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.