Sunday, October 31, 2010

Plagiarism and Medicine: Should We Care?

Recently, I wrote a post on plagiarism in medicine. I advocate a stringent code of ethics for our profession. Once our integrity becomes squishy, then the whole tapestry starts to unravel. We physicians are charged to search for and guard the truth.

In 1910, Sir William Osler wrote:
No human being is constituted to know the truth, the whole truth, and nothing but the truth; and even the best of men must be content with fragments, with partial glimpses, never the full fruition.
Of course, we physicians don’t always succeed in enlightening the truth, but we try. Every day, every one of us faces choices that test us. Some are easy. Most of us would not falsify billing submissions. Other choices are murkier. For example, do we coax a symptom out of a patient so that the procedure or visit becomes a covered benefit? Have we informed a patient whom we are recommending a colonoscopy about the radiologic alternatives? When a patient informs us that his primary care physician has referred him to a surgeon whom we do not hold in high regard, do we speak up? Some folks believe that dispensing medication samples to patients is improper because it encourages the use of expensive medications and raises drug prices for everyone.

I am not writing this because I am a paragon of ethical behavior. I have made some wrong choices in my career. I am also not suggesting that personal integrity is of greater worth for physicians than for others. However, although every individual and business should use honest weights and measures, personal integrity is a fundamental value of the medical profession. This is why I am so troubled about ethical lapses of pre-medical students, physicians-in-training, practicing physicians and academic researchers. Medical plagiarism targets the soul of the profession

There’s new twist on plagiarism, which makes the offense even more complicated. Which of the following scenarios do you find more troubling?

A college student deliberately enhances his research paper with someone else’s work and then submits the paper as his own. He hopes that his plagiarism will not be detected.

A college student appropriates information from various websites and ‘pastes’ liberally into his research paper without attribution. He would readily disclose his research technique as he does not recognize it as ethically problematic.
In my school days, when pterodactyls flew overhead, we all knew what plagiarism was. We didn’t need introductory college lectures to define it. When we ‘borrowed’ someone else’s work without attribution, we knew it was wrong. These days, kids, and even many grown-ups, don’t even know what plagiarism is, or when they are committing it. They have diluted the definition to such an extreme, that only a verbatim extraction of whole paragraphs from the holy bible would be considered plagiarism.

Consider two points from a recent New York Times article.

  • 40% of surveyed undergraduates admit to have plagiarized on written work
  • Only 29% of students believe that copying from web constitutes serious cheating
Many cheaters today do not even regard the offense as an impropriety. Somehow, they believe that the internet and other sources are public domain information reservoirs to be ‘cut & pasted’ and presented as one’s own work. A student caught cheating in my day would be punished. Today’s offenders are likely to deny that any ethical breach has occurred. Counseling these individuals is much more difficult task. We all know the first step of a 12-step program.

Medicine, along with the rest of society, has suffered some ethical erosion. If premedical students, for example, have a relaxed ethical attitude, what kind of medical students will they become? Can we expect that these students, who plagiarize in college, would undergo an ethical metamorphosis when they become grant-seeking academic researchers or practicing physicians? What kind of role models will these researchers and academic faculty be for younger physicians and investigators?

Plagiarists, idea thieves, have chosen personal gain over the truth. If the plagiarist seeks to enter the medical profession, what is our response? Do we close the gate or escort him inside?

I don’t believe that an isolated episode of plagiarism should permanently disqualify someone from becoming a physician, or remaining one. I do think, however, that this is a serious offense that merits a designation of impaired. The offender would need to admit the failing and submit to a process of reeducation and rehabilitation, similar to what is required for other afflictions. The most critical time to address any ethical lapse would be during the undergraduate years and during medical school, with the hope that early detection could change the game.

I’m interested in the readers’ views, particularly those who disagree with me. If you like this post, feel free to ‘cut & paste’ it into your own blog, under your own name, of course.

14 comments:

A. Bailey said...

Ideas improve. The meaning of words participates in the improvement. Plagiarism is necessary. Progress implies it. It embraces an author's phrase, makes use of his expressions, erases a false idea, and replaces it with the right idea.

Nicholas Fogelson, MD said...

I've had a bunch of posts plagiarized and I don't like it..

But to play the devil's advocate a bit - the web has really changed the way information is accessed and transferred. The idea of intellectual property is being deprecated over time, to the point that many people no longer believe that copyright law should exist (and certainly act like it doesn't). I can see how the current youth culture that routinely steals music from the net without a second thought might not respect the intellectual property right of others, or feel the need to attribute them. Culture has shifted to deal with this issue, to the point that record labels now require 360 contracts that include merchandise and ticket sales, not just albums.

