own diagnostic acumen. Though studies have shown that overconfidence is the most common cause of medical error, the expert assumes that this caveat only applies to non-experts (168).

4. Do experts concentrate their efforts on a specific area, gaining expertise by seeing a large number of cases in their chosen field? Often, yes. But you must remember that simply seeing a large number of specimens does not prove that you're not an idiot. An incompetent pathologist can consistently misdiagnose a large number of specimens, just as easily as he can misdiagnose a specimen that he rarely encounters.

Basically, an expert is someone who is called an expert by others in his own field, such as yourself.

Given that experts can be mistaken, would it not be advisable to consult with more than one expert on very difficult cases? No, no, no, no. The absolutely worse thing you can do is to send a specimen to two experts. If they disagree, which expert will you believe?

Case in point. In 1993, Reggie Lewis was the 27 year old captain of the Boston Celtics. Mr. Lewis collapsed during a basketball game, and was treated by several teams of expert cardiologists. The team assembled by the New England Baptist Hospital believed that Mr. Lewis had focal cardiomyopathy, a life threatening condition requiring Mr. Lewis to retire from basketball. A second team of experts, assembled at the Brigham and Women's Hospital, disagreed. They rendered a diagnosis of vasovagal fainting, a benign condition. A third team of experts, from St. John's Hospital in Santa Monica, California, was non-committal. The Santa Monica team suggested that Mr. Lewis play basketball, but with a heart monitor attached to his body. With three discordant diagnoses, Mr. Lewis decided to take his chances, continuing his athletic career. Soon thereafter, Lewis died, quite suddenly, from cardiomyopathy, while playing basketball (169).

7.3 ADVICE FOR EVIL SCIENTISTS

1. Always strive for complexity. Stupid people confuse complexity with cleverness, and you can make this work for you.

2. Involve yourself in complex projects. Complex projects receive the most funding.

3. The more complex your data, the less likely it will be that anyone can prove that the data is wrong.

4. When competing for a contract on a complex project, always underbid your competitor. Knowing full well that the project will not be completed, regardless of who is awarded the contract, the contract committee will always opt for the lowest bidder.

5. Remember the "one miracle per grant" limit. Review committees will not give you a contract if your grant has too many high hurdles to surmount.

6. Remember to have a scapegoat. When some major catastrophe hits, someone, other than yourself, will absorb the blame (43).

7. Make certain that your staff writes detailed progress reports, on a monthly basis. The contracting agents will not have the time, patience, or intellect to read your reports. When the project goes sour, and it will, you can point the finger to someone within the contracting agency, indicating that you had provided them with all of the necessary information to modify or abort the project.

8. When the money runs out on the contract, abandon any wacky ideas about finishing the research at your own expense. Just walk away from the project, and don't look back.





CHAPTER 8. SCIENTIFIC GLOBETROTTING

"90% of success is just showing up."

-Woody Allen

"I've never been an intellectual but I have this look."

-Woody Allen

"An army marches on its stomach"

-Attributed to both Napoleon and Frederick the Great

When you step into an elevator in any research institute, and you chance to hear a conversation between two or more high-level administrators or scientists, you will soon learn that every exchange conveys the following five items:

1. An announcement of how busy you are.

2. The city/country/meeting that you recently attended.

3. What you ate while there.

4. You next port of call.

5. What you will eat at the next port of call.

Today, professionals are constantly on-the-go. Physicians, who are among the top paid professionals, have learned that patient care need not interfere with an active travel itinerary. A lawsuit filed by federal officials alleges fraudulent billings for radiation therapy in a Melbourne, Florida cancer clinic between 2003 and 2008 (170). According to federal officials, when 62 of the treatments were provided, the treating physician was in Cancun, Mexico, and Seoul, South Korea. When 144 of the treatments were provided, another treating physician was in Hong Kong, Athens, Rome and Quito, Ecuador. Medicare still labors under the old-fashioned notion that, for complex cancer treatments, a physician should occupy the same continent as the patient he is treating; thus the lawsuit.

In the past, most inhabitants of earth stayed put, seldom venturing more than a few miles from their birthplace. Even the wealthy and powerful understood that you sent people to travel on your behalf; you didn't go yourself. Henry the Navigator (1394 1460) understood that travel is a vicarious pleasure (Figure 8-1). Henry organized many Portuguese expeditions, and helped established Portugal as a colonizing nation. Henry himself neither voyaged, explored, nor navigated.



Figure

Figure 8-1. Henry the Navigator. Source: Wikipedia, public domain.

The Horticultural Society in London, at the turn of the nineteenth century, sent collectors to the four corners of the earth to find, and send home, exotic plant species. David Douglas (1799 - 1834) was a great Scottish botanist, with over 200 plants named after him, including America's Douglas fir (Figure 8-2).



Figure

Figure 8-2. David Douglas. Source: Wikipedia, public domain.

Douglas, at age 23, was sent to the Northwestern region of North America to see what he could find. By New Year's Day, 1826, at the age of 26, Douglas was writing his own obituary, having recently endured a series of weather calamities including hurricanes, torrential rains, hail storms and accidents that contributed to a general deterioration of his health, including difficulties with vision. His benefactors in London had predicted that he would perish in America. Despite the odds, he managed to return to England, in 1827, where he freely dispensed advice regarding Britain's future role in the Northwest region. Douglas wanted Britain to annex what is now called Washington State. The British government ignored him, and it was soon agreed that the proper place for Douglas was back in the wilds of North America. A new set of near-death experiences befell Douglas in California. During these adventures, he discovered gold, fully seventeen years before the Gold Rush of 1849. Unfortunately, nobody, was much interested in his findings. Douglas's health continued to decline, along with his eyesight. In 1834, while exploring Hawaii, he fell into a pit where a bull had been trapped. He may have fallen in because his eyesight was poor; or he may have been pushed. Regardless, the bull survived the encounter, but Douglas, age 35, did not. Douglas is remembered as one of the greatest explorer-scientists in history (76).

Douglas was soon followed by Richard Spruce (1817 - 1893), who embarked from Liverpool to explore the Amazon River, in 1849 (Figure 8-3).



Figure

Figure 8-3. Richard Spruce. Source: Wikipedia, public domain.

During his expeditions to South America, Spruce flirted with oblivion on many occasions, narrowly avoiding death from yellow fever, stinging ant invasions (tucandera), blood-sucking bats, hoards of mosquitoes, extremes of weather, riots, revolutions, and wars. Eventually, Spruce developed malaria. Over the years, he became one of the world's greatest authorities on Bryophytes, discovering hundreds of species of moss and liverworts. His last and greatest achievement was his expedition, launched in 1859, to find and take a collection of Cinchona plants (Red Bark tree) and seeds for successful cultivation in India (171). At the time, South American Cinchona was the only source for the only cure for one of the worst diseases of mankind: malaria. Spruce's last expedition established a cheap, world-wide supply of quinine and quinidine. The Cinchona expedition took its toll on Spruce, turning him into an invalid by the age of 43. This great scientist and savior of millions of people arrived back in England, penniless. Some of his influential friends helped Spruce to eventually secure a small government pension, on which he lived out his days, barely able to walk. He died at age 76. Richard Spruce did not lend his name to the sturdy spruce tree. The tree took its name from a botched pronunciation of Pruce, for Prussia, its presumed country of origin. Richard Spruce is commemorated by the humble moss, Sprucea (76).

Today, scientists will eagerly travel the globe to attend a meeting of fellow scientists, but very few scientists make any kind of effort to discover a new species of moss. Speak to any successful scientist and ask him where he has been lately. He will rattle off a list of cities, domestic and foreign, that would be the envy of any travel writer. Scientists who do not travel are relegated to obscurity. Nobody will know their name. Their work will not influence the work of other scientists in their field.

Travel for modern scientists, in contrast to predecessors such as Spruce and Douglas, is easy, pleasurable, and fully reimbursed. Most scientists work in major metropolitan areas and have access to an international airport. In the U.S., almost anyone can fly to Chicago (a centrally located location that hosts many meetings and scientific societies) in about two hours. London-based scientists can hop on a non-stop flight from Heathrow to Las Vegas; air travel time, a tolerable nine hours.

More than a few budding scientists are drawn into their fields by the opportunity to attend lavish meetings, held in exotic locations. Young scientists enjoy the opportunity to meet bright, attractive colleagues in a socially exciting atmosphere, to network, and to enhance their careers just by being there. Senior scientists enjoy the adulation and the amenities, particularly fine wining and dining. Those with tight per diem budgets will enjoy the meeting freebies.

10:00 A.M., Tuesday morning, Venetian Hotel, Las Vegas. There is nothing quite like a scientific meeting in Las Vegas. Things that are impossible anywhere else are likely to occur here. Here, you have a chance to meet beautiful women who are well beyond your pay grade anywhere else. You march briskly through the casino aisles, barely glancing at the human residua seated night and day at the gaming tables, and you approach the vast meeting area that lies beyond. Another set of tables awaits the scientists. These are filled with trinkets brought as gifts by the laboratory vendors. The treasures consist of pens (retractable, gel-tipped, glow-in-the-dark, on-a-rope), pocket flashlights, paperweights, miniature souvenirs and keepsakes marked with a corporate logo (valuable collectors' items), key rings, t-shirts, lanyards, coffee mugs, thumb drives, nail clippers, business card holders, money clips, umbrellas, mirrors. They're all for you and they're all for free. Then come the foods: coffee, cookies, potato chips, pretzels, chocolates. If you're a VIP, you won't need to collect freebies by visiting the tables. The vendor organizers will prepare a VIP basket filled with a selection of the best freebies from all the vendors, plus special gifts selected just for you. The personal services are a nice touch. Look for 3-minute massages (to relieve the stress that comes with every meeting), and caricatures (drawn by an artist or rendered by a computer from a digital photograph). You can count on a door prize and a grand raffle, so be sure to register early on the first day. Consolation prizes will include golf clubs, and answering machines. Luckier attendees will receive computers, or free registration to next year's meeting. The top prize is $5,000 in cash. Seduced by trinkets, by meeting's end you will have fallen in love with every vendor in the room. Do you worry that once you've accepted a vendor freebie, you can no longer promote yourself as an impartial expert in your field. Nonsense. What happens in Las Vegas stays in Las Vegas.

What is the purpose of a scientific meeting? All meetings serve one purpose; to produce wealth for the meeting sponsors and power for the meeting organizers. If you have a big radiology meeting, or surgery meeting, you can bet that the meeting was supported by vendors of radiology equipment or surgery equipment. The vendors will construct elaborate booths for the purpose of selling their wares. The vendors, who are much better showmen than the scientists who attend meetings, will set the general tone of the meeting, and will greatly influence the meeting agenda. In many cases, vendor representatives will make scientific presentations, often brazen advertisements for their latest products.

You own a software company. Years ago, you were an earnest assistant professor at a major university, and you take pride in your scientific credentials and the network of scientific associates that you cultivated over the past decade. When one of your former students (now the head of the Program Committee) invites you to present a lecture on Middleware, you jump at the chance. Your company exclusively produces middleware, and there is nobody in the world who has more ground-level experience with the subject than you. Here is your chance to convince the scientific community to place their trust in your middleware product, and yours alone. You will come prepared with the slickest visuals that any of those ivy tower pundits have ever seen. You have signed a disclosure form that tells everyone that you are the President and owner of a middleware company, so you needn't worry about anyone complaining that they weren't warned. You will spend the hour hyping the importance, value, and dependability of your product. You will be very careful not to mention any of your competitors. This is your hour, not theirs. They would do the same, if they were asked to speak.

Here are the signs of a commercial agenda disguised as a scientific presentation:

1. Only the speaker's product will be mentioned by name. The speaker will only mention competitors in the context of the deficiencies of their products.

2. The speaker will refute any criticism of their commercial product, even when the criticism is fair. In many instances, they will try to discredit or marginalize all critics.

3. The speaker will not discuss any technical difficulties that members of the audience might have had with their product.

4. Open source or free products will be mocked ("Oh yes. I've heard of the freeware you're referring to. You get what you pay for.").

5. The speaker will discuss issues related to product popularity, rather than product value ("We've had 100,000 visitors to our web site").

6. The speaker will plant friendly associates in the audience, who will provide personal testimonials stressing the value of the product.

7. The speaker will often place a moderator or panel chair who will divert discussion away from criticisms ("We'll be discussing this general issue at this evening's round-table. So I'm asking you to defer this question until then.")

8. The speaker will have professional quality graphics for his presentation. The average scientist would not go to the trouble of creating impressive graphics.

9. The speaker will be attractive and well-spoken; real scientists are neither.

10. The speaker will be sincere. Real scientists seldom seem sincere because they are constantly re-examining their own assumptions and conclusions. Commercial speakers have learned to fake sincerity.

11. The speaker will use buzz words. Besides the hackney "synergy, leverage, network, enterprise," look for terms that seem out of place in a scientific venue: CIO, CFO, return on investment, workflow, user profile, enterprise, product.

12. The speaker will not give credit to prior art. This would jeopardize pending patents.

13. The speaker will be future-oriented, not past-oriented, even with regard to their own product. This will avoid criticism from members of the audience who had problems with earlier versions of their product. Also, speakers are often people who are newly hired by the company. They honestly don't know much about the history of the product.

14. The speaker may be an academic. Companies will sometimes pay a respected scientist to promote their product during a "science" lecture. Read the meeting documents. There will be a page that lists the conflicts of interest disclosed by the speakers. You will find that the speaker has been paid by a company that stands to profit from a favorable presentation.

Why are commercial speakers, and scientists with commercial conflicts of interest, allowed to speak at scientific meetings? Disclosure forms are used as a sort of license to say anything at a meeting, without consequence. The Disclosure form is a document wherein a speaker lists his real or potential conflicts of interest that might cause him to produce a less than objective presentation. As originally conceived, the Disclosure form had benefit for the attendees, not of the speaker. When a speaker publicly disclosed a conflict, those attending his presentation would be able to detect self-serving remarks and biases. The Disclosure was not intended to relieve speakers from their basic obligations: to be objective, honest, fair and unbiased. In practice, Disclosure forms are not scrutinized by attendees. Speakers who have disclosed their conflicts of interest always believe that their audience has been provided fair warning. Once a speaker takes the podium, he knows that he has license to say anything that suits his agenda; if he has signed the Disclosure form.

Meeting presentations are certainly the least reliable sources of scientific information. Every word spoken at a meeting, whether heard in a hallway or from a keynote speaker, is unsubstantiated. At a meeting, you can lie all you like, without triggering an investigation by the Office of Research Integrity. Scientists are expected to make mistakes during oral presentation. Feel free to distort the truth or omit a discussion of opposing ideas. Don't worry about being grilled during the question periods that follow a presentation. You can ignore tough questions by providing an answer to another, less incriminating, question. Nobody really cares.

If meetings are simply exercises in brain-washing, shouldn't you be spending more time reading scientific books? Don't be silly. Successful scientists are way too busy to waste their valuable time reading books. The very act of reading a scientific work alienates the reader from the hordes of devoted non-readers who dominate every scientific field.

You might argue that reading provides the knowledge and insight required for your scientific field. Reading permits you to think deeply about scientific problems. Nikola Tesla, one of the world's greatest scientists, once said "The mind is sharper and keener in seclusion and uninterrupted solitude. No big laboratory is needed in which to think. Originality thrives in seclusion free of outside influences beating upon us to cripple the creative mind. Be alone, that is the secret of invention; be alone, that is when ideas are born. That is why many of the earthly miracles have had their genesis in humble surroundings." Though Tesla was a great scientist, he was shunned by the scientific establishment and died without friends or money. Nonetheless, we can find a few examples of productive scientists and thinkers who led circumscribed lives, with little or no travel.

Isaac Asimov (1920 - 1992), one of the most prolific science and science fiction writers in history, with hundreds of books to his credit, was a claustrophile (a lover of small spaces) and an avid indoorsman (Figure 8-4). Asimov refused to fly. He lived a life of ideas, without much action, and seldom traveled any great distances. His productivity was enhanced by his immobility.



Figure

Figure 8-4. Isaac Asimov. Source: Wikipedia from a photograph donated to the public domain by the New York World Telegram and Sun.

Immanuel Kant (1721 - 1804) never left his country of birth, Prussia. He rarely ventured from Konigsberg, the town where he was born and where he died (Figure 8-5). In 1781, he published Critique of Pure Reason, one of the most widely read and influential books in Western philosophy. From his Prussian home, Kant had an unobstructed view of the boreal universe. Proceeding without the assistance of observatory or telescope, Kant, in 1755, was the first cosmologist to explain the origin of nebulae and solar systems from the chaos of hot, elemental matter produced at the dawn of the universe. His nebular hypothesis, as it came to be known, was ignored until 1796, when Laplace made a similar suggestion. Kant provided the first satisfactory description of the universe, reckoning over time and space, without leaving his armchair. Kant correctly deduced that the milky way galaxy was a flat disk, and that the dense swath of stars, seen nightly from his window, was nothing less than our own galaxy, viewed on edge.



Figure

Figure 8-5. Kant's tomb in Konigsberg (known today as Kaliningrad, Russia), where he lived his entire life. Source: Wikipedia, public domain.

Friedrich Wilhelm Nietzsche (1844 - 1900) spent his writing years in ill-health (Figure 8-6). His life was spatially restricted and thus conducive to mental creativity and prolific writing. He wrote highly influential (perhaps too influential) books on religion, morality, culture, and science.



Figure

Figure 8-6. Nietzsche's moustache, left and center. Nietzsche, right. Source: Wikipedia, public domain.

If you are a genius, you might be able to achieve your evil goals without the benefit of attending meetings. But you're not. The goal of the evil scientist is to become better off than his peers (not to become a better scientist than his peers). Commuting to airports, standing in long lines for security checks, waiting for delayed flights, cramming yourself into small airline seats, listening to inane banter from adjacent seats; they are all worth the effort. The information that you will need to get ahead in your career is the information provided at meetings; not books and journals. The roster of meeting speakers tells you who is important in your field. When you hear each speaker making identical points, using almost the same words, you can be sure that these are the dogmatic opinions that form the heart of your discipline. You need to remember that a brilliant idea appearing in one book, written by an author who is never invited to speak at meetings, has no value.

The cost of meetings reflects their importance, but most organizations will not divulge the cost of their meetings. In 2003, the American Association for Cancer Research (AACR) was scheduled to have its annual meeting in Toronto. Unfortunately, their meeting date coincided with an outbreak of SARS virus; also in Toronto. The meeting was canceled just days before it was scheduled to commence, and the AACR indicated that their cost for cancellation was $7.5 million (172). One can only speculate that the meeting expenses are in excess of the cancellation costs. In addition to the costs for the meeting organizers, there are the uncounted costs of thousands of attendees traveling to Toronto, paying registration and housing fees, food and living costs, and the costs of all of the vendors who transport their wares to the meeting site, construct booths, and pay for salespersons to man their on-site operations. The American Association for Cancer Research sponsors many meetings throughout the year. There are many thousands of scientific organizations that do the same. When you contemplate the high cost of scientific research, don't forget to factor in the cost of meetings.

With few exceptions, scientific organizations do not support themselves with the dues provided by their members. Virtually every professional organization is supported by corporations, and the largest source of corporation funding comes through corporate sponsorships of meetings. With millions of dollars on the line, you can predict that meetings are among the most tightly controlled scientific forums in existence. It is of paramount importance to assemble a roster of speakers whose interests coincide with the interests of the vendors who subsidize the meeting. If you seek a venue in which to voice an opinion that opposes the interests of the meeting organizers and the meeting vendors, don't bother coming to meetings.

8.1 ADVICE FOR EVIL SCIENTISTS

1. Never miss an opportunity to attend a meeting. Remember, meetings are called meetings because they allow you to meet people. Potential employers will mindlessly trust you if you've met someone that they have also met. This makes no sense, but it is true!

2. Remember that meetings are vehicles for mass indoctrination. A powerful speaker can rally scientists to support his agenda, without resorting to an open debate of opposing ideas.

3. Meetings may not teach you what you need to know, but they can certainly teach you what you don't need to know. Scientific issues related to your field of interest that are not covered at meetings, are intellectual cul-de-sacs.

4. Don't worry if meetings take you away from your responsibilities. Real researchers delegate scientific research to underlings. No scientists has ever been denied tenure because he attended too many meetings.

5. No self-respecting evil scientists pays for meetings with his own money. Institutions, funding agencies, and meeting sponsors all understand that a meeting is like a party. You don't pay to attend a wedding or a funeral. Why should you pay to attend a meeting? If you can't get your institution, or industry, or somebody else to pay all your meeting expenses, you don't deserve to register!

6. They say that an army marches on its stomach. The same is true for scientists attending a meeting. Never forget that regardless of the scientific agenda, the meeting is all about food. The best meetings provide the best food. Steer clear of "donut meetings". Meeting organizers who think that donuts substitute for breakfast are clearly catering to graduate students, not successful scientists. A good meeting provides sit-down meals, with wine and dessert, an attentive wait staff, and an open bar.

7. Cultivate your palate. Your superiors may not be particularly fond of you, but it's a safe bet that they all love wine. Every scientific meeting is a hotbed of eonophilia. Listen to the urbane elders as they compare the virtues of one wine or another. Their inane patter is the sound of science, fermented and aged.

8. Be sure to attend the keynote speech at every meeting. Meeting organizers assign the keynote speech to a time and place that does not conflict with other meeting activities. Once you've attended the keynote speech, you're free to waste the remainder of the meeting gossiping in the hallways, drunk in a hotel room, or otherwise indisposed. If anyone should ask, you can prove that you attended the meeting by recapitulating some pearl of wisdom tossed by the keynote speaker.

9. Do not waste your meeting time at the poster sessions. Posters are presented by scientific losers. Most poster presenters sit forlornly in front of their works, while disinterested throngs pass by, on their way to collecting free gifts at the resplendent vendor kiosks. The poster people naively believe that they can achieve a coveted status among their peers by presenting the results of their laboratory experiments. How absurd.

10. The action at meetings occurs in the hallways. Short, hurried, conversations occur all day and all night long, but the best time to have a hallway conversation is during the refreshment breaks. When gossiping in the hallways, feel free to say whatever pleases you, unconstrained by accuracy or truth. These conversations are so short and so distorted by noise and competing conversations, that your assertions will never be seriously challenged.

11. Most lectures are not recorded, so you can claim anything you like without much fear of contradiction. An exception occurs for lectures that are taped for later review. Institutions must get permission to tape your lecture for future use. Just refuse permission. If asked why, indicate that your employer, as a matter of policy, prohibits employees to make videotapes without pre-approval. Nobody, in the history of science, has every gotten into trouble for fudging, distorting, or fabricating information delivered in a lecture. If challenged, you can always say there was a misunderstanding, or that someone on your staff handed your the wrong data, you mispoke, or any excuse that suits your purposes.

12. Stop reading journal articles. People attend meetings instead of (not in addition to) journal reading. Journals are read by disadvantaged scientists who do not have the wherewithal to attend meetings.

13. Stop reading books. In the time that your pathetic colleagues take to read a book, you could have traveled to Istanbul, eaten Shish Kebob and Kazan Dibi sloshed down with Ayran, and returned to tell the tale, at your next meeting.





CHAPTER 9. EVIL INTELLECTUAL PROPERTY

"Don't worry about people stealing your ideas. If your ideas are any good, you'll have to ram them down people's throats."

-Howard Aiken (American computer engineer and mathematician 1900 - 1973)

"Most people are other people. Their thoughts are someone else's opinions, their lives a mimicry, their passions a quotation."

-Oscar Wilde

"What is mine is mine. What is yours is negotiable."

-Nikita Khruschev, who is credited with using it to describe the American approach to arms control negotiations with the former U.S.S.R.

Intellectual property is the "dark matter" of the scientific world. We know that there's a lot of it, that it's everywhere, and that it has a strong effect on our lives, but it's all quite invisible to our senses.

When we think of intellectual property, we usually think in terms of patents (for inventions and processes) and copyright (for literature). Patents are rights assigned to an inventor, for a specified interval, in exchange for disclosing his invention to the public. Patents probably came to us, like most great ideas, from the ancient Greeks. In 500 B.C.E., the Greek colony Sybarus (in Southern Italy), gave inventors the exclusive rights to profit from their invention for a period of one year. The length of a patent grew over the centuries. In 1449 King Henry VI granted a 20-year patent to John Utynam, who brought colored glass-works to England. The holder of a patent collects royalties from those who use the patent. The term royalties carries the idea that money that would ordinarily go to the king is assigned to the patent holder.

The idea of copyright seems to descend from the settlement of sixth century Irish dispute over copies of a book of psalms. King Diarmait reasoned, "To every cow belongs her calf, therefore to every book belongs its copy." Basically, copyright guarantees that a book's creator owns the copies. In the United Kingdom, modern copyright was enacted by the Statute of Anne (Copyright Act of 1709). Every nation extends copyright protection to authors. Today, copyright protection extends to the form and content of the text and images and does not apply to particular ideas that might be expressed in the copyrighted work. Copyright protection lasts much longer than patent protection. In the U.S., Copyright persists 70 years after the death of author, unless the author is a corporation, in which case, copyright extends 95 years from publication or 120 years from creation, whichever expires first. As in the case of patents, royalties are paid to the copyright holder, in lieu of the king.

Evil scientists have used and abused intellectual property protection. A legal and popular method of bypassing the patent system is through "trade secret." If nobody knows your secret, your exclusive use of a property could be leveraged to your financial advantage. Nobody understood the concept of trade secret better than the surgeon William Chamberlen. Circa 1570 Chamberlen invented or acquired the design of an improved delivery forceps (tongs with large curved grasping handles that can be pressed together with a scissors action). The forceps was highly profitable to William and to his heirs. His son Peter became the attending physician to Queen Anne, the wife of James I and to Queen Henrietta Maria, wife of Charles I. The forceps kept the Chamberlen family in riches for over a century. A descendant fell upon hard times and sold the secret of the forceps in 1720 to Dutch surgeons. The forceps monopoly was broken when several of the new owners published the secret. A largely apathetic world paid little notice until the highly influential William Smellie published his description of the improved model of the forceps, in 1750 (Figure 9-1). Because an intellectual property was kept secret, the world was deprived of a life-saving medical advancement for approximately 180 years (126), (173).



Figure

Figure 9-1. William Smellie. Source: Garrison FH. History of medicine. WB Saunders, Philadelphia, 1921.

Though depriving society of a medical advance is not a crime, few holders of intellectual property resort to secrecy nowadays; they use patents, copyrights, and courtrooms to protect their interests. The modern patent is a property right (lasting 20 years) given by a government to an inventor of a method, or invention, or a novel item. Patent means "open," so named because the patent process opens the invention to scrutiny. The U.S. Patent and Trademark Office (USPTO) publishes detailed descriptions of every awarded patent, and equivalent patent archives are available in other countries. The right to patent is sometimes referred to as the right to sue patent infringers. The idea is that patents are made public. Users of patented inventions must pay the patent holder a royalty. In return for a royalty, the patent holder refrains from taking legal action against the user.

When a patent or a copyright has expired, the work falls into the public domain and can be used freely. Many patent holders have been ruined by poor timing. Patent holders need to recoup their investment and earn all their profits within a twenty year window. When a patented invention requires twenty years or more to develop a market, the patent holder cannot profit from his work. Likewise, patent holders may not profit if the practical implementation of their invention requires a second technological advance, that comes twenty years later.

A fine example of a patent issued before its time is the Lamarr/Antheil patent for Frequency Hopping Spread Spectrum (U.S. patent 2,292,387, 1942), issued to Hedy Lamarr and George Antheil. Circa WWII, Hedy Lamarr was a glamorous actress, and George Antheil was a Hollywood music composer. The two came up with and idea for secretly passing messages by jumping a signal from frequency to frequency, giving it the appearance of noise to enemy interceptors. When the sender and the receiver change frequencies simultaneously, the message can be retrieved. Their patent preceded the technology required to implement the idea. Today, decades after the patent expired, spread spectrum radio uses the Lamarr/Antheil technique. In a symbolic gesture, Wi-LAN, a telecommunications firm, purchased the original patent as an historical document, for an undisclosed amount. This was the only income that Hedy Lamarr and George Antheil received from their patent.

In the U.S., the first patents were issued in 1790; three in total. By 1800, there were 41 patents issued. In 1900, there were 26,414 patents issued. In 2000, there were 159,255 patents issued, of which 157,494 were inventions, 17,413 were designs, and 548 were plants (174). The reason that the rate of patent issuance has increased through the centuries has less to do with the heady pace of scientific progress and more to do with the profitability of holding intellectual property.

The original intent of patents was to grant the inventor the exclusive right to make, use, sell, or license his invention. Over the years, the uses of a patent have expanded to include the following:

1. Patenting to suppress innovation. If you were in the oil business, and an inventor developed a source of free, unlimited energy (e.g., solar power), you might be inclined to buy the patent for his solar energy invention for the sole purpose of halting its implementation. Likewise, if you held a patent on a gene or a drug, you could assert your patent to squelch research or medical testing on your property, for the duration of the patent (175).

In the case of healthcare, there are some limits on the use of patents to suppress a scientific discovery. In 1999, Congress passed 35 U.S.C. 287 specifying conditions that would limit the damages collected by patent holders from healthcare practitioners (176). If you held the patent on a new way of tying a knot, and if a surgeon required the use the patented knot as a ligature in a surgical procedure, the patent would probably not be enforceable on the surgeon, under 35 U.S.C. 287. For the moment, patent holders cannot stop physicians from saving lives.

2. Patent farming. If you hold a patent for an algorithm or a manufacturing process that could be used in other technologies, you might benefit by "seeding" your invention into the derivative technology. When the new technology is released, you can "farm" your patent by announcing that anyone using the new technology will need to pay you royalties. For example, if a committee is creating a new software standard, you might strive to become a member of the committee. If you can insert your algorithm or subroutine into the new standard, then your patent rights will extend to the final standard. If the standard is mandatory, you can expect to collect royalties from thousands or millions of unwilling users.

3. Patent spreading. Every patent contains a set of claims that specify the intellectual components that are protected by the patent. For example, a patent for a software application may claim each of the algorithms or subroutines that are featured in the application, the graphic user interface by which the application is accessed, and novel features included in the application. An evil scientist will maximize his list of claims, effectively magnifying his intellectual property.

4. Patent holding. A shrewd capitalist can buy patents that cover fundamental processes that are necessary for a particular field. Whereas a single patent may be vulnerable to challenge, a collection of patents that insinuate their claims throughout a complex industry, might be invincible. Patent holding companies (called patent trollers by their detractors) strategically collect patents on devices and processes that are vital to an industry. When the time is ripe, after a new technology has become an indispensable component of business, the patent holding companies will assert their portfolio.

5. Patent shifting. Sometimes, a patent holder may find himself in a position where it would be unwise to assert his patent. Large corporations and patent holding companies occasionally reach agreements with their competitors to hold each other harmless from patent infringements. These kinds of agreements can save companies a vast amount of time and expense. In such cases, a corporation may choose to sell various patents to a third party (an individual, a corporation, or a holding company). The third party, unrestricted by a non-litigation agreement, can prosecute the patent. This works best if the patent is not owned directly by the company that sells the patent.

For example, if a corporation sits on a committee that is developing a new industry standard, it may need to sign an agreement promising not to prosecute patents held by the corporation and implemented by the standard. This kind of agreement is developed by standards committees to discourage patent farming. The company can simply sell the patent to a holding company. Sometime in the future, when the standard becomes entrenched in an industry, the holding company will assert the patent against all of the patent users. The corporation that developed the patent would have made its profit up front, at the time of the patent's sale to the holding company.

6. Remixing prior patents. You can re-mix prior art to make a new device that you can patent for yourself. This provision in patent law is particularly useful for software corporations; virtually all new software is made by re-mixing old software. You must be careful, though, to produce a re-mixed product that is not obvious to your peers. In KSR v. Teleflex (April 30, 2007), the U.S. Supreme Court, in a unanimous opinion, reversed a Court of Appeals decision, and determined that a prior patent was unenforceable because it was obvious (177). The opinion discussed, at length, the principles of obviousness. In particular, the Supreme Court indicated that merely putting together prior art to make a new device can only qualify for a patent if the resulting device is unexpected by people working in the field; hence, not obvious.

7. Patenting the uses of unpatented inventions. The wheel is an unpatented invention. If you were to come up with a novel, useful, and nob-obvious application of the wheel, you might be able to patent your work. This means that when you use an invention that is not covered by a patent, your use of the invention may still constitute a patent infringement. Here is an example. DICOM (Digital Imaging and Communications in Medicine) is a freely available, unpatented standard for radiologic images. Currently, there is an effort to have all medical specialties adopt DICOM as the exclusive format for all medical images. Nonetheless, there there are specific circumstances for which the DICOM standard cannot be used without infringing on patented intellectual property. U.S. Patent 6725231, issued Apr 20, 2004, to Jingkun Hu and Kwok Pun Lee and assigned to Koninklijke Philips Electronics N.V., has the following claim.

"1. A method for mapping a DICOM specification into an XML document, comprising: mapping each entry of a DICOM table of the DICOM specification into a corresponding XML element of a plurality of XML elements,outputting each XML element of the plurality of XML elements to the XML document, in an output format that conforms to at least one of: an XML document-type-definition and an XML Schema."

In addition, the patent owners have been granted a similar patent by the European Patent Office (EPO). Mapping image information from a free specification, such as DICOM, into another free specification, such as XML, is a common task for medical informaticians. Does this activity constitute an infringement on an existing "use" patent? These are the types of questions that keep patent lawyers busy.

8. Patenting life. What must it feel like to own a species of living organisms? It must be like God would feel, if God had the the Supreme Court on his side. In a 1980 5-4 ruling, the Supreme Court upheld that a living organism could be patented. The case was Diamond v. Chakrabarty and involved a dispute over a patent for a genetically modified bacterium (178), (179).

After a patent on life is awarded, the consequences can be far-reaching. For example, Monsanto developed and patented genetically engineered corn that is resistant to Monsanto's Roundup weed killer. Using Monsanto's corn seed, robust corn grows in fields that are liberally treated with Roundup. This guarantees that farmers who buy Roundup-resistant corn will also buy Roundup, at Monsanto's price. When farmers buy Roundup-resistant corn, they agree not to collect seed (from their corn crops) for replanting. This means that each growing season, they must buy new seed from Monsanto, at Monsanto's price (180). The use of genetically engineered seed is rapidly spreading. As more and more farmers use Monsanto's seed, the risk increases that genetically engineered seed will drift (from the winds, or from passing seed transport trucks) onto the fields of farmers who chose not to use genetically engineered corn. After genetically engineered corn invades a field, Monsanto can assert its seed patent on the hapless farmer, even when the farmer had not intended to use Monsanto's seed.

It is dangerous to rely on a single genetic variant of vital crop seed. A newly emerging disease that targets the crop can decimate the world's food supply. In the specific case of roundup-resistant corn, new varieties of roundup-resistant weeds may emerge. In 2010, twenty-two states were infested by multiple new species of roundup resistant weeds, essentially nullifying any benefit from the genetically engineered corn (181).

The Diamond v. Chakrabarty ruling extends "life" patents to genes and sequences of DNA. Jensen and Murray reported in 2005 that 4,382 of 23,688 human genes in National Center for Biotechnology Information had been patented (182). The two most highly patented genes were BMP7, an osteogenic factor, and CDKN2A, a tumor suppressor gene (182). These two genes are claimed in more than 20 patents.

The tide may soon turn for patent owners of DNA sequences. On March 29, 2010, Judge Robert Sweet, a United States District Court Judge, ruled that DNA sequences cannot be patented (183). The court's decision is currently under appeal, but the decision has jeopardized every existing DNA patent.

9. Viral patenting involves asserting a patent on the manufacturer of an assembled device, and asserting the same patent on the users of the manufactured device. Viral patenting is risky for the patent owner. In a precedential case, the U.S. Supreme Court unanimously ruled that LG Electronic could not assert a patent against Intel (the manufacturer that implemented a memory-technology patent owned by LG Electronics) and on the computer makers that install Intel chips in their computers (184). The patent power to collect royalties was effectively exhausted by its first license (with Intel).

10. Royalty stacking. For a complex process, it may be possible to assert different patents on various steps in a process. For example, a medical test may involve processing cells using a patented technology, using one or more patented reagents, performing a patented analytic process, using a patented machine, and evaluating the data with patented software. After all the royalties are stacked, the totaled costs are transferred to the patient or to a third party payer (185).

11. Reaching through a patent. Savvy patent holders may issue licenses that contain an insidious "reach-through" clause. The clause may stipulate that license holders can use the patent under the condition that any future technologies, that the license holder develops with the licensed technology, will be assessed a royalty. The clause allows the patent holder to reach through into the intellectual property created by the license holder, and impose an additional royalty.

If you were to take the time to visit the USPTO website, you would soon learn that most patents are trivial, obvious, derivative, or useless. True "Eureka" moments are rare. Those who file patents are often motivated by fear ("If I don't patent this, somebody else will, and I can't bear to think that I may be required to pay royalties for my own invention."), opportunism ("Hmmm. I can't believe nobody has patented this! I'd better do it before someone else does."), security ("My boss will not give me that raise unless I produce another patent this year."), or greed ("I'll squeeze every penny out of my competitors."). To receive a patent, an invention should be novel, non-obvious, and useful, but the reviewers at the patent office cannot always make that determination.

Software developers are among the angriest critics of the USPTO. In recent years, the USPTO has awarded many software patents, a practice that seems to counter the principle that "ideas" are not patentable. Software developers argue that all software is built from recycled algorithms whose original sources are lost to techno-history. You cannot create a software application without using bits of code that where developed by legions of software developers, over the past half century. Today, software developers live in fear that a line of their code or a brief algorithm they may have included in a complex software application will infringe on one or more software patents. The ever-present risk of patent infringement is a nightmare for earnest software developers, and a dream come true for evil scientists. If you can patent an algorithm or subroutine that every developer uses, you stand to make a fortune.

Of course, nobody is obligated to patent his discoveries. On November 8, 1895 Wilhelm Roentgen performed the experiment that marked the discovery of X-ray imaging (Figure 9-2). Six years later, in 1901, Roentgen's effort was awarded with the Nobel prize. Roentgen declined to seek patents or proprietary claims on his discovery and even declined, unsuccessfully, the eponymous appellative, "Roentgen ray." Such altruistic behavior is unsuitable for evil scientists.



Figure

Figure 9-2. One of Roentgen's earliest x-rays, taken on January 23, 1896. Source: Wikipedia, public domain.

The government awards patents, but when someone infringes on your patent, the government takes no action. Only the patent holder is harmed, and only the patent holder can litigate against the infringing party. For this reason, a patent is sometimes referred to as the right to sue. Paradoxically, the typical patent holder is terribly frightened of lawsuits and will do almost anything to avoid a court appearance. Why?

Imagine that you hold a software patent, and you have identified a person whose software contains some code that seems to infringe on one or more of the claims contained in your patent. Your lawyer sends this person a letter claiming infringement and demanding that the person either stop using the patented property or begin paying an assigned royalty. This is the so-called "demand letter" that every software programmer fears.

The alleged infringer, if smart, will seek remedy in a federal court, arguing that your patent is invalid or unenforceable, or that he did not infringe. He will ask for a declaratory judgment to stop you from pursuing your patent demands.

The declaratory judgment is a preventive adjudication. Its purpose is to clear the air, so that the defendant (the alleged infringer) need not worry about your impending lawsuit (186). Your alleged infringer will bring his case to a federal court venue where he lives (you will need to travel to the location), giving him the home court advantage. If he asks for a declaratory judgment based on non-infringement, you will be required to pursue a counterclaim of infringement; an action that you may not be prepared to pursue. In the case of software patents, virtually every patent holder stands on very weak ground. All software is derivative of someone else's work; hence, every software patent is vulnerable to a declaratory judgment. You may have spent millions of dollars developing your invention and seeking your patent, but all of your investment could be lost through a declaratory judgment.

Declaratory judgment cases must be triggered by a significant controversy, usually a threat of litigation. Your demand letter, indicating infringement and requiring compensation, is all that is needed to trigger a claim for declaratory judgment. This means that, if you have a vulnerable patent (and you probably do) you must not send a demand letter that has the effect of a threat.

