Fraud, distortion, delusion, and consensus: the problems of human and natural deception in epidemiologic science.

From the Clinical Epidemiology Unit, Yale University School of Medicine, New Haven, Connecticut, and Cooperative Studies Program Coordinating Center, Veterans Administration Medical Center, West Haven, Connecticut. This work was supported in part by a grant from the Andrew W. Mellon Foundation. Requests for reprints should be addressed to Dr. Alvan R. Feinstein, Yale University School of Medicine, I 456 SHM, P.O. Box 3333, New Haven, Connecticut 06510. Manuscript submitted November 25, 1987, and accepted December 15, 1987. During the past two decades, the quest for scientific truth in the world of medicine has had prominent problems when evidence was found to be fabricated, or when non-fabricated evidence evoked major controversies about its validity or interpretation. If the search for truth is both a professional and moral objective in the practice of scientific research, any deceptions that disguise truth are particularly repugnant. The degree of repugnance associated with different types of deception, however, will depend on the manner in which they are produced. Certain deceptions are deliberately planned frauds, but many others occur inadvertently. They arise as distortions or delusions, produced by flaws in the conventional methods used for the “standard” practice of scientific research. Although everyone is greatly distressed by the immoral aspects of fraud, the other types of deception have no associated ethical opprobrium. They are usually accepted as part of the inevitable risks associated with the benefits of scientific investigation. In this view, the research process is somewhat like an efficacious treatment that may occasionally have adverse side effects. We are pleased with the good things that occur in research; and we hope that the inevitable bad things will be infrequent or at least not too bad. Accordingly, vigorous counteractions are taken when deceptions are found to have been deliberate, but not when they are inadvertent. If an investigator paints mice, forges data, or creates non-existent patients, the scientific “immorality” is egregiously shocking and corrective measures take place promptly. People lose their jobs or reputations; old committees are reprimanded and new ones created; better procedures are developed for supervision, mentoring, and monitoring of research activities. After all the furor subsides, however, the research “industry” usually returns to its previous equilibrium. We feel better about the improvements instituted to avoid deliberate deceptions, but we give little or no attention to the much greater and more frequent problems of the inadvertent deceptions that occur when “established” standards of practice lead to distortions or delusions. In the inadvertent deceptions, no data or observations have been faked. The investigators may have been honest, dedicated, sincere, and hardworking; and the data may have been assembled and analyzed with conscientious care; but something went wrong. In a disfortion, something has affected the observed evidence submitted as “news”: the data may be inaccurate or the comparisons biased. In a delusion, something has affected the “editorials” that emerge when the observed evidence is interpreted to form hypotheses or conclusions. A distortion is usually produced by failure to recognize important distinctions in the complexity