A journal focused on child health and pediatric medicine has issued a somewhat surprising disclaimer to 138 case studies it has published: The stories were false. They made them up. The cases were “fictional.”
The case reports, which stretch back to 2000, were part of a series created by the journal Paediatrics & Child Health as part of its Canadian Paediatric Surveillance Program (CPSP). But, while the journal is a publication of the Canadian Paediatric Society, the impacts of these fabricated medical episodes have been truly international: Taken together, the fictitious cases have been cited 218 times, as fact, across the peer-reviewed medical literature.
The mass correction event was prompted by a telltale admission made to the New Yorker in January by a coauthor on one of the more controversial of these invented case reports, known as “baby boy blue.” This report, dating to 2010, described an infant allegedly exposed to opioids via breast milk due to his mother’s own consumption of acetaminophen with codeine.
“It is the most compelling published description of neonatal opioid toxicity from breastfeeding,” according to one longtime critic of these alarming claims about tainted breast milk, Dr. David Juurlink. “And it is wrong.”
“Corrections,” but not retractions
Dr. Juurlink, a professor of medicine and pediatrics at the University of Toronto, personally believes that the “baby boy blue” case is too inflammatory for a simple correction notice to suffice.
“The paper should obviously be retracted,” he told Retraction Watch, a publication of the nonprofit Center for Scientific Integrity. “It’s a fictional case portrayed as real and its scientific underpinnings have collapsed, yet it perpetuates them.”
Two other journal articles, published elsewhere, that also claimed significant or sometimes fatal doses of opioids delivered to infants via breast milk laced with codeine, have since been retracted. Another, a 2006 Lancet article, has also now been amended with an “expression of concern” about the integrity of the case study’s evidence.
The Lancet article alleges that an infant had been killed in 2005 by the breast milk of a mother who had been prescribed Tylenol 3, which contains 30 milligrams of codeine, an opioid, to augment the name-brand non-opioid pain reliever.
The editor-in-chief of Paediatrics & Child Health, Joan Robinson, told reporters that the disclosure to the New Yorker had prompted the journal to “add a correction notice to all 138 publications drawing attention to CPSP studies and surveys to clarify that the cases are fictional.”
“From now on,” she explained to Retraction Watch, “the body of the case report will specifically state that the case is fictional.”
Robinson added that the original intent in soliciting and publishing these reports was “that the cases should be fictional to protect patient confidentiality.” While these so-called “clinical vignettes” went decades without any clear flagging to readers for this dramatic license, submission guidelines to prospective authors as of 2015 did instruct authors to deliver “a fictional case as it relates to a study or a one-time survey,” which they wished to (presumably responsibly) dramatize.
Curiously, the submission guidelines from 2010, the year that Paediatrics & Child Health published its wholly invented opioid breastmilk horror story, did not instruct authors to submit fictionalized cases, however.
Downstream effects
While welcome and laudable, the corrections issued by Paediatrics & Child Health only begin to remedy the mess of misinformation created by the journal’s hundred-something made-up case studies.
As is standard practice, the Canadian journal also delivers the full text of its articles to PubMed Central, a free archive of peer-reviewed biomedical and life sciences journal research maintained by the U.S. National Institutes of Health’s National Library of Medicine. These versions of the fictional case studies on PubMed also bore no notice of creative license.
Worse, at least 61 of the 138 case studies have been cited by other journal articles at least once over the years, based on records kept by the citation database Semantic Scholar.
And, at least one author, Dr. Farah Abdulsatar, a pediatrician at the Schulich School of Medicine & Dentistry in Ontario, has been told that her factual case study published by Paediatrics & Child Health has now been mislabelled as fictional.
“The editor acknowledged that the editorial team is at fault for overlooking the fact that our case was real during the review process,” Dr. Abdulsatar said. But, the journal editor reportedly told her, going back to correct the correction “would be difficult.”
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