You may try having a salesman send the letter (not a lawyer). A letter from a salesman is less likely to imply the threat of legal action than a letter from retained counsel. In the letter, you might want to simply identify the patent and indicate that it is available for licensing. It may be wise not to suggest that infringement has occurred.

The purpose of a "demand" letter is to motivate the receiver to buy a license, without triggering a declaratory judgment action. If the letter is sufficiently bland and non-threatening, it may do the trick. Remember, though, that the receiver will likely interpret your letter as a thinly veiled threat. When determining jurisdiction for a declaratory judgment, courts look at all the relevant circumstances. If you have a history of vigorously pursuing patent claims, or your have a history of intimidating people with the implied threat of legal action, a court may interpret any letter from you, no matter how bland, as an intent to litigate.

9.1 ADVICE FOR EVIL SCIENTISTS

1. Money distinguishes the professional from the amateur. Just as prostitutes don't "give it away", neither should scientists.

2. A patent is often referred to as a right to sue. This is nonsense. The last thing an evil scientist wants is to defend his patent in court. A patent is better thought of as the right to intimidate.

3. A patent is expected to be new, non-obvious, and useful. Don't let this discourage you. There are about 175,000 new patents issued each year. If they were all new, non-obvious and useful, we'd be living in utopia. Most patents do not meet any of these criteria.





CHAPTER 10. EVIL STANDARDS

"Standards have become so popular that everyone wants one of their own."

-Anonymous

Standards provide an impenetrable, yet subtle, refuge for evil. Many of the most accomplished evil scientists are totally ignorant of the chaos and corruption that comes from the imposition of standards upon the scientific community. When you create a new standard, you are imposing a set of behaviors on the world. The purpose of this chapter is to explain how to exploit the standards-making process for your own benefit and to the detriment of your competitors.

Here are the basic elements of an evil standard:

1. Hard to understand. A well-written standard should be indecipherable to everyone except the members of the committee that created the standard.

2. Unimplementable. We spend our lives being told to live up to one set of standards or another. But we always fail, because successful standards cannot be implemented. Consider the Ten Commandments. It's hard to do a good day's work without breaking three or four of these impractical behavior standards. For most of us, the Ten Commandments could be renamed the Ten Recommendations or the Ten Options.

3. Expensive. Believe it or not, standards are intellectual property. They can be owned and licensed, with all manner of charges imposed on the users. It's really the greatest scam you can imagine. First you and your cronies invent a set of rules that work to your advantage and to the disadvantage of everyone else; then you tell everyone that they must conform to your standards; then you tell them that they must pay you to use the standards.

4. Encumbered (both the standard itself and the uses of the standard). People believe that standards are free. Not necessarily. Many standards are developed by organizations that expect to make a profit from their efforts. Such standards require the purchase of a license. Once you've bought a license to use a standard, you don't get to use the standard any way you choose. You must use the standard within the limited conditions specified in the license. You may be able to use the standard at your primary place of work, but not at your satellite offices. Your information technology officer may use the standard, but not your chief technician. You may be able to use the standard for your CAT-scan reports, but you may be restricted from using the standard for your MRI reports. It all depends on the wording of the license. This provides the owner of the standards with the greatest possible power over the people who must use the standard.

5. Incompatible with all standards, including itself. Of course, you don't want your standard to be compatible with any other standards. You want to lock them into your standard. A good standard is issued in successive versions, sometimes on an annual basis, with each new version incompatible with its predecessors.

6. Monopolistic. The best standard has no competitors. The best way to get rid of your competitors is to convince the government that life would be better if everyone followed one standard... yours. Again and again, the U.S. government has been duped into backing a standard that nobody really wants.

7. Coercive. Every standard organization strives to make life miserable for the people who ignore the standard. If your standard is sufficiently coercive, those who do not use the standard to will be ineligible for government contracts, unable to interoperate with their clients who use the standard, and generally squeezed out of business.

You might assume that standards are produced by the government. This is simply not the case. The government, disinclined to create new standards, expects industries and user communities to create their own standards. Even NIST, the U.S. Government's National Institute for Standards and Technology, is barred from making standards. The U.S. government's hands-off approach towards standards is specified in the National Technology Transfer and Advancement Act of 1995 (NTTAA), Public Law 104-113 (187).

In most instances, NIST is reduced to providing scientific assistance to SDOs (Standards Development Organizations). SDOs are organizations composed of entities who benefit from standards. For example, the tool and dye industry might benefit from a uniform standard for cutting tools. A consortium of tool and die manufacturers might form an SDO to develop an industry standard.

It all seems innocent, until you follow the money. Money is required to assemble and charter the SDO, to pay for organizational meetings, to transport participants to the meetings, to pay the salaries of the SDO staff members, to market the standard, to launch a lobbying campaign to legitimize the standard and to compel government officials to enforce its use, to prepare licenses, and to collect license fees. Lawyers must be retained to protect the value of the standard as an intellectual property, and to litigate against unauthorized uses of the standard. It can easily cost millions of dollars to develop and protect a standard that might be used by a small number of scientists and ancillary industries.

Every standard has its financial benefactors, and those involved in standards efforts learn that "he who pays the piper calls the tune." Most standards are developed by committees compose in part by representatives of the corporations that pay for the effort. Consequently, most standards are written to support the commercial interests of the benefactors.

How might a commercial interest benefit from a standards development effort? Much can be learned from the legalistic adventures of Rambus, a patent licensing organization (188). Rambus served as a participant when the Joint Electron Device Engineering Council (JEDEC), developed a new standard for dynamic random access memory (DRAM) devices. JEDEC incorporated a technology into the new standard that happened to be owned by Rambus. While the standard was under development, Rambus did not disclose that its intellectual property was inserted into the standard. After the user community was locked into the new standard, Rambus asserted its patent and imposed license fees on the users.

The Federal Trade Commission found that Rambus should have disclosed its patented property to JEDEC before it was inserted into the new standard. The U.S. Court of Appeals overturned the FTC, concluding that JEDEC had failed to adequately clarify its disclosure policies to the standard developers. Furthermore, JEDEC failed to convince the Appeals Court that the standard would exclude Rambus' technology if the disclosure had been provided. The Rambus cases is considered one of the finest examples of patent farming (188).

Can SDOs develop certifiably patent-free standards through a disclosure document? Probably not. A participating corporation can simply shift its patented properties to a third party (e.g., a patent holding company) when it learns that the technology will be inserted into a standard. Profits to the corporation can come through a back door arrangement through the holding company that returns a portion of the holding company's licensing fees collected from each user of the new standard. In practical terms, a disclosure form cannot force corporations to disclose what they do not know, do not own, and cannot predict. Corporations can come forth, after a standard is developed, with patents whose applicability to the standard was not anticipated during the disclosure process. Furthermore, Corporations can buy standard-critical intellectual property after a standard is designed. Most importantly, corporations can develop and patent novel, non-obvious and useful application for a standard, after it the standard is developed.

An important incentive for working on a new standard comes from learning potentially patentable uses of the standard. Corporations commonly instruct their delegates to listen closely to their counterparts from competing corporations, without actually contributing to the new standard. The strategy is to let your competitors work on the standard, while you sit on the sidelines, looking for an opportunity to exploit their work. After each SDO meeting, delegates are debriefed by their supervisors.

In some cases, a corporation may benefit if the standards effort is delayed (arriving when it is too late to matter), debilitated (producing a standard that is so weak that it has no impact on the industry), discouraged (resulting in a standard that is immediately rejected), or derailed (aborting the effort to make a new standard). In this case, a corporation may go through the motions of backing the standard, while instructing their committee delegates to interfere with development efforts.

There are thousands of standards development organizations, producing an endless assortment of standards. It stands to reason that many of the newly developed standards are unnecessary and counter-productive.

Some of the most numerous standards relate to digital data. For example, there are dozens of standard formats for electronic images. Some of the standards are proprietary, others are free and open source, and some have fallen into the public domain. Virtually all image formats are interconvertible. This means, that you do not need to buy a license for a proprietary image standard. You can work with images stored in a free image format. Those who prefer to use a licensed image standard can interoperate with you by converting your images to their licensed standard, as needed. Though many people feel the need for a single, mandatory standard for digital data, the dirty truth is that a multitude of electronic data standards do not pose a technical obstacle to the free exchange of information. If an obstacle exists, it's one of perception; people mistakenly believe that data can only be exchanged when stored in the same digital format.

When a standards organization manages to create a standard whose usage is compulsory for an industry, the consequences can be disastrous. A mandatory standard may impose license fees and royalty fees on the user community. More importantly, three scenarios may arise that have dire legal consequences.

First, the mandatory standard may limit competition by other standards, thus inviting anti-trust actions against the organization that produced the standard.

Secondly, and less obviously, the standard may impose burdens upon users of the standard and upon non-users who conduct commerce with users, and this might fall under RICO (the Racketeer Influenced and Corrupt Organizations Act, encacted 1970) (189). Here is an excerpt from RICO:

-"1951. Interference with commerce by threats or violence

-(a) Whoever in any way or degree obstructs, delays, or affects commerce or the movement of any article or commodity in commerce, by robbery or extortion or attempts or conspires so to do, or commits or threatens physical violence to any person or property in furtherance of a plan or purpose to do anything in violation of this section shall be fined under this title or imprisoned not more than twenty years, or both.

-(b) As used in this section-

-(1) The term "robbery" means the unlawful taking or obtaining of personal property from the person or in the presence of another, against his will, by means of actual or threatened force, or violence, or fear of injury, immediate or future, to his person or property, or property in his custody or possession, or the person or property of a relative or member of his family or of anyone in his company at the time of the taking or obtaining.

-(2) The term "extortion" means the obtaining of property from another, with his consent, induced by wrongful use of actual or threatened force, violence, or fear, or under color of official right."

Though RICO was designed to provide prosecutorial power against the mafia, its uses have been expanded since its enactment. When a group conspires to interfere with commerce under color of official right, this might fall under RICO. It is important for a standards organization to avoid using their "official right" to extort money.

There is a third legal consequence of having a mandatory standard. A standard may be technically flawed, resulting in loss to property, loss of commerce, and injury or death to persons. If you tell people that they must construct their machines or buildings or software, or medications in a manner dictated by your standard, you had better be certain that nothing bad happens as a result of conforming to the standard.

10.1 WHAT THE STANDARDS DEVELOPMENT ORGANIZATIONS NEVER DO

"Everything should be made as simple as possible, but not simpler."

-Albert Einstein

Every standards development organization complains that there is nothing they can do to prevent their standard from becoming encumbered by patents. Actually, SDOs have many opportunities to protect their standards from encumbrances. Here are just a few examples of the kinds of progressive measures that SDOs routinely avoid:

1. Work with the USPTO (US Patent and Trademark Office) or the EPO (European Patent Office) to block trivial or non-original patents applied to your standard. The USPTO supports the Peer to Patent project, which opens the patent examination process to public participation (http://www.peertopatent.org/).

2. Collect and publish a list of prior art for all the methods included in your standard. This document would make it difficult for someone to obtain a patent on technology contained in the standard.

3. Do your own careful patent search to ensure that your standard does not include any previously patented methods.

4. Require your members to search their company's patents to ensure that they have no patents within the standard. Clarify these instructions and have each committee member organization provide a binding document indicating that they hold no patented property included in the standard, and that they never held patented property that is included in the standard.

6. The patent searches conducted by companies that are members of the standards committee should include any patents transferred to patent holding companies.

7. Require members of the standards committee to sign agreements (co-signed by authorized representatives of their companies) that no company patents (held or transferred) or claims will apply to the standard.

8. Whenever possible, use open source, or public domain methods within your standards.

9. Whenever possible, use "escape" methods in the standard so that users are not locked into a single method that implements the standard.

10. Make optional standards, not required standards, so that the user community is not locked into one implementation.

11. Make interoperable standards (that can port to-and-from related standards).

12. Have open [to the public] committee meetings and publish the minutes of your meetings

13. Include a "user advocate" in the standards committee

14. Publish the documents related to the efforts you have made to comply with items 1 through 13.

Luckily for evil scientists, standards are typically prepared by other evil scientists. Every standard is made for mischief.

10.2 ADVICE FOR EVIL SCIENTISTS

1. Standards are written by committees of powerful people who represent large corporations. As a member of a standards committee, it is your primary responsibility to advance the interests of your corporation, not the interests of the users of the standard. Use your position to design a standard that works against the interests of your competitors.

2. Don't do any real work on the standard. Attend standards meetings to protect the interests of your company, to gather information on your competitors, and to to report back to your supervisor. That's all. Let the other companies waste their time.

3. Make the standard a requirement for your user community. This can be accomplished by lobbying the government and/or user organizations. Though the U.S. government is reluctant to create new standards, it has a long history of backing hard-to-implement, ineffective, expensive, or unpopular standards. Enforcement of your standard will require new government regulations (rules provided by a Federal agency) or new laws (rules provided by Congress). Let your lobbyists write the regulations and laws, and pass them to an influential agency bureaucrat or congressman.

4. Encumber your standard with licensing fees. You might need to wait until the user community is locked into your standard before you release the hounds.

5. Surreptitiously plant your company's patented technology into the new standard. When the standard becomes a legal requirement, you can intimidate the users to pay royalties.

6. Strive to produce a standard that is too complex for your competitors, but not so complex that you cannot master its subtleties. Doing so will solidify your position as your corporations authority on all questions related to the standard. Remember that the more confusing a standard, the less likely that your inserted patents will be detected.

7. There is no limit to the number of encumbrances that can be placed on a single standard. You can charge a license fee for the standard itself; you can charge royalties for any and every piece of technology that embeds the standard; and you can charge a royalty for novel uses of the standard that are covered by a patent.

8. Research agencies and 501K charities will use their non-commercial status to beg for exemption from your licensing fees. Negotiate on a quid pro quo arrangement. If they can persuade their members to purchase licenses for your standard, you can be charitable.

9. Coerce your potential users. Tell holdouts that they will be ineligible for government contracts, unable to interoperate with their clients who use the standard, and generally squeezed out of business if they do not adopt your standard.

10. Bad standards, such as yours, get worse over time. A poor standard provides the opportunity to make a new version of the standard. Your users will be forced to purchase licenses for the new standard, at a price that you dictate.





CHAPTER 11. ABUSING POWER

"Comfort the afflicted and afflict the comfortable."

-Finley Peter Dunne

Power is influence over other people. Powerful people do not contribute anything to society, directly. They coerce others to contribute, and they take the credit. If you're lucky enough to have power, you'd be a fool not to abuse it.

Among the powerful scientists are department chiefs, deans, editors, journal reviewers, grant reviewers, institutional review board members. The title "Director" is often bestowed on administrators, with no training in the sciences, who find themselves directing teams of scientists. Basically, the powerful people in the world of science are marginal scientists or non-scientists, who decide what working scientists must and must not do.

Here are the basic duties of powerful scientists:

1. Influence peddling. Your influence will often have more value to other people than it has for you directly. In such instances, other people will be eager to pay you to exert your influence, in exchange for money and other favors. Be careful not to break the eleventh commandment - "Thou shall not get caught". Bribery cases have resulted in billion dollar fines (190).

2. Influence influencing. Whether the vacancy is for a Chair of Physics, or Chemistry, or Mathematics, or Medicine, the dynamic is always the same: a group of department heads, often from other institutions, with no affiliation, loyalty, or knowledge of the particular needs of a department, will fill the vacancy with one of their esteemed cronies. Why does this happen? University administrators have a deep mistrust of their faculty. Their assumption is that faculty, left to their own devices, will always choose a chair who is loyal to the faculty. The administrators want a chair who will be loyal to the administrators. This means that administrators will solicit advice from department chairs outside their own institution.

3. Influence cycling. When powerful people change their jobs, the power moves with them. For example, the life cycle of an attorney may begin as staff lawyer for the EPA (Environmental Protection Agency). Soon, he may be hired by the chemical industry, eager to employ someone with in-depth knowledge of EPA regulations. Later, he might be hired as a federal attorney, prosecuting industry moguls who run afoul of EPA regulations. Next, he may be hired by industry, to defend them in the same types of courtroom cases that he was previously prosecuting. Later, he may be hired in a top leadership position within the Federal government, still in the environmental field. Eventually, he may be hired on as chief counsel, head lobbyist, board member, or officer working for a corporation or consortium. The point is that powerful people bounce through the corridors of power, working both sides of an adversarial conflict.

4. Intimidation is the power to make people do what you want them to do, without asking. An intimidated faculty will know that your name should be added as a co-author to every paper they write. At the end of every departmental lecture, the staff will know that you reserve the right to ask the first question. In any discussion, when your interjection interrupts a colleague's remarks, in mid-utterance, he will awkwardly halt, while you will smoothly continue. The simplest application of intimidation involves sparing yourself from unwanted interpersonal interactions. Ideally, the people around you will not engage you in conversation without your invitation.

5. Neglecting others. True power means never having to say you're sorry. The powerful person is expected to neglect others. The general principle is that powerful people are more important than powerless people; their time is more important, their thoughts are more important, and their sense of importance is more important. They expect others to hang on their every word, while they are expected to disregard your deepest concerns. The best and most effective method to neglect others is to ignore them entirely. If you send an email to an important person, do not expect the favor of a reply.

6. Cronyism. In science, if you have friends, you will always be forgiven, no matter what sins you may have committed. If you have no friends, you will never be forgiven, whether you're sinful or righteous. Everything you do, no matter how innocent, will be ignored, or will be treated with great suspicion. The social pact wherein friends do favors for other friends, is called cronyism. Powerful scientists are in the best position to help their friends, to the detriment of strangers.

Here is an example of how cronyism might work. Two senior investigators, from different institutions, frequently give lectures to similar audiences. Whenever either one talks, he exaggerates the contributions of the other. Ersatz boastfulness is highly effective. Audiences ignore self-promotion, but they will believe anyone who confers adulation on a competitor in the same field. Only by attending lectures by both speakers will anyone discover their cynical strategy to inflate each other's merit.

6. Judging. Rejection is the cornerstone of science. As a person of power, it is your job to do the rejecting. Always reject the work of strangers and enemies. If you do your job right, the rejected individual will search within himself for the cause of his failure.

When it comes to your friends, remember the words of Arnold Bennett (1867 - 1931), who said, "It is well, when judging a friend, to remember that he is judging you with the same godlike and superior impartiality." Approve the follies and foibles, misdeeds and mistakes of your friends. They will do the same for you.

7. Exercising authority. Herman Kahn (1922 - 1983) said, "Authority is not power; that's coercion. Authority is not knowledge; that's persuasion, or seduction. Authority is simply that the author has the right to make a statement and to be heard." Your authority has value to those whose authority is tapped out. New York Times reporter Natasha Singer recounts how the Pharmaceutical company, Wyeth, paid a research company, DesignWrite, to write papers favorable to their hormone replacement therapies. Once written, DesignWrite solicited Professors to allow their names to appear as the authors. The papers, which appeared in respected clinical journals, failed to disclose DesignWrite's or Wyeth's role in the final publication (191), (192).

8. Hiring and Firing. Only the meek and powerless anguish over decisions related to hiring and firing. For the powerful, there is only one rule to remember: hire your friends, and fire your enemies.

10. Distributing largess. Because you occupy a position of influence over others, you will find yourself courted by subordinates. You decide who gets a bonus, and who does not. You decide whether a graduate student finishes in 4, 5, 6, or 7 years; or never. You can create sinecure positions for your friends.

12. Raising money. Power does not grow on trees. It costs money, most of which will be spent on your salary, your bonus, and your perks. Raising money usually consists of forcing your staff to acquire large grants; cutting a large slice of the university's budget for your department; buttering up investors and donors in the typical locations: the golf course, the boardroom and the bedroom.

13. Building and protecting the pecking order. In academic circles, the pecking order is maintained by the person with the most to gain from its persistence; the department chair. Those with the least to gain from the pecking order are the graduate students, medical students, post-doctoral fellows, and experienced technicians. These unfortunates get pecked by everyone, but they don't get to any pecking of their own.

14. Power politics. Power, like marriage, is a game of give and take. If you want others to do your bidding, sometimes you must do the bidding of your powerful allies. New York Times reporters Gardiner Harris and David M. Halbfinger reported a tale of power sharing at the FDA (193). ReGen Biologics, Inc., developed a patch for injured knees. Reviewing scientists at the FDA repeatedly and unanimously determined that the ReGen patch was unsafe and had a high failure rate. Four congressmen from the Garden State, where ReGen is located, challenged the FDA's scientific panels; a challenge that came hard on the heels of significant campaign contributions provided by ReGen to said congressmen (193). The FDA director,apparently conferred greater credibility on the honorable New Jersey Congressmen than he credited to his own science panelists. The ReGen patch was approved for sale (193).

11.1 THE DEPARTMENT CHIEF

Of course I believe in luck. How otherwise to explain the success of some people you detest?"

-Jean Cocteau,

Department chiefs are hired by their institution's administration, and not by their own department. The administration expects department heads to work for the administrators, and to side with the administration in conflicts between departments and institution. Therefore, department chiefs have no reason to work within their departments, or to extend loyalty to faculty and staff within their departments.

Most of the academic rank and file have no idea what the department chief does for a living. Most department chiefs prefer it this way. Here are the responsibilities of department chiefs:

1. Bring money into the department, usually accomplished by fighting with the other department chiefs for a piece of the university's budget.

2. Hire staff who will bring money into the department.

3. Fire staff who are not bringing money into the department.

4. Distribute perks and bonus money to staff members who have faithfully served the department chief.

5. Keep an eye on compliance issues (usually related to how money is spent).

6. Balance the departmental budget (always delegated to the department's business manager).

7. Occasionally spearhead new projects that bring additional money to the department.

8. Participate in institutional committees.

9. Travel a lot.

Who hires the department chief? In academic institutions, department chiefs are seldom selected by the departmental faculty. Though the professors in a department are in the best position to know the best, brightest and most productive professionals in their field, these qualities are not major factors in the selection process. Because the salary of the department chief is paid by the institution, the leadership within the institution selects department chiefs.

If the institution is wealthy and powerful, the administration will usually not choose a department chief recommended by the outgoing chairman. When an outgoing chairman leaves to take over chairmanship at another institution, they often take with them some of the best faculty. The transformation of a trusted general to a heinous traitor takes occurs with lightning speed. When the current chairman leaves to begin retirement, there is usually a sense that the departure was long overdue. In either case, the advice of the exiting chairman is no longer required.

Evil administrators always draw department chiefs from outside the department. When an in-house faculty member has all of the qualities of a good department chief, they are likely to be tainted by peer loyalties. A good chairman will be loyal to the leadership of the institution and will not extend his loyalties to the department's faculty. As a department chief, he will be asked to fire, demote, or marginalize his former colleagues.

If the institution chooses a department chief in-house, it is always a sign of weakness. It means that the institution is ineffectual, hated, unknown, or cheap. Nobody outside the institute will want the job.

During the selection process, institutional leadership will go to extreme lengths to shield outside candidates from exposure to the department faculty.

You want to be a Department Chief. You are interviewed for the job in the evening, over dinner, by the search committee. After dinner you are given a tour of the lab. There's only a skeleton staff, and you aren't introduced to any of the workers. The next day, you are interviewed by the top administration at the hospital. You don't meet the day staff. Six months later, you are offered the position. Six months after that, you have moved your family to their new home. You know some of the department staff member by reputation. You don't consider anyone your friend. You introduce yourself to them, as their new boss. Each staff member voices some perfunctory complaint about their lack of resources. Some indicate their distaste for the furtive way in which you were hired. They all seem hostile. At the end of the day, you write a litter, tendering your resignation. Three months later, you are back at your old job.

11.2 CARL LINNAEUS AND HIS IMMORTAL CRONIES

Carl Linnaeus (1707-1778) did not invent the idea of giving species a binomial name. Two centuries earlier, Caspar Bauhin, also remembered as Gaspard Bauhin (1560 - 1624) published the "Pinax thatri bontanici", in which he classified about 6,000 species of plants, providing each species with a binomial name, much as Linnaeus did, two centuries later.

Why is it that Caspar Bauhin is virtually unknown, while Carl Linnaeus has been glorified in history as the father of modern biological classification?

Linnaeus lived in the era of the adventurer-scientist. Most aspiring botanists joined perilous expeditions to the far corners of the planet, in search of new species. Was Linnaeus a daredevil who earned the respect and admiration of his peers? No. Linnaeus did not care much for adventure. His field work was confined to the countryside near his home in Sweden and to the Scandinavian peninsulas. At one point in his career, Linnaeus was invited to partake in an expedition to South Africa and America. Linnaeus declined, indicating his distaste for hot climates. He did, however, understand that botanical expeditions were necessary, so he sent his students.

Linnaeus had 17 devoted students, whom he called his "apostles." His first student-adventurer, Chrostopher Tarstrom, was sent to China, but he died from infection before reaching his destination. Tarstrom's widow held Linnaeus responsible for her husband's death; vehemently so. To avoid further remonstrations from grief-ridden widows, Linnaeus resolved to send only unmarried students on future missions. Though some apostles died, others survived their ordeals and supplied Linnaeus with hundreds of new specimens to add to his taxonomy.

Did Linnaeus do a more thorough job than Bauhin? No. Linnaeus gained his reputation with a slim, 12-page work, the "Systema Naturae", printed in 1735, when Linnaeus was 28 years old. Over his career, the taxonomy grew. When the "Systema Naturae" was in its 10th edition, in 1758, it contained somewhat more species than the preceding work of Bauhin, but this was based largely on contributions submitted by other botanists.

Was the taxonomy of Linnaeus more accurate than the taxonomy of Caspar Bauhin? Not really. Indeed, the Linneaen taxonomy preserved many of the genera (classes) provided by Bauhin. You must understand that taxonomies are hypothetical constructs. They are meant to be examined, questioned, modified, forever. Just as Bauhin's taxonomy was flawed and re-worked, so was the "Systema Naturae" of Linnaeus. The 13th edition of the "Systema Naturae" was published in 1954, nearly two centuries after Linnaeus' final edition.

The reason that Linnaeus is honored is that he popularized the binomial nomenclature within the scientific community. Think about this for a moment. Terminologies are the dullest things in existence. A biological taxonomy is an endless list of obscure, latinized names. How could the word "popular" apply to a taxonomy?

Here's the lesson that every evil scientist must learn. Linnaeus popularized his biological taxonomies by providing new species with the names of his cronies. It's just that simple! When a botanist-explorer mailed a newly discovered plant from Japan to Uppsala, he knew that there was a very good chance that the new species would carry his name, forever.

When Bauhin invented the binomial nomenclature, he made the mistake of naming species with words that described the plant. He was trying to be helpful, but his colleagues found his efforts tiresome and forgettable [because they had been left out of the loop]. Linnaeus, knowingly or not, hit upon a method to immortalize his friends. The conceit of attaching a human name to the epithet (i.e., the second term in the binomial name) of a plant or animal was Linnaeus' crowning achievement.

Every scientist wants to be remembered for eternity. If a species in the Linnaean taxonomy were named for you, wouldn't you extoll the virtues of the taxonomy to your students?

11.3 ADVICE FOR EVIL SCIENTISTS

1. All self-respecting scientists seek power. If you do not scratch and claw your way to the top, your colleagues will assume that you lack self-esteem. They will eat you up and spit you out.

2. As a person of great power, you must understand that excrement always flows downhill. This means that the cleanest scientist is the one on top of the dung hill.

3. Every scientist loves to criticize. As a powerful person, you will be invited to criticize other scientists. When you criticize, you must leave the impression that your are superior to the person who is the object of your criticism, even when you are totally ignorant of the matter being criticized. Never accept criticism from subordinates. Criticism moves from top to bottom, never the other direction.

4. Loyalty can be bought. Use bonuses to reward your allies and to punish your enemies.

5. Use your position to expropriate the ideas of your subordinates. Stealing someone else's ideas is a time-honored privilege of powerful people.

6. Relax. Most of the atrocities committed by powerful people are accomplished with passive-aggressive inaction. Whenever it suits you, simply neglect to return urgent phone calls; do not even bother to read emails; papers that require your signature can sit in the in box indefinitely; pass unavoidable problems to your least competent assistant; travel to a meeting whenever a messy problem erupts in your institution. Problems are solved by the people who are most adversely affected. After someone else has solved your problems for you, be sure to take full credit for the solution.

7. Delegate all work. The most effective way to accomplish this is through the pecking order. Each person delegates their work to their direct subordinate. Only the lowest person in line does any work.





CHAPTER 12. GOVERNMENTS AND EVIL SCIENCE

"Science is 10% intellectual and 90% psychological."

-Anonymous

Evil is concentrated in governments and other institutions of power. Wars, crusades, genocidal massacres, mass starvations, blitzkriegs, firebombings, nuclear devastation, mass rapes and murders, ritualistic human sacrifices, and holy crusades, inquisitions, are all the products of respected, and trusted institutions.

Face it, governments can get away with behavior that would be considered reprehensible if committed by individuals. We see, again and again, that when it comes to the government, a good lie is preferable to a bad truth. When the U.S. government tested atomic bombs in the Nevada Proving Grounds, north of Las Vegas, the activity was gleefully welcomed by the locals. Tom Zoellner, in his book, "Uranium: War, Energy and the Rock that Shaped the World" recounts that nuclear tests were felt on the Las Vegas strip, where roulette balls and dice were jostled by the blasts. Herds of Utah sheep sickened and died. Sores appeared under their wool. The Atomic Energy Commission blamed livestock deaths on malnutrition and cold weather. The public bought the lie. At the time, the tests were widely supported by the people who were directly and adversely affected. The testing sights brought federal jobs, and scientific prestige to the American West. Politicians who urged a testing ban were sharply criticized by the public. Zoellner quotes the Las Vegas Review-Journal, "We in Clark County who are closest to the shots aren't even batting an eye" (194). In the ensuing decades, the number of cancer deaths in the region were high. The National Cancer Institute has estimated that between 11,300 to 212,000 cases of thyroid cancer alone may have resulted from 90 atmospheric tests conducted over the Nevada Proving Ground (195). In 1990, the U.S. passed the Radiation Exposure Act to provide some some compensation to cancer victims who had lived in downwind regions.

Everyone likes a good lie, if it benefits them. On August 18, 1993, The New York Times exposed a fascinating tale of cold war disinformation, entitled "Lies and Rigged 'Star Wars' Test Fooled the Kremlin, and Congress (196)." The story begins during the early 1980s, soon after President Ronald Reagan launched the Strategic Defense Initiative, popularly known as the Star Wars project. Military scientists were instructed to deploy orbiting space satellites, armed with powerful lasers. These satellites would detect launched missiles aimed at the United States, and would fire powerful laser beams, destroying the missiles in flight, before they reached their target.

When the Star Wars project was announced, civilian physicists scoffed at the idea. Experts said that the technology needed for the project was far beyond our capabilities. Nonetheless, the project was funded. Three early tests of the system were complete failures. A fourth test was planned. If this test failed, Congress would almost certainly cut funding for the project.

The fourth test was a stunning success. Shooting down a missile, from a satellite, using a laser blast, is equivalent to pulverizing a bullet, in mid-flight, with another bullet, when the first bullet is shot, without warning, from any location, and aimed in any direction. Congress was highly impressed.

Despite the dramatic success of the fourth Star Wars test, the project never produced any practical results. Star Wars funding was continued throughout the 1980s, but eventually, the space-based defense strategy fizzled out; replaced with a modest earth-bound anti-missile launchers, such as those deployed against Scud missiles in the 1991 Gulf War. These launchers are impressive, when everything goes right and the enemy missile is destroyed in mid-flight. But it's very difficult to strike incoming missiles, and the launchers don't always work as advertised. There are many possible defenses against anti-missile launchers. When an enemy launches a barrage of dummy missiles (with no warheads), with a few armed missiles mixed into the fray, it's very difficult to know which to target.

What went wrong? Why had the Star Wars project failed, after such a miraculous beginning? The fourth, decisive test of the Star Wars project was a fake, plain and simple. According to one of the military scientists interviewed for the New York Times article, "We rigged the test. We put a beacon with a certain frequency on the target vehicle. On the interceptor, we had a receiver." The launched missile colluded in its own destruction, something that rarely happens in warfare. The continued funding for the Star Wars initiative was predicated on a hoax.

When news of the deception was revealed, in 1993, there were no public outcries. Nobody in the Pentagon was punished. Pentagon officials freely admitted the subterfuge. If there was any reaction, it was congratulatory. Though Congress and U.S. citizens were deceived, and the deception was sustained over the ensuing years of the Reagan administration, and billions of dollars were wasted on a senseless project, neither the Congress nor the public were outraged. Why not?

Circa 1989, the Soviet empire collapsed. The Pentagon attributes the collapse of the Soviet empire to economic exhaustion. According to the Pentagon, it was Soviet policy to pump billions of dollars into a military system that matched, project-by-project, the U.S. military system. According to the Pentagon, the faked Star Wars test was a clever ruse aimed at the Kremlin, not Congress (196). The Kremlin, it seems, was suckered into investing money in their own impossible Star Wars initiative. The Soviet's unsustainable military spending spree, we are told, eventually led to the demise of the Soviet communist state.

I have discussed this story with a number of scientists. None of my colleagues have expressed any outrage. Everything seemed to turn out well. The deception was a justifiable cold war strategy. Or was it? Actually, there are some serious flaws in the Pentagon's story. First, if the Kremlin scientists were fooled by the faked Star Wars test, and if this led to unsustainable military spending, you might expect that there would be a lot of retired Soviet military scientists to confirm the assertion. Former Soviet scientists, military experts, and politicians blame the fall of Soviet Communism on a wide variety of complex issues, all unrelated to Star Wars. We should not lose sight of the fact that the test was a fraud, committed by military intelligence, the same group who later told us that the fraud was part of a successful cold war operation. Why would we believe the same people who lied to us in the past?

Let's give the Pentagon the benefit of the doubt. Let's assume that the fourth (faked) Star Wars test convinced the Soviet scientists that the U.S. was close to developing a space-based weapon capable of destroying Soviet nuclear missiles, before they reached their target. This would mean that the U.S. would soon be capable of launching their missiles at the Soviet Union, whenever they pleased, without the threat of mutual nuclear annihilation. Essentially, the Soviets would have no defense against nuclear attack. In this case, wouldn't the Soviets be strongly motivated to launch an all-out preemptive nuclear strike against the U.S., before the Star Wars initiative could be deployed? If the Kremlin truly believed that the U.S. Star Wars test was successful, wouldn't this precipitate a nuclear holocaust?

As an evil scientist, I think of the faked Star Wars test as a lie that resulted in the career advancement of everyone involved in the lie (project scientists and military planners). The hoax fooled Congress and bilked the American taxpayers out of billions of dollars. The Star Wars Project could have led to the end of the world, if the Kremlin had been as gullible as the U.S. Congress.

A simple explanation for the Star Wars ruse is that the military enjoys working on huge, complex projects, and the scientists involved in these projects will go to extremes to defend their own interests. We see that kind of thing happening all the time. One of the longest-running endeavors involves the V-22 Osprey, affectionately renamed "The Grand Ole Osprey." In the history of engineering, there have been many attempts at dual-purposed devices: automobiles that can sprout wings and fly, boats that come ashore and covert to automobiles, washing machines that also dry clothes, houses on wheels that can be towed, behind a car. All of these devices exist, but they have not replaced single-purposed devices. It's very difficult to engineer a reliable and inexpensive composite device when each component is complex.

Circa 1980, the Pentagon decided it needed a hybrid aircraft that could take-off and land like a helicopter, but fly like a plane. Thus began the long, expensive and disappointing sago of the V-22 Osprey. After more than a quarter century in the making, and $16 billion dollars spent, the U.S. government has not created a safe and dependable aircraft. Through the years, multiple crashes of the Osprey have resulted in 30 deaths. One might think that somewhere during 22 years of troubled development, someone might have put a halt to the program. Actually, there is little incentive to stop a multi-billion dollar funding project. Nobody wants the gravy train to come to a halt.

In January, 2001, the New York times reported that a Marine Lieutenant-Colonel had been fired for falsifying Osprey records and for ordering the members of his squadron to do the same (197). "We need to lie or manipulate the data, or however you wanna call it," he said (198). The lies were intended to win new funding, but a squadron member caught the orders on tape.

All is not lost for the Osprey. Mike Lieberman, a military affairs aide on the House Armed Services Committee, was quoted by a Wired article as saying, "My God, we've thrown so much money at it, we have to get something out of it. (198)" Yes, the Grand Ole Osprey has grown too big to fail.

12.1 GOVERNMENT COVER-UPS

"There is no trick to being a humorist when you have the whole government working for you."

-Will Rogers

When people eagerly consume official government lies, it hardly seems worth the effort to cover-up the facts. Still, you can argue that it's easier to hide the truth than to invent a lie.

One of the most outrageous medical cover-ups occurred in April, 1979 in an area 850 miles east of Moscow, in a building designated compound 19, now the acknowledged site of cold war biologics research. Simon LeVay, in When Science Goes Wrong, describes an incident when anthrax was accidentally disseminated through the air ducts of compound 19, and into the immediate environs. Spores settled in the lungs of the unfortunate inhabitants of Sverlovsk (199). During the ensuing six-week period, about 76 people became ill, and at least 66 people died.

The U.S. State Department made public their suspicions that the anthrax outbreak was the result of a germ warfare experiment gone awry. The Soviet Union was a signator of a multinational agreement banning the development and deployment of biological and toxic weapons. If the accusation were true, the Soviet Union would have been in breach of the treaty.

Russian authorities acknowledged the anthrax outbreak, but insisted that it was animal-born, originating in farm animals and spreading to humans via the ingestion of black market meat. This explanation raised certain suspicions, because the anthrax illness was pulmonic (involving the lungs, as would occur if spores were inhaled). Symptoms did not involve the skin (as would occur if infected animals were handled) or the gastrointestinal tract (as would occur if infected meat were eaten). The date of occurrence did not fit an animal outbreak. April in Sverlovsk is cold, and animals are not put to pasture (where the anthrax lives) until the Russian spring. Moreover, the victims did not cluster within families. If the epidemic arose from infected meat, we would expect victims to cluster as infected households.

There followed a decade or more of erudite scientific discussions, accusing and defending the Soviet authorities of causing the outbreak. In general, those who had a vested interest in exonerating the Russians argued on the side of innocence. The anti-Soviets, particularly the CIA, were inclined to argue on the side of guilt.

After the fall of the Soviet Union, forthcoming detailed accounts clarified that the outbreak resulted from a containment breach in the germ warfare facility; a crucial filter was removed and not replaced. Boris Yeltsin eventually ordered compensation for the victimized families; compensation that never came.

12.2 GOVERNMENT AGAINST THE PEOPLE

"Be thankful we're not getting all the government we're paying for."

-Will Rogers

Nobody is really surprised when government-sponsored research fails to meet its goals. Far more sinister is the use of government research for the purpose of killing its own citizens. On June 12, 1998, the [Baltimore] Sun reported on a South African government-funded laboratory that developed ingenious methods to eliminate opposition (from its own citizenry) and to reduce its black population (200). In the early 1980s, according to the article, the Roodeplaat Research Laboratories produced more than 500 items "ranging from chocolates laced with botulism to cigarettes with anthrax and whiskey with weedkiller." According to testimony, an anti-apartheid sympathizer was killed, in 1984, with a simulated snake-bite. A black dissident was killed with a paroxane-soaked shirt. According to testimony from scientists who had worked at the laboratory, the biggest project was the infertility project; designed to reduce the fertility of black citizens, while sparing white citizens.

When questioned, scientists from the lab indicated that they worked under the threat of assassination. If they refused to work, they would be killed. Certainly, the threat of assassination is a strong motivator, but you must stop and think that a laboratory staffed entirely of scientists working under the threat of death might not function at peak efficiency. Wouldn't the workers, about 2:00 each day, say to themselves, "Well, I've worked enough to avoid being assassinated tonight. I think I can knock off for the day." You would think that when staffing a government laboratory whose purpose is to invent weapons for use against its own citizens, one might be somewhat selective. During the job interview, openly evil scientists would have a hiring advantage over scientists who profess goodness.

