MD, PhD, FMedSci, FSB, FRCP, FRCPEd

What a question, you might say. And you would be right, it’s a most awkward one, so much so that I cannot answer it for myself.

I NEED YOUR HELP.

Here is the story:

Ten years ago, with the help of S Lejeune and an EU grant, my team conducted a Cochrane review of Laertrile. To do the ‘ground work’, we hired an Italian research assistant, S Milazzo, who was supervised mainly by my research fellow Katja Schmidt. Consequently, the review was published under the names of all main contributors: Milazzo, Ernst, Lejeune, Schmidt.

In 2011, an update was due for which the help of Dr Markus Horneber, the head of a German research team investigating alt med in relation to cancer, was recruited. By then, Milazzo and Schmidt had left my unit and, with my consent, Horneber, Milazzo and Schmidt took charge of the review. I was then sent a draft of their update and did a revision of it which consisted mostly in checking the facts and making linguistic changes. The article was then published under the following authorship: Milazzo S, Ernst E, Lejeune S, Boehm K, Horneber M (Katja had married meanwhile, so Boehm and Schmidt are the same person).

A few days ago, I noticed that a further update had been published in 2015. Amazingly, I had not been told, asked to contribute, or informed that my name as co-author had been scrapped. The authors of the new update are simply Milazzo and Horneber (the latter being the senior author). Katja Boehm had apparently indicated that she did no longer want to be involved; I am not sure what happened to Lejeune.

I know Markus Horneber since donkey’s years and had co-authored several other papers with him in the past, so I (admittedly miffed about my discovery) sent him an email and asked him whether he did not consider this behaviour to amount to plagiarism. His reply was, in my view, unhelpful in explaining why I had not been asked to get involved and Horneber asked me to withdraw the allegation of plagiarism (which I had not even made) – or else he would take legal action (this was the moment when I got truly suspicious).

Next, I contacted the responsible editor at the Cochrane Collaboration, not least because Horneber had claimed that she had condoned the disputed change of authorship. Her reply confirmed that “excluding previous authors without giving them a chance to comment is not normal Cochrane policy” and that she did, in fact, not condone the omission of my name from the list of co-authors.

The question that I am asking myself (not for the first time, I am afraid – a similar, arguably worse case has been described in the comments section of this post) is the following: IS THIS A CASE OF PLAGIARISM OR NOT? In the name of honesty, transparency and science, it requires an answer, I think.

Even after contemplating it for several days, I seem to be unable to find a conclusive response. On the one hand, I did clearly not contribute to the latest (2015) update and should therefore not be a co-author. On the other hand, I feel that I should have been asked to contribute, in which case I would certainly have done so and remained a co-author.

For a fuller understanding of this case, I here copy the various sections of the abstracts of the 2011 update (marked OLD) and the 2015 update without my co-authorship (marked NEW):

 

OLD

Laetrile is the name for a semi-synthetic compound which is chemically related to amygdalin, a cyanogenic glycoside from the kernels of apricots and various other species of the genus Prunus. Laetrile and amygdalin are promoted under various names for the treatment of cancer although there is no evidence for its efficacy. Due to possible cyanide poisoning, laetrile can be dangerous.

NEW

Laetrile is the name for a semi-synthetic compound which is chemically related to amygdalin, a cyanogenic glycoside from the kernels of apricots and various other species of the genus Prunus. Laetrile and amygdalin are promoted under various names for the treatment of cancer although there is no evidence for its efficacy. Due to possible cyanide poisoning, laetrile can be dangerous.

OBJECTIVES:

OLD

To assess the alleged anti-cancer effect and possible adverse effects of laetrile and amygdalin.

NEW

To assess the alleged anti-cancer effect and possible adverse effects of laetrile and amygdalin.

