Prominent Cancer Screening Critic Accused of Plagiarism

Nick Mulcahy

August 21, 2018

A Dartmouth University investigation committee found that prominent researcher H. Gilbert Welch, MD, committed "plagiarism" on a mammography screening study, according to reports this week from Retraction Watch and STAT .

Welch disagrees with the finding and says this is "an authorship dispute."

The study in question appeared in 2016 in the New England Journal of Medicine (NEJM)  and concluded the overdiagnosis of breast cancer via mammography screening is "larger than is generally recognized." The study's lead author was Welch, who is well known for his analyses and critiques of the shortcomings of some widely used medical interventions, including cancer screenings of the breast, prostate, and thyroid.

The study's findings and methods were controversial at the time of publishing, as reported by Medscape Medical News.   

After the study appeared, Welch was then accused of research misconduct by fellow Dartmouth faculty member Samir Soneji, PhD, and another academic, Hiram Beltran-Sanchez, PhD, from the University of California Los Angeles.

Per a recent internal document from the Dartmouth provost obtained by Retraction Watch, in an ensuing investigation, Dartmouth eventually concluded that Welch "engaged in research misconduct, namely, plagiarism, by knowingly, intentionally, or recklessly appropriating the ideas, processes, results or words of Complainants without giving them appropriate credit."

However, Welch emphasized to Retraction Watch that the dispute is "about the origin of the idea — not about the validity of the work."

That idea — and its origin — relates to tracking the size of breast tumors over time epidemiologically as a way of determining whether screening was effective. The paper described that hypothesis this way: "The goal of screening mammography is to detect small malignant tumors before they grow large enough to cause symptoms. Effective screening should therefore lead to the detection of a greater number of small tumors, followed by fewer large tumors over time."

This idea came from Soneji, he says in an email posted in the Retraction Watch story: "Professor Welch and I met in his office and he said that he had never thought of my research ideas to a) compute the share of incident breast cancers by tumor size over time and b) use the temporal patterns in tumor size-specific incidence rates to quantify the contribution of breast cancer screening."

Welch says that the 2016 NEJM paper is a "natural progression of my work."

Previously, Welch was the lead author of a 2012 epidemiologic study, also published in the NEJM  and reported by Medscape Medical News, that tracked the incidence rates of breast cancer stage (early vs late) over time as a way of determining overdiagnosis.  

NEJM Is Not Retracting the Study

Dartmouth sent a summary of its investigation to the NEJM and requested that the study be retracted. But on August 10, the journal declined to withdraw the article, saying the issue was an "authorship dispute" and that their opinion was in line with the US Office of Research Integrity. Furthermore, the journal described the situation as a case of "alleged research misconduct."

"The complainant party in this matter claims that he was not given adequate recognition for his contribution to the work we published. We do not deem this sufficient grounds for retraction of the article," summarized Jeffrey Drazen, MD, editor in chief, and Dan Longo, MD, deputy editor in a letter posted online.

The NEJM editors also said they would like to amend the study as needed.

"We are happy to work with you and the article authors to reach a solution whereby sufficient acknowledgment is given so that the contribution of the complainant is adequately recognized," they wrote.

In an email to Medscape Medical News, a Dartmouth spokesperson said the university is not commenting on the story: "This is a confidential personnel matter, and out of respect for the privacy of all parties involved, we are unable to comment on any details of the investigation at this time."

In a story in the radiology trade publication, Soneji had strong words for Welch and the NEJM. "Welch's actions — and the New England Journal of Medicine's failure to retract the plagiarizing paper — offer a formula for plagiarism," he said. "Yet, we are confident the research community as a whole remains committed to the ethical conduct of scientific research."

For his part, Welch strongly disagrees with the Dartmouth finding, he told via email.

"Both the United States Office of Research Integrity — the federal office responsible for enforcing laws governing research misconduct — and the New England Journal of Medicine have reviewed this matter and have judged it to be an authorship or credit dispute," he said.

"More importantly, the public should know that no one is questioning the article's data and findings. The underlying data are publicly available — all the analyses, all the figures, and all the writing in the article are my co-authors' and mine. For the past 20 years, I have investigated the effects of efforts to detect cancer early and this paper was a natural progression of my work," Welch said.

Follow Medscape senior journalist Nick Mulcahy on Twitter: @MulcahyNick

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