12.3 THE POWER OF BUREAUCRATS

"The brain is a wonderful organ; it starts working the moment you get up in the morning, and does not stop until you get to the office."

-Robert Frost

"Procrastination is the art of keeping up with yesterday."

-Don Marquis

Sometimes, if you procrastinate long enough and well enough, somebody else will do your work for you. If you're really lucky, you can submit the work as your own, and take all the credit.

Government bureaucrats, if you didn't already know, wield enormous power. They can make your life miserable just by "misplacing" a form or a letter. When it comes to bureaucracies, no country has a longer history than China. Confucious (551 B.C.E. - 479 B.C.E.) admired the Chinese bureaucracy so much that he transformed it into a religion. Though the Imperial bureaucracy ended in 1905, Communism eventually restored the status quo. Today, in China, everyone has a file, containing their academic records, locked in a bureaucrat's cabinet. If your file shows an unblemished history of high achievement, you can expect to get a very good job. A history of failures and low achievement will work against you. If your file is lost, you vanish. In 2009, The New York Times reported the sad story of a promising student whose file mysteriously disappeared, along with his academic standing (201). Accusations were raised that officials stole the files, removed identifiers, and sold the files to underachievers who could afford to pay a bribe to acquire an exemplary academic record (201).

Whereas many powerful scientists actively exercise their influence, the bureaucrat, like the Aikido warrior, practices a passive philosophy. Much can be accomplished by not doing. For example, suppose the rich inner life of a powerful bureaucrat is interrupted by a work request. The following steps must be observed:

1. Work requests received without a clear chain of evidence, linking you to the request, should be immediately destroyed, regardless of who submitted the request. If anyone ever asks, just say that you never got the request. Requests should be tracked through the system, recording the persons and times involved in for each step in handling the request. It's the system's fault if they pass you an untracked request. By destroying un-tracked requests, you're actually improving service, by punishing those who would bypass the system.

2. Work requests received from an unimportant person, even with a clear path to you, can be ignored. If anyone asks why nothing has been done, indicate that you are prioritizing your work.

3. Work requests received from an important person should be done slowly. If you return the work quickly, they'll expect a fast turn-around in the future.

12.4 ADVICE FOR EVIL SCIENTISTS

1. Sometimes, a scientist, in the course of his research, discovers that his project cannot possibly succeed. The evil scientist is obligated to keep the funding coming, in the face of demonstrated failure. Military research projects provide many examples of failed projects that are kept on artificial life support, sometimes for decades, with billions of dollars wasted.

2. Not infrequently, governments will promote some completely nonsensical device, process, standard, or idea. You know it cannot succeed. Nonetheless, so long as it has the government's endorsement, you stand to make some profit by playing along.

3. The Federal workforce is composed primarily of low-grade bureaucrats who have no particular party loyalty. However, the highest ranking government bureaucrats hold presidential appointments. Heads of agencies will tend to make decisions that reflect the philosophy and the culture of the administration that hired them. If you want to get ahead in a federal agency, you should carefully watch to see which way the wind is blowing on Capitol Hill.





CHAPTER 13. CORPORATIONS AND EVIL SCIENCE

"This is a government of the people, by the people and for the people no longer. It is a government of corporations, by corporations, and for corporations."

-Rutherford B. Hayes, U.S. President 1877 - 1881

A corporation is a legal construction that exists separately from the people who created it. Corporations exist to make money and to survive. Corporate activities that do not create wealth and do not extend the life of the corporation are always dysfunctional and can trigger a legal action against the agents of the corporation (e.g., the CEO and Board of Directors).

Corporations have rights and protections much like those of humans, under the legal doctrine of "corporate personhood." In addition, corporations have certain defining rights (not granted to private citizens), and rights attained through the application of wealth and power (not available to private citizens). Here are a few examples:

1. Limited liability. If a corporation fails, shareholders only lose their investment. They are not liable to pay the debts held by the corporation.

2. Tax advantages. Some large corporations may pay little or no tax.

3. Immortality. There is no natural life-span that limits a corporation. Companies can live forever, as long as they continue to create wealth. A corporation may be too big to be allowed to fail; the government will provide artificial life support at taxpayer expense. There are no humans who are too important to die.

4. Power. Corporations can afford to hire teams of lobbyists, public relations managers, and lawyers to promote or defend their interests.

5. Political influence. In 2010, the Supreme Court affirmed the first amendment right of corporations to contribute as much as they please to promote the election of a favored office-holder (202). Eventually, all three three branches of U.S. government will be owned by corporations.

6. Unrestricted conflicts of interest. Corporations can hire employees directly from government agencies, thus providing corporations with inside knowledge of regulatory plans and tactics. In addition, government organizations can, and do, hire their leadership from the corporations that they regulate, thus inculcating friendships and loyalties with the same corporations that government must regulate.

7. Right to sue humans. Corporations can bring legal actions against citizens.

8. Right to "take". Corporations can take property from citizens when the government asserts eminent domain (Kelo v New London, 2005 (203)).

The kinds of profit made by large corporations are enormous, and the fines they pay for their indiscretions are proportionately large. For example, Siemens AG, was found guilty of bribing foreign officials, to obtain contracts (190), (204). This kind of corruption, is considered by some corporate executives to be standard operating procedure, and just another cost of doing global business (204). If so, why would a corporation try so very hard to bury their bribery payments in their books? In the Siemens case, Siemens pleaded guilty to criminal violations of the books and records laws (190). More than $1.6 billion in fines and penalties was levied against Siemens (190).

The Johns-Manville corporation was an early adapter of asbestos, a mineral fiber with extraordinary fire and heat resistance, used for a wide variety of industrial and domestic purposes. Unfortunately for Johns-Manville, asbestos causes mesothelioma, a malignant cancer that rarely arises in the absence of asbestos exposure. Asbestos also causes an incapacitating lung disease (asbestosis) that often leads to death. Claims against the company led to chapter 11 bankruptcy. A Trust was created to deal specifically with tort claims. As of March 31, 2007 the Trust had received 782,349 claims and had made total claim payments of approximately $3.4 billion (205).

These settlements pale in comparison to the fees paid by the tobacco companies, which total in the hundreds of billions of dollars. Still, cigarette advertisements continue, much as they did in the past (206).

13.1 ERBITUX AND THE BRAVE NEW WORLD OF GENE TARGETED THERAPY

"People who enjoy eating sausage and obey the law should not watch either being made"

-Otto von Bismarck

Erbitux is an anti-cancer drug developed by ImClone Systems, Inc. On March 1, 2006, the FDA approved Erbitux for use in squamous carcinoma of the head and neck. In the first nine months of 2007, sales totaled about $1 billion (207). This all sounds well and good, but the apparently happy ending for ImClone follows a long and turbulent history.

On December 28, 2001, the FDA informed ImClone that it would not receive fast track approval for its anti-cancer drug, Erbitux (208).

On December 27, 2001, one day before the FDA's action, Zvi Fuks, chairman of the department of radiation oncology at Memorial Sloan-Kettering Cancer Center, sold over $5 million worth of ImClone stock. In 2005, Zvi Fuks was charged with securities fraud and conspiracy to commit securities fraud. In the criminal complaint, Fuks was accused of acting on an insider tip-off, passed by ImClone's then CEO, Samuel Waksal (209), (210), (211). On June 10, 2003 Samuel Waksal was sentenced to 87 months in prison and ordered to pay $3 million in fines for tax evasion and insider trading (212). ImClone insider trading was not the exclusive domain of scientists; etiquette guru Martha Stewart also indulged. Stewart was charged with securities fraud and obstruction of justice, and served a five month prison term, starting in 2004.

The House Energy and Commerce Committee investigated the ImClone application for FDA approval. The Committee invited testimony from Dr. Raymond Weiss, a medical oncologist from Georgetown University. After reviewing ImClone's data, Weiss found that nearly 27% (37 out of 139) of the trial patients did not meet criteria for inclusion in the trial. Furthermore, 15 of the 37 unqualified patients were entered into the trial through waivers, a forbidden practice, according to Weiss.

In 2007, ImClone was scheduled to appear in court to battle a patent infringement lawsuit brought by MIT, and a biopharmaceutical firm, Repligen. One day before the scheduled court date, ImClone paid MIT and Repligen $65 million to settle the case (213).

Ambitious scientific ventures can be very messy. Like sausages and legislation, if you like science, you should never watch it being made.

13.2 IT PAYS TO ADVERTISE

"Without the people who go to far, we wouldn't go far enough."

-Michael Kinsley

You are an overweight middle aged man, who leads a sedentary life. You have dangerously high blood levels cholesterol and triglycerides. Your doctor has put you on a strict diet, with instructions for daily exercise, and has prescribed simvastatin, a low-cost, generic statin, to control your dyslipidemia.

While watching TV, you see a commercial, featuring Dr. Robert Jarvik, inventor of the Jarvik artificial heart, talking about the benefits of Lipitor. The scene shifts from a close-up view of Dr. Jarvik, to a panoramic view of a man who looks like Dr. Jarvik, rowing a canoe. In the space of a short commercial, you make the following assumptions.

1. You assume that Dr. Jarvik was the inventor of the Jarvik heart.

2. You assume that artificial hearts, like artificial hips, and artificial breasts, are a practical alternative to natural hearts.

3. You assume that Dr. Jarvik was making a public service announcement, not a crass advertisement. Dr. Jarvik was paid in excess of $1 million dollars for his spot in the commercial.

4. You assume that Dr. Jarvik is a practicing physician.

5. You assume that Dr. Jarvik has expertise in the pharmacologic field relevant to lipitor (dyslipidemias and their treatment).

6. You assume that Dr. Jarvik had some professional experience with Lipitor.

7. You assume that Dr. Jarvik rowed the canoe.

8. You tell your doctor to switch your cholesterol-lowering medication from the cheap generic drug (simvastatin) to the high-priced patented drug, Lipitor. If he asks why, you tell him that Dr. Jarvik recommended Lipitor.

Your assumptions about the Lipitor ad were inaccurate (214). Let's review:

1. Dr. Jarvik was not the inventor of the Jarvik heart; at least, not the sole inventor. Remember Stigler's Law of Eponymy, "Credit always goes to the wrong person." The father of the Jarvik artificial heart was Kolff, who never commercialized his name. A large team of scientists developed the Jarvik heart. Kolff brought Jarvik into the project.

2. Artificial hearts are not practical alternatives to natural hearts. Though originally designed as a permanent replacement for failing hearts, a succession of artificial hearts, including the Jarvik, failed to do the job. Today, artificial hearts are bridge devices; they keep patients alive from the time that their natural hearts fail until the the time that they receive a transplant heart. It's more accurate to think of these devices as types of cardiopulmonary bypass machines, and not as artificial hearts.

3. Though the commercial had the appearance of a public service announcement produced by a kindly, concerned cardiologist, it was, in fact, a carefully choreographed advertisement produced by a large pharmaceutical corporation with the single goal of increasing Lipitor sales. Dr. Jarvik was paid in excess of $1 million dollars for participating in the project.

4. Dr. Jarvik received an M.D., but never pursued the post-doctoral ordeals that that qualify practicing physicians: internship, residence, fellowship. Nor did he pass any medical specialty Boards that certify competence in a particular area of patient care.

5. Dr. Jarvik has no professional expertise or experience in the dysplipidemias, or their treatment.

6. Dr. Jarvik is not a cardiologist, and has never prescribed Lipitor.

7. An actor, who looked like Dr. Jarvik from a distance, rowed the canoe.

The Jarvik commercial was caught up in a congressional investigation into false and misleading advertising by the pharmaceutical industry; the ads were pulled (214).

Did Dr. Jarvik commit any crime? No. Did the pharmaceutical company commit any crime? No. How are Lipitor sales doing? Lipitor is the number one selling statin drug. Global annual sales of Lipitor exceed $13 billion.

The Lipitor story has a moral. Corporations exist for the purpose of making money. When a corporation advertises, the purpose of the advertisement is to promote a product, and not to provide an accurate representation of reality.

13.3 SCIENTIFIC ORGANIZATIONS ARE INSTRUMENTS OF LARGE CORPORATIONS

"The strongest man is he who stands alone in the world."

-Henrik Ibsen.

Do you belong to a scientific organization? If so, have you read your organization's charter? Every charter lists the purpose of the organization, and this usually involves the advancement of a field of science through the efforts of the membership. The charter is always a distortion of reality, because most organizations exist to serve the interests of their sponsors. It's a matter of economics. Organizations attract members by holding lavish conferences that attract many influential leaders. Big conferences cost a lot of money; much more money than the membership provides through dues and registration fees. Consequently, conferences turn to corporations to make up the difference (and then some). He who pays the piper calls the tune. The culture of the organization, the scientific direction of meetings, and the type of people accepted into leadership positions in scientific organizations are all determined by the sponsoring corporations.

Every successful scientific organization has the following attributes:

1. Sponsors. The sponsors are often corporations, but they can include any type of entity with power and money (e.g., government agencies).

2. Authority in its scientific field. This can be obtained through a large membership, or through the participation of powerful figures.

3. Numerous lavish, well-attended, meetings.

4. Intellectual property. For example, The American Chemical Society owns Chemical Abstract Services, the American Medical Association owns the CPT (Current Procedural Terminology) that hospitals use to assign billing codes patient care transactions, the IEEE (Institute of Electrical and Electronics Engineers) owns the IEEE Standards Association. Many professional organizations own and publish successful journals.

5. Official status. Powerful organizations often serve the government in an official capacity. For example the National Academy of Sciences was signed into being by President Abraham Lincoln, and is mandated to provide advice to the Federal government.

6. Lobbying activities. Many professional organizations maintain offices or headquarters in Washington, D.C., so they can effectively promote their interests to Congress.

7. Cultural monopoly. A successful corporation sets the mindset of the field it represents. People who think and operate outside the culture are typically fringe players, with no influence.

8. Credentialing. Powerful professional organizations can sometimes determine who gets to be credentialed as a professional. For example, the College of American Pathologists offers credentialing services for laboratories and laboratory testing services. The Society of Actuaries administers the actuarial exams.

9. Wealth. Large organizations have lots of money.

9. Non-profit status. Yes, you can be rich as Croesus and still have a non-profit status.

13.4 ADVICE FOR EVIL SCIENTISTS

1. Corporations have more legal rights and more legal power than individual citizens. Evil scientists should not mess with corporations.

2. Without corporate money, organizations die. Corporate sponsors pay for the lavish meetings, high speaker fees, abundant meals and refreshments, travel perks, lobbyists, publications, and administrative expenses of every successful professional organization. Evil professional organizations will exert their influence for the benefit of the sponsoring corporations.

3. The difference between an irresponsible corporation and an responsible corporation is the focus. Irresponsible corporations focus on their successes; what makes them money. You can't argue with success! Responsible corporations focus on their mistakes: what can be done to avoid errors and improve their corporate productivity. Nobody wants to live under the never-ending burden of self-improvement.





CHAPTER 14. UNIVERSITIES AND EVIL SCIENCE

"A professor is someone who talks in someone else's sleep."

-Anonymous

Though Universities promote themselves as egalitarian institutions, where admission and advancement are based on academic merit, this is hardly accurate. Universities, like Corporations, exist for the purpose of achieving wealth and perpetual life. The goal of every university operation, including admissions, is directed toward enhancing the wealth and health of the university.

The Madey v Duke lawsuit settled any lingering doubts as to the self-serving motives of academic institutions. John Madey was a lab director who was fired from his position at Duke University. Madey owned patents preceding his job at Duke. Duke used those patents without paying royalties, prompting Madey's suit against the university. Duke asserted the traditional academic "experimental use" protection. Duke also asserted that the patents had been developed for the government. Because, Duke argued, the patent was used to fulfill their work under a government contract, the government's own exemption from patent costs should extend to Duke.

The District Court upheld Duke's positions, but the Federal Court reversed the District court decision in favor of Madey (215). Though Duke's work was done under a government contract, the Federal Court held that the activities in question advanced the interests of the University, and were not done for the Federal Government and were not motivated by non-commercial scientific curiosity. In its reversal decision, the Federal Court affirmed the obvious truth that academic centers have the same goals as corporations; the accumulation of wealth and power and the perpetuation of their own existence.

The commercial interests of universities was further demonstrated in Greenberg v. Miami Children's Hospital. The Greenbergs and about 150 other families provided funds, tissues, and a range of services in support of Dr. Reuben Matalon's efforts to find the gene responsible for Canavan disease. He succeeded, and promptly patented the gene, for his employer, Miami Children's Hospital (U.S. patent 5,679,635, October 21, 1997). The Miami Children's Hospital charged a royalty fee for the test. The families, thinking that their donations of time, materials and money had supported an altruistic effort, were shocked that Miami Children's Hospital was trying to profit from the the misfortune of those with Canavan's disease; hence the lawsuit. Miami Children's Hospital essentially won the settlement, and was permitted to continue to charge royalties for the use of their diagnostic test (216). However, the settlement provided that scientists could use the gene, without paying royalties, for research purposes only. Once again, we learn that researchers and institutions are inspired by the universal motivator: money.

Universities, like other corporations, lobby for influence and money. In his book, "So damn much money: The triumph of lobbying and the corrosion of American government" (Knopf, 2009), Robert Kaiser discusses a successful lobbying effort conducted by Tufts University, in 1976. Jean Mayer, world-famous nutritionist and President of Tufts, wanted a nutrition center on the Tufts campus. He sought the services of the lobbying firm, Cassidy and Associates. Gerald Cassidy was an avid reader of the Congressional Record. He learned that a law had been passed authorizing a national nutrition center. After a talk with Tip O'Neill, Congressman from Massachusetts, newly elected Speaker of the House, and personal friend of Jean Mayer, Congress appropriated $27 million, for the center known today as the Jean Mayer USDA Human Nutrition Research Center on Aging.

In a story reported in the New York Times, the School of Ostopathic Medicine at the University of Medicine and Dentistry of New Jersey hired a powerful state legislator. There followed a dramatic increase in legislated funds funneled to the university (217). Apparently, the legislator was hired to lobby himself!

Every university president knows that the right word, from the right lobbyist, at the right time, to the right politician, can bring millions of dollars.

14.1 ACADEMIC FREEDOM IS THE FREEDOM TO LIE TO YOUR STUDENTS

"Wise men may not be learned; learned men may not be wise."

-Chinese proverb

If you are a student, you only know what you're told by your instructors. If your opinions on a subject differ from those of the instructor, you will learn, when you fail the final examination, that your opinions have no value. Consequently, students accept whatever nonsense a professor professes to be true.

When a professor has a conflict of interest that influences the content of his lectures, the results could be very detrimental for students. At Harvard, students were lectured by a professor who strongly promoted the benefits of a cholesterol lowering drug. The same professor, when confronted by a student who asked about adverse side effects of the drug, was answered with a comment that seemed to belittle the student. The students later learned that the same professor was a paid consultant for ten pharmaceutical companies, including five companies that manufactured cholesterol lowering drugs (42).

In the case of Harvard Medical School, about 1,600 faculty have disclosed that they, or their close family members, have financial arrangements with businesses tied to their teaching, research, or clinical care responsibilities (42). The former dean of Harvard Medical School served on the board of Baxter International, a medical products company that supplemented his dean's salary with up to $197,000 per year (42).

The corporate takeover of academia has the flavor of cheesy science fiction plot:

1. Non-human corporations invade the minds of faculty (with money) and take control of their thoughts;

2. Faculty enlist legions of students using slogans and speeches prepared by the supreme commander of the corporate forces;

3. A student uprising against the faculty is suppressed, using a diabolical super-weapon, academic freedom, that selectively destroys students.

4. The student body capitulates, and obeys the commands of the faculty.

5. Students, the subjects of non-human corporate mind-control, graduate to become the next generation of faculty.

What is the difference between science fiction and real life? It costs $8 to send your child to a science fiction movie; it costs $266,000 to send your child to four years at Harvard Medical School.

How can the faculty receive money from pharmaceutical companies and promote the interests of these companies in their lectures to students? Isn't this a flagrant conflict of interest? Of course, but there is a loophole that protects the faculty, and the loophole is called academic freedom. Academic freedom permits professors to make assertions that are unpopular. Academic freedom also provides faculty with the right to operate openly, as the shill of corporate interests. This means that academic faculty can openly promote the positions of their corporate sponsors, even when those positions have no scientific merit. The most important feature of academic freedom is that it belongs to the faculty, not the students. Students, you see, are the victims of academic freedoms exercised their instructors.

When students attempt to use the same freedoms enjoyed by their professors, the consequences can be dire. The Christian Science monitor reported the unusual fate of Petr Taborsky, who worked on a corporate-sponsored science project as a University of South Florida (USF) student (218). According to Mr. Taborsky, he developed a new way of purifying waste water while participating in the project. The USF took an interest in the research, claiming ownership of the process. A judge agreed, forbidding Mr. Taborsky to use the research data. Mr. Taborsky had other ideas, and proceeded to successfully patent the process. When he refused to sign the patents over to the university, he was sent to prison, where he served on a chain gang. Universities are ruthless, greedy entities no different from corporations. If anyone doubts this, just ask Petr Taborsky.

It's easy to exploit students. A popular tactic is to divvy up their responsibilities on a research project, keeping each participant ignorant of the others' work, and taking credit for the total product.

Here is an example of how the process might unfold:

1. A graduate student isolates a class of related chemical compounds, obtained from an herb. The herb is touted, by traditional Chinese healers, to have anti-cancer activity. The related chemical compounds have some inhibitory effect on a cellular pathway known to be activated by an oncogene.

2. Another graduate student, in the same lab, develops methods to isolate, purify, and chemically characterize the different active compounds.

3. Another graduate student, in the same lab, demonstrates that these compounds inhibit the proliferation of several different cancer cell lines.

4. The laboratory chief (a full professor in the University, and a paid consultant for 15 different pharmaceutical companies) contacts the University's Technology Transfer Office. Plans are laid to patent the class of compound as an anti-cancer treatment, based entirely on cell line studies, with no actual anti-cancer trials in any animals or in humans. Under the University's technology transfer policies, the patent will be assigned to the University. The laboratory chief will receive 25% of any patent royalties and licensing fees received by the University. The graduate students who had key roles in the discovery, will receive nothing; neither will the traditional Chinese healers.

Though universities and faculty make a big show of academic freedom, most faculty will gladly sign away their freedom to corporations; if the price is right. Thirty-five percent of agreements signed between industry and academic researchers allow the sponsor to delete information from publications; 53% allow sponsors to delay publications (219). Basically, what a professor says, and when he says it, can be determined by his industry sponsor.

14.2 THE FERTILE GROUND EXCUSE

"For what vice, pray, has ever lacked its defender?"

-Seneca (about 2000 years ago)

Just as academic faculties enjoy protections under the guise of academic freedom, university administrators seek refuge under the "fertile ground" principle (220). Basically, "fertile ground" depicts universities as nurturing environments in which students develop into national assets. Extending the analogy, the best fertile ground is covered by manure and compost.

Fertile ground distinguishes the ivy leagues from the on-line universities and the community colleges. It promotes the idea that if you haven't been immersed in the cultural milieu provided by a prestigious college, you haven't been adequately educated. With fertile ground under your feet, you can let education lie fallow for a few generations. Providing a strong curriculum, with qualified teachers, and stringent criteria for grading becomes less important than establishing a diverse student body, famous faculty, and influential administrators. Successful football and basketball teams contribute to the fertile ground of a university. Generous athletic scholarships for non-scholars is par for the course, along with obscenely high salaries for coaches.

In a fertile ground university, academic faculty are not required to teach, if they bring prestige or money into the university. The University of Medicine and Dentistry of New Jersey was forced to fire cardiologists when a newspaper investigation uncovered that the staff members did no actual work for the University. The cardiologists were given academic titles and were paid as much as $150,000; but their only university-related activity involved referring patients to the University Hospital (221). Federal law forbids payments for referrals, but federal law does not forbid the appointment of academic faculty who do little or no work. The issue was eventually settled in court. The U.S. Attorney's Office got a $1.4 million settlement with one of the cardiologists, for taking a salary from the UMDNH while improperly referring cardiac patients (222).

In an investigative article written for The Washingtonian, Harry Jaffe recounted the imperial lifestyle and lavish expenses incurred by a former president of American University (223). Eventually, his personal expenses, charged to American University, upset the wrong people; the details of his lifestyle were leaked to the public. American University's problems multiplied when federal prosecutors began to serve subpoenas for financial records. The high-maintenance president departed, but not without providing a glimpse of the strange fruit grown from the fertile ground of academia.

14.3 ADVICE FOR EVIL SCIENTISTS

1. Universities have the same aspirations as corporations: the acquisition of wealth, and the perpetuation of existence.

2. Universities don't want to advance science, they want to cash in on science.

3. Academic freedom is the right of university faculty to abridge the academic rights of students.

4. Universities can lobby for whatever they please: money, scientific legitimacy, grants, contracts, privileged treatment. Universities can hire public relations firms, advertising agencies, and lobbyists that promote a particular scientific opinion. They can create bogus think tanks that issue technical reports that promote their own views. Truth is determined by the loudest university.





CHAPTER 15. ETHICS, AND THE AVOIDANCE OF SAME

"Science doesn't work because we're all nice. Newton may have been an ass, but the theory of gravity still works."

-Gavin A. Schmidt, NASA climatologist (224).

In the realm of human subjects research, the ultimate bastion of ethics resides in the IRBs (Institutional Review Boards). In the U.S., an IRB is a committee formed by institutions that receive federal funding for human subject research. IRBs operate in accordance with a regulation known as the Common Rule (225). Other countries have their own versions of IRBs. Their mission is to protect human research subjects from harm. Investigators who conduct human subject research must submit their research proposals to an IRB; research cannot proceed without IRB approval.

The bulk of the members of an IRB are drawn from staff within the institution. Individual IRB members come with their own biases, their own perceptions of human subject risks, and their own personal and professional agendas. IRBs are the natural enemy of investigators, who see the IRB as an existential threat. Here are some problems that researchers might have with their IRBs:

1. IRBs may not like certain research fields, finding them inherently harmful to patients, essentially stopping the career of faculty who work in the field.

2. IRBs may dislike particular researchers. Death by nitpicking is the standard punishment reserved for unpopular investigators.

3. In an effort to protect the sovereignty of the IRB, the Common Rule provides no mechanism wherein investigators can demand accountability for bad IRB decisions. Any IRB can hound any investigator to distraction, without needing to justify their actions to a higher authority.

4. IRBs have notoriously poor communication with investigators. Final judgments are issued without explaining to the investigator what he must do to submit a proposal that would be acceptable to the IRB.

5. IRBs often have nobody on the committee who can competently read the proposal. IRBs seldom try to maintain the pretense of scientific competence, taking the position that their job is to assess risks to patients, not judge the research on its scientific merits. This skirts the issue that if they do not understand the science, they cannot estimate the resulting risks. When in doubt about research risks, IRBs tend to err on the side of "no".

6. IRBs don't have a very good record regarding consistency; handing down a rejection a trial that has the same research risks as another trial that was previously accepted by the same IRB. IRB committee turnover contributes to the problem, but the overall lack of firm principles of operation probably accounts for the bulk of inconsistent judgments.

7. There is wide variability in the way that different IRBs operate. A project that is approved at one IRB can be summarily rejected by a different IRB. Some of these inter-institutional differences may be due to the many ways that the Common Rule regulation is interpreted.

8. IRBs have a tendency to be overly protective of human research subjects. Whereas the Common Rule is designed to protect research subjects from harm, many IRBs protect research subjects from any perceived annoyance or inequity, no matter how trivial or unlikely. In many cases, such protections, if enforced, would abrogate the scientific value of proposals.

9. Principle 19 of the World Medical Association's Helsinki Declaration (226) states the following: "Medical research is only justified if there is a reasonable likelihood that the populations in which the research is carried out stand to benefit from the results of the research." The ugly truth is that there is never a reasonable likelihood that anyone, other than the researchers themselves, will benefit from the results of the research. Consider the field of cancer research. Despite hundreds of thousands of experimental studies, we don't have a cure for cancer, but we have produced thousands of smug, well-funded scientists. Knowing this, it would be fair to say that every future cancer study will have the same likelihood of success as all of the past experiments; that's a number pretty close to zero. If human subject research required a likely benefit for the subjects, all clinical research would come to a grinding halt.

10. IRB decisions have finality. Investigators cannot appeal decisions rendered by the IRB. The only solution for a rejected proposal is to come back to the same IRB with a new proposal.

In the U.S., the Office of Human Research Protections (OHRP) registers and regulates IRBs. You might think, that with all the angst generated by IRB decisions, the OHRP might focus its attention on the decision-making process. Not so. The OHRP is not in the habit of faulting IRBs for bad decisions. Like any government office, the OHRP is all about processes (not results) (227), (228). IRBs must ensure the OHRP that approved protocols are legitimate (the applicant did not misrepresent the study presented to the IRB), that researchers are not conflicted by financial or other interests that might lead them to harm patients, that the actual trial conforms to the submitted protocol (no bait and switch), that adverse events are reported, and that these activities are documented and organized (so they can be found), dated accurately, and saved. The job of an IRB is to develop and deploy a well-documented process for approving and following protocols. That's all.

You might think that institutions could assemble and operate a smoothly functioning IRB. It seldom happens. Here are just some of the many rituals followed by institutions that run IRBs: providing no guidance to the members of the IRB; placing lazy and unqualified staff into IRB positions, as a sort of administrative punishment; bullying IRB members into approving or disapproving protocols for reasons unrelated to human subject protection; placing staff into IRB positions who have known conflicts of interest stemming from financial arrangements with drug companies; performing no quality assurance over the general activities of the IRB, to ensure that the IRB is adequately fulfilling its responsibilities.

Despite their limited functions, IRBs manage to make life miserable for many of the most ambitious and innovative researchers. What can evil scientists do to protect themselves from the people who are trying to protect human research subjects? Keith-Spiegel and Koocher have written a fascinating report, describing some of the tactics used by investigators (229). Because the Common Rule only covers research, investigators will disguise their data-collection as non-research activities. Non-research activities might include teaching, or quality assurance, or clinical documentation. If a data set collected under a non-research pretense looks promising, the investigator can submit an IRB proposal to use the data in a research publication. Keith-Spiegel and Koocher discuss the plight of researchers delayed by the infrequency of IRB meetings. The IRB can take many months to review a research application; during which time, researchers are expected to wait. Not surprisingly, some researchers will forge ahead, seizing the initiative and braving the consequences (229). Other investigators, burnt by past encounters with IRBs, omit or gloss over information that might provoke the IRB to reject their protocols (229).

Institutions are often clueless on matters relating to the execution of approved protocols. Those who actually conduct clinical trials often have little or no research training. In a recent article entitled, "Should the NCI worry about community research?", Alan C. Milstein, an attorney, in reference to protocol oversight, was quoted as saying, "I have deposed researchers in these situations where the answers are just startling, to the point where I have asked them 'did you read the protocol?' And the answer is no. (230)"

15.1 CONSENT AND UNCONSENT

We are just "a volume of diseases bound together."

-John Donne

Human subject protection usually begins with consent. Patients who are put at any risk in an experimental study must be provided with the right to just say no. To this end, researchers must provide prospective human subjects with a consent form that states the purpose of the study, the risks involved, and that discloses any information that might reasonably affect the participant's decision to participate (such as financial conflicts of interest among the researchers). The consent form must be understandable to laymen, must be revocable (subjects can change their mind and withdraw from the study), must not contain exculpatory language (no waivers of responsibility for the researchers), must not promise any benefit to the participants, and must not be coercive.

The non-coercive rule is subject to wide degree of moral latitude. In the operating room, your surgeon holds your vital organs, knife at-the-ready; your life or your death in his hands. When this man hands you a consent form and asks you to sign it, are you likely to say no?

Veteran doctors know that any amount of patient resistance to any type of consent form can be overcome with the proper application of psychologic pressure. When the consent form needs to be signed by the close relatives, or by a guardian, use a guilt-soaked admonition:

"If you don't sign this, you're sentencing your (father, mother, sister, brother, son, daughter) to death, and you will have to live with the consequences of that decision."

If things don't work out exactly as hoped, and the patient dies, the doctor may ask the next-of-kin for permission to perform an autopsy. In this case, indirection is key. The best strategy is to join the relatives in a defensive action against phantom bureaucrats. First, ask "Have the administrators informed you of your rights to have your (father, mother, sister, brother, son, daughter) autopsied?" The relatives will answer in the negative. Then say, "I don't know what their game is, but let me tell you that whenever a patient dies in this hospital, the relatives have the right to request an autopsy that will be done at no cost to them; the hospital will pay for it. Don't let the hospital bureaucrats take that last right away from you and your (father, mother, sister, brother, son, daughter)." This always works.

In the military, consent is not always required. The personal choices available to soldiers are always limited. If military command decides to vaccinate soldiers against perceived biological threats, the soldiers must submit to vaccination. Apparently, soldiers can be ordered to take PB pills (pyridostigmine bromide, to counter nerve gas), and anthrax shots (231), (232).

Informed consent for children is a tricky subject. Children really can't reach an informed decision relating to a medical procedure. A parent or guardian needs to decide for them. When it comes to consent for participation in a research project, parents seldom choose to put their children at any risk, even when the risk is small. Consequently, it is nearly impossible recruit children into clinical trials. As a result, few new medicines have been tested on children; hence, few new medicines have been shown to have a demonstrated benefit on children. The FDA, frustrated by the lack of clinical trial data on children, enacted a requirement, in 1998, that drug makers test new products on the pediatric population. In 2002, the U.S. District Court ruled that the FDA lacked the authority to impose a pediatric testing requirement (233).

Though consent is usually considered an obvious ethical necessity, it has a number of moral vulnerabilities that every evil scientist must learn.

1. Consent is a revenue source for researchers. When consent must be obtained on thousands of patients, the consenting costs can actually exceed the costs of conducting the trial. You need to consider that the consent must be explained to the subject, by a professional staff member. The consent form can be quite long, and the time for acquiring consent can be lengthy. After consent is obtained, it must not be lost. In most cases, the consent information must be entered into a database (another cost). Patients have the right to reverse consent at any time during the clinical trial. The trialists need to have a way of flagging cases for which consent was withdrawn; not an easy task. The tasks related to the consent process cost money, without materially contributing to the research output. Because funding institutions must support consenting efforts, you can ask for and receive obscenely large grants when consenting is required.

2. Consent is itself a confidentiality risk. The moment you ask for consent, you're creating a new security risk, because the consent form spells out the procedure and the patient. The consent form must be stored, and retrieved as needed. Copies of the consent form will usually need to be attached to the patient's medical record, and other documents needed for the duration of the patient's care and during the trial follow-up period. As more and more people have access to copies of the confidential consent forms, the risk of a confidentiality breach increases. In many trials, the physical risks to the patient are minimal (e.g., obtaining a swab of the oral mucosa, drawing one extra vial of blood during a routine phlebotomy procedure). In minimal risk trials, confidentiality risks associated with the acquisition of consent may represent the greatest threat to the patient.

3. Consent diverts attention from a wide range of nefarious activities. There is a limit to the number of problems anyone can worry about. If half of your research effort is devoted to obtaining, storing, flagging, and retrieving consent forms, you're less likely to pay attention to other aspects of the project. More importantly, an IRB (Institutional Review Board) that approves a consent process will have less time to supervise your methods of treating patients, recording intended and unintended consequences of the treatment, and analyzing the resulting data.

4. Consented research data can be used for unconsented purposes. Once you've gotten permission to do a study, the results of the study can be used for purposes unrelated to the original project. Here's how it's done: when you have collected all the data for your consented research, remove the patient identifiers (names, addresses, social security numbers, and any other identifying information) from the trial records. This yields a de-identified database. Government regulations pertaining to human subject research and the uses of medical records do not apply to de-identified data (234), (225). Use the de-identified data for any purpose, commercial or non-commercial, that suits your fancy. You can combine your data with other data that you collected, or with data held by other collaborators, including pharmaceutical companies. The project for which the consent was obtained can be implemented as a ruse, the sole purpose of which is to support research that patients would not dream of consenting, otherwise.

Is it ethical to ask consent for a research effort that you never intended to pursue? Maybe not. But it may be what you need.

15.2 CONFLICTS OF INTEREST

"The movies are the only business where you can go out front and applaud yourself."

-Will Rogers

Most people simply do not understand the meaning of conflict of interest, often confusing the term with payola, or bribery, or some intentionally deceitful action designed to further one's own interests. A conflict of interest is simply the condition where a person is put in a position where his decisions may be influenced by factors other than the usual and expected factors that motivate a person. Here is a good example of a conflict of interest. A physician's son is sick. The doctor decides to diagnose his child himself, without sending the child to the pediatrician. Normally, a physician who encounters a sick child has one driving interest: to render a correct diagnosis, even when that diagnosis is terrible news for the child and the parents. A father's primary interest is his child's welfare. The father-physician wants, more than anything else, for his child to have a benign illness. The father-physician has a conflict of interest, because the motivation to render a diagnosis may conflict with the motivation to have a healthy child. A conflict of interest is not necessarily a dishonest action; it is merely a situation where a person's motivations are muddled.

How pervasive are conflicts of interest in the science literature? Stelfox and colleagues reviewed papers that supported the somewhat controversial issue of drug safety of calcium channel blockers. They found that 23 out of 24 authors who defended the safety of calcium channel blockers had financial ties to the pharmaceutical companies that manufactured these drugs (235). Of 70 articles reviewed for the study, only two of the articles disclosed potential conflicts of interest (235). Studies that have looked specifically at the issue of financial disclosures by authors of research articles have shown that voluntary disclosures of conflicts are rarely reported (104). Most academic institutions have no conflict of interest policy for staff receiving commercial support (236).

Conflicts of interest accompany exercises in power, and are most likely to occur among top-level scientists. Here is an example. A university professor is a consultant for a pharmaceutical company. He relationship with the pharmaceutical company extends over several decades, during which time he has collected a considerable amount of stock in the company. He conducts clinical trials testing drugs that the pharmaceutical company has developed. Clearly, he has a conflict of interest. He wants the drug trial to succeed for a variety of reasons that are unrelated to scientific curiosity. If the trial succeeds, his stock will increase in value. If the trial fails, his stock will plummet in value. He has every reason to distort or misinterpret the findings of the trial to favor the pharmaceutical company. He has every reason to minimize, fail to report, and fail to treat adverse reactions from the drugs.

Jesse Gelsinger was a 17 year old who volunteered in a clinical trial conducted in 1999, that resulted in his death. The trial was led by James M. Wilson at the University of Pennsylvania. Accusations of misconduct resulted in an investigation, and in 2005 the U.S. Justice Department settled a civil case against Wilson and his major collaborators and with the University of Pennsylvania. As part of the settlement, Wilson was required to write an article on "lessons learned. (237)" In 2009, a decade after Jesse Gelsinger's death, an article appeared in the journal Genetics and Metabolism, written by James M. Wilson, and entitled "Lessons learned from the gene therapy trial for ornithine transcarbamylase deficiency. (238)" In the article, the author reflects on the professional motivations of academic scientists, such as himself. In this case, Wilson was a founder of a biotechnology company focused on gene therapy, while he led clinical trials of gene therapeutics. Furthermore, he owned stock in Genovo, another gene therapy company. Success in Jesse Gelsinger's trial may have bolstered the value of stocks held in the gene therapy sector. Wilson wrote, "I learned it is very hard to convincingly uncouple drivers for academic success from the incentives derived from potential financial gain. (238)" Indeed.

Situations arise when an entire group of scientists are equally conflicted. For example, most scientists have membership in several different scientific agencies. The steering committee for one organization is usually populated by the same scientists who hold office in other organizations. Issues will arise that relate to the way that one organization interacts with the other organizations in the same field. Decisions are made to co-sponsor events, to send mailings to members of the other organizations, to recruit new members from the ranks of the other organizations, or to purchase services and goods from other organizations. In each case, the committee members have conflicts of interest. Which organization will their influence serve? Nobody knows, and nobody seems to care. The occurrence of conflicts among the officers in scientific organizations is so pervasive that it cannot be stopped. In most instances, these kinds of conflicts are simply ignored.

