Crossing the Line

https://ori.hhs.gov/case-summary-potti-anil

The above link routes to the ORI case summary for a high-profile case of from 2015.  I remember this case from my time at UGA and then in practice, as well as a partial discussion of it in prior classes here at VT.  Depending on the source, there have been upwards of 20-30 total published manuscript retractions or revisions under this one individual.  Around 10 retractions had occurred before the official completion of the ORI investigation, which involved another 8 retractions.  Further, 11 personal settlements have been reached with patients that were in clinical trials.  All tolled, over 1.5 million  US dollars have been paid out as a result (and this is just what I can easily and repeatedly find, the damage may be much higher!)  Nearly half of this was related to an active grant by the American Cancer Society, which Duke University had to refund.

Although I acknowledge that misconduct does occur, my emphasis is NOT on research, but my training IS heavy in ethics – so it does not really cross my mind to even begin to fake something like oncologic results.  I understand there is a pressure for primary research, the “publish or perish” mantra, but I have never really been in a scenario to which I would feel that pressure.  As such, I remember the case, but I cannot fully relate to what would lead to such egregious falsifications.

When looking at the final resolution, the reputation of Anil Potti is permanently damaged, but it does not really feel like complete resolution.  As he was not involved with active Public Health Service research grants, nor was he intending to do so, there was really no penalty upon him.  Rather, Duke felt the brunt of it, damaging their own credentials and anyone whom was employed there in any capacity.  Potti had already moved on several times by the point of final resolution, practicing clinically in the Midwest.  Personal medical settlements with the NC Board of Medicine had finished as well.  So there was an ending of the story, but it seems almost hollow when the story had already stopped.  Not that I expect malicious action, but the ability to still continue to perform human medicine after gross ethical violations concerns me, frankly.

Mistakes happen, they do.  A number is transposed wrong, a machine errors, a document corrupts a figure, etc.  All of these things happen, and they can be fixed without permanent damage to one’s credentials.  Even legitimate medical error occurs and can be deadly.  But to make up critical data for human subjects that influence multiple oncologic subjects, trials, and HUMAN LIFE – how does one cross that line?  I do not know what would drive such a person to cross that line, but to me that is a line that cannot be uncrossed in the medical field.

Further, and this is more marring on Duke, but where was the oversight?  Why was it not more aggressively dealt with internally when the first concern was raised?  Although I am aware that a fair amount of research and work is carried out without all involved authors present, I cannot help but feel like no one was paying attention.  I understand Duke not wanting to over-react and cause panic, but it seems like the internal investigation should have been larger, although that is only my opinion from years later with the full case in front of me.   I do believe they would do things differently, now, after everything that it cost them.

Yes, there is a huge push for publishing ground-breaking research, and a person’s livelihood may depend on it, but at what point is it worth potentially taking the life of someone else in the process?  Although I am not aware of any direct deaths caused by him, the treatments for patients may have been sub-optimal as a direct result of his falsifications.  How do you explain that to the patient affected, or the family of that patient?  How does one rebuild trust from a client?  But hey, if you are in the right location you can currently book an appointment with him – would you trust him?

-Ethics Blogpost Assignment, GRAD5104

2 Replies to “Crossing the Line”

  1. Hi Jeremy,

    Great post! I wasn’t familiar with this case before reading your post, but it seems crazy to me that this individual is still allowed to be practicing medicine despite his involvement in serious ethical violations. The fact he was still able to receive a medical license in other states seems ridiculous. I agree that there should’ve been more oversight from Duke and other collaborators, but I too feel like Duke took the brunt of the consequences for Potti’s actions.

    And to answer your ending question- no. I would not trust this man to be my doctor.

  2. Hi Jeremy,

    Great post! I wasn’t familiar with this case before reading your post, but it seems crazy to me that this individual is still allowed to be practicing medicine despite his involvement in serious ethical violations. The fact he was still able to receive a medical license in other states seems ridiculous. I agree that there should’ve been more oversight from Duke and other collaborators, but I too feel like Duke took the brunt of the consequences for Potti’s actions.

    And to answer your ending question- no. I would not trust this man to be my doctor.

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