SEARCH METHODS:

OLD

We searched the following databases: CENTRAL (2011, Issue 1); MEDLINE (1951-2011); EMBASE (1980-2011); AMED; Scirus; CancerLit; CINAHL (all from 1982-2011); CAMbase (from 1998-2011); the MetaRegister; the National Research Register; and our own files. We examined reference lists of included studies and review articles and we contacted experts in the field for knowledge of additional studies. We did not impose any restrictions of timer or language.

NEW

We searched the following databases: CENTRAL (2014, Issue 9); MEDLINE (1951-2014); EMBASE (1980-2014); AMED; Scirus; CINAHL (all from 1982-2015); CAMbase (from 1998-2015); the MetaRegister; the National Research Register; and our own files. We examined reference lists of included studies and review articles and we contacted experts in the field for knowledge of additional studies. We did not impose any restrictions of timer or language.

SELECTION CRITERIA:

OLD

Randomized controlled trials (RCTs) and quasi-RCTs.

NEW

Randomized controlled trials (RCTs) and quasi-RCTs.

DATA COLLECTION AND ANALYSIS:

OLD

We searched eight databases and two registers for studies testing laetrile or amygdalin for the treatment of cancer. Two review authors screened and assessed articles for inclusion criteria.

NEW

We searched eight databases and two registers for studies testing laetrile or amygdalin for the treatment of cancer. Two review authors screened and assessed articles for inclusion criteria.

MAIN RESULTS:

OLD

We located over 200 references, 63 were evaluated in the original review and an additional 6 in this update. However, we did not identify any studies that met our inclusion criteria.

NEW

We located over 200 references, 63 were evaluated in the original review, 6 in the 2011 and none in this update. However, we did not identify any studies that met our inclusion criteria.

AUTHORS’ CONCLUSIONS:

OLD

The claims that laetrile or amygdalin have beneficial effects for cancer patients are not currently supported by sound clinical data. There is a considerable risk of serious adverse effects from cyanide poisoning after laetrile or amygdalin, especially after oral ingestion. The risk-benefit balance of laetrile or amygdalin as a treatment for cancer is therefore unambiguously negative.

NEW

The claims that laetrile or amygdalin have beneficial effects for cancer patients are not currently supported by sound clinical data. There is a considerable risk of serious adverse effects from cyanide poisoning after laetrile or amygdalin, especially after oral ingestion. The risk-benefit balance of laetrile or amygdalin as a treatment for cancer is therefore unambiguously negative.

END OF ABSTRACT

I HOPE THAT YOU, THE READER OF THIS POST, ARE NOW ABLE TO TELL ME:

HAVE I BEEN PLAGIARISED?

P S

After the response from the Cochrane editor, I asked Horneber whether he wanted to make a further comment because I was thinking to blog about this. So far, I have not received a reply.

13 Responses to The Cochrane review of laertrile for cancer – have I been plagiarised?

  • In my opintion, I would not consider this plagiarism, considering the order of authorship as well as your consent in letting the others take charge of the update. I think it is customary, polite and practical to invite all previous co-authors to contribute to the update, but not to the extent that I would consider your case plagiarism.

  • What a situation!!
     
    First, one thing in the post doesn’t make sense. “I … sent Horneber an email and asked him whether he did not consider this behaviour to amount to plagiarism. His reply was, in my view, unhelpful in explaining why I had not been asked to get involved and Horneber asked me to withdraw the allegation of plagiarism (which I had not even made).” The italics are mine. Your meaning is very unclear: if you asked if behaviour did not amount to plagiarism that is surely an allegation of plagiarism?!
     
    The abstract items you post are unequivocally close to 100% identical, but the concept of plagiarism is complicated by the fact that the two authors of the 2015 update were also authors of the original piece. Self plagiarism is not really applicable to a Cochrane update. So the clear fault, as your post already intimates, is with the Cochrane editor. If she “did not condone” the omission of your name from the list of co-authors then who did? I have experience of several journals that make a huge issue of, e.g., such things as adding or removing an author’s name from a paper between review and publication. They require signatures from all the authors in such circumstances.
     