Sometimes, conflicts of interest rise to the level of criminal action. For example, a former head of the FDA, Lester M. Crawford, owned stock in companies that his agency regulated. Two months after his approval, by the U.S. Senate, as FDA Commissioner, Crawford found himself pleading guilty to a conflict of interest charge. He received a sentence of three years supervised probation and a fine (239).

15.3 BETRAYING CONFIDENTIALITY

"Everything is funny as long as it is happening to Somebody Else."

-Will Rogers, Illiterate Digest (1924)

Confidentiality is the process by which you tell someone a secret about yourself, trusting that they will never divulge that secret to anyone else. There are a lot of entrusted secrets in scientific research. For many scientists, keeping secrets is often a condition of employment. In the broad field of biomedical research, virtually every piece of data collected on a human being is considered a confidential secret. You might think that with all their experience handling secrets, scientists would get pretty good at it. Not really. Here are just a few examples to the contrary.

On May 3, 2006, a laptop computer was stolen from a Veterans Affairs data analyst. On the computer and its external drive were the names, dates of birth and Social Security numbers of 26.5 million soldiers and and veterans. By the end of June, the laptop was recovered, by the FBI. There was no evidence that the data had ever been accessed. In the interim, the 26.5 million potential victims of identity theft suffered sufficient emotional distress to launch a class action suit against the VA. Three years later, the VA agreed to pay a lump sum of $20 million dollars to the plaintiffs (240).

The episode brings to mind a flood of questions:

1. Is it customary for VA employees to take confidential information home with them? Apparently, government staff just can't help it. The problem extends to the top agent in the top security agency in the U.S. While he was the CIA Director, John Deutch breached his own security protocols by bringing sensitive CIA information to an unclassified computer at his home (241).

2. Is confidential information typically bundled into a neat, no-nonsense file, with all of the information pertaining to the many millions of individuals, organized for an easy one-click download? Apparently, all the high-tech jargon thrown around concerning encryption algorithms and security protocols just never trickles down to the front-line staff.

3. Is there any way of really knowing when a confidential file has been stolen? The thing about electronic data is that it can be copied, perfectly, and in secret. A database with millions of records can be downloaded in a few moments, without the victim knowing that the theft has occurred.

Perhaps you are thinking that the VA laptop fiasco was an aberration. Certainly, breaches of confidentiality would not occur in databases that are collected on the condition of confidentiality, such as the U.S. census. During World War II, 120,000 U.S. residents of Japanese ancestry were collected and sent to internment camps, for the duration of the war. Rounding up 120,000 people is not an easy task. It helps to know where everyone lives. The 1940 U.S. census had data on the race, nationality and addresses of everyone living in the U.S. In a paper written by William Seltzer, a statistician and demographer at Fordham University, and Margo Anderson, a history professor at the University of Wisconsin at Milwaukee, the authors report that the U.S. census bureau collaborated with the War Department on the internment effort (242). According to the authors, the census bureau identified, for the War Department, concentrations of Japanese-Americans in areas as small as city blocks; thus facilitating the roundup (242). Of course, World War II was a time of national emergency. Strange things happen during wartime, and it is difficult, in retrospect, to assign fault. The point here is that things change, and promises of confidentiality made with the very deepest sincerity may someday be withdrawn.

Perhaps there is something to be learned from the ingenuity of failed dotcom companies. In an article written for CNET news, Greg Sandoval describes the privacy work-arounds practiced by a few failed dot-com companies whose databases contained customer data including names, phone numbers and credit card numbers. Customer data is collected under the assumption of privacy, and confidentiality is protected by dotcom entities. When the dotcom entity ceases to exist, so might the protection. Customer databases may convey to the company that buys the failed entity; and the new owners may use the data as they see fit (243). How does this relate to research? Hospitals are bought and sold; hospitals go bankrupt. The patient data collected by a hospital conveys to the new owner. The new owner may acquire several multiple hospitals, and all of the medical records held by every acquisition will be available to the new owner. Patients sometimes conceal medical information by seeking treatment in different hospitals and medical offices. A patient who goes to hospital A for his colon resection and hospital B for his psychiatric appointments, may not be eager for doctors in hospital A to have access to the same records held in hospital B (or vice versa). The owner of hospital A and B will certainly combine the records.

Despite what you may hear, a person's medical data has minimal intrinsic data for anyone, including the patient. Doctors routinely order tests and never bother to review the results. They imagine that if any of the tests produced an abnormal result, somebody from the lab would call them. Though it could be argued that insurers might take interest in your incurable disease, nobody really wants to hear about your hemorrhoids, your constipation, or your acne.

15.4 EVIL PATIENTS

"Only the paranoid survive"

-Andrew S. Grove, former Intel CEO

You have just pissed into a cup. You pass the cup, along with the requisition form, to a medical student, who will submit the specimen to clinical pathology. On the following day, your doctor will have the results of a complete urinalysis; part of a routine medical check-up. The medical student looks at your paperwork and pauses a moment. She turns to you and asks if you would like to participate in a medical study. You decline. She tells you that there is an ongoing study for men, aged 40 to 70 (your age range) that measures small quantities of prostate-associated proteins in urine. You decline again. She mentions that you will not be bothered in any way by the study. They can use the same urine sample that you just submitted for your annual check-up. You decline. She informs you that the results of the study may lead to a way to treat early prostate neoplasia, before it has a chance of becoming malignant. You decline again. She mentions that this treatment may be available to you within your lifetime. You thank her for the good news and decline again. She wishes you a good day. You proceed with your life.

Patients can be just as selfish as scientists. Many scientific experiments pose no hazard whatsoever to the patients involved. Often, the scientist wants to use a piece of tissue that was removed in the course of some procedure. Excess tissues removed at surgery are usually sampled by a pathologist. The pathologist saves the small tissue sample and discards the remainder. The excess tissue can sometimes be used in research projects. Hospitals usually request patients to sign a form allowing such tissues to be used for research purposes. Well over 90% of patients sign the form, happy to participate in medical research when there is no risk involved.

A subset of patients will refuse to cooperate, under any circumstance. Rarely, the objection will be based on religious grounds. For example, some native American tribes believe that bodies should be kept intact. Tissues removed at surgery are collected, saved for the duration of the patient's life. When the patient dies, his body is buried along with the all the pieces removed during life.

In some cases, patients object without any rational reason. Some will insist that their tissues must have some monetary value to the scientists. Rather than give their tissues away, they want to negotiate a contract for a piece of any profits that might result from the experiment. This tactic never works. The scientists will simply obtain their tissues from the next patient.

Even when assured that a lucrative contract is simply not in the offing, and that their excess tissues will be discarded if not used for research, some patients will refuse to sign a release for the tissues. In this case, refusing to donate excess tissues is a matter of selfishness, not greed. These patients do not like to give anything of theirs to another person. They would rather have the tissue incinerated.

The Helsinki declaration of the World Medical Association (WMA) insists that participants share the benefits that come from clinical trials: "The WMA hereby reaffirms its position that it is necessary during the study planning process to identify post-trial access by study participants to prophylactic, diagnostic and therapeutic procedures identified as beneficial in the study or access to other appropriate care. Post-trial access arrangements or other care must be described in the study protocol so the ethical review committee may consider such arrangements during its review (226)." This being the case, shouldn't those who refuse to participate be denied benefits? Every consent form should have a paragraph that reads, "I refuse to participate in this research project. I understand that I will not be permitted to use the medicines, and treatments that may become available as a consequence of this research. Further, I understand that my name will be included on a list of people who cannot receive medication or treatments developed from this research project."

Justice happens whenever a person gets what they've asked for, and then they are required to live with the consequences.

15.5 HARMING ANIMALS

"Boys throw rocks at the frogs in jest. But the frogs die in earnest."

-attributed to Pliny the elder (23 - 79 A.D.)

Mankind's casual cruelty and selfishness are apparent in the manner in which we treat other living species. The number of animals sacrificed in the name of scientific progress is small compared to the number of animals destroyed in the insatiable food industry. At least a quarter of all animals used to produce food are not eaten. Meat becomes spoiled, or discarded as excess, or passed over because the gastronomic result was disappointing. The remaining three quarters of animal-based food is unnecessary: humans can survive quite nicely on a varied and balanced vegetarian diet (ask just about anyone in India).

Here is the typical way of rationalizing a carnivorous lifestyle. "I love to eat meat. The quality of my life would be greatly reduced if I could not eat meat. The survival of all animals species on earth depends on the death of other animal species. Animals must die for humans to live. That is simply the way things are. The greatest religions of the world acknowledge this simple fact. It would be an insult to God, who provided animals for mankind to kill and eat, if I did not not enjoy a good steak."

For most of us, the argument is won in the first five words, "I love to eat meat." As humans, we relentlessly pursue our pleasures. The well-being and ultimate destiny of farm animals has never held much sway on the human psyche. Mind you, we do not eat every part of the farm animal. Today's finicky eater is only interested in muscle meat. The organs (livers, kidneys, intestines) are considered inedible by humans.

Ironically, we now have the technology to produce muscle meat without killing animals. We could take a small, harmless biopsy of a cow's flank, and grow muscle cells in tissue culture dishes. A single progenitor cell, cultured in flasks, could yield megatons of meat. The technology is well-established, but has never been developed for large-scale production. Scientists can do a lot of things that society, quite literally, will not stomach. Still, the option of a carnivorous diet without animal slaughter is out there.

The animals that are not used for food are likely to be used for consumer product development. Industry tortures and kills millions of animals each year to test the toxicity of cosmetics, shampoo, conditioners, and thousands of household products. Just about every new product intended for human use will be tested in animals. The animals sacrified for medical progress are a small fraction of the animals killed each year to test new, improved products that we do not really need.

The argument for the use of animals in medical research boils down to, "my species is better than yours." You have heard it often, delivered loudly, and with indignation. "If I have a choice between saving a child dying from cancer, and killing a bunch of rats, you'd better believe that I'll kill those rats."

About 10 million young children die each year, worldwide. Death of young children in developing countries is rare, and nearly all of the 10 million deaths occur in impoverished or embattled countries. Deaths are caused by malnutrition and a host of diseases that could be prevented or treated, if the world seriously cared. Laboratory rodents are not responsible for the dying children; it seems absurd to require rats to pay the ultimate price for society's emotional lethargy.

When you argue that humans are fundamentally different from rats, and these differences lead you to value the life of humans over the life of rats, you might stop and think about how these differences may influence our ability to extrapolate laboratory observations from rats to humans. In fact, the differences between rats and humans are a major impediment to using rats in cardiovascular research, cancer research, human behavior, and research into the most important human infections (malaria, sleeping disease, Chagas disease, parasitic diseases due to worms, HIV, and so on). Many of the research breakthroughs found in rodent and other animal models cannot be translated to humans.

How much of the money, time, and effort spent on animal models of human disease has been wasted? It is impossible to say. Certainly, there have been medical breakthroughs that have been attained with animal models. I often wonder where we would be if rodent models were abandoned, and medical research were confined to in vitro studies (using biological reagents without using animals), studies on the so-called lower organisms (e.g., insects, plants, fish), and naturalistic studies (observing and developing therapies for diseases found naturally in animals, without re-creating the diseases in laboratories).

Is there any difference between the modern practice of sacrificing animals for research, and the ancient practice of sacrificing animals to please pagan gods? In both cases, the animals are killed, so that the gods will not inflict their diseases on the humans. Perhaps, today, the profit margin is bigger. Laboratory animals are provided by a large, successful industry that employs many people. Despite the objections of animal rights organizations, the laboratory animal industry enjoys broad support from the public. Scientists who use laboratory animals in their research will tell you that medical progress will end if animal experimentation is impeded. It is a safe bet that animal experimentation will continue unabated so long as we have a steady supply of incurable diseases. As an evil scientist, you will learn to think of animals as Petri dishes that poop.

15.6 ADVICE FOR EVIL SCIENTISTS

1. For every ethical problem that arises over the course of your career, there will be an unethical solution.

2. IRB members view themselves as judges, not inspectors. Once the IRB approves a research protocol or clinical trial, they almost never check to see if the human protection provisions are followed. Basically, you can conduct your research as you please, once the IRB approval is obtained.

3. Ambiguity is the lifeblood of ethical misconduct, and should be inserted into clinical trials ad libitum. A lengthy, expensive, and medically intensive trial that benefits a few patients, while providing no benefit to the majority, will often attain IRB approval when you show that no patients would benefit in the absence of your experiment.

4. An easy way to get an IRB approval is to submit a protocol that is virtually identical to some other protocol that has already been approved by the IRB. The practice of minimizing innovation to maximize IRB approval does little to advance scientific progress, but it will do wonders for your career.

5. Risk is an inescapable condition of the universe. At times, you will need to put others at risk. The best way is to do this is to conduct your research in a country far far away. Many of the restrictions in the U.S., such as stem cell research, research on human embryos, the use of placebos, informed consent requirements, and the inclusion of children and mentally ill patients in clinical trials, are routinely tolerated in poor and corruptible countries (244).

6. If you are an IRB member, do not confine your deliberations to your mandated duty; protecting human subjects from research harm. You should see yourself as the ultimate protector of your institution's integrity. Feel free to expand the scope of your review to include any minor aberration that detracts from the highest levels of professional conduct. This will undoubtedly result in the rejection of every protocol that comes to your desk; except, of course, your own.

7. Never mistake a clinical trial for a serious, factual, evaluation of reality. Clinical trials are experiments, and have the same limitations found in any experiment: poor quality of the measurements, cover-ups of errors, data fabrication, data misinterpretation, data censorship, and so forth. Just like any experiment, the results of clinical trials need to be repeated before they achieve credibility. Ultimately, the results of clinical trials need to be re-affirmed by clinical experience gained in multiple institutions and in large populations.

8. Evil scientists need not behave unethically, in all circumstances. Ethics is about how we treat others; the best way to meet your goals as an evil scientist is to treat others well enough to make a few friends. Alexander Dumas said it best: "I prefer rogues to imbeciles, because they sometimes take a rest."





CHAPTER 16. CLINICAL TRIALS ON TRIAL

"Wir Haben die Luge notig...um zu leben." (We need lies...in order to live.)

-Friedrich Wilhelm Nietzsche

Scientists have a long history of inflicting pain, suffering, and death on people. James Syme, a surgeon who performed mastectomies in Edinburgh, Scotland, in the 1830s, decades before the implementation of surgical anesthesia, left the following notes (245):

"Allie stepped up on a seat, and laid herself on the table... arranged herself, gave a rapid look at James [her husband], shut her eyes... and took my hand. That operation was at once begun; it was necessarily slow; and chloroform - one of God's best gifts to his suffering children - was then unknown. The surgeon did his work. The pale face showed its pain, but was still and silent... It is over: she is dressed, steps gently and decently down from the table, looks for James, then, turning to the surgeon and the students, she curtsies - and in a low, clear voice, begs their pardons if she has behaved ill. The student - all of us - wept like children; the surgeon wrapped her up carefully, and resting on James and me, Allie went to her room."

Surgeons accused of mutilating cancer patients are quick to reply that the tumor, left untreated, would produce far more mutilation, with far more pain, than the patient's surgery. Still, history teaches us that scientists and physicians have an enormous capacity to tolerate the pain and suffering of others.

The clinical trial is a relatively new innovation. Prior to the mid-twentieth century, standards of clinical care were developed by trial and error. A doctor would try a new technique or medication and watch his patient to see if the consequent physiologic effect was salutary. If so, he might try it on a few more patients. After a sufficient number of successes, he might report his treatment in a medical journal. If enough doctors found the treatments to work equally well for their own patients, it would enter common practice.

To this day, most of what we call clinical practice was based on this kind of semi-scientific method. Here are a few examples:

1. 1796 - Edward Jenner successfully vaccinates 8 year old James Phipps with unproven smallpox vaccine (prepared from cowpox).

2. 1881 - Louis Pasteur successfully vaccinates Joseph Meister with unproven rabies vaccine.

3. 1900 - Jesse Lazear demonstrates (on himself) that yellow fever is transmitted by mosquito bite. Lazear dies from successful inoculation.

4. 1985 - Marshall infects himself with H. pylori, thus developing gastritis and demonstrating the bacterial origin of gastric ulcers.

Some of the early clinical trials were so poorly conceived that they serve as purely cautionary tales, with no other scientific value. Notable is the egregious Tuskegee Syphilis Study, conducted by the U.S. Public Health Service (PHS) between 1932 and 1972. This study observed the natural course of late stage syphilis in 399 black men. The men were poor Alabama sharecroppers who were never told that they had syphilis. Their doctors had no intention of curing them. The data for the experiment was to be collected from autopsies. Some of the ravages of untreated late stage syphilis include heart disease, paralysis, blindness, insanity, and death (246). The project was the longest nontherapeutic human experiment ever conducted.

In 1963, in a study at Memorial Sloan-Kettering Cancer Center, cancer cells were injected into hundreds of chronically ill patients (247). The investigator was curious to see who could, and who could not, reject an injected bolus of tumor cells. He found that cancer patients, and patients with chronic illnesses developed tumor nodules at the sites of injection. These nodules grew for a few weeks, then regressed. Regression occurred fastest in healthy volunteers. His experiment was performed without benefit of informed consent (247). What happened to the investigator? He went on to become the President of the Association for Cancer Research.

By the late twentieth century, there was a push to design scientifically rigorous clinical trials. Here are the defining steps of an idealized randomized prospective double-blinded study:

1. The trial is designed by a team of physicians, biomedical scientists, and statisticians, who have no self-serving interest, financial or otherwise, in any particular outcome of the trial.

2. The trial is designed to be free of biases and to have sufficient power to determine the efficacy of the treatment.

3. Candidates for trials are selected from a diverse population, without preference for race or socio-economic status.

4. Candidates for voluntary trials are not promised a cure or any direct personal benefit for their participation.

5. Candidates for trials are informed of the risks associated with the trial, and sign an informed consent document indicating that they wish to enter the trial and that they understand the risks.

6. Trial participants are randomly assigned into treatment groups and control groups.

7. Neither the patient nor the people treating the patient know who receives any particular treatment.

8. The treatment of patients begins with the trial and the trial persists for a predetermined length of time that permits the evaluation of the effects of treatment and the outcome after treatment.

9. The data from the trial is collected and analyzed by statisticians who have no involvement in the trial.

10. The sponsors of the study do not impose their own interpretation on the statistical analysis of the trial; nor do they prohibit, censor, or delay the publication of the trial results.

11. All results of clinical trials are published, even when the conclusions conflict with the interests of the study's sponsor.

12. The raw data from the clinical trial is de-identified, to remove links to patients, and placed in a repository, for public review.

In practice, one or more of these steps will be subverted or omitted. For example, Gross and Co-workers reviewed 100 industry-sponsored trials published in prestigious medical journals (the Annals of Internal Medicine, BMJ, JAMA, Lancet, and the New England Journal of Medicine) (103). The Uniform Requirements for Authors recommends that manuscripts specify the type and degree of involvement by the sponsoring agency. Only eight of the 100 industry sponsored studies complied. According to the authors of the study, for the eight complying studies, terms used to describe the role of the sponsor included: "preliminary evaluation," and "coordinating data collection and statistical analysis (103)." Richard Smith, writing for the BMJ, described the experience of an editor for the Annals of Internal Medicine, who was faced with authors who refused to tone down their conclusions, despite repeated editorial requests to do so. When the editor asked why they would not make the requested changes, they indicated that they were doing what their sponsor had requested (102).

Testing a new drug can take many years. In the realm of cancer trials, the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO, NIH/NCI trial NO1 CN25512) serves as an example. The PLCO is a randomized controlled cancer trial. Between 1992, when the trial opened, and 2001, when enrollment ended, 155,000 women and men between the ages of 55 and 74 joined PLCO. Screening of participants and the collection of follow-up data will end around 2016. The purpose of the study is to determine if screening will reduce mortality from these cancers (248).

The Framingham Heart Study began in July 1948 and will be completed in September 2008. This 60 year study investigates factors that may influence the development of cardiovascular disease humans (249).

Khufu built the Great Pyramid at Giza, (2589 - 2566 BC) with the assistance of an estimated 100,000 laborers. The Great Pyramid is still standing and is visible to astronauts orbiting the globe. Khufu managed to complete construction of the Great Pyramid in just 23 years (nearly 40 years faster than the Framingham study).

Clinical trials are experiments, and unexpected events may occur. Simon LeVay recounts a clinical trial that went terribly wrong (107). The drug, TGN1412 is a monocolonal antibody developed by a biotechnology company. The biotechnology company provided TGN1412 to a drug-testing company, for the purposes of conducting trials in humans. After preliminary safety tests in laboratory animals, a safe dose was selected for humans.

Eight paid healthy volunteers were assembled. These subjects would be the first humans to receive the test drug, under any conditions. In a single session, six of the volunteers were infused with TGN1412, and two volunteers were infused with a placebo. In about an hour, all six of the subjects developed cytokine storm, a life-threatening condition in which an immune-response precipitates shock, and a wide range of extreme system-wide responses, including shock, and multi-organ failure. Prompt treatment saved all their lives. Two of the six had prolonged hospital courses. The incident occurred in 2006, and the six patients must now deal with long-term medical consequences of the event.

When a new drug is administered in humans, for the very first time (a so-called first-in-man trial), you never know what to expect. That being the case, why were all of the subject treated at the same time? Furthermore, why were all of the volunteers given the same dosage of the drug? Wouldn't it make sense to start with a very small dose, carefully observing the patient over a day or more, and then proceeding to a somewhat higher dose on the next patient. Another aspect of the trial that eventually came to light involved the speed of infusion of the drug. Would it not have been prudent to infuse the drug slowly, so that the infusion could have been stopped if there were any measured rapid effects?

An expert panel was assembled, to review the incident and to make recommendations. Among their conclusions, "New agents in first-in-man trials should be administered sequentially to subjects with an appropriate period of observation between dosing of individual subjects. (250)"

Clinical trials are a big business. In the U.S. alone, about $20 billion dollars is paid to clinical trial providers (2008 study) (251). Considering all the clinical trials that have occurred over the decades, wouldn't you think that drug testing companies would know that, in a first-in-man trial, you might want to observe the effects of the drug on the first volunteer, before delivering the drug to the full study population?

Ellen Roche was a 24 year-old healthy volunteer who died from lung failure on June 2, 2001, several weeks after participating in a Johns Hopkins University asthma study (38). Investigation of the incident revealed that she had been administered Hexamethonium, a drug which was not approved by the FDA, and for which there was some evidence that it could be harmful to humans. The informed consent sheet that Ms. Roche signed did not indicate that she would be exposed to a drug of uncertain safety (38). The FDA criticized Johns Hopkins University for conducting a human subjects experiment using an unlicensed drug, without receiving FDA approval; for failing to report an unanticipated adverse reaction that had occurred in the experiment prior to Ms. Roche's participation; and failing to inform participants that hexamethonium was experimental (252).

16.1 BIASES IN SURVIVAL DATA

"Deep doubts, deep wisdom; small doubts, little wisdom."

-Chinese proverb

A Clinical trial can make or break a corporation; why would anyone want to leave the outcome to chance? By introducing bias or, better yet, allowing a pre-existing bias to persist, you can produce any clinical outcome that suits your agenda. Here are just a sampling of biases that evil scientists can use in their clinical trials.

Accrual bias - Accrual is the process by which patients are enrolled in a clinical trial. According to the U.S. National Cancer Institute, less than 5% of adults diagnosed with cancer each year will opt for treatment through a clinical trial (253). Features that distinguish the small fraction of people who enroll themselves in a clinical trial from the overwhelming majority who do not, produce a trial population that is different from the general population.

Co-morbidity bias - Survival is the length of time that patients live following a diagnosis of cancer. Whether a patient dies of cancer or heart disease or motor vehicle accident is immaterial. People with life-shortening co-morbid conditions at the time of their cancer diagnosis will have a shortened survival time on this basis alone. People who are in good health when they are diagnosed with cancer, will tend to liver longer than people with co-morbid conditions. Depending on the design of the clinical trial, co-morbid conditions can bias the survival results.

Confounder bias - Confounders are unanticipated or ignored factors that alter an outcome measurement. It is impossible to design clinical trials that account for all confounder influences because confounders are typically unanticipated. Confounders are the statistical byproducts of the "Law of unanticipated consequences," which simply asserts that there will always be unanticipated consequences. Here's an example: Statins are widely used drugs that reduce the blood levels of cholesterol and various other blood lipids. To the best of my knowledge, nobody expected that the use of statins would have any effect on the incidence or mortality of cancer. In a recent study involving nearly a half-million male patients conducted between 1998 and 2004, statin use exceeding six months was linked to a significant lung cancer risk reduction, of 55%. Participants who took a statin longer than four years had a 77% reduction in lung cancer risk (254). If we held a cancer trial for a non-statin chemotherapeutic agent, and we did not take into account whether any of the trial participants were receiving statins, this might create a confounder bias for the trial.

Demographic bias - A variant of population bias. In most clinical trials in the U.S., patients are assigned broad demographic groups (European, Asian, etc.). Treatment response rates that may differ in unaccounted subgroups within a broad group. For example, there may be widely varying biological responses patterns among Asians, depending on their land of origin (e.g., Manchuria, Korea, Thailand, Malaysia). See Population bias.

Diagnosis bias - Diagnosis bias occurs when the patients in a repeat-trial group have a disease or lesion that is different from the disease or lesion affecting the first group. This distorts the survival outcome after treatment. For example, if patients were accrued into a study based on erroneous diagnoses rendered by an incompetent pathologist, a group of patients with breast cancer might become diluted with patients who have benign breast disease. More commonly, treatment groups are tainted when a new subset of patients is added to the original group, through enhanced detection and diagnosis of a biologically distinctive variant of disease. For example, over the past few decades, there has been a many-fold increase in the detection and diagnosis of ductal carcinoma in situ (DCIS) of breast, due in large part to mammographic screenings (255). DCIS has a very good prognosis. Only a small percentage of patients with DCIS progress to invasive ductal carcinoma. If a breast cancer clinical trial group included an increased proportion of patients with DCIS, improved survival can be achieved, without an improvement in the therapeutic protocol. The remedy for diagnosis bias is to subdivide your study groups carefully. This remedy has its own problems. If the first study did not carefully separate patients by their prognostic subtypes, there's nothing much you can do to compare the first study to later studies. Also, if you break groups by their tumor subtypes, will each group contain a sufficient number of patients to produce statistically useful results?

Eligibility bias - Every trial is designed with strict eligibility requirements. When these criteria are applied to some subjects and waived for other subjects, you get eligibility bias. Judith Randal reported for the Journal of the National Cancer Institute, that a trial for the drug Erbitux was populated, in no small part, by people who did not meet the eligibility criteria for the trial (208). Twenty-seven percent of the participants were ineligible for the trial, for one reason or another. The trialists simply waived eligibility requirements for some participants.

Income bias - In clinical trials, groupings are usually based on stage of disease and age. Seldom do clinical trials stratify patients by income. Nonetheless, socioeconomic status greatly influences cancer survival (256). Groups that contain many economically disadvantaged patients are likely to have a shorter survival than groups whose members are financially well-off.

Lead-time bias - In medicine, an increase in survival is measured as an increase in the interval between diagnosis and death. Suppose a test is introduced that provides early diagnoses (i.e. diagnoses at a younger patient age). This test will yield an improved survival, even though the age at which the patient dies is unchanged. The reason is that survival is measured as the interim between diagnosis and death, not as the prolongation of life after diagnosis. Much of the touted advantages of early diagnosis are the direct result of lead-time bias.

Marketing bias - The purpose of drug marketing is to create the need for a drug that you otherwise would not know you needed. Marketing works; that's why the money spent on drug marketing dwarfs the costs of research and development (138).

Medical record bias - Trialists draw information related to the diagnosis, treatment, and outcome of patients by reviewing medical records. The quality of medical research often depends on the quality of medical records. When medical records are incomplete, incorrect, illegible, or otherwise uninterpretable, the results for an otherwise well-planned clinical trial can be disastrous. What do researchers do when they find that their medical records are inadequate? Often, they resort to re-abstraction, a time-consuming, expensive and occasionally futile undertaking. Re-abstraction involves revisiting charts, visiting outpatient clinics and the private offices of medical doctors, re-interviewing patients and families, and a host of extraordinary efforts aimed at restoring credibility to clinical trial data. If a subset of patients has better maintained records than another subset, a bias can be introduced to the trial.

Meaningless bias - Sometimes findings have no relevance to any population other than your study set. This is particularly evident in genetic association studies, which are usually done on families, not large populations. Until you can show that the family you are studying shares disease traits found in a wide population, your work has no generalizable significance (257).

Measurement bias - The accuracy of response measurements may be poor. For example, some of the newest anti-cancer drugs have low toxicity for cancer cells. Current and future drugs may act by decreasing the growth rate of a tumor, or reducing the likelihood that the tumor will metastasize. These effects may fail to shrink or eradicate a tumor, but they may increase the length and quality of post-diagnosis survival. In these cases, the measurements of tumor response and patient survival should be modified to provide useful information related to the value of the treatment, without producing an unjustified expectation of cure.

Negative study bias - When a clinical trial produces negative results (fails to show improved survival), there may be little enthusiasm to publish the work. Sponsors of negative studies may be disinclined to rally the cancer research community and the public around their failures. Dickerson and Rennie have written, "The fact that some trial results are never published would not be a problem, except that there is good evidence that the results from unpublished trials are systematically different from those of published trials" (258). When statisticians analyze the results from many different published manuscripts (meta-analysis), their work is biased by the pervasive absence of negative studies. In the field of medicine, negative study bias results in a false sense that every kind of treatment yields positive results (259).

Population bias - For many different reasons, some populations accrue more easily into clinical trials than other populations. It is notoriously difficult to include children and pregnant women in clinical trials. Insurers can refuse to cover the costs of medications for pregnant women and children if there is no evidence indicating that the drugs are safe and effective in these groups. See Demographic bias.

Prayer-based bias - In the world of alternate medicine, many people believe the total amount of prayer directed toward a patient will determine the clinical outcome of a disease. The following anecdote has been passed among clinical trialists, but it is impossible to verify its historical accuracy. The story goes that the Institute for Alternative Medicine at NIH funded a study to determine whether directed prayer improved recovery. Two groups were formed, the control group (nobody prayed for them) and the prayed-for group. The subjects didn't know which group they were in. A reporter requested an interview with the trial's principle investigator, but NIH refused to cooperate, thinking that the press would ridicule the experiment. The reporter managed to get his interview, after threatening to sabotage the whole trial by praying for the trial patients, without authorization.

Second trial bias - After a therapeutic trial, clinicians can determine the type of patients who are most likely to benefit from an intervention. For example, a trial of bone marrow transplantation for patients with metastatic carcinoma may find that patients over the age of 55 responded poorly to transplantation. Older individuals with transplants may be more prone to die from their treatment than from their cancer. On the second trial for the same protocol, the clinicians wisely exclude older patients. The second trial shows markedly improved survival, compared with the first trial. The improvement was achieved simply through better selection of subjects, without any improvement in the treatment protocol.

Sponsor bias - Are the results of clinical studies skewed in favor of the corporate sponsors of the trials? In a fascinating meta-analysis, Yank and coworkers wanted to know whether the results of clinical trials conducted with financial ties to a drug company, were biased towards favorable results (260). They reviewed the literature on clinical trials for anti-hypertensive agents, and found that ties to a drug company did not bias the results. However, the found that financial ties to a drug company are associated with favorable conclusions. This suggests that regardless of the results of a trial, the conclusions published by the investigators were more likely to be favorable, if the trial were financed by a drug company. This should not be surprising. Two scientists can look at the same results and draw entirely different conclusions. It happens every day. How could investigators, financed by a drug company, not be influenced by their benefactors?

Stage bias - Stage bias uses a diagnostic or screening tool to shift the proportion of people in a particular stage of disease, to produce a false impression of clinical improvement. For example, if we introduce a screening device that detects people who are infected with mild Alzheimer's dementia and misses people with severe dementia, then the prognosis of Alzheimer's in the general population will improve, because there will in an influx of mild cases in the diagnosed population. The diagnostic tool would be credited with increasing the prognosis of Alzheimer's diseases, though it contributed nothing to treatment or outcome.

Stage treatment bias - This involves finding a treatment that is effective for a small subset of people with a disease, that is falsely interpreted as an intervention that is effective for everyone with the disease. An example is the use of prostatectomy to treat prostate cancer. Prostatectomy is a procedure that is credited with a high cure rate, but it is only performed on patients with tumor confined to the prostate. For patients with prostate cancer that has metastasized to lymph nodes in the region of the prostate or to distant organs, prostatectomy is contra-indicated. Why is this? If the cancer has spread beyond the prostate, removing the prostate will not benefit the patient. An apt analogy is closing the barn doors after the horses have fled the farm. Of the cases of prostate cancer confined to the prostate, we know that most cases are indolent, and do not benefit from treatment. Autopsy studies have found that by age 80 to 90 years, 70% to 90% of men have prostate cancer that was undetected during life (261), (262). This indicates that prostate cancer is a very common disease that kills only a small proportion of affected individuals. Because prostatectomy is only performed on men whose prostate cancer is believed to be confined to the prostate, the group cure rate is high.

Statistical method bias - Strange as it may seem, a statistician can look at a set of data, apply different statistical methods to the data, and arrive at any of several different conclusions. Often, conclusions based on different statistical measures, on different data sets, are contradictory. In this case, articles with opposite conclusions appear in the medical literature, permitting scientists to selectively cite those papers that support their own agendas (263).

All these biases are important tools for the evil scientist. Of the sources of bias listed, stage bias is the most subtle. It is also the most important bias introduced by the most modern cancer trials, which are often aimed at developing stage-specific treatments for groups of patients with common cancers.

Suppose every patient with X type of cancer is staged into one of two groups (I and II). The stage I group has no evidence of distant metastases at the time of diagnosis and has a 40% chance of 5-year survival under the standard treatment protocol. Patients are put into the Stage II group if they have distant metastases at the time of diagnosis. Their chance of having a 5-year survival under the standard treatment is 2%.

Professor Rads, at the University of Goodcare, has recently developed a very sensitive imaging device that can detect small metastases that would be undetectable by less sophisticated devices. In the next clinical trial for treatment of cancer X, Professor Rads tests each trial candidate with his new device. He finds that about half of the patients who would otherwise be assigned to Stage I (no metastases) are found to have metastases with his sensitive machine. With this information, these erstwhile Stage I patients are re-assigned into Stage II.

A clinical trial is conducted with the standard treatment. The Stage I group is now much smaller than the Stage II group. When the trial is complete, we find that the 5-year survival for the Stage I group is now 80% (up from 40%). The 5-year survival for the Stage II group is now 2% (the same as before).

The newspaper headline following the trial is: "New imaging discovery yields 100% improvement in survival for Stage I Cancer X"

Actually, the clinical trial, as described, yielded no improved survival for any patients. All it accomplished was to correctly re-assign some of the Stage I patients into the low-survival Stage II group. The apparent improvement in survival in Stage I cancer patients was simply the result of more accurate staging of patients in the low-risk category of disease.

What does this mean? Was the clinical trial a fraud? Did it accomplish nothing at all? No, accurate staging of patients with cancer is an absolutely crucial step in the development of new, effective anti-cancer regimens. It is impossible to assess the effects of a new chemotherapeutic agent on a group with heterogeneous disease. The detrimental effects of a new drug on Stage I cancer patients might be lost in a study where the Stage I group is mixed with patients with Stage II cancers. Evil scientists understand this and use it to their own advantage.

John P.A. Ioannidis is the chair of the Clinical and Molecular Epidemiology Unit at the University of Ioannina School of Medicine and Biomedical Research Institute in Greece. In a provocative article entitled, "Why most published research findings are false," he points some common misinterpretations that pose as clinical facts (264). These include: post hoc subgroup selection and analyses (i.e., cherry-picking a subgroup that qualifies for statistical significance); changing clinical group inclusion or exclusion criteria and disease definitions after the trial has concluded; selective or purposefully distorted reporting of results; data dredging (sifting through study data, searching for outlier groups); for multi-center studies, reporting the significant findings from some of the centers and ignoring negative results from other centers (264), (265).

Dr. Ioannidis has suggested several prevalent research conditions that produce invalid research findings (264):

1. Small studies are less likely to produce true research findings than large studies.

2. Small effects are less likely to be true than larger effects.

3. Research findings are more likely to be true in confirmatory studies (such as phase III trials that confirm observations made in a phase II trial) than in hypothesis-generating studies.

4. The greater the flexibility in design, definition, and measured outcome, the less likely that the research findings will be true.

5. The greater the financial and other interests in a study, the less likely that the results will be true.

6. The hotter the scientific field, the less likely that the results will be true.

It is best to think of prospective randomized clinical trials as experiments that have all the vulnerabilities inherent in any scientific study. They can be poorly designed, misinterpreted, invalid for under-represented patient subpopulations, unrepeatable, and falsified.

The best validation of clinical trials, diagnostic tests, screening tests, and any treatment intervention are made by continuous clinical correlations with patient outcomes in medical centers wherein many different types of patients (male, female, different nationalities, different ages, concurrent diseases, multiple medications) are managed. Survival data need to be validated by post-trial epidemiologic data. The data that are being interpreted must be made available to the public, and the conclusions should be scrutinized and debated. As luck would have it, it is neither easy nor lucrative to do these kinds of large-scale clinical reality tests. Consequently, evil scientists can continue making outrageous conclusions from biased clinical trials, without much fear of discovery.

16.2 ADVICE TO EVIL SCIENTISTS

1. The effective dose of almost any drug is a somewhat arbitrary quantity, because individuals will respond differently to any chosen dose or dose regimen. If you want a new drug to appear more effective than an older drug, design your clinical trial so that the new drug is administered at a high dosage, while the old drug is administered at a low, ineffective dose. The new drug will almost always produce a better response, even when it is an inferior agent.

2. For safety trials, you can make your new drug seem much safer than the old drug by administering the new drug at a low (sub-toxic) dose and the old drug at a high dose (above the common therapeutic range).

3. When you market your drug, have your salespeople quote clinical trials that support your drug's effectiveness. Trials that show that your drug is ineffective or unsafe are best ignored.

4. Because clinical trials are complex, long, expensive, and have strong economic consequences for its sponsors and investigators, an evil scientist has many opportunities to manipulate the outcome to suit his agenda.

5. Most clinical trials go unpublished. Selectively publish those clinical trials that promote the safety and effectiveness of your drug. Have someone on your staff write the results. Pay any academic authority in the field, to allow his name to appear as the author on the published product. Don't worry about interference by the author's institution. Most academic institutions have no policy on conflicts of interest between faculty and industry (236).

6. Not all clinical trials are equal. Some clinical trials are performed on small groups of patients, without informed consent, by clinicians or other personnel who have very little knowledge of how to design, analyze, or report clinical trial data, and who have a financial stake in the trial outcome. If you have performed an invalid clinical trial, a diligent search will produce a journal that will publish your study. Submit your study results to a journal that neglects to include a financial disclosure statement, or a clinical trial registration number, or proof of IRB (Institutional Review Board) human studies approval. The number of journals that slide over these details is large (104).

7. Biases are present in every clinical trial. For best results, introduce at least three biases into your own trials.

8. Effectiveness lies in the eyes of the beholder. A two week increase in survival may mean very little to you, but it may be worth $100,000 to the family of a cancer patient. Never hesitate to promote the effectiveness of a marginal drug.

9. So long as you do not fabricate your data, nobody can accuse you of scientific misconduct.





CHAPTER 17. SCIENTIFIC DISASTERS

"The purpose of life is to be defeated by greater and greater things."

- Rainer Maria Rilke

It is normal to fail. Within the course of your career, you will have many setbacks.

As an evil scientist, you will be contributing to many horrible mistakes during your career. Some of these mistakes will destroy the lives of innocent people. As examples, engineers design buildings and bridges that collapse; physicians prescribe medications that kill; chemists brew compounds that wipe out exposed populations; microbiologists release virulent organisms; nuclear scientists may bring an end to human life on this planet. If you play your cards right, you will never be held responsible for any of these mistakes.