Perhaps the very idea of copyright stemmed from the relative difficulty of copying something at all. It used to be non-trivial to copy a cassette tape (I remember playing Pac Man fever from one stereo and recording the sound into another as a child). The difficulty of the process discouraged it. Its now so easy that the only thing that keeps us from doing it is ethics, which have evolved to make it OK.

Consider this. When I was on plastic surgery, one of my chiefs discussed a case with me and gave me a 5 minute discourse on all the ways we could treat it. The next day on rounds the attending asked me about how we could treat this patient. As I have a very strong auditory memory, I basically spooled out the lecture I heard the previous day, word for word. The attending was blown away. 24 hours earlier I knew nothing about the patient.

Did I plagiarize it? I remembered it right out of my brain, and for all intents and purposed that information was now mine. Ultimately the credit of having a good medical student still went to the chief.

Anonymous said...

Dr. Fogelson,

Of course you plagiarized it. Just because you remember something doesn't make the thought yours. If I own a Picasso and I remember it sitting in my study, does that mean I created it? Of course not, and proper attribution is required. And as to A. Bailey, plagiarism is never required when credit due is given. Building on other's work has always been acceptable. The crux is admitting that it is someone's prior work.

It scares me to think that these comments represent the quality of medical professional that I am exposing myself to. I expect my doctor to be able to think and understand, not just regurgitate what he/she has heard from someone else.

Michael Kirsch, M.D. said...

Comments appreciated. While shifting cultural trends have caused ethical erosion with respect to plagiarism and other issues, values of right and wrong must stand firm. If we give in to prevailing culture and redefine values, then we become ethically unmoored. Plagiarism is theft and is wrong. Redefining the transgression doesn't sanitize the offense in my view.

Nicholas Fogelson, MD said...

I agree. It is interesting though that an entire culture is shifting away. The EFF (Electronic Freedom Federation) is an entire organization, well funded, that is dedicated to destruction of the concept of copyright. It is well respected by a large cadre of technorati, including major players like Leo Laporte. EFF has defended pro-bono many of the folks that were sued by the RIAA for music sharing violations. Times they are a changin...

Carolyn Thomas said...

A lovely example of plagiarism at its finest is the widespread practice of ghostwriting and 'guest authorship' in medical journals. In both cases, the name that appears in print as a study's author is not actually that of the true author. That smells like basic plagiarism to me.

An ‘honorary’ or ‘guest’ author acknowledgement in a medical journal article is usually something bestowed as a tribute to an academic department chair or to the person who acquired funding for the research.

But isn't fraudulently bestowing credit to somebody who is NOT the author just like university students putting their own names on purchased internet essays?

The similarity: neither actually wrote them.

The difference: the students are punished for their fraud; department chairs are honoured for it.

More to the point, doctors and researchers get to add one more title to the all-important list of published papers on their CVs, without all that bother of actually doing the work.

How is this fraud any more palatable than medical ghostwriting?

More at "Medical Ghostwriting And Guest Authorship: Twins Separated At Birth?" on THE ETHICAL NAG: MARKETING ETHICS FOR THE EASILY SWAYED
http://ethicalnag.org/2009/09/22/guest-athors/

Michael Kirsch, M.D. said...

Carolyn, I enjoyed your piece. You might wish to review http://bit.ly/14SgLT.

Brad Lander said...

Hi Michael,

This is exactly what I was doing research on this summer. We finally finished the manuscript and are in the process of submitting it to journals. I think you'd find it interesting, I'll send it your way.

Brad

Michael Kirsch, M.D. said...

Brad, I would be delighted to review your non-plagiarized manuscript. I assume I would then be entitled to be listed as an author.

Nicholas Fogelson, MD said...

>> Of course you plagiarized it. Just because you remember something doesn't make the thought yours.

Does plagiarism actually transmit to verbal communication..? especially when such verbal communication is of information, not independent creative thought..?

I'd say no. My example was rhetorical.

A. Bailey said...

We are not without defenses to the siege of plagiarism.

If you entered my previous post into Google, it would have pulled up the actual author, and my plagiarism would have been instantly recognized.

Anonymous 806 is a better person than I. As I can make no sense out of post-modernism except on its own metalevel, I had no idea what the quote meant.

Michael Kirsch, M.D. said...

The concept is quite simple, I think. If you are expressing someone else's idea, in any form, the source should be credited and not presented as original.

ee said...

Why not have applicants to residency write their personal statements as well as answer, in writing, an impromptu question, requiring no skill other than a facility in English, as does Sarah Lawrence College at their interviews.

wisdom teeth removal said...

My content I post on my website is plagiarized all the time. I suspect yours is as well.

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