    I share your pain: you have been treated unreasonably by former colleagues. If you were omitted for innocent reasons, surely they would have apologized and said so by now.

    • thanks – but I would argue a question cannot be an allegation. at least it was not meant like one. as this post is not an allegation either – just an attempt to bring light into a potentially important matter.
      if I ask you ARE YOU AN ADULTERER? I am not saying that you are. or is my understanding of English incorrect?

      • Your English is usually excellent, Professor Ernst, but this point is at least ambiguous. If you ask me “Would you not consider your behaviour amounts to commiting adultery?”, you are effectively saying “I think your behaviour is adulterous.”

        • sorry, but this not how I meant it.

        • Frank, What you are saying may well apply to the vast majority of people who aren’t disciplined in science, critical thinking, and communication skills. However, those who work in the harsh arena of applied science have no excuses whatsoever to mistake questions for accusations. Such mistakes have the pungent aroma of desperately trying to hide something, hence the idiom “I smell a rat!”

  • Wasn’t it Shakespeare who said “What’s in a name? That which we call a rose by any other name would smell as sweet.”
    Romeo and Juliet (II, ii, 1-2)

    The way this is presented here doesn’t only smell but reek of desperation from that other author, and I don’t quite get why something should need an update if no new references were located between publishing the last and the most recent article.

    One should run both version through the Turnitin software to find out what else is new and improved…

  • Even with the copyright assigned to the Cochrane Collaboration, when an article or book contains substantial portions of text which are not significantly different from an earlier version, the authors of the previous version would be cited, if not also invited to participate in the updated version. We have all seen this in course textbooks.

  • We, translators, are frequently dealing with such things as update. For example, EMA was not satisfied with submitted documents: a research study was deemed to be of low quality, something had not been stressed in the Package Leaflet, the documents get updated and passed to us, translators. Are we paid for translating entire document? Of course not. Just for implementing the necessary changes, because that is all we have done.
    The same with the texts: one cannot say he has written a new text, if he has taken one and made some tiny alterations in it.

  • No I don’t think you have. It is a Cochrane review update which is a unique “species” of publication (and in a perfect world would write itself). But I am mystfied as to why your name was taken off it.

    • that I understand [sort of] – I did not contribute to the last update.
      I am much more mystified why I was not invited to contribute to a review that I originally initiated.

  • I only came across your site while looking up osteopathy but then decided to search topics concerning apricot kernels, so here we are. As to plagiarism or no, I’m sure your sense of things was ruffled but really this is pretty small potatoes in the scheme of things don’t you think? I looked up the Paracelsus med school and its activities seemed lightweight to me. Perhaps your (apparently former given this development) colleague is simply running short of meaningful things to do, as why else update research on what we all must surely know is nothing more than very profitable quackery; amygdalin/laetrile is hardly a topic for productive or even legitimate medical research. But from my perspective, as a producer of California apricot kernels for more than 30 years, I can tell you that consumer interest in this subject is increasing markedly every year. My business produces about 300 metric tons of apricot kernels every year. I sell only to manufacturers of marzipan (ok, persipan if you prefer but in fact without adding apricot kernels for their benzaldehyde content pure almond paste tastes like sweetened cardboard). However, in the past 5 years I have had many calls from marketers selling apricot kernels on the internet. Sales are obviously booming because there is considerable and new competition these days for the raw material (apricot pits waste streamed by processors of fresh apricots). I wish these things protected against cancer, I really do, but I’m afraid the only effective purpose for amygdalin is chemical warfare by Prunus members against insects and small animals who might otherwise ingest their kernels before germination. And given the number of dead birds on the ground after ingesting some of the pits while they are dried every year, this cyanogenesis is serious warfare, believe me. By the way, as an organic chemist I fail to see any difference between amygdalin and “laetrile”, other than Krebs’ desire to develop a brand name.

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