The hard part about producing a fission bomb involves procuring highly enriched uranium. Most raw uranium ore consists of more than 99% non-fissile U-238. The fissile isotope of uranium is U-235; extracting U-235 from the ore requires large machines, enormous power, and advanced scientific resources and talent. A few powerful governments can produce enriched uranium. Terrorists cannot. After a football-sized chunk of enriched uranium is procured, the task of making a working fission bomb is relatively easy; within the capabilities of terrorist organizations. Consequently, the thrust of nuclear security measures are focused on guarding the supplies of enriched uranium.

Tom Zoellner recounts an interesting story. In 1951, in Dalhart, Texas, three boys found a rock, near railroad tracks, that was far heavier than its size would suggest. Another, similar rock, was found in a nearby junkyard. The rocks were enriched uranium. The two rocks, slapped together, could have destroyed the town (194). How those rocks came to their resting places in Dalhart is a story that the authorities have not explained to the public (194)

In his book Uranium: War, Energy, and the Rock that Shaped the World, Zoellner provides several additional examples of U.S. nuclear "materials uncaccounted for" (official acronym, MUF) (194). Is it absurd to suppose that MUFs are exclusively a U.S. problem. Russia, India, Pakistan, and every nation that stores nuclear materials for energy or for defense, is likely to have MUFs.

The world was shocked twice by nuclear reactor disasters: first at Three-Mile Island (1979), followed by Chernobyl (1986). In both these cases, events occurring in large nuclear facilities led to a partial core meltdown (Three Mile Island) and an explosion (Chernobyl). An incident that has escaped public attention occurred on January 3, 1961, in a remote U.S. testing station 40 miles west of Idaho Falls, Idaho. Simon LeVay recounts the story of a fatal accident that occurred when a technician lifted a cadmium metal control rod about 10 inches too far, triggering an uncontrolled chain reaction (107). The story behind this obscure nuclear accident began soon after World War II, when the United States embarked on a plan to build small, transportable, and low-power nuclear reactors. One such reactor was Stationary Low-Power Reactor Unit 1, which was operated by three-man shifts. Cadmium rods inserted between enriched uranium plates controlled the reaction. The higher the rods are lifted (from the fuel), the greater the energy released. If the rods are lifted too high, a nuclear chain reaction occurs, and a large amount of energy and radiation is released, in a single, horrible moment. Nobody knows why the rod was lifted above a critical height. But it happened, and three men died. The clean-up was hazardous and expensive. In those early days of nuclear power, one man, and one cadmium rod, pulled a few inches too high, were all that were necessary to cause a catastrophic nuclear accident (107).

17.1 WHAT IS THE MAXIMAL AMOUNT OF DAMAGE THAT CAN BE CREDITED TO A SINGLE PERSON?

On December 3, 1984, methyl isocyanate (MIC), a highly toxic gas, escaped from the Union Carbide chemical plant in Bhopal, India, quickly killing thousands of people, and injuring many others. Accurate numbers for deaths and injuries are not known, but the consensus seems to be about 15,000 deaths (including the number of people who died at the time of the accident and the weeks thereafter), and about 200,000 injuries.

Here is what happened at Bhopal (199). A worker was cleaning one of the pipes, with water. Water from the cleaning operation flowed into an MIC tank, causing an explosion. Escape vents released hot MIC gases into the atmosphere. About 40 tons of toxin descended as a hot cloud on the population around Bhopal. Many people died on the spot. Some families had a chance to flee. Parents with gasping children had to decide quickly which child could be carried to safety and which child would be left behind. Many survivors have endured decades of suffering from lung, liver, kidney, and immune system ailments. The rate of birth defects is high in the Bhopal population (266). The Bhopal disaster is considered to be the worst industrial accident in history.

After the event, Union Carbide lawyers blamed the disaster on one individual; the worker who was cleaning the pipe. According to Union Carbide, because the disaster was the work of a saboteur, Union Carbide could not be held responsible.

Let's say, for the sake of argument, that a lone saboteur caused the Bhopal disaster, What would this saboteur need to know in order to pull off his deadly scheme.

First, he would need to know, that he alone would be selected to wash out some clogged pipes that happened to connect with the MIC tank. He would need to know that the valves separating the pipes from the MIC tank were leaky. He would need to know that the cleaning operation would not be inspected by an experienced shift supervisor (a position that was eliminated to save money) who would have probably inserted a safety disk to compensate for the leaky valve. He would need to know that the refrigeration unit for the MIC tank was not working, and that the MIC was not stored at a sufficiently low temperature to ensure the stability of the MIC/water mixture. He would need to know that the procedure for logging the temperature in the MIC tank had been halted, thus preventing other workers from noticing the rising tank temperatures. He would need to know that the first tell-tale reaction odors would reach co-workers during tea break, and that crucial human responses would be delayed until after tea was served. He would need to know that the flare tower, intended to safely burn off released gases, was inadequate for the job. He would need to know that the MIC would be vented from a high stack (105 feet), above the reach of the water jets intended as a safety curtain. He would need to know that the warning siren would not sound until two hours after the gas release (after most of the damage was done). He would need to know that emergency measures to protect the population would not be taken. Rather than quickly evacuating the population, plant spokesmen at first denied that an accident had occurred. Rather than advising people that injuries could be reduced by applying a wet towel on the face and shutting the eyes, spokesmen reassured the public that MIC was not particularly harmful (199).

Here we are, twenty-five years later. What is the news from Bhopal?

The former CEO of Union Carbide was issued an arrest warrant by the Indian government, which has not been served because the Indian government is officially unaware of his whereabouts. The former CEO is said to be residing comfortably and openly in the Hamptons (267).

The Bhopal site has not been cleaned up. Dow Chemical has since acquired Union Carbide and accepts no responsibility for the clean-up. Dow asserts that a 2001 payment of $470 million to the Indian government has resolved the issue. The Indian environment minister, when visiting the Bhopal site, lifted a clot of dirt and proclaimed, "See, I am alive," certifying that the area is now safe. Nonetheless, each month, an estimated 10-30 people die from the contaminated groundwater and residual toxic waste (268).

17.2 OTHER DISASTERS

Radiological contrast agents are dense liquids used by radiologists. Some contrast agents are injected intravenously, some are swallowed. When the contrast agent travels to an organ, the contours of surrounding tissues can be visualized with an x-ray photograph. In the 1930s through the 1950s, it was common to use thorotrast, a colloidal suspension of radioactive thorium dioxide, as a radiological contrast agent (269). After administration, the agent was absorbed into the liver's Kupffer cells (specialized cells that absorb and store particulate matter). The Kupffer cells, loaded with thorotrast, emitted alpha particles, bombarding neighboring liver cells. Emission continues at a time-exponentially decreasing rate over the lifetime of the patient. In retrospect, you would expect that people taking thorotrast as a radiologic contrast agent might develop liver cancers and chronic liver damage. Just so. In fact, the tumors caused by exposure to radiological thortrast are hepatocellular carcinoma (a relatively common tumor), and two types of rare liver cancers: cholangiocarcinoma, and hepatic angiosarcoma.

When a carcinogen increases the incidence of a common tumor, it can be very difficult to prove that any particular agent can be held responsible for the increase. When you have an increase in the incidence of a rare tumor, the situation changes. You can say, "This tumor is very rare. Suddenly, we see a large number of cases occurring exclusively in people who were exposed to a chemical that was first synthesized and administered two decades ago. These tumors must have been caused by this agent." Hepatic angiosarcoma was the rare, sentinel tumor that warned scientists that thorotrast was causing cancers. Today, iodinated contrast agents have replaced thorotrast, and the incidence of liver angiosarcomas has plummeted. Thorotrast came into general use in the early 1930s and stayed in use until the early 1950s. It is estimated that two to ten million patients worldwide were exposed to thorotrast. The increased numbers of deaths from liver cancers and cirrhosis are unknown.

In May and June of 1981, an outbreak of severe pneumonia occurred in Madrid, Spain, and the surrounding regions. The epidemic affected about 17,000 persons; with 246 deaths. Many of the people who survived pneumonia eventually developed a constellation of neuromuscular symptoms including diffuse myalgia (muscle pain), muscle atrophy, weight loss, weakness, sensory loss, hyporeflexia, and assorted additional abnormalities (270). It is impossible to predict the reduction in length-of-life among the current survivors.

The cause of the epidemic was bad cooking oil, contaminated by rapeseed oil that had been denatured by the addition of 2% aniline. The oil was intended for industrial use, but a distributor had illegally marketed the oil for human consumption. Though the aniline was removed from the oil prior to distribution, analysis of the marketed product showed that it contained a variable mixture of rapeseed oil, other seed oils, liquefied pork fat, and small quantities of aniline and fatty acid anilides (270).

17.3 ADVICE FOR EVIL SCIENTISTS

1. If you are a lazy, disloyal, self-centered bastard, you need to put somebody who is industrious, loyal and altruistic into key positions of responsibility. Take all the credit you like, but never take on a mission-critical task that you cannot delegate to a competent person. Otherwise, all of your schemes and machinations will lead to your own destruction.

2. Success comes from within, while failure often seems to come from external forces. When your manuscript is rejected, it is because the reviewer failed to see the value of your work. When your grant is unfunded, it is because the study section, composed of your fierce competitors, colluded to deny you a high score. Academic rejections, passed over promotions, snubs from coworkers, and all manner of professional disappointments can be interpreted as the failings of other people. Nobody can succeed in science if they do not have a misguided faith in themselves and a seething contempt for others. The worst mistake any scientist can make is to care about what other scientists think. If you follow the advice from this book, other scientists will think what you want them to think.

3. Remember to get paid. Failed projects are opportunities for windfall profits. For example, if your contract secures the payment of a specified amount of money, payable at the end of the project, you stand to gain if the project is terminated early. If you plan for failure, you are guaranteed success.





CHAPTER 18. BELIEF AND DISBELIEF

"There is a cult of ignorance in the United States, and there always has been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that "my ignorance is just as good as your knowledge."

-Isaac Asimov

"A lot of people mistake a short memory for a clear conscience."

-Doug Larson

"An idea that is not dangerous is unworthy of being called an idea at all."

-Oscar Wilde

"Morality, spirituality, the meaning of life - science doesn't handle those issues well at all. But that's cool. We have art and religion for that stuff."

-Thomas Hayden (271)

Religion is believing things, in the absence of proof. Science is about withholding belief until there is proof. It would seem that science and religion are mutually exclusive concepts. Nonetheless, some people prefer to have a scientific justification for their religious beliefs. The scientific argument for religion usually begins with a simple observation: "Things exist in the universe." Then follows a piece of logic: "If things exist, they must have been created." Then the coup de grace: "If there is a creation, then there must be a creator."

The logic seems unassailable. The counter-argument uses the same logic: "If there is a creator, then the creator exists." This is followed with: "If the creator exists, the creator must have been created." Then the coup de grace: "Therefore, every creator has a higher creator, and there is no ultimate creator."

Perhaps the most cynical scientific rationale for the belief in God came from the mathematician and physicist, Blaise Pascal (1623 - 1662), whose personal epiphany was was based on game theory. Pascal reasoned that if you believe in God, and if God exists, you've won. If you believe in God, and God does not exist, then you haven't really lost anything. Therefore, it's best to believe in God.

Humans have a natural tendency toward wishful thinking (i.e., pretending something is true because you want it to be true). Adept evil scientists routinely use this human weakness to blur the distinction between religion and science. The basic strategy involves convincing scientists to accept a single assertion that they want to believe, without proof. From there, you can build the assertion into a complex religion composed of contingent ideas. The original assertion is usually something that people have a strong vested interest in believing (e.g., everlasting life, the avoidance of eternal damnation, eligibility for success on earth, angels and ancestral guides, etc.). Sometimes belief is grounded in real-life experiences or conveyed observations that have not been tested (e.g., thirteen is an unlucky number, madness occurs when the moon is full, disease strikes when you miss Sunday sermon, etc). The most entrenched beliefs are those that confer credibility on primitive or atavistic fears (e.g., change is bad, foreigners and outsiders are bad), or that cannot be otherwise explained (e.g., UFOs, ghosts, miracles). Once you believe the original assertion, you're not likely to deeply examine anything that follows.

There has always been a tension between established religions and the scientific community. Galileo (1564 - 1642) offered irrefutable evidence that the earth orbited the sun (Figure 18-1). Galileo subsequently retracted his scientific findings, after being threatened with torture by Papal messengers.



Figure

Figure 18-1. Galileo Galilee, portrait in crayon by Leoni.

Sometimes religion is swayed by science. The Roman Catholic Church officially acknowledged in 1950 that the theory of evolution was not in conflict with Christian doctrine (Pope Pius XII, Humani Generis). In 1996 Pope John Paul II, in an address to the Pontifical Academy of Sciences, said,

"Today, almost half a century after the publication of the encyclical [Humani Generis], new knowledge has led to the recognition of the theory of evolution as more than a hypothesis. It is indeed remarkable that this theory has been progressively accepted by researchers, following a series of discoveries in various fields of knowledge. The convergence, neither sought nor fabricated, of the results of work that was conducted independently is in itself a significant argument in favor of this theory."

Today, most scientists are non-religious, i.e., they do not believe in a personal God, as described by any particular religion (272). A non-religious scientist is one of the following:

1. An atheist (someone who believes that God does not exist)

2. An agnostic (someone who does not know whether God exists)

3. A spiritualist (someone who believes in a greater force or mystery beyond our perception, but who does not believe in a personal God that answers our prayers and intervenes in human activities)

4. A secular humanist (someone who is not particularly concerned with God's existence or non-existence).

In general, the more prestigious the scientist, the less likely that he will be religious. Among members of the National Academy of Sciences, fewer than 10% of members are religious (272). Why is this? If you've been paying attention to this book, you should know by now that scientists are motivated exclusively by selfishness. If scientists are non-religious, there's got to be a reason that relates to money, power, or pleasure. Any student of history knows that scientists lost their religious convictions when religions stopped funding science.

Through much of human history, the arts and sciences were patronized directly or indirectly through religious authorities. In Europe, after the fall of the Roman Empire, the greatest architecture, the greatest art, and the greatest science, such as it was, received commissions from the church, or by wealthy benefactors who were closely tied to the church. It is a safe bet that every scientist receiving religious patronage professed religious zeal.

Until the twentieth century, most scientists were religious (272), but things began to change when secular governments plowed their resources into research and development. Today, in the U.S. and most other developed countries, scientists get their funding from the government. A scientist's funding does not depend on his religious allegiance. Hence the rise of agnostics, spiritualists, humanists, and atheists. The contrast is evident in those few countries whose governments are influenced by clerical authority. You won't see many atheist-scientists in Israel and Iran.

Simply because most scientists are non-religious, you should not assume that scientists have no deeply held beliefs. Scientists will believe almost anything, without question, so long as it is held to be true by their peers. For example, consider the etiology of gastric ulcers. For many decades, medical students were taught that stomach ulcers resulted from a character flaw. Certain people "internalized" their anger, by secreting huge quantities of stomach acid, which ate away at the normal mucosal lining, producing ulcers. This theory reinforced physician's innate tendency to blame the patient for the illness ("You've brought this ulcer on yourself with your stressful lifestyle"). The patient is also at fault for the lack of a cure ("I can't help you if you ignore my advice to vacation in Hawaii for the summer"). A vindictive approach to healing relieves the physician from pursuing any serious research into the cause and cure of the disease. For many years, the treatment for gastric ulcers targeted the patient's turpitude: tranquilizers, psychotherapy, change of job, relocation to a less stressful environment, etc. With this approach, symptoms sometimes abated (as they would with no treatment altogether).

Scientists justified the "anger" theory of gastric ulcers on the misbegotten idea that an infectious agent could not possibly live in the acidic environment of the stomach. If an infectious agent could not be the cause of ulcers, then the patient himself must be the cause. Gastritis and gastric ulcers arose from the overproduction of acid, causing the stomach to "eat itself"; the excess of acid having a psychogenic origin. Nonsense.

In 1983, Robin Warren and Barry Marshall described what they called "unidentified curved bacilli" in patients with gastritis, by direct visualization under a microscope. These structures later proved to be Helicobacter pylori. Marshall experimented on himself, by ingesting gastric juice from a "dyspeptic" man. About ten days later, he developed gastritis, suggesting that an agent in stomach contents from patients with gastritis, could transmit the disease to other people.

Marshall, at the time of their discovery, submitted an abstract of his work. He was "flatly rejected" by the Australian Gastroenterological Association (144). Undaunted, he persevered, and showed that the most common cause of gastritis in humans is a transmissible agent, Helicobacter pylori, that lives in the stomach. In retrospect, we know that medical scientists labored in profound self-inflicted ignorance of the gastric microorganisms that had been visualized as early as 1875 (145). In 2005, the Nobel prize for medicine was awarded to Robin Warren and Barry Marshall. Helicobacter pylori infections are easily treated with antibiotics.

Buried within our language are the remnants of long-abandoned belief systems. We use the word "quintessential" to signify the perfect form of existence. The word derives from a long-abandoned theory that life is composed of four essential elements (earth, wind, rain, fire), plus a fifth, heavenly element (the quint essence) found in latent form in earthly objects. The names of diseases remind us of formerly cherished superstitions. Malaria means "bad air" (in Medieval Italian), reflecting the old belief that the disease was caused by vapors emanating from marshes and swamps. Though malaria was treated successfully with quinine, through most of the 19th century, the pathogenesis of the disease was unknown until 1898, when Sir Ronald Ross correctly blamed mosquitoes (an insect that thrives in marshes and swamps). We now know that malaria is caused by a protoctist organism (phylum Apicomplexa, genus Plasmodium), and transmitted by the Anopheles mosquito. We stubbornly flaunt our former ignorance by preserving the misnomer, malaria.

Scientists, like laypersons, base their scientific beliefs on dubious sources. Mihaly Csikszentihalyi, in his book, The Evolving Self: A Psychology for the Third Millennium, asked this question (273):

"If you made a list of all the things you know for certain under four

headings:

(1) those things that you know from direct experience,

(2) those that logically follow from self-evident truths,

(3) those that you believe because you were told,

(4) those you "just know" because of an intuitive gut-level feeling,

which one of the headings would have the longest list?"

Because humans have a short life-span (compared with millennia of documented scientific inquiry), and limited intelligence (basically, creativity is rare and comes in spurts), and the corpus of published scientific knowledge is large (nobody understands all of important contributions within any field of science), most scientists have a belief system based on wisdom received from authorities (i.e. what they were told). Very few scientists ever stop to ask themselves, "How do I know what I think I know?"

You can take any scientist and ask him to explain the principles of his field, pressing deeper and deeper into fundamental phenomena, and you will soon leave the realm of experimental evidence and enter the realm of blind faith. Once you grasp this truth, you can understand that all scientists are pretenders; they will believe anything, without proof, if they have faith that somebody else has established the truth of the statement.

It's a funny thing that atheism creates a blank slate upon which evil scientists can build pseudo-scientific belief systems. Shortly after the 1916 overthrow of the Russian Csar, a biologist named Trofim Lysenko (1898 to 1976) rose to fame in the new Soviet empire. Lysenko believed that plants and animals could adapt to changing conditions in their environment and pass their physiologic adaptation to their offspring. By exposing wheat to cold temperatures, it would adapt and become cold-tolerant. Future generations of wheat would be cold-tolerant, and further adaptations would result in more extreme cold-tolerance in later generations. Lysenko's theories were embraced by Soviet officials, who mistrusted traditional, European science. After producing a successful crop in the 1920s, Lysenko received Stalin's embrace and was appointed was the U.S.S.R.'s Director of Biology. Lysenkoism rose to the level of official scientific doctrine, dominating Soviet biology from the 1920s to the early 1960s. During this time, Soviet farmers failed to replicate the high crop yields reported earlier by Lysenko. Soviet skeptics of Lysenkoism were politically censured; meanwhile, Western science made great progress in biology, unraveling the mystery of DNA, and firmly establishing molecular genetics. After many years of disappointing harvests, and following the amazing improvements in crop productivity accomplished by Western plant geneticists, the Soviets finally abandoned Lysenkoism. In 1964, an official committee of Soviet scientists reviewed Lysenko's experimental data and pronounced him a fraud.

The failure of Soviet biology was an example of how the impulse to believe, without the benefit of scientific proof, is a fundamental human property, that exists in atheists as well as religious zealots. The problem that the Soviets faced was that reality exists independently of personal belief systems; simply believing one way or another will not alter the truth. Still, it is not hard to find examples where belief and hope prevail over scientific skepticism: genetic engineering (manipulating the genome to eliminate common diseases), immune stimulation (improving the immune system to conquer cancer and infectious diseases), the cancer genome anatomy project, artificial intelligence, manned interplanetary space missions, and human-manufactured nuclear fusion as a practical energy source. All of these projects offer great hope for the future, but none of them have yielded a reality that matches their earliest promises.

Major scientific advances come like a bolt out of the blue; not from planned initiatives. We cannot know which scientific initiatives will work, and which will fail. But we certainly can pretend that we do. As an evil scientist, you must learn to use belief systems to promote any idea, without benefit of facts or supporting evidence.

Scientists could learn a lot from religious leaders, who have created an evidence-independent belief system. Often, the most effective way of dealing with the truth is to avoid it altogether. Here are a few options open to scientists.

1. Destroy the truth. Ignorance is bliss.

2. Delay the truth. Journal editors demand that authors not reveal articles until publication date. For accepted papers, publication dates often fall one to two years following the original article submission. This essentially imposes a one to two year quarantine on scientific discoveries.

3. Change the truth. Some truths are inconvenient and are best exchanged for a self-serving lie. For example, the Office of Research Integrity (ORI) investigated a physician and principle investigator working under an NCI-supported Gynecologic Oncology Group (GOG). The ORI found that the investigator had "engaged in scientific misconduct by soliciting a pathologist to falsify the originally correct tissue-type on the pathology report (omentum) as being another type (ovary) and submitting the falsified report to the GOG group member at the University of Iowa, in order to justify enrollment of a patient in GOG clinical protocol 182 (274)".

4. Ignore the truth. People can lead perfectly happy lives, in abject ignorance of the truth; many prefer it this way.

5. Withhold truth. In a 2006 article, Vogeli and co-workers measured data withholding practices in the sciences. They surveyed over one thousand doctoral and post-doctoral trainees, trying to determine the success rate when they asked scientists to supply them with research data or materials that had been described in published research. Twenty three percent reported they had requested, and been been denied, access to the primary information, data, or materials (275). Federal agencies hide data vital to the public interest if releasing the information would antagonize members of congress; as done for Transportation Department data that indicated the safety risks of driving while talking on the cellphone (276).

6. Appeal to authority. Few among us have the time, energy, intelligence, or inclination to understand complex scientific issues. Scientists will defer to an authority if it relieves them from the task of mastering a new idea.

7. Sell yourself. If you create a relationship of trust, everyone will believe your message. Personal appearance is important; nice suit, polished shoes, and styled hair are more persuasive than a logical argument.

8. Pray for revelation. For many, great truths are revealed through an epiphany, a much more efficient method for scientific progress than the soul-numbing process of conducting experiments.

9. Appeal to dogma. You can usually avoid data if you have a set of all-encompassing beliefs that provide answers for every imaginable question.

These truth-avoidance methods are standard tools of scientists. If used properly, belief-based assertions will always carry more sway than calculations, logical inferences, and experimental results, all of which tend to confuse or bore your peers.

Book burnings are a time-honored tradition enjoyed the world over by religious zealots. Some of the greatest books in history have been burned to a crisp. The first recorded, but least successful, book burning in history occurred around 612 B.C. and involved the library of Ashurbanipal (668 - 627 B.C.), king of the neo-Assyrian empire. Among the texts contained in the library was the Gilgamesh epic, written in about 2500 B.C. Marauders set fire to the palace and the library, with limited effect. Many many of the greatest works were written on cuneiform tablets. The fire baked the clay tablets, preserving them to the present day. It is interesting that Sumerian tablets written more than four thousand years in the past, can be read today, while many mid-twentieth century books, printed on high-acid paper, are already lost. Likewise, many digital works produced in the past decade, and stored on outmoded media (digital tape, floppy disks, zip drives, micro-fiche) or forgotten data formats, will never be accessible.

The Library of Alexandria was the most famous library of the ancient world. As a repository of truth and knowledge, it was a popular target. At least four major assaults punctuated the library's incendiary past: Julius Caesar in the Alexandrian War (48 B.C.), Aurelian's Palmyrine campaign (273 A.D.), the decree of Theophilus (391 A.D.) and the Muslim conquest (642 A.D.). We do not know the number of books held in the Library, but when the Alexandria library was sacked, the books provided sufficient fuel to heat the Roman baths for six months.

Book burning never goes out of style. As recently as 1993, during the siege of Sarajevo, the National Library was enthusiastically burned to the ground. Thousands of irreplaceable books were destroyed in the literary equivalent of genocide.

Book burning has been modernized for the computer age. Modern hospitals use complex, powerful information systems to collect terabytes of patient-related data each year. After a length of time varying from two years to ten years, old data is routinely purged. As years go by, and old information systems are replaced by newer systems, the legacy data in the old systems is routinely lost. It would be prohibitively expensive, some say, to transform the legacy data into a format that would be compatible with the new system. Nobody knows the value of old data, until they make an effort to use the data. There is very little justification for purging old hospital records. The costs of electronic data storage are miniscule compared with the costs of buying a new information system. The reason that hospitals purge their old clinical data is the same as the reason why libraries are burned. Hospital legacy data may contain incriminating information, or it may contain information that would cause staff to challenge the wisdom of past and present hospital policies.

Book burning is just one of many techniques for limiting access to important information. One of the most heavy-handed techniques is to limit the number of people who can read or otherwise interpret literature. In the middle ages, books were written in Latin; a language spoken by none and understood by few. This worked quite well in Europe for about 1,000 years. The re-production of mechanically printed books, rendered in common languages, heralded the demise of the Dark Ages, and the beginning of the renaissance. Still, a university education would remain available to none but a privileged few. Women, of course, were excluded. The practice of depriving women of an education has persisted throughout world history, to this day.

You might think that modern scientists would want to disseminate their work to the widest possible audience. This is seldom the case. In March 2005, the NIH announced a startling new policy; the public would henceforth have access to the results of NIH-funded research. In recent years, members of the public had expressed concern that they were paying well in excess of $20 billion dollars each year to for NIH-funded research projects, yet they were being systematically deprived of the research results. It seems that when scientists publish their research results in journals, they transfer copyright on their manuscripts to the publishers of the journal. In essence, the journal publishers receive the rights to virtually all taxpayer-funded research, merely by agreeing to publish the manuscripts containing the summarized final results. Taxpayers wishing to read research manuscripts (paid for with taxpayer dollars), must pay journal publishers for the privilege.

The 2005 policy issued by NIH asked principle investigators to voluntarily deposit a copy of their published manuscripts in a government repository (PubMed Central), that would be made freely and openly available to the public. Investigator compliance with the new policy was dismal, about 2.3% (277). Non-compliance was attributed to a variety of intractable obstacles, such as technical difficulties, labor and expenses of compliance, and prior contractual obligations to publishers. The real reason for non-compliance was a potent combination of laziness and selfishness on the part of researchers. After a three year interval of near total non-compliance, the NIH Director modified the policy. Effective 2008, compliance would henceforth be mandatory (278). Since then, the aforementioned obstacles have magically vanished, and compliance has soared.

What is a manuscript? A scientist asserts his findings, then asserts his conclusions, then publishes them in a manuscript. Typical journal articles are about five pages in length. The primary data (from the scientist's laboratory notebook) is likely to consist of reams of numbers and assorted information that could never fit into the final manuscript. Scientists are expected to summarize their findings in a table that holds average values for selected types of data. When you read a journal article, you are implicitly asked to suspend your natural disbelief; accepting as a matter of good faith that the author has honestly rendered his data into an objective summary.

Is it reasonable to accept the assertions in a manuscript without having access to the primary data upon which the assertions were based? Ask any UFO abductee. Today, there are thousands of people who claim that they were abducted by UFOs. Many of these people have undergone psychologic testing, and the results would suggest that UFO abductees are pretty much normal people, with no underlying pathology that would lead them to lie. Most people who claim to be abductees receive no monetary or social benefit from their experiences. Nonetheless, most of us refuse to believe in alien abduction. Despite the many stories told, by some very sincere people, there is no evidence offered that supports their assertions: no flying saucers, no little green men, no alien artifacts, no implanted probes, nothing to directly support abduction claims. Eyewitness testimony is not credible without the existence of evidence.

Somehow, the evidence requirement seems to be lifted for scientists. Few scientists feel the need to provide the evidence (the primary data) that supports their claims. This should come as no surprise. If scientific claims really required evidentiary proof, we would have very few scientific "discoveries".

Pierre do Fermat (1601 - 1665) is a case in point. He is known as one of the greatest mathematicians of all time, yet he seldom provided his colleagues with complete manuscripts. For the most part, he simply declared his discoveries in letters to other French mathematicians. Fermat's last theorem, an unproven assertion, stymied mathematicians for over three centuries. Modern scientists, lack Fermat's gravitas, and have no more credibility than the garden variety alen abductee.

The Internet and electronic publishing permit scientists to post complete data sets, regardless of their size, as supplemental files that accompany their manuscripts. The raw data upon which manuscripts base their assertions are often produced by complex instruments, collected by dozens of different laboratories, or extracted from public databases. There is no reason why this evidentiary data cannot be made available to the public (279), (280). This almost never happens. As it turns out, scientists apply lower standards to their fellow scientists than they apply to alien abductees. There are two self-serving reasons why this is so: vindication and self-preservation. When your manuscript promotes an idea that benefits your colleagues, your assertions will be accepted with enthusiasm and without criticism. Nothing passes scientific muster easier than a manuscript that vindicates everyone's biases. Furthermore, if you were actually required to provide the evidence for your assertions, so might your colleagues. Scientists will not set professional standards that are inconvenient.

One day, you will be giving a lecture, and some smart alec will ask you why you have not provided the primary data that supports your assertions. As an evil scientist, you will need a glib excuse. Here are a few:

1. To preserve confidentiality. The data is confidential and it would be unethical for me to release this data to the public.

2. To avoid confusing the scientifically-challenged masses. Commenting on the wisdom of making clinical trial data to the public, a director for the Center for Drug Evaluation and Research at the FDA was quoted as saying, "I would be very concerned about wholesale posting of thousands of clinical trials leading to mass confusion" (281).

3. To protect the integrity of your findings. Competitors may purposely misinterpret my data.

4. To maximize your productivity. Preparing the data in a format that can be distributed to the public (e.g., the internet) requires time, effort, expertise and money. My time would be better spent on research activities.

5. For the betterment of your field of science. I want to control the direction of research in my field, and my control would be lost if everyone in the field had access to my data. Always remember, science is like a compass and must always point in the right direction.

6. To avoid acrimony and to foster trust. It is disrespectful to insist on having the primary data.

7. To comply with legal obligations. My data is integral to another manuscript that is in press. If I distributed the data, it would violate the publisher's ban on pre-publication release of research data.

8. To conform with standard practice. Nobody else provides their data, why should I?

9. The data does not belong to the author. The data belongs to my university; it's not mine to give.

10. As a courtesy to your co-authors. The decision isn't mine alone; my colleagues wouldn't like it.

11. The data is in a proprietary format. I would like to release the data, but we used a proprietary standard for formatting the information, and files prepared in this manner cannot be shared without violating our license.

12. To avoid a technical fiasco. The data is spread over many different laboratories in many different formats, and I have no practical way to collect all that data into a single document.

13. To stay current. The data in the field is constantly being refined, and it would be confusing to provide old data set that does not reflect the newest advances coming from our laboratory.

14. To wait until the data is finalized. Nothing is ever final in science, so this excuse is applicable for eternity.

15. To avoid distractions. If everyone had access to the data, we would be deluged with requests from would-be collaborators. My laboratory does not not have the funding to handle that kind of situation.

All of these points avoid the basic problem that if the primary data cannot be reviewed, then acceptance of the conclusions offered in the manuscript becomes a matter of personal belief, not science. Nobody knows what horrors the future may hold. One day, scientists will be required to turn their laboratory notes over to governmental agencies or to the public. Today, scientific data collected through a federal grant, and used for the purpose of determining a public action, policy, or regulation, is subject to a Freedom of Information Act (FOIA) request (i.e., citizens can force you to provide your primary data).

As an evil scientist, you must take action to protect yourself from these assaults on your freedom. Collect as little data as possible. Don't bother to annotate your data with specifiers that can tie your numbers to a specific date, experiment, or technician. Don't conduct quality assurance activities. If you must perform calibrations and quality control measurements, destroy your records as soon as feasible.

All scientists are salesman; and salesmen understand that the product they are selling is themselves. If the customer trusts the salesman, they will buy the set of encyclopedias, the broom, the shoes, the mascara, and anything that the salesman offers. If your colleagues trust you, you can sell them any scientific idea that suits your agenda. How do you get colleagues to invest their trust in you, an evil scientist?

1. Trust them. If a person feels that you trust and respect them, they will trust and respect you.

2. Behave like them. This includes taking an interest in the same things that interest them. If a colleague's office contains pictures of his family, be sure to ask about that person's family. Indicate that you are a family man as well. If you have no family at the moment, talk about your youth and your relationship to your parents. If you hate your parents, lie.

3. Look like them. People are uncomfortable in the presence of other people who are dressed differently from them. If you don't know how a person will be dressed, always err on the side of dressing up (not dressing down). Formal attire is a sign of respect.

3. Understand their beliefs, and incorporate those beliefs into your pitch. The number of white, Christian scientists and engineers shrinks every year. Many scientists are agnostics or atheists, or follow a non-Christian religion. If you don't know the religious convictions of your colleagues, just follow their cue. The same applies to their prejudices. An evil scientist is a moral chameleon.

If you adopt a particular religion, you are entitled to use your religious beliefs to enrich and inform your scientific work. Nobody has the right to tell you otherwise. You will find that people will be eager to believe any scientific assertion that lends credence to their preferred religious doctrines.

Here are a few ways to use religious beliefs to your advantage:

1. If you say that an assertion falls within the realm of science and religion, non-religious scientists will not have the right to challenge this assertion. This argument has worked for the proponents of intelligent design. Religious scientists insist that intelligent design has just as much legitimacy, as an area of scientific study, as does evolution.

2. If a detractor insists that your work lacks scientific evidence, remind him that scientists cannot measure or understand every force in the universe. Evidence can exist in a form that we cannot see and measure, but which we can infer, based on our beliefs. Remind your detractors that some scientific truths cannot be verified within the limitations of current scientific beliefs.

3. If someone scolds you for mixing science with religion, scold them right back, for pursuing science without the aid of religion.

Scientists pretend to hold a monopoly on truth, but we all know that most scientific beliefs can be easily destroyed. Invoking the slogan, "Further study is necessary," will bring any scientific theory to its knees. The call for "further study" has been used many times in the past to put a halt to social justice and to halt science-based social initiatives. Here are a few examples:

1. Genocides. "The evidence you provide to support your accusation of genocide is extraordinarily complex. Further study is required".

2. Global warming. "Can we really be certain that the warming we see is not a short-term aberration? How do we know that Mother Nature will not rectify the problem, without human intervention? Further study is required."

3. Past ecological disasters. "The Easter Islanders didn't leave any documents explaining why their population declined. Further study is required."

4. Species extinctions. "Species extinction is a natural process. There is no way to be certain that any particular species was lost due to human intervention. Further study is required."

5. Impending natural catastrophes. "You cannot be absolutely certain when an eruption will occur, and evacuations cause economic and social upheaval. Further study is required."

6. Ill effects of lucrative vices. "In moderation, alcohol is a healthful drug and some people can drive responsibly with blood alcohol levels that might impair others. We should factor in the positive social and economic aspects of alcohol consumption before we reach any rash conclusions about the ill effects of alcohol. Further study is required."

7. Predicted exhaustion of natural resources. "Humans are resourceful. How can you be certain that we will not find additional oil preserves in the future? Further study is required."

8. The theory of evolution. "Let's not get carried away with Darwinian evolution until we explore alternate theories, such as Intelligent Design. Further study is required."

Because all science needs further study, all science can be dismissed as unproven. The U.S. government has codified the refutation of scientific opinion with the Data Quality Act of 2001, a short and cynical document that virtually guarantees that no legislation will be based on scientific achievement. The Act was passed as part of the FY 2001 Consolidated Appropriations Act (Pub. L. No. 106-554. codified at 44 U.S.C. # 3516, note.) The Act requires Federal Agencies to base their decisions on high quality data and to permit the public to challenge and correct inaccurate data. The drawback to this legislation, is that science is a messy process, and data may not always attain a very high quality. It may require decades before the data in a new area of study achieves the level of quality that critics will accept. The easiest way to bring scientific progress to a grinding halt is to insist on data quality. Special interest groups have invoked the Act to reject published, peer-reviewed studies appearing in prominent journals, claiming that such publications may not reach the standard of data quality required for government work (282), (283). Always remember that if the opposite of "Pro," is "Con," then the opposite of "Progress," is "Congress."

Evil scientists are pretty much insulated from the negative repercussions of the Data Quality Act, which applies almost exclusively to those scientists stupid enough to base their conclusions on experimental data. If you play your cards right, you can live a luxurious life in a data free zone, sustained entirely by hype.

Large research projects depend on public and private contributors. Those contributors require scientists to paint an impossibly bright and hopeful image for every project. Consequently, the scientists who work on a scientific initiative will never say anything that imperils the initiative. Never! The human genome project is a case in point (284). The project began in 1990 as a multi-institutional effort to sequence the three billion base-pairs of the human genome. Why bother? Early claims stressed that the human genome sequence would be the basis for understanding the genetic causes of human disease (285). Once we understood the genetic basis of diseases, prevention and treatment would follow. As the project moved forward, the federal effort was duplicated and surpassed by a private initiative. After about ten years, the federal and the private efforts mutually announced that the human genome had been sequenced (more or less). With the successful sequencing of the human genome, the world entered the so-called post-genome era, wherein scientists would review and analyze the collected genome. The project is considered, by everyone involved, one of the greatest advances in the history of mankind. In retrospect, considering the success of the private effort, it hardly seems that the government-sponsored effort was necessary.

The project has a few dirty secrets. Common diseases have a multitude of genetic components; each genetic component may be caused by variations in multiple different genes; and each variant gene may have multiple different genetic changes. The aforementioned sentence can be re-stated without jargon: common diseases have many different underlying genetic alterations, and that is exactly why common diseases occur commonly. For common diseases, such as schizophrenia, bipolar disorder, and type 2 diabetes, we find very little evidence that there are specific genetic traits present in the majority of cases. Dr. Goldstein, a population geneticist has said that, "we have cracked open the human genome and can look at the entire complement of common genetic variants, and what do we find? Almost nothing. That is absolutely beyond belief" (284). A cynic might conclude that the Human Genome Project was one of the greatest examples of scientific hype in the history of mankind.

Pharmacogenomics, sometimes referred to as personalized genetic medicine, is an over-hyped scientific field that draws heavily from the human genome project. Soon after the human genome had been sequenced, there was enormous enthusiasm for individualizing medical treatment based on an analysis of each person's genome.

In a 1999 article entitled, "New era of personalized medicine targeting drugs for each unique genetic profile," two Wall Street Journal reporters described a $45 million dollar effort launched by a consortium of 10 of the world's largest drug companies intended to "identify several hundred thousand chemical signposts" (286). The drug companies would use the gene data to create drugs specifically targeted to each persons unique genetic profile (286). A rich scientific literature emerged at the turn of the millennium, heralding the new age in gene-based medicines. A decade later, medicine hasn't changed very much. Most drugs are dispensed in the traditional range of 20 to 200 milligram doses. Trial and error is still the most effective way of finding the right drug for any individual. Without genetic analysis, physicians and their patients somehow settle on a drug and a dosage that works for the individual.

