Discussion

A medical journal says the case reports it has published for 25 years are, in fact, fiction

october8140: I think research should be assumed fiction until it’s peer reviewed.

moi2388: Independently replicated. Reviewed says pretty much nothing.

contubernio: There is not good evidence that peer review improves quality and there is perhaps some to the contrary (many predatory journals are peer reviewed). The arxiv (unreviewed) is among the most reliable sources available.

sourcegrift: In the era of GitHub etc, if you're not giving out every single data point of your research, it should be assumed it's fake.

newzino: The detail that makes this more than a labeling error: the fictional nature appeared in the journal's author guidelines, not in the published articles. Researchers who cited these 61 papers had no way to distinguish them from genuine case reports. 218 citations later, the fiction is embedded in secondary analyses and literature reviews written by people who had no idea.The "Baby Boy Blue" (2010) case is the clearest example of the harm. An infant allegedly exposed to opioids through breast milk. That case influenced clinical guidance on codeine safety in nursing for years. The CARE guidelines (Consensus-based Clinical Case Reporting Guidelines) exist specifically to create transparency in case reporting. They're voluntary, which is how a journal can run a 25-year undisclosed fiction program and technically say the authors knew.

SiempreViernes: Doesn't sound like these works were "full" articles, but rather something more like short review articles.

fsh: The article is about case reports, not about empirical studies. Putting a fake case report on GitHub wouldn't make it any less fake.

observationist: Yeah, it's almost like science is better when the scientific method is applied to everything, instead of delegating validation to some third party based on credentials or authority or social status.

qwertox: > Putting a fake case report on GitHub wouldn't make it any less fake.Much easier to review for whomever wants to review it.

kittikitti: https://onlinelibrary.wiley.com/doi/10.1111/jpc.14206Maybe we should revisit the routine practice of infant male genital mutilation?

krisoft: What a mess.> One author of a case report was surprised to learn of the correction — because the case described in her article is true.So they managed to mess up even the correction of their giant mess.> correcting the correction "would be difficult."I bet. That's why they should have got it right in the first place. I would be absolutely ballistic if they would be libelling my work like that.

SiempreViernes: Yeah, they seem to have been quite sloppy with these vignettes.Thought note that in the situation of the mislabeled real case, the formal solution is could be a retraction of the entire highlight article since it is against the (poorly implemented) policy to have a real case study.Don't know how patient consent for being used in a case study works, did this author get a perpetual license, did they just copy something from another article they wrote, or from an article someone else wrote?

snapetom: Original HN discussion about the case:https://news.ycombinator.com/item?id=46789205

insane_dreamer: I don't mind the fact that the case reports were fictional -- actual cases can be problematic in terms of privacy as it may be easy to ascertain the patient's identity from the details -- but not putting a notice that it was fictional (or altered from a real case for privacy), for teaching purposes, is pretty bad.

Towaway69: And then there be large amounts of fake data for the next generation of AIs to learn from.What is stopping anyone from faking the data they use in their research papers?Sure it might be verifiable but if the data was made to give the desired results, i.e. faked to be what is required for the paper.

damnesian: Too late, it's already in the bloodstream, LLMs will be recommending things to pediatric doctors and families from fabricated archives for years, probably.

TomMasz: This is fine, though somewhat belated. But it does nothing to deal with the public's growing distrust of science in general, and medical science in particular.

sekuraai: They had access to ChatGPT for last 25 years!

smelendez: You can see the full article here: https://www.cpsp.cps.ca/uploads/publications/pxy155-Teething...It looks like it has a short intro paragraph that talks about a specific case with no identifying details (beyond "a previously healthy 4-month-old boy"), citing this report by other doctors: https://pubmed.ncbi.nlm.nih.gov/27503268/ followed by further discussions of physician reports and survey data.The correction is explicitly listed as applying to that article (https://academic.oup.com/pch/article-abstract/24/2/132/51642...), which itself seems false since that article doesn't seem to include a fictional vignette.

andrewflnr: It looks like they labelled all of them fiction based on a single instance of one of the authors fabricating their case, a gross overcorrection. I wonder if they flinched at the prospect of actually assessing the validity of all of them and decided it was safer to just disclaim them.

petesergeant: > It looks like they labelled all of them fiction based on a single instance of one of the authors fabricating their caseDoes it? That's directly at odds with what the article and editor say

programmertote: Speaking this as a spouse of a medical doctor -- case reports are sometimes a good way to increase the bullet point count in your CV if you are a medical resident. A lot of residents do that just for the sake of beefing up their CVs (to apply for fellowship for example).

snapetom: In vet med, case studies are still pretty important, but that's because vet med is in its infancy compared to human medicine. At least one case study, usually two, are required to be eligible to take boards. Future board renewals, I think for most boards, are "published one original piece of research or two case studies" among a slew of other requirements.

jfengel: The "growing distrust" is due to a concerted disinformation campaign which is independent of the facts.There was indeed much negative information that the public was not aware of, and they should perhaps have held more skepticism than they did. But the gleeful acceptance of outright anti-science lies implies that they were never really in a position to make a sound judgment one way or the other.In those circumstances I'll settle for people reaching the correct action: that practically all accepted medicine is correct and they should follow their doctor's advice. If they choose to over-inflate the importance of things that do indeed go wrong, then they are the ones failing to reach valid conclusions.

tw85: No, it isn't. Anthony Fauci and Rochelle Walensky were both on record, on television, claiming that anyone who takes the covid vaccine will not contract the virus (sterilizing immunity). The medical community and public health in particular disgraced themselves by going all in on demonizing anyone who raised questions about the covid jabs, mocking Ivermectin as "horse paste", claiming cloth masks were very effective against respiratory viruses (they are not, and this has been known for decades), and even that the concept of acquired immunity from recovering from an infection doesn't exist. These are all trivially verifiable things that happened during covid madness, and instead of walking back some of their false claims they simply doubled down on blaming the anti-vaxxers (even after jab uptake exceeded 80%).

learingsci: “Pics or it didn’t happen,” goes a long way in my book.

MarkusQ: You may want to update that, given recent advances in generative AI.No idea what you should update to, mind you, but the old era of photographic evidence is on its last jpgs.