What went wrong? Before you can get much benefit from pharmacogenomics, you need to collect phenotypic data (treatment, outcome, clinical, historical, physical) on millions of patients, catalog the genetic alterations that can account for diseases and drug responses in millions of subjects, and integrate the phenotypic data with the genetic data. Simply acquiring genetic data will not suffice. This project is well beyond the capability of modern science. No team of scientists and healthcare workers can do the job, no matter how much money is at stake.

Gene therapy is another over-hyped ideas that captured the twentieth century imagination. If there are genetic causes of diseases, should we not try to cure those diseases by correcting the gene defect? James Le Fanu, in The Rise and Fall of Modern Medicine, wrote that in 1995, after spending hundreds of millions of dollars in gene therapy research, NIH reluctantly concluded that the approach was useless (287). By the turn of the millennium, most of the funding for gene therapy had dried up. Nearly fifteen years later, in 2009, the field has made some progress. Gene therapy has successfully corrected several cases of Lebers congenital amaurosis (blindness), a rare congenital disease (288). There is every indication that continued work in gene therapy will lead to the correction of some diseases caused by single-gene mutations. But there is little hope that gene therapy will transform us into anything close to genetically perfect beings.

Nanotechnology, the science of small mechanical devices, has inspired some of the very best science fiction. Star Trek's Borgs could not live without their nanotechnology. The same Borg technology has inspired (invaded?) the minds of the NIH leadership. An NIH funding announcement, issued in 2007, clarifies the future role of nanotechnology in medical research: "Nanotechnology and nanoscience have the capacity to drive a new wave of medical innovation through the engineering of bioactive nanoscale structures, processes and systems based on the advancement of our understanding of biology at the nanoscale (289)" NIH, along with the Borg, might be correct in their assessment of the importance of nanotechnology in human medicine. Or they may be wrong. Either way, the time for hype is now.

Today, the most hyped area of scientific investigation is stem cell research. Who can say that stem cell research is any more important than any other area of active research? Experience tells us that most of the important advances in medical science have come out of left field, without the early support or recognition by large federal institutions or funding agencies. What makes an institution or agency lavish publicity and funds on one area of research and ignore some other areas? Hype is the answer. How many areas of research were underfunded in the last two decades of the twentieth century, in deference to a well-hyped idea whose time had not yet come?

A disease advocacy group successfully lobbies to funnel large sums of money to their pet disease. Over the years, well-funded laboratories make incremental advances toward a cure. The advocates applaud every small advance. The number of small advances is used as an argument that a cure is certain to come very soon. From their funded research, a sensitive screening tool is developed. Though there is no cure for the disease, individuals with early, non-clinical disease, can now be selected from a healthy population. Soon, a drug is developed that extends the life expectancy, of people who have the disease, by twelve days. Advocates consider this drug a major breakthrough. A high level of funding provides researchers with an incentive to pursue their research over the next five decades. Finally, a cure for the disease is discovered. A Nobel prize in medicine is awarded. The advocates, who persevered over more than a half-century, collecting billions of dollars for their project, are jubilant. You wonder to yourself, whether the money might have been better spent on some other disease, that could have been cured with less money, in less time, for the benefit of more people.

One day, you will attend a lecture on a scientific topic, and the speaker will smile throughout the talk, and he will tell you that every idea and hypothesis in the field is exciting, every experiment is successful, and every scientist in the field is brilliant. When this happens, you must know that this is not science; it is advertising.

The life of young scientists is occupied by endless hours of cheap, unappreciated labor, self-doubt and the feeling that they have put their trust into the hands of villains (older scientists). The lives of older scientists are dominated by a maniacal quest to justify their languishing careers and to obtain the approval of their peers. Hype allows you to achieve prestige, wealth, fame, and power, for marginal scientific contributions.

Have you read any of the reviews attached to books on Amazon.com? Anyone can write a review for any book. Reviewers can supply their names, but others simply identify themselves as "reader," and the city where they live. Amazon keeps the names of the reviewers confidential. Sometimes mistakes happen. The Associated Press, on Saturday, February 14, 2004, reported that the identity of reviewers had been unintentionally revealed on the Amazon.com's Canadian website. As the names of reviewers came to light, it became obvious that some authors had posted glowing reviews of their own work. Was anyone surprised?

Here are some clues that you are being hyped:

1. The speaker's cause is virtuous and without negative consequences. The speaker has made great personal sacrifices to advance the cause. The speaker stands to gain nothing.

2. The speaker professes to see events that will unfold in the future.

3. Time is of the essence. Speed will be rewarded with success while any delay will prove disastrous.

4. The opponents of the speaker's cause are small, narrow-minded individuals and represent a minority opinion.

5. The speaker humbly admits that he had admired you and your work for many years (typically, in silence).

In 2009, researchers found a 47 million year old fossil that may represent an early primate bone. This kind of finding has some interest to paleontologists, but its value as a popular interest item is limited. Nonetheless, the discoverers parlayed their finding into a media event involving: a ceremony at the American Museum of Natural History, a film detailing their study, a book release, an exclusive deal with ABC news, and a web site (290). When interviewed, Jorn H. Hurum told the New York Times, "Any pop band is doing the same thing (290)."

For nearly two centuries, physicians held fast to a code that prohibited self-advertisement. The American Medical Association's Code of Ethics, of 1847, was adapted from Thomas Percival's "Medical Ethics; or a Code of Institutes and Precepts adapted to the Professional Conduct of Physicians and Surgeons (1803)". The 1847 Code of Ethics, Chapter II, Article I, Section 3, describes the practice of physician advertising as "derogatory to the dignity of the profession." This self-imposed humility came to a crashing end in 1975, when the U.S. Federal Trade Commission decided that the prohibition against self-advertisement was "restraint of trade," in effect elevating physician self-advertisement to the status of a statutory right (291). Today, as an exercise in civic responsibility, physicians brazenly advertise on television, radio, newspapers, the Internet, and many any other media outlets. When a television commercial features a dozen physicians from a large practice, administering to their patients, while a disembodied voice assures viewers that they will receive the best of care from this dedicated team of professionals, it's easy to buy into the illusion.

18.1 MATHEMATICS IS NEITHER SCIENCE NOR RELIGION

"Biologists think they are Biochemists,

Biochemists think they are Physical Chemists,

Physical Chemists think they are Physicists,

Physicists think they are God,

And God thinks he is a Mathematician."

-Anonymous

"Mathematics is the part of science you could continue to do if you woke up tomorrow and discovered the universe was gone."

-Dave Rusin

"Only two things are infinite, the universe and human stupidity, and I'm not sure about the former."

-Albert Einstein

The most dangerous question a scientist can ask is, "How do we know what we think we know?" Among all branches of science, mathematicians are the only one who take the concept of "proof" seriously. Theoretical mathematicians are obsessed with the ideas of "assumption", "proof" and "provability." As such, mathematics occupies a realm that is beyond belief and disbelief (i.e., beyond religion and science). God may alter the rules of chemistry and physics, but God cannot change the rules of mathematics. In 1824, Abel (1802 - 1829) proved that it is impossible to find solutions to quintic equations; impossible for Abel, and impossible for God. Indeed, there are many straightforward computational problems that, if God were to try his hand at solving them, his computations would never end (292). In short, God must observe the computational limitations that are established by human mathematicians.

With the exception of mathematics, which enjoys an existence unfettered by the space-time continuum, the residuum of science is very much a human enterprise, not fundamentally different from football or tap-dancing. As mathematicians have come to care more and more about truth, the other scientific disciplines seem to care less and less. Medical professors openly confess that half of what they teach is simply wrong, but they cannot determine which half is wrong and which half is right. Evil scientists should work within the real world, avoiding higher mathematics like the plague.

18.2 STATISTICS AND OTHER PSEUDO-MATHEMATICAL FIELDS

Statistics should never be mistaken as a branch of mathematics. Statistics is basically just another field that uses mathematics to lend some credibility to their dubious beliefs. Statisticians are the only professionals to use this ploy. Those who focus their life on large quantities of money (economists, financiers, international bankers, investors) have found that mathematics confers a [false] sense of intelligence and trustworthiness.

Methods that use mathematical predictors to analyze aggregate numbers relieve professionals from their responsibility to catalog and understand individual events, while, at the same time, distancing the professional from the consequences of complex events. It's beautiful, really.

Nobody really understands how any statistical test works. None of them are mathematically "provable." If you don't believe me, let's take a close look at null hypothesis testing, the fundamental concept upon which all statistical reasoning is built.

Null hypothesis testing is a probabilistic analog of simple logical inferencing. For example, here is a non-statistical situation where a null hypothesis is tested (adapted from Jacob Cohen's brilliant monograph, "The Earth is Round (p.05)" (46).

Null hypothesis (the hypothesis you want to prove or disprove): If a person is an American, then he is not a member of Congress.

Stop everyone you see on the street and ask if he/she is a U.S. citizen. If so, ask if he/she is a member of Congress. Eventually, you will find an American who is a member of Congress. At that point, you will know that your null hypothesis is not true, and you will reject it.

When we project null hypothesis testing into the realm of statistics, we reach the opposite conclusion.

Probabilistic null hypotheses (the hypothesis you want to prove or disprove): If a person is an American, then he is probably not a member of Congress.

Here you can choose a random sampling of Americans (a few hundred or so), and you will almost always find that none of them are members of Congress. You will then accept the probabilistic null hypothesis ("If a person is an American, then he is probably not a member of Congress"). Furthermore, you are now ready to believe the general rule that Americans are not members of Congress.

Of course, the probabilistic null hypothesis is nonsense, as all members of Congress are Americans. The probabilistic null hypothesis is accepted because there are very few members of Congress and there are many Americans. The non-probabilistic version of the same hypothesis was rejected by examining the population to which the hypothesis applied. If we began with an understanding of the rules of fitness for Congress (i.e., Congressman must be an American), and good data on the relative numbers of Americans and Congressmen, we wouldn't have been suckered into examining a probabilistic absurdity.

Statistical testing is the closest thing the evil scientist has to sleight-of-hand deception. How does an evil scientist know when you to believe a statistical conclusion? If the conclusion is consistent with your own biases, and if it furthers your own selfish agenda, you can swear on the results. Otherwise, reject the conclusion by invoking one of four popular classes of statistical error.

Type 1 error. Rejecting the null hypothesis when the null hypothesis is correct (i.e., seeing an effect when there is none).

Type 2 error. Accepting the null hypotheses when the null hypothesis is false. (i.e. seeing no effect when there is one).

Type 3 error. Rejecting the null hypothesis correctly, but for the wrong reason, leading to an erroneous interpretation of the data in favor of an incorrect affirmative statement.

Type 4 error. Erroneous conclusion based on performing the wrong statistical test.

Type 5 error. Erroneous conclusion based on bad data.

18.3 ADVICE FOR EVIL SCIENTISTS

1. In science, belief is a choice. You might as well believe in those assertions that advance your career.

2. Nobody has the right to make you believe anything, even when it's true. Just say, "I have listened to everything you have said, and I have reviewed all of the evidence that you have provided, and, frankly, I am just not convinced." Always remember that your ignorance is just as valid as your critic's knowledge.

3. Scientists are hired for their ability to see into the future. It is not unusual for an interviewer to ask a job candidate for their prediction of where they see the department, five years hence. Never hesitate to take a stupid (but beloved) project and predict its great success in the future.

4. Nobody has ever proven anything in the natural sciences. To create an impasse, just insist on having proof. In particular, when you need to stop progressive legislation that threatens your agenda, invoke the Data Quality Act (that's why the Act was created).

5. Your data is your data. Hide, hoard, or suppress your data whenever it suits your agenda.

6. When asserting your authority, don't get involved with facts or logic. Simply indicate that you are the authority on the subject, and the opposition lacks authority. People will appreciate this simple and forthright approach to the problem. Remember that everyone will yield to authority when the authority promotes an opinion that furthers their own selfish pursuits.

7. By asserting authority, you render an act of kindness on all those involved in the decision-making process. Through a simple act of trust (in you), everyone is relieved from the intellectual burden of analyzing data and judging opposing arguments.

8. Declare that intelligent design is a scientific ideology on par with evolution. Insist that the purpose of science is to confirm the fundamental beliefs of your funding religion (whatever those beliefs may be). When your colleagues suggest that your beliefs are nonsensical, reply that they are being close-minded, anti-scientific, and godless.

9. Self-promotion is a time-honored pursuit among evil scientists.

10. It is a terrible thing to cheapen your reputation; make sure you charge top dollar. Understand that your clients believe that the best professional will charge the most money for his services.

11. When you're wrong, and you know it, insist that "Further study is needed."

12. Understand that science is politics, and successful scientists are politicians. Any set of data can be interpreted to support any political agenda.

13. If you want to be an evil scientist, stay away from mathematics as a career.





CHAPTER 19. SEX AND GENDER

"Nobody really cares if you're miserable, so you might as well be happy."

-Cynthia Nelms

You are a 35 year old male pathologist, married. There are three parts to your job: service, research and teaching. The service you perform is to render accurate diagnoses on human tissue specimens (biopsies, blood samples, cytologic preparations, etc.) that are delivered to the pathology department. The research you perform involves trying to understand the causes, mechanisms, diagnostic methods and treatments for human diseases. Your teaching responsibilities may include performing a few lectures to medical students and allied health scientists.

Most of your teaching involves supervising the residents (pathologists-in-training) who rotate through your department. The pathology residents have all graduated from a school of medicine. Each holds a medical degree, but they must devote more years (typically 5 years) in specialized training before they can sit for the pathology board examination and become someone who can independently practice pathology.

Pathology residents tend to be in their late twenties or early thirties, though you sometimes encounter a resident who is in his fifties. On this particular day, as you walk in the long, long hallway that leads to the pathology department, you find yourself gazing at the rear end of the woman just ahead of you. She is a new pathology resident. She walks in tandem with two other residents, but they fade into invisibility. You find yourself automatically adjusting your speed to match that of this alluring new resident. You keep a safe distance (one car length) behind her. The swaying, up and down, back and forth, of her shapely ass captivates your attention. Through an act of will, you lift your eyes a bit to survey her torso and her lovely red hair. For a brief moment, you are happy.

Suddenly, she twists here head and spins her body a bit to look in your direction. She smiles and your eyes meet. You smile back. Once she has received your smile, she turns back and continues walking forward with her friends, as though nothing had happened. "Did she know that I was staring at her ass?", you wonder.

Later that day, you sit in your office, peering at a glass slide through your microscope. On the glass slide is a thinly sliced tissue section of a tumor that a surgeon had removed from his patient the prior day. The surgeon will be expecting your rendered diagnosis later that afternoon. You are relaxed, doing a service that your were trained to do and that you do well.

A resident enters your office. You look up, and see, for the first time, the front of the female resident. She comes closer, extending her hand, as she tells you her name. You do not get up (a pathologist at his microscope is not expected to rise when greeting colleagues). You shake her hand. Without invitation, she sits on the chair adjacent to your desk. She has somehow taken charge of the encounter.

She talks briefly about herself, her medical school, the service rotations that she has had, and she asks questions about the current service: on-call requirements, reporting time in the morning, frozen section responsibilities. You reply to each of her questions with a smile. You try your best to be witty, and she laughs lightly. To add emphasize to her remarks, she reaches over, from time to time, to touch your knee. You do nothing to dissuade this familiarity. Suddenly a third year female resident walks into your office. The new resident calmly keeps here hand clasped on your thigh, just above the knee. Now, both of the residents are looking at you. You shift your position, extricating your knee. Somehow, the awkward moment passes and both residents leave your office to resume your duty.

A horrible, sinking feeling overwhelms you. You lost something that you valued; respect.

Every workplace is charged with sex. Office romances are never announced, but you know when it happens. Sometimes it is overt, with coworkers having affairs and cheating on their spouses.

It is winter here in Chicago. Two coworkers who seem very friendly at work are both traveling to the same scientific meeting, in New Zealand. They book their flights themselves, not through the department secretaries. They fly on on the same plane, on adjacent seats. A colleague who attended the same meeting says that he would see them together in the hotel and at restaurants in the evening, but that he saw neither of them in the conference rooms. Your colleague returns from New Zealand pale and a bit haggard after his long trip. Your two coworkers return relaxed, happy, and tan.

Sex can be stormy. What begins as sexual favoritism can end abruptly.

A young, beautiful junior scientist has joined your department. Within three months, she is asked to co-author the fifth edition of a major textbook authored by a senior male professor in the department. Three months after that, she is abruptly dismissed from the staff. You hear that she has found a good job at another university, far away. Her name never appears as a co-author on the book.

Most workplace sexuality is subtle. An insecure man flirts with every woman in an office. He has no intention of cheating on his wife. He seeks affirmation that he is desirable. Women do the same. The most prevalent form of office sexuality is favoritism: the object of your desire can do no wrong.

You are a woman attending a staff meeting. An object of your sexual desire presents his scientific research to the group. You see a major flaw in his approach to a problem, but you keep quiet. The group decides to follow a plan that will certainly waste everyone's time. Afterwards, you congratulate him on his presentation.

People think, incorrectly, that marriage somehow corrects the inequities that result from office sex. Not so.

You are the male head of the physics department. Your wife is an assistant professor, who is coming up for tenure. If she does not receive tenure, she will be forced to look for a position in another university. Physics positions are few, and she might need to leave the state for work. Because of your obvious conflict of interest, you have recused yourself from participating in your wife's tenure committee. Your wife has submitted a paper to a prestigious journal for publication. After waiting months for review, the paper was rejected, She has no other publications in any major journal, and this will not bode well for her. You have friends who are members of the National Academy of Sciences. One of them can sponsor her paper in the Proceedings. As for the tenure committee, you notice that one of the committee members has requested a sabbatical. You set a date to discuss his request; the day following your wife's tenure review.

19.1 WHERE THE BOYS ARE

"The American male doesn't mature until he has exhausted all other possibilities."

-Wilfrid Sheed

If you read the history of any field of science, you may notice the paucity of female participants. For the greatest part of human history, women have been steered away from the sciences. This is true for virtually every culture on the planet. There are theories offered as explanation. You've heard most of them. In keeping with the theme of this book, consider this question: "Are women sufficiently self-absorbed, power-hungry, and generally evil to be good scientists?" Maybe not. Boys are brought up to be self-centered, and ambitious. A boy learns to take what he wants from weaker boys. Wars are a natural extension of learned boyhood behavior.

Look at prisons. They're filled with men. Hardly any women at all. Most of the men in prison are relatively young; covering the intellectual peak years for scientists. During their long, stumbling course toward maturity, males are basically sociopathic, committing most of the violent crimes that plague society, and achieving most of the scientific breakthroughs that benefit society. Basically, science is just another anti-social activity of young men; miraculously twisted into the service of humankind. Women account for a minority of the scientists, for the same reason that they account for the minority of prison inmates; they're not evil.

19.2 ADVICE FOR EVIL SCIENTISTS

1. In the long run, the workplace is the wrong place for sex.

2. For men, being evil comes naturally. Women may need to work at it.





CHAPTER 20. GREED

"If you're an engineer, you don't want to outlaw the great technology you've been working on. If you're a marketing person, you don't want to outlaw the thing you've been trying to sell. If you're a C.E.O., you don't want to outlaw the thing that's been making a lot of money."

-Bob Lucky, an executive director at Bell Labs, who developed car cell phones, knowing that on-road conversations distracted focus away from the task of driving (293).

"The haves have not what all the have-nots have since much of having is the need to have."

-Samuel Hazo, in his poem, "The Necessary Brevity of Pleasures"

I have never met a high-paid professional who thought that his salary was too high. Never. But if a highly-paid professional truly earned the salary they received, the World Trade Center Towers would be standing, Wall Street would not have collapsed in 2008, the mortgage crisis would have been averted, Enron would still be in business, cancer would be eliminated as a common disease, we would need many fewer physicians, and our planet would not be slowly roasting, like a slab of meat on a rotisserie. Every day, we pay some individuals large salaries, so that they can do a very bad job. Why is this?

Jeffrey Kluger, in his book, Simplexity: Why Simple Things Become Complex (and How Complex Things Can Be Made Simple), uses a visual tool to answer this question (294). Imagine a U-shaped tube. At the two top ends of the tube are the highly complex jobs. The low-complexity jobs fall into the bend. The salary curve follows the U, with the lowest paid jobs at the top-left point in the U, the medium salaries in the bottom bend, and the top salaries at the top-right point. The lowest paid jobs (top-left) are highly complex. They may involve mastering a large inventory, knowing what multiple co-workers are doing at any given moment, satisfying the real or imagined needs of a fussy and diverse public, and so on. These jobs are found in Wal-Mart stores, Burger King restaurants, airports, etc. The highest-paid jobs, on the other end of the U, are also complex. They may involve sticking an endoscope down another person's esophagus, watching a screen with hundreds of stock prices, or writing wills. In the middle are the jobs of low complexity, where workers do a few well-defined tasks and meet an acceptable level of competence.

The people at one end of the "U" will earn 100 times or more than the salary of the people at the opposite end; while the level of complexity is the same at both ends. Those at the high-paying end are the professionals. They have gone through a filtering process that serves to reduce their numbers, without actually improving the final product. Life, as everyone knows, is unfair.

The most highly paid of the scientific professionals are physicians. How much are they really worth, and in what regard should they be held?

The earliest physician known by name was I-em-hetep, who practiced medicine about 4500 B.C. in Egypt. He was worshiped as a demi-god at least up to the time of Mycerinus (about 2500 B.C.) (128). Not to be outdone, the Greeks had their own god of medicine, Aesculapius. Legend has it that Aesculapius was born while his mother was being consumed by fire on a funeral pyre. At the last possible moment, he was cut out from her womb, and given his name, Aesculapius, which means "to cut open." Today, most physicians have less eventful births than Aesculapius, and shorter legacies than I-em-hetep, but they feel a deep sense of entitlement just the same.

In the Book of Ecclesiasticus, written about 180 B.C. by Jesus Ben (Son of) Sirach, we receive the following advice (128):

"Honour a physician according to thy need of him with the honours due unto him:

For verily the Lord hath created him.

For from the Most High cometh healing:

And from the King he shall receive a gift.

The skill of the physician shall lift up his head:

And in the sight of great men he shall be admired."

Obviously, the ancients held their physicians in high esteem, and this may have been based, on large part, on the ambiguaty between the healing arts and the priestly arts. If the doctor's power comes through prayer, and if the physician knows how to channel divine interventions to his patients, his adulation would be well-deserved. Nowadays, the power of physicians to heal comes from thousands of scientific discoveries and technical contributions that were made without his input. Basically, if you can get accepted into medical school, the practice of medicine is included in the tuition.

Physicians typically endure about eight years of post-undergraduate training. Though the length of physician training is long, it is no longer than that of many scientists. Graduate studies in the sciences (the period between undergraduate graduation and the time when the Ph.D. is received) can easily extend 6 years or more. Following graduation, Ph.D. scientists can expect to serve in a low-paying post-doctoral position for three years or more. Much of the effort constitutes a long filtering process whose primary purpose is to reduce the number of trained specialists, and hence raise incomes for the fully-filtered residue (remember the "U" tube principle).

If you've been to a doctor's office recently, odds are that you were seen by a Physician's Assistant (PA), not an M.D. Physicians Assistants are professionals whose medical education was delivered in a two-year bolus. This short spin around the hospital qualified them to take care of you and your family. In all likelihood, you will find that your PA surpasses your doctor in terms of professional demeanor, level of expertise, quality of care, and personal hygiene.

The next time you drive by an obscenely large mansion, and your passenger confides that the owner is a physician, you might want to run through the following set of questions pertaining to the mansion's owner:

1. Did the doctor have anything to do with developing the medications or the technical instruments, or the treatment protocols that he uses in his practice?

Answer: Of course not.

2. Did the doctor prove that the medicines he prescribes are effective?

Answer. Of course not; that's done for him by the pharmaceutical industry and regulated, in the U.S., by the FDA

3. Does the doctor have any role in lowering the incidence of disease in the population?

Answer. Not much. Public health authorities, epidemiologists, nutritionists, exercise trainers, civil engineers, and a large cast of non-physician characters have had the greatest influence on lowering the incidence of disease, primarily by instituting preventive measures. On average, people who drink clean water, have well-balanced diets, abstain from smoking and excessive alcohol consumption, maintain an optimal weight, exercise regularly, reduce their exposure to pollutants and toxins, and lead a risk-averse life, require fewer medical services than people who do the opposite. Every doctor knows that the majority of doctor visits are precipitated by life-style indiscretions. If the American public behaved sensibly, the medical workforce would shrivel into a tiny ball. Physician salaries and healthcare costs would plummet. Basically, the delivery of medicine is sustained by the stupidity of the receivers. It is simply not in the interest of the medical profession to change the status quo.

4. Does the doctor have any role in increasing the incidence of disease in the population?

Answer. Yes. The Institute of Medicine has estimated that medical errors cause up to 98,000 deaths occur each year, in the U.S. (11). In addition, the rising death rate from antibiotic-resistant organisms (previously known as antibiotic-sensitive organisms) are due, in greatest measure, from poor prescription practices, by physicians.

5. Does the doctor promote the diagnosis and treatment of conditions that do not benefit from or require treatment?

Answer. American physicians get paid for performing diagnostic procedures and for treating patients. The more tests and treatments they perform, the more they get paid. Tests and procedures work best on healthy patients, because healthy patients are less likely to suffer adverse consequences from tests and procedures than the people who really help. Consequently, physicians are motivated to provide services to those who need them least. Increasing the number of physicians with access to expensive tests and procedures will produce a greater volume of unnecessary treatments. To counter the rising number of unnecessary, expensive, and potentially harmful tests, a number of laws and regulations have been enacted or proposed. For physicians, the two most oppressive laws are the Anti-Kickback Statute and the Stark Law (295).

6. Does the doctor charge fair and reasonable fees?

Answer. How many impoverished doctors do you know? Doctors charge what the market bears.

7. Does the doctor wash his hands?

Answer. Not often enough (129).

8. Does the doctor treat all his patients with the same level of care?

Answer. Some patients pay thousands of dollars for so-called concierge practice, where patients pay for preferential attention and quick service (296). Isn't this a violation of the Hippocratic Oath? Don't physicians swear to treat all patients as equals. Actually, no. The Hippocratic Oath seems to have omitted any such ethical obstacle. But the AMA (American Medical Association) indicates that it is the doctor's responsibility to provide timely attention to the needs of his patients. Specifically, the AMA Code of Medical Ethics states the following (297):

"(3) The patient has the right to courtesy, respect, dignity, responsiveness, and timely attention to his or her needs."

Because timely and responsive care is a fundamental patient right, it seems somewhat odd that physicians would provide it only to those who are willing to pay extra.

From the doctor's point of view, the concierge system is a win-win situation. In one strategic move, they have eliminated from their practice the socio-economically disadvantaged patients, who often present with complex, serious medical problems; and they gain a healthier, wealthier patient population willing to pay for the semblance of preferential treatment.

Who are the patients that physicians give preferential treatment? We don't need to speculate; doctors are eager to tell us. In a New York times article, reporter Natasha Singer focused on a California dermatologist who maintained two waiting rooms: one for sick patients, and one for patients seeking beauty treatments (298). The waiting room for sick patients is adequate, while the waiting room for people seeking botox and other enhancements is luxurious, with soft music and flowers. Phone calls from sick patients go directly to voice mail. Phone calls from patients seeking beauty treatments go to a phone answered by a staff member. The treatment rooms for diseased patients lack the aesthetic touches found in the treatment rooms reserved for the would-be beautiful patients. Singer found that some offices hire special receptionists for patients seeking cosmetic work, and offer these patients quicker appointments than the patients with actual diseases.

Beauty treatments are usually not covered by medical insurance policies, and the costs of cosmetic treatments are not controlled by payers, such as Medicare. For beauty treatments, doctors will charge whatever the market bears. It's much less profitable to treat a disease than to provide a cosmetic procedure.

20.1 TO UNDERSTAND THE PRACTICE OF MEDICINE, JUST FOLLOW THE MONEY

In the United States, there is no healthcare system. What we have is a medical technology system wherein the provision of medicine is determined almost exclusively by the method and amount of reimbursement obtained for the different technologies employed. Basically, the practice of medicine is pre-determined by money, not disease.

Here is an example. A 300 pound, 30 year old smoker comes to his private physician, complaining of difficulty breathing. After a quick history and physical examination and some simple blood work the physician finds that the patient has hypertension, hyperglycemia, a complex dyslipidemia, osteoarthritis of knees and ankles, chronic bronchitis, sleep apnea, back pain, GERD (gastro-intestinal reflux disorder), halitosis, chronic fatigue, depression, and frequent absenteeism from work.

The doctor knows that all of these problems are the direct result of the patient's morbid obesity. If the patient were put on strict diet, with exercise, all of his medical issues would soon vanish - even the halitosis (which is secondary to GERD). The most effective approach to the patient's treatment would be a lengthy discussion, with the physician, in which the doctor would explain that all of these disorders stem from dietary excess or dietary indiscretion, coupled with a lack of regular exercise, and exacerbated by smoking. If there were an effective public health system, the patient would be tracked to a personal trainer, who would plan the patient's diet and exercise program and supervise a smoking cessation program. His family would be brought into the discussion, and instructed how they must support his efforts to reduce weight. His employer would participate in his therapy program by providing a supervised period, in the morning and afternoon, when employees would engage in light exercise. Employers are happy to cooperate, when they know that a program will reduce absenteeism and enhance staff productivity. The cost of this kind of treatment is small. The benefit to society is immense. Of course, this description does not characterize the practice of medicine in the United States.

In the United States, an obese smoker with attendant ailments is a medical gold mine. The doctor tells the patient that he is a diabetic and will develop blindness and almost certainly require amputations of his legs, if he doesn't begin lifelong treatment with oral hypoglycemic agents, and, eventually, insulin. The patient will learn that his hypertension is out of control and that he will start treatment with two expensive medications. His treatment for hypertension will be a life-long process. His dysplipidemias will require life-long treatment with the most recently marketed statins. His sleep apnea would require an expensive evaluation followed, with an assistive breathing device (CPAP, Continuous Positive Airway Pressure) that would be fitted to the patient and worn through each night, for the remainder of his life. GERD will require endoscopy, esophageal biopsies, and medications to reduce the production of stomach acid. Chronic bronchitis, will require a consultation from a pulmonary medicine specialist, who will follow the patient indefinitely, providing a rich array of agents intended to cleanse airways and open bronchi, oxygen therapy as needed, and antibiotics for attendant lung infections. An orthopedic consultation will be called to evaluate the patient's knees and ankle arthritis. He will probably recommend arthroscopic procedures. Back pain will probably require various pain killers, muscle relaxants, corticosteroid treatments, and possibly surgery. Fatigue and depression will lead to psychiatric examinations and trials with various tranquilizers, anti-anxiety, anti-depressent medications. The many daily, long-term medications will interact with one another in an unpredictable, and malevolent manner, producing strange incapacitating symptoms that no doctor will be able to diagnose correctly. The patient will continue to smoke and to gain weight at a rate that is alarming, even to himself. The patient's work absenteeism will worsen, as his many doctor visits increase in frequency and his various complaints multiply with age. His employer will become obsessed with finding a way of firing the patient without violating the patient's employment contract.

In a healthcare system, the patient would be treated for the primary problems that caused all of his symptoms: over-eating and smoking. But the U.S. does not have a healthcare system. We have a health technology system, which is geared toward providing tests (e.g., laboratory tests on blood or tissue biopsies, various imaging scans), procedures (e.g., endoscopies, biopsies, surgical interventions), and medications (particularly, expensive new drugs that are protected by patent). In a health technology system, doctors are paid for the technology that they employ. In a health technology system, there is no satisfactory way to reimburse a doctor for the hours spent coaching an obese patient to participate in a healthy, effective diet. Consequently, patients are treated on a symptom-by-symptom basis. It's an expensive and ineffective way of practicing medicine, but that's the whole point. A health technology system is aimed at generating reimbursed costs.

20.2 MAN-MADE DISEASES

Many physicians cannot stop themselves from dividing diseases into two broad categories: God-made diseases and Man-made diseases. God-made diseases are all the awful genetic, developmental, microbiologic, and parasitic, disorders that mankind did not create. These account for most of the diseases of infancy and childhood.

Man-made diseases are those conditions that arise from self-indulgences (over-eating, substance abuse, smoking) or follow directly from the actions of humans (motor vehicle injuries, violent assaults, safety lapses). Man-made diseases account for the vast majority of the diseases of adults.

There is also a grey-zone of diseases where there seems to be some collaboration between God and man. Cancer is a good example. Humans did not invent cancer, but human connivance vastly increases the number of cancer occurrences (e.g., smoking, alcohol abuse, over-eating, unsafe sex, meat-intensive diets, pollution of air and water, etc.).

All physicians know that if adults simply behaved better (calorie-restricted diets, no smoking, no substance abuse, moderate and regular exercise, vegetarian or reduced-meat diets, less pollution, defensive and attentive driving, home and occupational safety precautions, fewer wars, less assaulting, better personal hygiene) the health delivery system would shrink from the size of a fungating tumor to the size of an adolescent's pimple.

You might argue that every human will eventually get sick and die. It's just a matter of time before we all need the services of a physician. This is true, but it does not change the fact that clinics are filled with people who have made themselves sick through their own life-style choices. The individuals who have God-given diseases or who have age-related infirmities represent a small fraction of the total number of patient-physician encounters in the U.S.

From the perspective of the pharmaceutical industry and the medical device industry, the best thing about lifestyle diseases is that they persist for the duration of the patient's life. As long as the patient continues his indiscretions, he will continue to need the services of the medical-industrial complex. Most physicians and other members of the medical-industrial complex understand that they would be unemployed if their patients seriously pursued a healthy lifestyle. This is why the status quo is acceptable to so many people.

In the first half of the twentieth century, three infectious diseases received the bulk of attention here in the U.S.: polio, syphilis, and tuberculosis. Every physician knew these diseases intimately. There were medical journals devoted exclusively to these diseases. Doctors specialized in these diseases and invented now-obscure names for their specific clinical presentations or variant forms (e.g., Pott's disease for tuberculosis of the spine; craniotabes for syphilis). Few of us today remember that polio was also called infantile paralysis and that its full name was poliomyelitis, or that it came in several clinical forms (e.g., bulbar polio, abortive polio).

In the mid-twentieth century, a cure for each of these diseases was discovered. Everyone was predicting that in a few years, polio, syphilis and tuberculosis would be eradicated. The predictions were accurate for polio, but they were somewhat off the mark for syphilis and wildly wrong for tuberculosis.

In the case of polio, prevention consisted of getting vaccinated. Syphilis was also easy. If you've had syphilis for less than a year, a single intramuscular injection of penicillin will cure you. Curing tuberculosis required some effort. For active cases of tuberculosis, patients were expected to swallow multiple pills, daily, for up to 18 months.

Basically, the reason that polio is virtually non-existent in developed countries, and the reason that you don't hear too much about syphilis these days, is that the cure comes in the form of one or two doses of a medication that the physician personally delivers in the office. The reason that tuberculosis is still a major public health problem is that it requires long-term treatment administered by patients.

Physicians understand, but do not seem to care, that patients simply do not adhere to long-term medication regimens. When groups of patients are closely monitored for medication compliance, the bar, nobody expects strict adherence to long-term therapy. Acceptable adherence is 80% compliance. But patients seldom meet acceptable levels of treatment. In a group of patients with hypercholesterolemia, only about half of the monitored group achieved 80% medication (statin) compliance (299).

So, in the 1950s, when antiobiotics active against tuberculosis were discovered, everyone believed that this disease would soon be eradicated. They hadn't taken into account patient compliance. It was common for patients to stop their medication after a few weeks of treatment, or as soon as their symptoms abated. Not surprisingly, this practice gave the TB microbe (Mycobacterium tuberculosis) the opportunity to develop resistance to standard treatment. Within a generation, multidrug-resistant strains of tuberculosis emerged.

How did this play out in American cities? Baltimore is the home of Johns Hopkins Hospital, one of the most prestigious medical centers in the world. In Baltimore, Johns Hopkins employs more people than any other business. You would think that Baltimore would be the healthiest population in the world? It is not. In the 1970s, Baltimore had the highest tuberculosis rate of any city in the U.S. The incidence of new cases of active TB reported in Baltimore, in 1981, was 35.6 cases per 100,000 population (300). Baltimore hosts one of the greatest centers of health technology in the world, but physicians did not ensure that their TB patients followed their prescribed treatments.

The Baltimore City Health Department, in 1981, implemented directly observed therapy (DOT), a strategy wherein healthcare workers would routinely visit patients and watch them take their tuberculosis medications. The plan worked. In 2009, the incidence of TB in Baltimore was a mere 2.7/100,000 population (301). This is about 7.5% of the active TB incidence in 1981. The Public Health Department succeeded where the medical-industrial complex failed.

In the 1970s, tuberculosis re-emerged as a national health problem because the United States has a healthcare system that is disconnected from the realities that influence the incidence and severity of diseases. Currently, the healthcare system in the U.S. is faced with another, frightening, healthcare failure: the rise of new strains of staphylococcus and other common organisms that are resistant to currently available antibiotics. Like tuberculosis, antibiotic resistance arose in common organisms largely because treatment regimens were not followed to completion. Physicians worsened the problem by routinely prescribing antibiotics for people with viral syndromes (e.g. the common cold) that do not respond to antibiotics. Endogenous organisms, dwelling within those persons who receive inappropriate treatment with antibiotics, will develop resistance, over time. This is another example of a problem created by the medical-industrial complex. Like TB, the solution may come from the public health sector: making sure patients take the full treatment regimen for infections, insisting on scrupulous handwashing among hospital staff and thorough cleansing of patient rooms in clinics and hospitals. Low-tech methods, the same methods championed by Florence Nightingale (1820 - 1910), are the best weapons we have, at present, to fight drug-resistant pathogens.

It's funny the way things work out. The worse things become, disease-wise, the better things are for the medical-industrial complex. Emerging epidemics bring more patients, more severe diseases, more research funding, greater dependence on costly high-tech interventions (e.g., Intensive Care Units, non-generic antibiotics, genetic testing of microorganisms, scans, blood tests), and more revenue. The people who create public health problems are often the same people who benefit from the resulting havoc.

Public health measures are often much for effective and much less expensive than the pay-per-complaint practice of medicine so prevalent in the U.S. In Finland, in about 1970, the population had reached its highest incidence of cardiovascular diseases. As a result, public health measures were introduced to improve diet, exercise and other health habits (particularly smoking) in the population. The multi-decade effort, called the North Karelia project, stands as one of the greatest successes in public health intervention.

Here are the results of the North Karelia project (302).

1. An increased life expectancy (7 years longer for men and 6 years longer for women).

2. Lung cancer death rate reduced 70% in North Karelia

3. Heart disease mortality reduced 65% in men.

In the United States, patients hold their encounters with their private physicians with the greatest reverence. Many Americans would fight to the death (more literally than they might imagine) for the right to follow their personal physician's recommendations, even when those recommendations conflict with public health guidelines. We know that physicians commit preventable medical errors every day, accounting for up to 98,000 American deaths each year (11), but that doesn't seem to matter to most of us. We know that public health measures prevent disease, save lives, and extend our life-spans. But Americans seem oblivious of the realities.

If you don't look too closely, U.S. medicine is a simple and effective service. When you get sick, you seek the services of a highly trained doctor, who treats your illness, and you get better. In return, the doctor is paid by some third party (your health insurer or government Medicare), or you pay the doctor yourself. Nothing could be simpler, and nothing could be better.

The only problem is that U.S. medicine does not work very well. The U.S. pays more for health care than any other country in the world (by far), but the U.S. has the lowest life expectancy of any developed country.

When you try to assess overall satisfaction with medical care in the U.S., you're always working with a skewed population: survivors. About 90,000 U.S. citizens die every year from medical errors. Deceased citizens have very little say in the matter. Doctors are among the few professionals who can literally bury their mistakes.

Many of the satisfied living are lulled into a false sense of health, without receiving appropriate care for their illnesses. An obese patient with newly diagnosed type 2 diabetes, hypertension, and hyercholesterolism would probably prefer to be treated with pills than to be told that he must conform to a strict diet and a rigorous exercise program. American medicine, like any other business in America, is designed to keep the customer happy.

Essentially, U.S. medicine is run like any other American enterprise. Doctors make their decisions to maximize personal gain. They expect their patients to do the same. As the U.S. population gets sicker and sicker (and demand more services), doctors get richer and richer.

20.3 THE PHYSICIAN JOBS PROGRAM

How many doctors do we need? If you read the healthcare literature, particularly the government studies pertaining to the topic of physician workforce requirements,you would think that this is a complex and subtle problem. In a 2008 report produced by the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) Bureau of Health Professions, various technical approaches, all with many different measurement parameters, were considered: 1) a needs-based approach, 2) a demand/utilization-based approach, 3) a benchmarking approach, and 4)a trend analysis approach (303). Following 100 pages of tortured analysis, their conclusion was tentative: "HRSAs Physician Supply Model and Physician Requirements Model, like all models, are simplified versions of a complex health care system that generalizes the millions of decisions made by physicians, patients, insurers, and other entities into probabilities that certain events will occur based on historical patterns of behavior. (303) "

None of these analyses were necessary.

Here's how the U.S. physician workforce is calculated:

If the salaries of physicians are rising, you don't have too many doctors. If you don't have too many doctors, then you don't have a problem.

That's all there is to it.

For physicians, and for the leadership of medical societies, there is only one issue to worry about: physician oversupply. If you have too many physicians, salaries will fall. That's bad.

What about undersupply? If the U.S. doesn't have enough doctors, won't people die from medical neglect?

Not likely. Currently, in the U.S., there are very few people who lack access to medical care, if they have good health insurance or sufficient personal funds (304). There are lots of sparsely populated areas in the U.S. where physicians are few and far between, but if you can afford transportation, you can gain access to a doctor.

In the U.S., access to care is a wealth issue, not a physician supply issue.

In the unlikely event that physician undersupply became a reality, the U.S. has access to an unlimited supply of foreign medical graduates who would love to have the opportunity of practicing medicine in a country with no national healthcare service (such as the U.S.).

If every medical school in the U.S. were to implode today, and if the U.S. never produced another physician, we would have an inexhaustible supply of foreign medical graduates to fill every open residency position in every medical specialty.

If that's the case, you might well ask why we pay for U.S. medical schools. The answer is simple. America is the land of opportunity, and every American parent wants his or her child to have the opportunity of becoming a U.S.-trained physician. If parents and their children had no interest in medical careers, we would import all of our doctors from foreign countries.

Don't be shocked by this news. The hard sciences (e.g., physics, mathematics, engineering) are unpopular among U.S. college undergraduates. No matter. These days, we import our American scientists, mostly from Asia.

The most enduring symbol of TV doctor shows is the over-worked, chronically fatigued intern. If you believe everything you watch on TV (and who doesn't?), you will believe that the permanently-strapped-for-cash clinic has done all it can to adequately staff the ER, but there's just no money to spare for intern salaries!

Ha!

That's just not how hospital staffing works. Interns are no-cost slaves that work impossible hours. Medicare compensates hospitals for the salaries of interns, and much more! If it were up to hospital administrators, patients would need to push their way through an army of interns just to get from the parking lot to the hospital lobby.

There have always been overworked, chronically fatigued interns because that is what the U.S. economic model for physician manpower requires. It has nothing to do with cash flow problems in inner city emergency rooms; the same rules apply to poor and wealthy hospitals.

Here is a short course on graduate medical training economics in the U.S.

When students finish medical school, they enter a graduate medical education program. Interns are doctors in their first year of post-graduate training. Following internship comes residency, where doctors get training in their specialty of choice. Residency training can take anywhere from 2 years to 6 years depending on their field. After residency, some doctors enter fellowships, for even more specialized training. To make things simple, we'll refer to all post-medical schools trainees as residents.

Four government sources pay for almost every resident trained in the U.S.: Medicare, Medicaid (through State governments), the Veterans Administration, and the Department of Defense. Of these agencies, Medicare has been the number one payer since 1965 (when it was created), and currently pays about $10 billion dollars each year to support interns and residents (304) (305).

Under Medicare, the Health Care Financing Administration (HCFA) gives hospitals about $100,000 for each resident. The hospital pays the resident anywhere from $20,000 to $50,000 and the hospital pockets the remainder (306). Hospitals do not generally inform their residents about their sweet deal with HCFA. The resident, unaware of the economic realities, believes that his salary comes from the hospital's general budget. When hospitals face economic shortfalls, residents generally accept salary cuts, just like everyone else. It's beautiful!

Because the government is virtually the only payer for residency slots, the government can fully control the total number of slots and the total number of trained physicians that enter the workforce each year.

In the U.S. there are about a 800,000 physicians (303). The total number of resident slots paid by Medicare each year is about 24,000 (of which about 16,000 are filled with graduates of U.S. and Canadian medical schools). This number is intended to replace the number of doctors who leave the profession each year. By keeping the number of physicians more-or-less steady, this payment system has kept the average salaries of physicians in most medical specialties from declining. It has also kept hospital administrators happy, by providing free professional labor.

The only flaw with this system is that not every hospital runs in the black. For many hospitals that run on a thin margin of financial solvency, the money received for residents is the only thing that keeps them afloat. When Medicare reduces the total number of funded residents (as they will do in a manpower oversupply year), at-risk hospitals slide into bankruptcy.

In New York State, hospitals came up with an ingenious plan to bring in Medicare funding without training an excess of residents. New York hospitals convinced HCFA to pay them for "empty" residence slots. In effect, they asked Medicare to pay them NOT to train residents (306). And it worked!

Under the New York plan, hospitals cut their resident slots by 25% but were paid as though they were filling 100% of their slots (306). Hospitals would continue to provide the same care, but with fewer residents to do the job. Financially troubled hospitals got the additional funds they needed, and the total number of newly trained doctors did not rise. The only drawback in the plan was that the flesh-and-blood residents all had to work harder to compensate for the phantom residents who were paid at the same rate.

There you have it. The reason that hospitals employ so few residents to do so much work is simple: this keeps the number of physicians released into the workforce low, thus keeping physician salaries high.

Every few years, one committee or another scrutinizes funding programs for U.S. graduate medical training. They make feeble recommendations such as the following:

"The Secretary should conduct workforce analysis to determine the number of residency positions needed in the United States in total and by specialty. In addition, analysis should examine and consider the optimal level and mix of other health professionals. This work should be based on the workforce requirements of health care delivery systems that provide high-quality, high-value, and affordable care. (48)"

Medicare has been paying resident salaries, one way or another, since 1965. How is it that in 2010, we still can't seem to match residency funding with actual healthcare needs? The answer is simple: physicians and hospitals benefit from the status quo, the public, unaware that Medicare pays the bills for residency training, doesn't want government interference in medicine. It's all good.

20.4 FAST CARE AND SLOW CARE

Just as restaurants can be divided into two broad categories: fast and slow; so can medical care.

The fast care specialties involve treating large numbers of patients with short, billable procedures. These procedure-oriented specialties include dermatology, gastroenterology, anesthesiology, radiology, and emergency medicine.

The slow care specialties require listening to the patient describe his many complaints, detailed history-taking, drawn-out and repeated instructions, and follow-up encounters. Many of the most time-consuming efforts in "slow-care" specialties are non-reimbursable. These slow-care, procedure-poor specialties include family practice, geriatric medicine, and psychiatry.

Though surgeons pride themselves as being hands-on proceduralists, their work often requires them to talk to patients before and after surgery, and to attend to a host of post-operative medical sequelae. Like it or not, surgery is a slow care specialty.

Physicians are reimbursed for procedures, with their income depending directly on the number of billable procedures they perform. It comes as no surprise that there is growing competition among recent medical school graduates for placement in the fast care specialties.

The slow care specialties, including family practice and surgery, can no longer fill their training slots with U.S. medical school graduates (307). Hence, there is a strong incentive for the slow care specialties to become "faster" (i.e. less time per patient, and more dependence on ancillary caregivers such as nurse practitioners and physician assistants).

Psychiatry is the quintessential slow care specialty. They sit for long sessions, listening to patients talk about their relationships with fathers, mothers, spouses, children. In the time that a psychiatrist devotes to a tedious tale of a disappointing childhood birthday party, a dermatologist could have fattened four pairs of lips with collagen injections.

There is a limit to the amount of money a psychiatrist can charge for a procedure-free hour filled with angst, regret and guilt.

By all rights, psychiatrists should be teetering on the verge of extinction. Surprisingly, psychiatry is a thriving field! The percentage of graduating medical schools who choose psychiatry for a career seems to be increasing (307). There is a growing demand for psychiatrists, particularly in the sub-specialty of childhood and adolescent care (303).

How do they do it?

Well, the most important trend has been the migration of psychiatry from the analyst's couch to the drugstore. Psychoanalysis has been widely abandoned by contemporary psychiatrists. The history of psychiatry has been revised, and Freud is currently relegated the role of "philosopher" (not physician). Today, the works of Sigmund Freud are read with greater interest by English literature majors than by medical students.

Basically, a "slow care" method, such as psychoanalysis, cannot meet the payroll of a modern psychiatric practice.

Today, there is a pharmaceutical treatment [distinguish treatment from cure] for the common mental aberrations: depression, anxiety, bipolar disorders, schizophrenia, obsessive-compulsive disorder. Proximate causes of disturbed behavior, such as suicide, phobias, and physical aggression, are triggered by one or more of these drug-sensitive common disorders. Nowadays, psychiatry is virtually a sub-field of pharmacology.

No longer is it necessary to listen to the same patient drone on week after week, year after year. It never helped the patient much, in any case. Freud and his coterie of psychoanalysts sought to provide patients with self-awareness. If self-awareness led to a cure, all well and good. But a cure was too simple a goal for Freud. Freud's detractors, of whom there are many, doubt that Freud cured anyone.

Drugs simplify and abbreviate the practice of psychiatry. Psychiatrists need not waste their valuable time on physical examinations. Patient and doctor will readily concede that there is nothing like a rectal exam to undermine a mutual sense of trust. Today, office visits are short and can often be consigned to the time taken to write a prescription.

The existentional challenge for modern-day psychiatrists is: "How can I make money off of writing prescriptions, when the drug revenues flow to the pharmaceutical companies?"

Since 1987, the Antikickback Statute has restrained the drug companies from paying physicians for the prescriptions they write (308). Specifically, Section 1320a-7b(b) makes it a felony to solicit or receive remuneration (in the form of a kickback, bribe or rebate (directly or indirectly, overtly or covertly, in cash or in kind) for arranging an individual to receive an item (such as a prescription drug) or service for which payment may be made in whole or in part under [Medicare] or a State health care program (308).

The Antikickback Statute may have enhanced the level of trust between patient and physician, but it has nearly destroyed the mutually beneficial relationship between physicians and drug companies. If psychiatrists couldn't receive any remuneration for their prescriptions, might they not revert to their formerly standard practice of listening to patients?

The stakes are high. When an antipsychotic medication sells well, much of the credit should go to the psychiatrists who write the prescriptions. Two an anti-psychotic medications: Zyprexa and Risperdol, each provided sales exceeding $4 billion dollars, in 2006. A single zealous psychiatrist can easily generate over a million dollars for a drug company. If psychiatrists were to engage in pharmaceutical-free psychotherapy sessions, the drug companies stand to lose many billions of dollars.

For drug companies, psychiatry is a chemical industry, and mental illnesses are chemical deficiencies. For example, schizophrenia can be thought of as a Quetiapine deficiency, and depression can be thought of as an Escitalopram deficiency. The chemicals that nature failed to provide are now available in convenient gel-cap or tablet form, courtesy of the American pharmaceutical industry. To sell their chemicals, the pharmaceutical companies must convince psychiatrists of the following:

1. Every sanity-challenged patient can benefit from pharmaceuticals.

2. Patients deserve the very best pharmaceuticals available, and the best pharmaceuticals are the newest pharmaceuticals (i.e., still under patent protection).

3. Mental illness cannot be treated overnight. Patients must be treated indefinitely, or at the very least, until their health benefits and their personal savings, are exhausted.

If hefty kickbacks cannot clarify these three self-evident principles, then some other method of persuasion is necessary. The pharmaceutical industry, resourceful to a fault, developed the marketing concept of the "physician thought leader" (309). It works something like this:

1. A pharmaceutical company representative seeks the "expert assistance" of a local psychiatrist. The representative explains that his company, which employs thousands of professionals and earns billions of dollars each year, is woefully lacking in the kind of "hands-on" expertise wielded by the local doctor.

2. The doctor is asked to serve as a thought leader for his local colleagues.

3. A dinner seminar is arranged wherein the local doctor presents a powerpoint demonstration (prepared by the drug company) highlighting their products. As the thought leader, he moderates a discussion in which his colleagues ask quesions and discuss their own experiences prescribing the company's drugs.

4. The doctor receives a generous check; the first of many.

Doctors love being consultants for the drug companies. Besides the money, it's a highly valued ego boost. Psychiatrists seem to be particularly susceptible to this kind of manipulation. Knowing very little about clinical medicine, psychiatrists are seldom taken seriously by other members of the medical profession. Few psychiatrists have the ego strength to rebuff the advances of a pharmaceutical representative who values their clinical knowledge.

It's hard to find an academic psychiatrist who has not received money from the pharmaceutical industry (examples are easily found (310)). The payouts can exceed a million dollars. A Harvard psychiatrist received $1.6 million from a pharmaceutical company but did not report much of the income to Harvard University. The payments were absolutely legal. The psychiatrist got into some trouble only because he failed to report the income to his employer, Harvard (311).

In a recent review of authors who write clinical practice guidelines, it was found that the vast majority had financial ties to pharmaceutical companies (312). It was rare for any of these conflicted authors to disclose their drug company affiliations. A survey of physicians has shown most payments received by doctors, for collaborations with pharmaceutical companies and with the medical devices industry, are deemed appropriate by doctors (313).

The American medical-industrial complex is profoundly mercantile. Doctors, much like their prescribed drugs, are up for sale.

20.5 CASHING IN ON CANCER

"To be blunt about it, there's no money in prevention, and once you've got cancer you'll pay anything to try to stay alive."

-Peter Montague (314)

"Seventy-five percent of what we spend in health care is linked to chronically ill patients; less than 3 percent [is spent] in prevention,"

-Ken Thorpe, professor of health policy at Emory University (315)

In 1883, Oliver Wendell Holmes wrote, "There is nothing men will not do, there is nothing they have not done to recover their health and save their lives. They have submitted to be half-drowned in water, and half-choked with gases, to be buried up to their chins in earth, to be seared with hot irons like galley-slaves, to be crimped with knives like codfish, to have needles thrust into their flesh, and bonfires kindled on their skin, to swallow all sorts of abominations, and to pay for all this, as if to be singed and scalded were a costly privilege, as if blisters were a blessing and leeches a luxury" (316). Know one knows this better than the corporations that sell drugs for the treatment of cancer. Of all the diseases inflicted upon humanity, cancer has proven itself the most lucrative. Here's why:

1. Cancer is common. One in two men; one in three women will contract cancer during their lifetime.

2. Cancer is scary. Everyone is afraid of cancer, and the public continues to lavish money on the National Cancer Institute, despite decades of imperceptible progress.

3. Cancer is chronic. Cancer doesn't kill in a day or a week or a month. Most cancer patients will languish for years of treatment (317).

4. Cancer is expensive, and insurers are obligated to foot the bill for high-priced treatments.

5. There is no cancer cure on on the horizon. Drug companies don't need to worry that someone will come up with an effective, cheap cancer cure that will eliminate their source of income.

The leaders in the fight against cancer have never been limited to saints. One of the earliest and most successful cancer crusaders was Adolf Hitler. His liberal use of vivisection notwithstanding, Hitler launched an innovative campaign against smoking, and led a remarkably progressive screening program for cervical cancer (318), (319).

Today's pharmaceutical industry cynically embraces cancer research, knowing full well that desperate patients will grasp any cancer treatment that lengthens their life, even for a few weeks, and at any expense, so long as a third party foots the bill (320). Erlotinib, sold as Tarceva by Genentech, OSI Pharmaceuticlas and Roche Pharmaceuticals, was approved by the FDA for treatment of pancreatic cancer. It costs about $3,500 per month, and will improve survival by an average of 12 days (320) (321). This 12-day miracle has been embraced by the community of oncologists. The chief executive of OSI Pharmaceuticals, projected that annual sales of Tarceva could reach $2 billion by 2011 (322).

Bevacizumab (developed and sold by Genentech as Avastin) is one of the most popular cancer drugs in the world, bringing in about $6 billion in global sales, in 2009 (323). It can easily cost $50,000 to $100,000 per year of use. Avastin does not seem to be much of a wonder drug. Recent trials have shown that Avastin does not extend the life of men with advanced stage prostate cancer (323). Ditto for gastric cancer (323). In responsive cancers, studies indicate that it extends life by up to four months (324). Why is Avastin popular? A well-marketed drug that promises hope for to desperate patients, will sell, no matter the price.

At any moment, drug companies are running more than 800 clinical trials for cancer drugs (320). They know that if they can develop a drug that improves cancer survival, even for just a few weeks, they can recoup their investments. Big pharma sinks about a billion dollars into each new drug that come to market. Their exclusive right to market the new drug lasts, at most, twenty years from the patent filing date. In view of these circumstances, consumers expect pharmaceutical companies to charge a lot for each dose of a newly developed cancer drug. Conversely, consumers expect cheap prices for generic and ancient nostrums, that are easy to manufacture in bulk quantities and for which no research investment was made. No such luck.

Matulane (sold as Procarbazine), is a drug closely related to mustard gas, and was approved for the effective treatment of Hodgkin lymphoma, way back in 1969. Cheap to synthesize, it sold for a paltry 66 cents per pill until 2005, when the price jumped to $56 per pill, an overnight 8,400% increase (325). How could this happen? Easy. The price of drugs is not regulated by the FDA or any other federal agency. In the U.S., if you happen to have a monopoly on sales, you can charge whatever the market will bear.

Today, decades after the War on Cancer was launched (1971) the cancer death rate is about the same as it was in the mid-nineteenth century. The pharmaceutical industry has not produced many new cancer drugs. The public is paying exorbitant rates for a few new therapies, most of which have only minimally effectiveness. Who is to blame? Many would blame the FDA, clearly the least likely culprit in this sordid business. Guards are now posted at the FDA's public cancer advisory meetings, to protect the FDA staff and its invited committee members (326).

We are no closer to a cure for the common, advanced cancers than we were fifty years ago. The number of people with cancer is increasing and will likely triple over the next few decades. The medical-industrial complex is counting on cancer to be a dependable revenue source for the near future.

20.6 OFF-LABEL PHYSICIANS

"Every American is just a diagnosis away from poverty."

-Anonymous

Physicians do not discover effective treatments, but they certainly know what works for their patients; not! Physicians can be as clueless as their patients when it comes to effective therapies. Though the public is told that physicians are trained as medical scientists, nothing could be further from the truth. Their training in statistics, clinical trial design, outcomes research methods, medical toxicology, is rudimentary, at best. Very few physicians have the expertise or interest in evaluating new treatment protocols. Every drug salesman knows that physicians will believe what they are told, if you exercise the proper incentives.

Pfizer offered doctors $250 or more, per visit, for arranged "mentorships" (327). For fees received, doctors are mentored by the drug company representatives on the uses of their drugs, in real-life patient encounters. Would a physician prescribe a medication solely on the say-so of a drug company representative? Of course they would; why else would the drug company pay for their time?

According to Peter Lurie, former deputy medical director of Public Citizen, a Washington-based public interest group, "Most doctors don't keep track of FDA-approved uses of drugs," and "The great majority of doctors have no idea; they don't even understand the distinction between on- and off-labeling" (327).

It's bad enough that doctors rely on drug reps to learn new treatments, but the plot moves from stupid to criminal when the drug representative pushes off-label uses for drugs. Here is the problem. When the FDA approves a drug, the approval is restricted to one or several particular uses. Specifically, the FDA considers those uses that were tested in the clinical studies that pharmaceutical company submit to the FDA. All drug uses other than the uses approved by the FDA are considered off-label uses. In many cases, off-label drug uses have not been been shown, in clinical trials, to be safe or effective. It is illegal for drug companies to market drugs for off-label uses.

Doctors, unlike drug manufacturers, are not regulated by the FDA. In the U.S., physicians can legally prescribe drugs for off-label uses; and they do. In a 2006 study, it was found that "about 21% of all estimated uses for commonly prescribed medications were off-label, and that 15% of all estimated uses lacked scientific evidence of therapeutic efficacy" (328).

In 2004, Pfizer paid 430 million dollars in fines for illegally marketing Neurontin for off-label uses (329). Prosecutors in the case said Warner-Lambert [acquired by Pfizer] paid doctors to listen to pitches for unapproved uses of Neurontin. One doctor was paid nearly $308,000 to promote Neurontin at conferences (330).

Undeterred by Neurontin fines, in September, 2009, Pfizer Pharmaceuticals pleaded guilty to a U.S. criminal charge related to its promotion of Bextra. The drug company agreed to pay $2.3 billion to settle charges that it promoted Bextra and Zyvox directly to doctors for a variety of unapproved, or off-label uses and dosages (329).

Pfizer is not the only over-zealous drug manufacturer. Eli Lilly and Company paid $1.42 billion to settle claims related to the adverse effects produced by marketed, off-label uses of Zyprexa (331), (332), (333). Zyprexa is approved for use in some cases of schizophrenia and bipolar disorder. It is not approved for use in dementia. The drug carries an FDA waring that it increases the risk of death in older patients with dementia (331). Nonetheless, Eli Lilly urged their salespeople to market the drug for dementia (331).

Though it is illegal for drug companies to persuade doctors to practice off-label medicine, there are few restrictions on marketing efforts for on-label uses. Big pharma pays doctors millions of dollars to prescribe their high-cost medicines. The New York Times has reported a six-doctor practice in the Pacific northwest area, that was paid 2.7 million dollars by Amgen for prescribing $9 million worth of their drugs (334). The payments were totally legal.

20.7 GHOST WRITERS

"Behind every able man, there are always other able men."

-Chinese proverb

"Every writer I know has trouble writing."

-Joseph Heller

You have been working in your field for decades, attending meetings, holding press conferences, providing expert witness, and giving commentary to journalists. You have become a brand name in your field. Football players, basketaball stars, bicyclists, swimmers, all manage to bring in tons of endorsement money based solely on their celebrity. Is it fair that you cannot make a dime based on your sterling reputation? Nobody has approached you to endorse a tennis shoe or a breakfast cereal, but some day a pharmaceutical corporation will ask you to endorse their latest anti-anxiety drug or diet pill. When that day comes, you will not miss the chance to cash in.

Of course, the best way of authoring anything is to take credit for another person's work. In the past, wealthy people were well-accustomed to paying others to for every conceivable service. In Europe, the wealthy could pay to have a seat in Parliament. In early America, the wealthy would pay to have someone serve in the army in their place. Throughout the scientific community, wealthy students would pay to have someone else write their theses and their scientific papers. People who wrote books and articles for money, without appearing as a named author, were called ghost writers. Today, the lucrative field of ghost writing has been turned on its head. Scientists are paid, very handsomely, to have teams of corporate writers publish journal articles with the scientist listed as the sole author. Corporations have found that a journal article favorable to their product, and credited to an influential and respected author, has enormous value to the company.

In August, 2009, Natasha Singer reported, for the New York Times, on ghost writing in the Pharmaceutical industry (191). Wyeth pharmaceuticals helped produce 26 scientific articles between 1998 and 2005, that emphasized the beneficial effects of hormone replacement therapy (191). In a proposal prepared for Wyeth by a firm that wrote many of the articles, the goal of the publication's initiative was to "increase physician awareness on the multitude of benefits that hormone replacement therapy provides" and "diminish the negative perceptions associated with estrogens and cancer" (192). In a process likened to medical ventriloquism, the American physican community willingly believed that hormone replacement therapies had a protective effect on the heart (192).

Wyeth's sales of hormone drugs Premarin and Prempro were about $2 billion in 2001 (191). Sales subsequently dropped after a large, NIH-sponsored clinical trial showed that combination hormonal therapies increased the risk of breast cancer, heart attacks, dementia and pulmonary emboli (192).

Here is how drug company ghost writing generally works. The pharmaceutical company chooses a set of scientific points that it would like to emphasize. A company that specializes in medical communications is generally contracted to write a series of articles suitable to the pharmaceutical company. After the articles are prepared to the satisfaction of the pharmaceutical company, respected authorities in the relevant field are approached and asked if they will permit the papers to be published listing them as authors, in exchange for a consultation fee. The paper is published. The journal editor and the journal subscribers are unaware of the arrangement. Readers falsely assume that the article was written by the listed author, without influence by the pharmaceutical industry. Pharmaceutical companies have the right to help authors write papers that highlight the benefits of their products. Likewise, pharmaceutical companies are under no obligation to emphasize, in scientific papers, the risks associated with their products; nobody is held to such a standard. Scientists have the right to accept consultation fees from pharmaceutical companies, and they have the right to publish scientific papers. Everybody wins.

When the New York Times article broke, scant attention was paid to the role of journal editors in the tangled story (191). Why weren't the editors aware that the articles were ghost-written? What had happened to the vaunted peer review system? Why had the articles not raised suspicions among the eagle-eyed peer reviewers? Isn't it the job of the editor and the peer reviewers to ensure discussion of both sides of controversial scientific topics? Why was the journal-based review system unable to detect that the articles were ghost-written by an industry-paid company commissioned to promote the beneficial effects of hormone replacement therapies?

Ghost-writing is rampant in the scientific community. In a review of 809 scientific papers, by Flanagin and coworkers, 93 articles (11%) had evidence of ghost authors (64). In a Washington Post article, a nuclear energy consultant admitted that he was paid to write pro-industry editorials and farm them to colleagues, who allowed themselves to be listed as authors (335). This method of dissemination provides the illusion of many minds, but analysis of the text usually demonstrates the same key phrases in every editorial, pointing to a single, ghostly author (335).

A 1997 paper published in the Journal of Occupational and Environmental Medicine claimed no link between drinking chromium-polluted water and cancer incidence. At the time that the paper was written, a public utility was being sued for allegedly exposing California residents to chromium pollution. The editors eventually learned that ghost writers hired by the public utility had contributed to the article that seemed to provide exculpatory scientific evidence for the utility company (336). The paper was retracted by the journal, nearly a decade after the fact (337).

Sometimes, when industry ghost-writes a document, there are too many people willing to take the credit for the same work. Lobbyists working for Genentech ghost-wrote nearly identical position statements for over a dozen members of Congress. The Congressmen published the statements, as their own, in the Congressional Record. Any citizen with the time and inclination would see that the same text, with only minimal deviation, appeared repeatedly. In all, over 40 members of Congress used, as their own, points written by lobbyists who were paid by Genentech (338). It's a pleasure to see the American political system at work.

The services of ghost writers are many. Grant applications, review articles, clinical trial summaries, legislation, committee reports, consensus guidelines, industry standards, position statements, and all manner of documents traditionally produced by groups of scientists, can be prepared by a single ghost writer, serving a corporate agenda. Whenever you read a scientific report, never assume that the persons listed as authors had much input in the finished product. So long as there is power and money, there will be ghost writers.

20.8 ADVICE FOR EVIL SCIENTISTS

1. If you work in a large corporation, university, or government organization, you may one day be in a situation wherein billions of dollars can be gained or lost, based on your decisions. Keep cool. Remember that your personal wealth is determined by your control over the money; not on the competence of your decisions.

2. Patients who hold their lives dearly should not object to paying dearly to prolong their lives.

3. Remember that hope carries a big price tag. So long as the patient believes that a new cancer drug has a small chance of prolonging life, even for a few weeks or months, they will pay anything for the treatment.

4. With cancer, everyone gets a bite at the apple. Pharmaceutical companies, hospitals, medical associations, device makers, research agencies, and numerous other auxiliary services profit from cancer. If cancer were eradicated, all these industries would suffer. No compassionate person would want that to happen.

5. Drug manufacturers can fund innovative medical research. If the research happens to provide evidence for an off-label drug use, so much the better.

6. The FDA can tell you what you can market, but it cannot tell doctors what they prescribe. The most profitable returns on a drug often come from off-label uses (uses that were not approved by the FDA). For example, of the $2.27 billion Pfizer collected on sales of Neurontin, in 2002, $2.12 billion came from off-label use (327). Never forget that the most profitable niche in the multi-billion pharmacy industry comes from prescriptions that have no proven medical benefit.

7. Remember that scientific journals can provide effective propaganda for drug marketing. The most valuable journal articles are those in which your drug has been shown to have benefit for clinical situations other than those approved for use by the FDA (so-called off-label uses).

8. Though it is illegal to market off-label drugs, the penalties have been trivial compared to the profits. Though Pfizer paid $2.3 billion in fines and penalties for marketing off-label uses of Bextra and other drugs, the revenues on those same drugs, for the years 2001 to 2008, were $16.8 billion. The $2.75 billion paid by Pfizer for off-label penalties since 2004 represents about one percent of the company's earnings of $245 billion over the years 2004 - 2008 (327). Crime does pay.

9. Remember, you have a fiduciary obligation to the patient, not to the patient's family. Sometimes, a patient's family will weigh the dubious benefits of vigorously treating a terminal patient against the deprivations that the family will face when it tries to pay for your services. Don't let them put their needs ahead of your own.





CHAPTER 21. THE FUTURE OF EVIL SCIENTISTS

"We are here and it is now. The way I see it is, after that, everything tends towards guesswork."

-Terry Pratchett, Small Gods (1992)

"Hell is where everyone is doing his own thing. Paradise is where everyone is doing God's thing."

-Thomas Howard

"I don't try to describe the future. I try to prevent it."

-Ray Bradbury

"Never make predictions, especially about the future."

-Casey Stengel (sometimes attributed to Yogi Berra or to Sam Goldwyn

Everyone knows that winning is better than losing. By extension, most people believe that winners are better than losers. Consider the lottery. The person who wins a $50 million lottery had no influence over the lottery results. Anyone grounded in reality understands that the winner of the lottery is determined by chance. Nonetheless, the winner of a lottery becomes a celebrity, appearing on multiple news spots, in interviews, in human feature stories, and so on. People want to know how he chose his lucky number. Interviewers ask how he plans to spend his money, a question that would be considered taboo under any other circumstance. People admire this person. Why? For religious people, God works through elements of nature that are not controlled by the exercise of free will. If humans cannot control the outcome of the lottery through an act of free will, then the outcome of the lottery must be determined by God. For the non-religious lottery enthusiasts, chance is the instrument of fate. The lottery winner is fated to win, just as the lottery loser is fated to lose.

It is your job, as an evil scientist, to be a winner in the eyes of people who are too stupid to distinguish fate from chance. This usually means modifying circumstances so that chance favors you (i.e., fixing the bet). You can start to put the odds in your favor by eliminating the common causes of failure:

1. Caring about what other people think

2. Not accepting credit for other people's work and talent.

3. Breaking the eleventh commandment (XI. Thou shall not get caught).

4. Not blaming others for your mistakes.

5. Not being there. Woody Allen has told us that showing up is 90% of success.

6. Wasting time developing your talent and imagination when you have neither.

7. Cultivating the wrong friends.

8. Acquiring the wrong enemies.

9. Allowing personal feelings and interpersonal obligations to interfere with your selfish goals.

10. Not accounting for the perversity of nature. The ancient Greeks had a saying, "Man plans. The gods laugh."

If you indulge in scientific sentimentality (i.e., the belief that science is the pursuit of truth), you will join the legions of pathetic losers, who were incapable of advancing their ideas in a competitive environment. Here are a few:

Johannes Kepler (1571 - 1630) - Kepler was a great scientist, and astronomer. He wrote the laws of planetary motion, and he developed fundamental principles that would come to underly the invention of calculus. He made important contributions to optics and geometry. Though Kepler was very supportive of the universe, the universe did not support Kepler very well. Living in a time when mathematicians were not highly valued, he could barely support his family. Kepler endured a lifetime of uninterrupted poverty. He died in relative anonymity, but he is recognized today as one of the greatest scientists of all time.

Nikolai Ivanovich Lobachevsky (1792 - 1856) - Lobachewsky invented non-Euclidean geometry (sometimes called Lobachevskian geometry). Though a full professor at Kazan University, in Russia, who filled the roles of teacher and administrator, he was dismissed. His health deteriorated, and he became unable to walk, and nearly blind. He died in poverty, in 1856.

Nikola Tesla (1856 - 1943) - Special attention must be paid to Nikola Tesla; no man has done more for the world and received so little in return. Tesla was one of the greatest inventors and visionaries of the nineteenth and twentieth centuries, best known for his invention of AC (alternating current) power systems and methods for transmitting power over long distances. His enthusiastic support for AC current caused a huge rift with his early benefactor, Thomas A. Edison, who steadfastly supported DC power systems. Tesla tried to convince Edison, to no avail, that large power resources could not be transmitted over long distances by direct current; only AC could do the job.

Though Guglielmo Marconi (1874 - 1937) assembled a working radio, his accomplishment required more than a dozen patented discoveries of Tesla. Nonetheless, Marconi alone won the Nobel prize, in 1909, for inventing the radio. Perhaps Tesla's most significant uncredited accomplishment resulted from his experimentation with x-rays, in 1887. He used x-rays to photograph the bones of his hands, several years prior to Roentgen's famous experiment. Many of his findings in the field of x-ray technology and x-ray photography were lost in a lab fire, in 1895. That same year, Roentgen got the credit for x-ray imaging. In 1901, Roentgen was awarded the first Nobel prize in physics. For Tesla, the twentieth century was a time for continued intellectual productivity, rewarded by increasing isolation and social ostracism. His ideas were too strange for most people, including his peers, to grasp. If you've ever stayed at the Hotel New Yorker, caddy-corner to Penn Station, in New York City, you've been at the same hotel where Tesla lived out the last years of his life.

Edwin Howard Armstrong (1890 - 1954) - Armstrong invented FM radio and the superheterodyne receiver (used by all modern radios). His life and career was plagued by a prolonged patent litigation that eventually reached the Supreme Court. In addition, RCA lobbied the FCC for regulations that would curtail the rising dominance of FM radios. Endless court battles, combined with his single-handed battle against the corporate broadcasting giants, led Armstrong into poverty. In 1954, he committed suicide by jumping out of his apartment window, 30 floors above the streets of Manhattan. After his death, his family pursued his legal fight, and eventually won. Though Armstrong never benefited from his contributions to society, his heirs did.

These stories should convince you, beyond any reasonable doubt, that life is best spent as an evil scientist. But what, exactly, is the life and destiny of an evil scientist? Is it just evil, followed by more evil, followed eventually by death? Yes, that's basically it, but don't be discouraged. As Dave Lister said, in Red Dwarf, Series I, "Lots of people have died and gone on to do really really well."

Of course, when you die, you will go to hell. This is a consequence of the "evil" part of being an evil scientist. Evil scientists should not be dissuaded from pursuing their dreams just because of some irrational and unfounded fears of eternal agony. The purpose of this section is to explain what hell will be like for evil scientists and how it offers an enjoyable after-lifestyle filled with colleagues, a sense of community, and familiar surroundings.

The whole idea behind hell is that you get what you deserve; for eternity. If you've been an evil scientist all your life, following all of the suggestions offered in this book, and avoiding the temptations to be weak, ineffectual, unpopular, and poor, you can expect to be rewarded with the same standard of existence that you had when you were alive.

First off, your hell will be exclusively populated by other evil scientists. You will be re-united with all of your colleagues who passed away while you were alive. Everyone else (people who were not evil scientists) go someplace else when they die, and you won't be seeing any of them. This means that your hell will be the exclusive preserve of your peers, the people who understand you and accept you for who you really are.

As for the physical aspects of hell, they will be much as you remember your life. You will live is a realm somewhat reminiscent of downtown Detroit. There will be huge apartment buildings (to house all of the dead evil scientists), dingy laboratories, and hotels with enormous lobbies. The purpose of the hotels is to accommodate all of the conferences, workshops, seminars, conventions, congresses, task forces, review courses, brainstorming sessions, and other designated group meetings that will occupy most of your infinite time.

In life, you loved meetings. They were the places where you developed alliances, garnered undeserved credit for the accomplishments of others, and generally outmaneuvered your competition. In hell, every day will bring a new meeting. As in life, you will see the same people attending every meeting. You will hear the same lectures from the same speakers that you heard when you were alive. You will roam the same hallways, making contacts, handing out business cards, and discussing restaurants, wine, and the good things that bond evil scientists.

There will be the usual refreshment breaks, but you won't enjoy them very much. Small danish pastries will be available, served on large trays poised on long folding tables. The selection will be limited to apple danish; the pastry shells will be dry, and the apple center will be thin and sticky. You will find none of your favorite flavors: no pineapple, no prune, no raspberry. Will you have any chance of finding a blueberry danish tucked away somewhere on the pastry tray? No chance in hell!

Eating the dry apple danish will make you thirsty. A hot cup of coffee would be nice. You look around, but all you see are three half-empty two-liter plastic containers of off-brand colas; no ice. You needn't bother looking for wine or beer. A water fountain waits attentively, recessed in a cubby, at the end of a hotel corridor. You walk over and push the button on the side of the nozzle. A pathetic gurgle of water trickles out, barely breaching the spout. As you bend for a sip, the stream magically erupts, with the force of a firehose, directly into your right eye. Enough water splashes down your face and into your mouth to sate your thirst, for the moment. Note to self; next time, wear goggles.

All told, eternal meetings are somewhat disappointing, but you keep reminding yourself that you're lucky to be dead.

Publishing will be much the same in after-life as it was during life. In either case, the process of publication is endless. The key difference is that in the after-life, authors are required to read all of the papers on which they are listed as an author. For those scientists who are accustomed to taking credit as a co-author without actually contributing to the publication, this requirement can be agonizing.

Many evil scientists helped to develop unsafe, obscenely expensive, and ineffective drugs during their earthly careers. Nobody is perfect. In the after-life, pharmaceutical scientists are conscripted into a highly regulated, and distasteful ritual. First, they are obliged to contract the disease they purported to cure. Then they must pay the full, listed price for the drug that they developed. They are then required to experience the many side effects of these drugs. For the remainder of eternity, they endure the disease that was not cured by their own ineffective treatment.

All the sinful pleasures are available ad libitum in hell. Because the likelihood of having a loving relationship with any of your hellish co-habitants is just about zero, you might as well indulge yourself with the most superficial aspects of human involvement: gratuitous sex, food as a form of pleasure, and intoxicating chemicals that enhance your enjoyment of post-existence. These are basically the same sins you enjoyed during your lifetime. If you were deprived of these perks during life, here's your chance to rectify the situation, for eternity.

21.1 ADVICE FOR EVIL SCIENTISTS

1. Never do any work. Work is what other people do for you.

2. Travel. Travel. Travel. The key to advancement in science is through attendance at meetings, developing alliances, and building your reputation as an available speaker.

3. Remember that the purpose of research is to get grants (not the other way around). Never pass up the opportunity to be listed as a principle investigator on a grant, even when you cannot possibly contribute to the work. When the grant money ends, quickly abandon any work that that may have been accomplished.

4. Attack anyone who disagrees with you, even when you know that they are correct and you are wrong. Attacks should always be indirect; nobody should know that you are the attacker. Undermine your opponent's scientific credibility, authority, honesty, and grooming. Keep good documentation of the past indiscretions of your associates. A well-planned, surprise attack on a co-worker, or even a superior, has the best chance for success.

5. Confine your work to scientific fields of low "reproducibility". If the different laboratories in a field cannot reproduce each other's work, then you can publish almost anything without fear of being exposed (think microarray) (339) (340).

6. Hire cheaters. All cheating is high-risk behavior. When there is cheating that needs to be done, you'll need a professional.

7. Don't feel guilty about cheating innocent people. Remember, you cannot cheat an honest man.

8. Promote all your failures as though they were successes.

9. Hire staff to sing the praises of your efforts. People will believe you if they hear your words repeated by other people. Before long, the voices of your retractors will be lost in cacophony of praise.

10. Always take the easy way out. If a project becomes difficult, palm it off on a colleague, and settle for co-authorship. If the project is successful, take credit for the work, as though it was your own.

11. You have now learned all the tricks that evil scientists use. You can bet that your colleagues will try to use these tricks against you. Watch your back!





CHAPTER 22. FINAL EXAM

Do you have the aptitude to be a successful evil scientist? Take a few minutes to answer these twelve simple questions, and learn something about yourself.

1. As a high school student, did your love of learning light your path to higher education, or were you climbing the dark, crowded stairway leading to college entrance?

2. As a college student, did you choose to major in one of the sciences simply because you happened to ace the "Intro" course?

3. Have you ever made a scientific presentation in which you neglected to mention any of the drawbacks of your approach, the ambiguities in data interpretation, or the many obstacles that would render your work unrepeatable?

4. When someone in the audience points out the drawbacks of your approach, the ambiguities in your data interpretation, or the many obstacles that would render your work unrepeatable, does that person instantly become your mortal enemy?

5. Have you ever discovered an error in a paper that you authored or co-authored, and then neglected to inform the journal editor of the mistake?

6. Have you ever recommended one of your close colleagues to be a speaker for a scientific conference, bypassing serious scientists who contributed much more to the field than your colleague has, but who happened to be strangers to you?

7. Have you ever criticized the work of another scientist even though you had never actually studied their published papers and could not fully understand what they have done?

8. Have you ever spoken with admiration about a scientist whose papers you never actually studied, and whose works you never quite understood, simply because everyone else seemed to like him?

9. Have you ever made a scientific presentation in which you neglected to cite scientists whose views disagreed with yours? Have you ever declined to give credit to the competing laboratory that reached the same scientific conclusion, months before you?

10. Have you ever reviewed a paper and taken four months or more to return your review, instead of the two week turn-around period that you promised the editor?

11. Have you ever chosen to attend a scientific meeting based on its exotic location, or the alluring social amenities, or for any reason other than the scientific value of the meeting?

12. When you appear on a paper as one co-author from among many other co-authors, do you later count the paper as one that you have published or that you have authored when you know that your contribution was minimal, at best?

If you answered "yes" to all twelve questions, then you are a person of the very highest moral flexibility.

If you answered "yes" to between 1 and 11 of these questions, then you are a person capable of doing good and evil. Don't make the wrong choice.

If you answered "no" to all twelve questions, you must be lying. Nobody is that virtuous. Congratulations, you are now an evil scientist.





CHAPTER 23. GLOSSARY

11th commandment - "Thou shall not get caught."

404 moment - The moment when you realize that you have lost an important document. Origin found in the internet error message, "404 - document not found".

Academic freedom - The principles of academic freedom were specified by the Supreme Court as the freedom for a university and its faculty to determine: who may teach, what may be taught, how it should be taught, and who may be admitted to study. Though the Supreme Court has limited a few outrageous admission practices, the basic principle holds that academic freedoms are legally protected from outside influences. The people who are adversely effected by the exercise of academic freedoms are, of course, the students. Students, or their parents, pay a handsome fee for their educations, but they have no say over who is appointed to the faculty, what is taught, and the manner in which lessons are delivered. Using their academic freedoms, faculty can ram any nonsense down the throats of students, and the students will be required to regurgitate the same nonsense when they take their exams. Students have no control over the admissions process. When a university chooses to offer preferential admissions to the offspring of rich alums, the non-legacy students will complain, but nobody will listen. Basically, academic freedom is the freedom of academia to deny academic freedom to their students.

Acades vulgaris - Scientific term for student. From the Genus Acades (L. academic) and the species specific name, vulgaris (L. common).

Abandonware - Software developed with someone else's money (most often money from the U.S. taxpayer) and abandoned when the funding expires (341).

Accrual - The gradual collection of items. In clinical trials, accrual refers to the enlistment of patients into a study. Accrual is to an evil scientist what jury selection is to an evil lawyer. It is an important opportunity to advance your own agenda at the expense of truth or justice.

Advertisement - A commercial strategy that seduces people to believe your unproven assertions.

Agnostication - The process of not knowing. In medicine, agnostication is used whenever a patient asks, "How long have I got, Doc?"

Anonymization - The process whereby everything that might link a specific person to a piece of data is destroyed. When data is anonymized, it is rendered harmless to the individual. Furthermore, the individual can not claim ownership to anonymized data. Under HIPAA and the Common Rule, the two regulations that control the uses of confidential medical data, anonymized data can be used freely, for any purposes, without acquiring patient consent (234), (225). The tricky part about anonymization is that it can be done wrong (you think you have anonymized the data, but you haven't), and it cannot be reversed (once the data is anonymized, you can never re-identify the patient). The inability to re-identify anonymized data is the feature that distinguishes anonymization from de-identification (which allows re-identification under specified circumstances). Institutional Review Boards need to determine whether researchers who claim to have anonymized their data, have actually done so. Institutional Review Boards seldom have competence in this area, exposing a weakness to be exploited by clever evil scientists. See De-identification.

Anticipatory plagiarism - "Anticipatory plagiarism occurs when someone steals your original idea and publishes it 100 years before you were born," Robert Merton.

Apologize - "To lay the foundation for a future offence." - Ambrose Bierce

Arrogance - An evil scientist is an arrogant scientist. Arrogance is sometimes confused with a sense of superiority, but there is a difference. If I say, "I am a better scientists than you are," that is an expression of superiority. If I say, "I am a better scientist than you will ever be," that is an expression of arrogance. In the latter, there is the smug assumption that the universe is designed to reward you and thwart your competitors, despite the most heroic exertions on their part.

Authority - Herman Kahn (1922 - 1983) said, "Authority is not power; that's coercion. Authority is not knowledge; that's persuasion, or seduction. Authority is simply that the author has the right to make a statement and to be heard."

Bayh-Dole Act (The Patent and Trademark Amendments of 1980, P.L. 96-517) - Adopted in 1980, the U.S. Bayh-Dole legislation gave universities, small businesses and non-profits commercial control of inventions, processes and other intellectual property developed under federal grants (i.e., with taxpayer dollars). Investigators and institutions may seek intellectual property protection (e.g., copyright or patent), and these rights extend to both inventions and data data. In 1983 President Reagan extended the Bayh-Dole Act to cover large companies. The down-side of the Bayh-Dole act is that grantees who would have formerly opted to donate their grant-supported inventions to the public domain, may now prefer to sequester their inventions while they seek profits through commercial ventures. After Bayh-Dole, some institutions have adopted policies that prohibit faculty and staff from releasing software and data to the public, so as not to jeopardize potential profits.

Belief systems - A generic catch-all that includes religions, philosophies, and cults, whose deepest convictions are not based on proof.

Best - "The best is the enemy of the good," Voltaire.

Bigot - "One who is obstinately and zealously attached to an opinion that you do not entertain," Ambrose Bierce.

Bore - "A person who talks when you wish him to listen," Ambrose Bierce.

Busy - The universal excuse for not getting busy. When a scientist says he is busy, it really means that he will not make himself available to help you. Most scientists have a lot of leisure time; that's one of the perks of being a scientist. The rare scientist who is perpetually busy is usually someone with poor time-management skills.

Cause of death errors - Cause of death data comes from death certificates (342). Death certificate data have many deficiencies (343), (344). The most common error occurs when a mode of death is listed as the cause of death. For example, cardiac arrest is not a cause of death, though it appears as the cause of death on many death certificates. There is not much value in a death certificate for a man who died with end-stage cancer when the listed cause of death is "cardiac arrest." An international survey has shown very little consistency in the way that death data are collected (345). Most death certificates are completed without the benefit of an autopsy. At best, death certificates express a clinician's reasonable judgment at the time of a patient's death.

Cherry-picking bias - Selecting experimental parameters that are most likely to promote your own scientific agenda, or biases. In medical science, the most common cherry-picking activity occurs during patient selection. By choosing the right patients, you can often guarantee that your protocol will produce the results that you want. Purists complain that cherry-picking is unscientific, and produces results that are misleading and unreproducible in a general patient population. Evil scientists understand that cherry-picking is no different that the legal practice of voir dire during jury selection. If lawyers are allowed to cherry-pick a jury, why can't scientists cherry pick their patients?

Citation - Among scholars, a citation is a credit given to a previously published work from within a later work. A citation comes in the form of a pointer to the author, title, and source of the prior work, as a footnote or as a numbered item in a reference section. If you use an original finding, method, or comment from a previously published work, without citing the work, you are engaging in plagiarism. The number of times that a work is cited in the literature is a rough indicator of the importance of the work.

Co-author - Short for co-opting author. A person whose name has been included on the list of persons responsible for a scientific literary work (manuscript, chapter, or book), without making any substantial contribution to the final product. In most cases, the list of co-authors is chosen to achieve some political or social agenda. Co-authorship is, in many cases, tacitly understood to be a reciprocating process ("I'll list you as a co-author on my paper if you'll list me."). There is no upper limit to the number of co-authors that may be listed on a paper. Some manuscripts have over 100 co-authors. Obviously, in these cases, the majority of the co-authors could not have seriously contributed to the paper.

Committee - A group of people with nothing better to do. An adept bureaucrat can form a committee that will function in a totally predictable manner, if he chooses committee members whose prejudices, allegiances, and work customs are known. In modern times, service on committees has essentially replaced scientific productivity as the sign of a credible scientist. Many famous scientists have built their reputations exclusively on committee work.

Common Rule - The Common Rule (Title 45 Code of Federal Regulations, Part 46, Protection of Human Subjects) is the U.S. federal regulation that describes how scientists and institutions must protect their human research subjects (225).

Competing Interest - See Conflict of Interest.

Compilation - How do you tell the difference between a book (which tells a story) and a compilation (a bunch of informative essays published as an ensemble)? In a book, you cannot change the order of the chapters without destroying the product. In a compilation, you can devise a new ordering the chapters and still have an equivalent (or maybe even an improved) product.

Confidant (alternate, Confidante) - "One entrusted by A with the secrets of B, confided by him to C." - Ambrose Bierce

Confidentiality - Keeping safe an entrusted secret concerning another person.

Conniver - One who permits a dishonest act to proceed without interference.

Consensus - Scientific consensus is the illusion that truth is achieved when everyone agrees.

Conservation of Energy, Law of - Evil scientists need to conserve their energy; let others do the work. Sir Winston Churchill distilled the Law of Conservation of Energy into basic elements; "Never stand up when you can sit down, and never sit down when you can lie down."

Contract - Had Van Gogh been a house painter, he would have had steady employment. Just about everyone needs their house painted, at one time or another. Nobody really needs an original piece of art hanging on their wall. The relationship between house painting and art is analogous to the relationship between contracts and grants. A contract is a legal agreement to acquire a service or a deliverable item for a specified remuneration. The funding agency specifies what it wants, and the contractor delivers the item. In a grant, the researcher tells the government what mysteries he would like to pursue, and the funding agency provides him with the necessary money.

Corporation - A corporation is a legal entity that conducts business, whose purpose is to sustain itself, to grow, and to profit. As a legal entity, it has many of the same rights held by humans. Corporations can own and sell property; they can hold patents and copyrights; they have rights of free speech under the first amendment, and they can use those rights to mock their political enemies; they can sue people and other corporations; they have the right to enter into contracts and advertise their products. Most importantly, corporations can lobby congress. Under the law, corporations must be motivated by profit. When you combine an existential mandate for greed, with the power to influence congress, you can understand why corporations are usually much more successful than people. Remember the maxim: laws don't protect citizens from ruthless corporations; laws protect ruthless corporations from citizens.

Cronyism - Favoritism towards friends. Crass people think of cronyism as a safe way to discriminate against everyone in the world who is not your friend. Evil scientists think of cronyism as a sort of power cooperative. Cronyism permits individuals to contribute some of their power to a general pool of power (i.e., the sum of all evils). Members of the cooperative can dip into the pool, as needed. See Nepotism.

Data cooking - Discarding experimental data that does not fit your hypothesis.

Data quality act - Data quality act The Data Quality Act was passed as part of the FY 2001 Consolidated Appropriations Act (Pub. L. No. 106-554. codified at 44 U.S.C. # 3516, note.) The Act requires Federal Agencies to base their decisions on high quality data and to permit the public to challenge and correct inaccurate data. The drawback to this legislation, is that science is a messy process, and data may not always attain a very high quality. It may require decades before the data in a new area of study achieves the level of quality that critics will accept. The easiest way to bring scientific progress to a grinding halt is to insist on data quality.

De-identification - Similar to anonymization, but with an escape clause that permits data to be re-identified (linked to the unique person who is the subject of the data) under specified circumstances.

Disclosure - A disclosure is a form, signed by a conference speaker, that lists commercial relationships and other potential sources of bias, of the speaker. Many speakers believe, erroneously, that a disclosure allows them to promote their commercial interests during their lecture. They believe that anyone attending the lecture has access to the disclosure and has been properly warned that the lecture will contain a commercial message. This is simply not the case. The disclosure does not relieve speakers from any of the customary restraints and responsibilities imposed on speakers. The disclosure exists for the benefit the attendees and for the protection of the hosting organization. It informs attendees that the speaker has a potential conflict of interest.

Dishonesty - A special type, class, or subset of honesty (the "dis" kind).

Do-good doctors - You've seen them; they are the physicians who work tirelessly in free clinics, who provide pro bono services to the poor, and who travel to third world countries to provide basic health services. These are the doctors who join Doctors without Borders and other humanitarian organizations. Do-good doctors are weak people, of low self-esteem, who have succumbed to primitive compassionate instincts that normal doctors sublimate early in their careers. As an evil doctor, you understand that if every doctor provided free services, the entire medical-industrial complex would collapse.

Dogma - What we believe when we don't have evidence. Scientists like to think of themselves as rational beings, but most of science is riddled with dogma. Nobody has the time to verify every scientific assertion, and every scientist settles for believing those things that are believed by the majority of his peers. When the majority of scientists buy into an idea, it becomes accepted dogma (until it's replaced by yet another dogmatic belief). Once you grasp this basic flaw in the fabric of knowledge, you can use it to your advantage.

Economy of truth - If truth is as precious as people say, it makes sense to be economical with it. Use the truth sparingly, and only in situations where hyperbole, understatements, omissions, or distortions will not suffice.

Effective treatment - A therapeutic regimen that has been shown to be better than nothing at all, under restricted circumstances, and for a defined patient population, in at least one study.

Egotist - "A person of low taste, more interested in himself than in me." - Ambrose Bierce

Ethics - Distinguishing right and wrong, and then doing whatever you want. Ethics is easy once you understand whatever serves your interests is right, for you.

Expert - Someone who knows the limits of a field. Though experts often oppose one another on issues of theory and practice within their fields, they will often agree about the boundaries of their field. Only an expert can say, with confidence, what cannot be achieved through the application of a set of skills common to the practitioners of a field. A powerful expert can essentially destroy a new and exciting area of research, simply by insisting that it has no chance for success.

Expert witness - The term "expert witness" is usually an oxymoron, because in almost every case, the expert did not witness anything. More often than not, an expert witness is someone who draws a conclusion from some piece of evidence, or who comments on the scientific merit of the conclusions drawn from the evidence.

Felon - "A person of greater enterprise than discretion, who in embracing an opportunity has formed an unfortunate attachment." - Ambrose Bierce

Fertile ground - Academic centers liken themselves to fertile ground for students and faculty. The fertile ground simile permits universities to justify a wide range of activities that have nothing to do with education.

FOIA - The U.S. Freedom of Information Act (FOIA, pronounced Foy-a and rhymes with LaToya), enacted in 1966, gives U.S. citizens access to data produced by the federal government (i.e., the right to know what the government knows). In the U.S., some states have FOIA laws similar to the federal FOIA. The Southern Illinoisan, a newspaper, requested state health department documents relating to the incidence of neuroblastoma from 1985 to 1997. The state health department denied the request, arguing that although the documents were stripped of identifying information, it may be possible for a malevolent person to discover the identifies of the patients using demographic and other information contained in the records. The Illinois court ruled against the state health department, ruling the foia rights of medical researchers outweigh the privacy concerns of the health department (346).

FOIAable - (Pronounced foyable). Retrievable under FOIA

Freedom of Information Act. See FOIA.

Fudging data - Changing values in data, usually for the purpose of furthering a particular self-serving result. See Cooking data.

Funding rates - Each year, NIH receives about 50,000 new grant applications. The number, 70,000 is sometimes used. But this higher number includes grants that are amended and re-submitted in the same year, and grants that are bounced back to the applicant without review. The lower number more accurately reflects the actual number of reviewed individual grants. Of these 50,000 grants, about 20% are funded. This means that 80% of grant applications were a huge waste of time and money.

Genetic colonialization - The practice of institutions (generally Western institutions), sending scientists into underdeveloped countries, extracting samples of various indigenous species (usually crop species), and patenting the samples for themselves. Synonyms: "business disguised as science," "gene prospecting", "genetic colonization" and "trinket exchange" program (347).

Godwin's law - "As a Usenet discussion grows longer, the probability of a comparison involving Nazis or Hitler approaches one." A somewhat outdated Internet term (nobody uses Usenet anymore), signifying that multi-party Internet discussions will eventually deteriorate into an exchange of insults.

Golden Rule - All policies in the realm of scientific research are based on the Golden Rule, "He that pays the gold gets to rule." The corollary to the Golden Rule is, "Follow the money, and you'll find the science."

Graduate students - If you envision a department hierarchy as a totem pole, with the department chair sitting atop the pole, then you must understand that the graduate student is located about 5 feet underground, squeezed between the stump of the pole, and the cold earth beneath. Graduate study begins after the undergraduate degree is conferred, and extends to 4,5,6,7, or even 8 years. There is little or no incentive for departments to shorten the length of training, because graduate students are the cheapest labor force in the world.

Grant - A grant is a gift from a funding agency. Unlike a contract, which is payment for a deliverable product, there is no specified "deliverable" for a grant. For many grantees, the purpose of a grant is to fund the preparation of the next successful grant application.

Greater than total recall - The ability to recall events that never actually occurred or data that never existed. Strange as it may seem, "greater than total recall" is a much more common talent than "total recall."

Half-truth - Same as a whole lie.

Highly published scientist - A scientist who has published more papers than he has read. Highly published scientists are seldom aware of the contents of their own papers. If you try to engage a highly published scientist in a conversation related to one of his publications, he will immediately steer you to speak to one of his post-doctoral fellows.

HIPAA - HIPAA is the 1996 Health Insurance Portability and Accountability Act. As the result of that act, the HHS (Health and Human Services) has issued 45 CFR Parts 160 through 164, the Final Rule of the Health Insurance Reform: Standards for Privacy of Individually Identifiable Health Information (234). Although the HHS Final Rule is actually separate from HIPAA, common parlance refers to the Final Rule as "HIPAA". In the United States, illness is something that many people feel the need to hide. In particular, U.S. citizens want to hide their medical histories from health insurance companies and employers. HIPAA makes it a crime for health care professionals to violate the privacy of their patients. Nonetheless, U.S. insurers hire teams of investigators who use a variety of legal methods to find pre-existing conditions that can disqualify people from obtaining insurance or that can disqualify reimbursement claims from covered patients. A large percentage of U.S. Health Care investment is devoted to denying coverage to sick citizens.

Human subject - As defined in the Common Rule, a human subject is a living person who takes part in a research project. Deceased persons are not human subjects (as defined under the Common Rule) and are not protected under the regulation. Research on medical records is a type of human subject research protected by the Common Rule.

Immutability and mutability - An immutable message can never be altered, without revealing that an alteration has been made. Almost no information is immutable. People can go back into electronic records and change electronic messages, often with nobody the wiser. This applies to confidential medical records, legal records, and more. George Orwell deftly developed the concept of newspaper mutability in his masterpiece, 1984, wherein news was altered retrospectively to suit the agenda of a totalitarian state.

Indirect costs - When an investigator receives grant money from a federal agency, the investigator's institution receives money as well. The money that the institution receives is intended to support the structural and infrastructural environment that the investigator cannot provide for herself. The research building, the utilities, libraries, and the costs of keeping services current are examples of indirect costs. Indirect costs can equal or exceed the costs of the actual funded research. Institutions benefit from grants awarded to their faculty, primarily through these indirect costs.

Informed Consent (for Human subject research) - Subjects who are put at any risk in an experimental study must be provided with the right to just say no. To this end, researchers must provide prospective human subjects with a consent form that informs the subject of the purpose and risks of the study, and discloses any information that might reasonably affect the participant's decision to participate (such as financial conflicts of interest among the researchers). The informed consent must be understandable to laymen, must be revocable (subjects can change their mind and withdraw from the study), must not contain exculpatory language (i.e., no waivers of responsibility for the researchers), must not promise any benefit for participation, and must not be coercive.

Institutional Review Board - A committee formed in institutions where human subject research is conducted, that ensures that the institution complies with regulations that protect humans subjects from harm. In the U.S., the two federal regulations that are of greatest interest to Institutional Review Boards (IRBs) are the Common Rule and HIPAA (234), (225).

International reputation - Albert Einstein has an international reputation. You do not.

Iron Law of Oligarchies - Developed by Robert Michels (1876 - 1936). The office-holders in an organization work to increase the wealth, power, and longevity of the organization, rather than pursuing the mission of the organization.

Iron Law of Disciplines - Attributed to Ludwik Fleck (1896 - 1961). Scientific disciplines become increasingly conservative over time.

Journal article - The following warnings apply to every scientific manuscript you will ever read: 1) the paper may have been written by a ghost writer, with the listed authors as shills, prostituting their reputations for a consultation fee, 2) the listed authors may have undisclosed conflicts of interest, of a financial nature, 3) in the case of clinical trials, the study may have violated the rights of human subjects, 4) the conclusions may be based on falsified or fabricated data, 5) you will never have access to the raw primary data upon which the conclusions were based, 6) the discussion section is a subtle misrepresentation of the conclusions, designed to promote the selfish agenda of the primary author, 7) the references omit important precedent works published by competitors, and all relevant valid works whose conclusions oppose the conclusions promoted in the article, 8) the paper was accepted for publication only because it confirmed the biases held by the reviewers, 9) the research was probably submitted one to two years prior to the publication date and currently has negligible value, 10) the article may have appeared in another place and another time, in another language, with a different title and conclusion, 11) you are the only person on the planet who has bothered to read the published manuscript.

Laputa - From Jonathan Swift's Gulliver's Travels, Laputa is a flying island. The island is populated by over-educated theorists, who spend their lives in deep thought (348). A Laputan field of science is one in which new discoveries never yield any practical benefit. The scientists in the field are constantly startling one another, with observations and measurements of no apparent utility. Examples of Laputan efforts might include: alchemy, the design of perpetual motion machines, automobiles built as hovercrafts, jet back-packs that fly individuals from place to place, computers that predict sociological events such as wars and insurgencies, the strategic defense initiative. The jury is still out on some of the big, well-funded research projects of today, some of which have persisted for decades without much benefit to society: the human genome project, the cancer genome anatomy project, personalized pharmacogenomics, medical nanotechnology, artificial intelligence, gene therapy for common diseases, manned space missions including the space shuttle project, and human-manufactured nuclear fusion as a practical energy source.

License - A license is an agreement from a lawgiver or a copyright holder or a patent holder or an owner indicating that the restrictions that apply to everyone else (by virtue of a law, copyright, patent or right of ownership) will not apply to you. For example, if you have a license to use a patented process, that means that the normal rights of the patent holder will be suspended for you, in the manner specified in the license.

Menuese - Rhymes with Gouda Cheese. Menuese is the international language of science. If you can't read and speak fluent Menuese, your scientific career is ruined. Usage: "Menuese" is used in the following verse, "The Doctor ignores you when you wheeze; he's planning lunch in Menuese."

Merton's Hypothesis - From Robert K. Merton (1910 - 2003), who held that scientific discoveries come from multiple contributors (69).

MIA (Missing In Action) - A scientist is missing in action when he is present at work, for the purposes of collecting his salary, but nobody knows his whereabouts. If you call the office of an MIA scientist, the receptionist will inform you that he "has stepped out," or "has not been seen in the office", but nobody knows where he is. When pressed, they might volunteer that he "is somewhere," hoping that this information will suffice. In all cases, you will be invited to leave a message on his answering machine, send him an email, or, if you insist, leave a message with the receptionist. They will not volunteer to arrange an appointment with the MIA, because they do not know that you are appointment-worthy. In my experience, most scientists, particularly academics, are MIA more often than not. Where are academics when they are MIA? More than likely, they are at home, transporting children to scheduled events, shopping, indulging in a discrete sexual interlude, intoxicated, looking for another job, receiving medical services, engaging in private consulting, fulfilling the obligations of a second full-time job, or just sitting in their office and refusing to accept calls. The beauty about being MIA is that you collect your salary, without actually earning your salary.

Middleware - "Middleware is the intersection of the stuff that network engineers don't want to do with the stuff that applications developers don't want to do," Kenneth J. Klingenstein.

Moral flexibility - The ability to find a moral justification for an action, no matter how unethical.

Moral relativity - The idea that an immoral act is venial (forgivable after some limited punishment) if it is less immoral that some other immoral act.

Multi-author paper - A single journal article may have dozens or even hundreds of assigned authors. One of the most cherished absurdities in science is the notion that a journal article can be written by multiple authors.

Multi-tasking - The ability to do several things at once. What is commonly called multi-tasking is a euphemism for flightiness: the inefficient habit of hopping around from one unfinished task to another, without much to show for the effort. The multi-tasking mystique has several advantages for powerful scientists: it provides the illusion of productivity, and it allows the powerful scientist to abandon tasks that require sustained, intensive, and uninterrupted effort.

Nepotism - Nepotism is the blood-borne form of cronyism.

New idea - An old idea that you are hearing for the first time.

Obliteration by incorporation - As per Robert K. Merton (1910 - 2003), applies to ideas that are so broadly popularized that the original creator of the idea is forgotten. For example, do we know who invented the wheel, the fruit pie, or the back scratcher?

Obviousness in patents - For a device to be patented, it should be new, useful and non-obvious. In KSR v. Teleflex (April 30, 2007), the U.S. Supreme Court, in a unanimous opinion, reversed a Court of Appeals decision, and determined that a prior patent was unenforceable because it was obvious (177). The opinion discussed, at length, the principles of obviousness. In particular, the Supreme Court indicated that merely putting together prior art to make a new device can only qualify for a patent if the resulting device is unexpected by people working in the field; hence, not obvious. The decision may have raised the bar for patents, particularly patents that are built on prior art (e.g., all software and most software standards).

Off-label use - In 1962, Congress required that drug manufacturers produce scientific evidence that a marketed drug is both safe and effective for a specific use. When a drug company receives FDA approval, the approval is restricted to the specific use demonstrated in an FDA-approved clinical trial. All other uses of the drug (for populations and conditions not included in the clinical study, or for doses not deemed safe in the study) are not covered by FDA approval and cannot be marketed by the drug company. Off-label use occurs when the approved drug or device is used for a purpose other than the purpose approved by the FDA. The FDA controls drug companies, not doctors. Physicians are permitted to use drugs and devices for off-label uses, if they wish.

One field one book rule - The evil scientist does not waste time reading books in his field. At most, the number of books that an evil scientist will read is "1". Every field has a so-called bible, so named because it is contains contradictory, incredible, and merciless doctrine, often written by a committee, and altered by succeeding generations of scientists who are angry about being left out of the first edition. If you refuse to read more than one book, then you must read your field's "bible."

Orphan drug - A drug needed by a small number of people. In the past, drug companies were reluctant to manufacture drugs for rare diseases. The small population with the disease cannot produce an adequate return on investment for the manufacturer. Nowadays, drug companies produce orphan drugs charging up to thousands of times the manufacturing costs. Th idea is that third party payers (such as health insurers) will pay any fee for a medically required drug, so long as no competitors offer the same drug at a lower price.

Ownership - Ownership is a mercantile concept that bestows an entity with the right to sell. If you own a horse, that means that you alone have the right to sell the horse. If you own a tissue sample, that means that you have the right to sell the tissue sample. A long-honored tradition has prohibited the sale (hence ownership) of human tissue. This tradition was broken by a recent court ruling that assigned ownership of a collection of human tissues to Washington University (349)

Panglossian - Blind optimism, after Pangloss, the optimist in Candide (1759), by Voltaire (1694 - 1778).

Parker, Janet (1938 - 1978) - The last person on earth known to die from smallpox (107). In 1978, Janet Parker was a 40 year old photographer who lived in Birmingham, England. She worked on the floor above Henry Bedson's smallpox research laboratory. Virus particles escaped from Bedson's laboratory and infected Ms. Parker. After learning of Parker's infection, Bedson committed suicide (107).

Patent farming - Planting (usually, surreptitiously) patented intellectual property within someone else's intellectual property. The patent farmer reaps his crop by surprising users of the aforementioned intellectual property with notice that their activities rely on a patented process or device owned by the patent farmer. An example occurs when patented methods are included within technical standards. Hidden patents within standards can be asserted against anyone who implements the standard (350).

Patent holding company - Private entities that buy many patents, thus building portfolios of patents to assert intellectual property rights in strategically chosen business sectors.

Use patents - Even when intellectual property has been made freely available, the uses of the property may still be patented. This means that when you use an idea, device, or process that is not covered by a patent, you still need to determine whether your use of the patent may constitute a patent infringement.

Peer review - A venerable tradition, in which clueless editors, funding agencies, and awards panels ask scientists to spend their time and energy reviewing the grants and manuscripts written by their fiercest competitors. Not surprisingly, peer review provides reviewers with the risk-free opportunity to ravage their enemies and steal their ideas. Peer review has never been shown to serve a useful purpose; yet we persist (71).

Pharma - Slang for pharmaceutical industry. Used in conjunction with, and following, "big."

Ph.D. M.D. - A person who is qualified to be incompetent in two fields. If you're lucky enough to have these both degrees, you can parlay them into a lifetime of leisure. Basically, you can use your research activities to cover poor clinical acumen ("Sorry, I was busy in the lab"), and your clinical activities to cover poor research ("Sorry, I was in the clinic"). Because researchers seldom speak to clinicians, your colleagues on either side of your job will be unaware that you actually spend your afternoons in salacious trysts, with their wives.

Pilfer - Scientists don't steal from other scientists; they pilfer. Pilfering is a time-honored way of taking some scientific advancement produced by another scientist and using it to advance your own research agenda. One of the most successful acts of pilferage occurred when James Watson and Francis Crick got hold of Rosalind Franklin's X-ray photographs of DNA (without her permission). Watson and Crick have acknowledge that the photos were of critical importance in their work, which culminated in their discovery of the double-helical structure of DNA. Watson and Crick received the Nobel price. Rosalind Franklin received their gratitude. Though pilferers sometimes receive criticism from their peers, they never get into any serious trouble, because pilfering is not a crime. If you are ever accused of pilfery, the best defense comes from Isaac Newton, who famously said, "If I have seen further it is only by standing on the shoulders of giants." In other words, great science is accomplished by peering over the shoulders of your colleagues.

Plagiarism - Taking credit, through a literary device, for another person's intellectual contribution. Plagiarism is often confused with intellectual piracy. If I take an idea, developed in a book that you published, and I include it in my book, as though it were my original idea, without citing your book as the source of the idea, that would be plagiarism. Publication piracy is the copy-theft of a literary work. If I take your book, re-publish it, sell copies of the re-published work, and keep all the money paid to buy the re-published book, that's piracy. As books go, scientific works have negligible value, and are seldom pirated. Ideas are the currency of scientists, and plagiarism is rampant.

Predicting the future - The thing about predicting the future is that you need to start with a good understanding of the present. Nobody really understands what is happening in the here and now. So it is very unlikely that anyone can see the future.

Privacy - The right not to be bothered. Often confused with confidentiality, the right to keep a secret. See Confidentiality.

Proprietary Standard - A Standard that belongs to some entity and that cannot be used freely (i.e., without obligation, or restriction).

Prostitution - Currently the world's oldest profession, but at the time when it was invented, it was the world's youngest profession.

Publication dishonesty - Falsifying or fabricating data, lying about the original source of the data (e.g., plariarism), adding co-authors who did not contribute to the paper or whose contributions were marginal, failing to cite the proper precedent papers, and listing as co-authors persons who did not read and approve the final version of the paper. In the case of journal articles, duplicate publications are usually considered a form of publication dishonesty, because the appearance of the publication implies originality.

Re-abstraction bias - Gaps in records often require re-abstraction from other sources, and this may produce a final data set wherein the re-abstracted records are quite different from the records that did not require re-abstraction.

Record bias - Records can be inaccurate, incomplete or otherwise flawed. If you base your conclusion on false records, it's unlikely that your conclusions will have much value.

Reproducibility - Reproducibility was the former test for scientific legitimacy. If an experimental result could not be reproduced in another lab, then the original work was discredited (351). Today, reproducibility cannot be used to discredit bogus research. Many of the studies done today are way to expensive to repeat; or the data produced by the experiment is so immense (gigabytes) that there is no reasonable expectation of reproduction; or the information upon which the assertions are based is confidential, and must be accepted as a matter of untestable faith. Because research is no longer held to the standard of reproducibility, it is a safe bet that scientists will seize upon this new opportunity for risk-free scientific misconduct.

Retro-noting - The time-bending ability to post-date notes. It is one of the most valuable tools available to physicians. A doctor who hasn't seen his hospitalized patient in a month can make a short visit to the ward, pull the patient's medical chart, and insert short notes, for each day that the patient was in the ward, indicating something such as, "Patient visited 8:20 a.m., no change in status, vital signs stable, continue current treatment plan." Retro-noting permits lazy physicians to comply with time-crucial standards of care, and to bill for "visits" that never occurred.

RICO - RICO is the Racketeer Influenced and Corrupt Organizations Act, U.S. Code Title 18, Part 1, Chapter 96. RICO was designed as a legal tool against the Mafia and other institutions of organized crime. Since its passage, in 1970, the scope of RICO has been expanded. In particular, RICO has provisions that may apply to professional organizations that use their powers to obstruct the commercial activities of people working outside the organization.

Royalty - The idea of royalties traces back to the rights of the crown to claim a percentage of the proceeds from mines operating in the royal domain. Today, royalties refer to payments made to an author or a patent holder for the sale or performance of his or her intellectual property.

Royalty packing - A requirement placed on a product developer to include multiple patented technologies within the product. Sometimes, the requirement to use multiple technologies is a condition specified within the license for one of the necessary technologies. Sometimes a government agency or a professional society requires multiple technologies to be included in a product, to conform with a standard. It goes without saying that a clever owner of intellectual property may try his best to pack one or more of his patented holdings into a product, even when it is not a valid and necessary component of the device. Royalty packing increases the cost of the product, and is closely related to royalty stacking. See Royalty stacking.

Royalty stacking - Occurs when a product aggregates multiple patented technologies within the final product. The greatest number of aggregate patents occurs in manifold inventions, that involve multiple parts and subcomponents, each containing multiple patented properties. The practice of royalty stacking vastly increases the cost of using the product.

Scapegoat - An animal or human (usually a graduate student or technician) to which all sins can be transferred, after which the scapegoat is conveniently sacrificed to the gods. Every laboratory should be equipped with one or more of these indispensable tools.

Selfishness - A biological imperative. Evolution's "survival of the fittest," is just nature's way of telling you to look out for number one.

Semmelweis reflex - Dismissing the value of a novel scientific idea, without the benefit of thought. Occurs whenever a new idea is proposed or demonstrated by a non-authority (usually a young person, or a person who has worked in a different scientific discipline than yours). Named for Semmelweis, who proved that the number of patient deaths could be drastically reduced if the maternity room doctors washed their hands between patients; but the doctors decided they would rather not.

Stealing - The crime known as "stealing" is a lay term that cannot be applied to scientists. Scientists "pilfer"; they do not "steal", and pilfery is not a crime and is not a form of scientific misconduct. See Pilfer.

Stigler's Law of Eponymy - "No scientific discovery is named after its original discoverer." (69)

Striving - To struggle or to work with great effort and sacrifice to achieve a goal. The well-heeled scientist does not strive. Remember, your goal as an evil scientists is not to be better than your colleagues; your goal is to be better off than your colleagues.

Synonym - "A synonym is a word you use when you can't spell the other one," Baltasar Gracian.

Trusted Authority - A pharmaceutical company, software vendor, or wealthy corporation that can be trusted to pay you a consulting fee, if you promote their self-serving assertions as authoritative.

Type errors - Even statisticians will admit that the fundamental concepts of their field are based on untenable assumptions about the nature of reality. When you try to draw conclusions by sampling populations, you're bound to produce scurrilous results. Rather than correcting the fundamental errors in their field, statisticians have simply classified them into four types:

Type 1 error. Rejecting the null hypothesis when the null hypothesis is correct (i.e., seeing an effect when there was none).

Type 2 error. Accepting the null hypotheses when the null hypothesis is false. (i.e. seeing no effect when there was one).

Type 3 error. Rejecting the null hypothesis correctly, but for the wrong reason, leading to an erroneous interpretation of the data in favor of an incorrect affirmative statement.

Type 4 error. Erroneous conclusion based on performing the wrong statistical test.

Type 5 error. Erroneous conclusion based on bad data.

Nobody really understands how any statistical test works. None of them are mathematically "provable." Evil scientists have ample opportunity to choose a test that supports their favorite hypothesis. When you commit a Type 4 statistical error, the only people who will criticize you will be those who favor an opposing hypothesis.

Viral research - Research whose only purpose is to replicate itself and infect many different laboratories, all devoting research funds to the same area, without producing anything of value for society. The field of artificial intelligence, infected hundreds of computer science labs from 1970 through about 1995. Artificial Intelligence has since lost some of its virulence. The idea behind artificial intelligence was that computers could function like the human mind, only better. Promising results spread from lab to lab, and much of the funding in computer science was devoted to artificial intelligence. As a field of science, artificial intelligence is purely pathologic, without fundamental principles, and built from words that have no single meaning to different workers in the same field. Many of those researchers who survived their battle with the artificial research virus have moved on to healthier areas: collective intelligence, cloud computing, computer aided decision making, and search engine algorithms.

Visionary - One of the best titles an evil scientist can hold is "Visionary." A visionary is a person who has never made any serious professional contribution to his scientific field, yet wields enormous influence nonetheless. The major difference between a visionary and a prophet is salary; visionaries are always well-paid. Prophets live and die in poverty.

WNL - The intended meaning of "WNL" appearing on multiple locations throughout a patient's chart, is "Within Normal Limits." In many instances, the real-life meaning of "WNL" is "We never looked," indicating that the observation was neither measured or recorded, but was assumed to be normal just the same.

Zipf law and Zipf bias - George Kingsley Zipf (1902 - 1950) gave us Zipf's law, asserting that in a text corpus, the frequency of any word is roughly inversely proportional to its rank in the frequency table. A practical way of interpreting Zipf's law is that a small number of words (the, if, of, a, the, is, in, on, for) account for most of the occurrences of words in any text. Zipf's law can be extended to most comprehensive collections of objects in the real world. For example, a few computer companies account for the bulk of computer sales; a few misbehaving students receive the bulk of the attention from the school faculty; a few types of tumors (squamous cell carcinoma of skin, basal cell carcinoma of skin, lung cancer, colon cancer, prostate cancer, breast cancer) account for the overwhelming majority of cancers occurring in humans. When people are unaware of the Zipf distribution in an experimental study, they can be misled into thinking that a random sampling from a population contains a fair representation of all the different types of individuals in a population. In fact, Zipf's law tells us that most random samplings will contain the most frequently occurring objects in the population and will exclude almost all of the objects that account for the wide diversity of unique objects in the population. For example, a martian randomly extracting 100 animals from earth, might find 40 ants, 30 spiders, and 30 assorted marine organisms. The likelihood that a human would be included in the mix is virtually nil. If martians were unaware of Zipf's law, they would leave us with a grossly distorted view of terran life (i.e., the Zipf bias). Like all eponymous laws, this one may have been attributed to the wrong person. Vilfredo Federico Damaso Pareto (1848 - 1923), observed that, for many events, roughly 80% of the effects come from 20% of the causes. Pareto's principle is the simplified predecessor to the Zipf law.





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Books by Jules J. Berman, covers


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