Pergamon Neuromusc. Disord., Vol. 4, No. 3, pp. 289-293, 1994

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BOOK REVIEWS

The Book Review Editor would be very happy to hear from anyone who would be willing to review books of interest to readers of Neuromuscular

Disorders.

Fraud and Misconduct in Medical Research. Edited by STEPHEN LOCK and FRANK WELLS. Published 1993 by BMJ Publishing, London. ISBN 0 7279 0757 3, 202 pp. Price £24.95.

Medical obituaries are reverential and medical autobiographies self-congratulatory. It is, there- fore, refreshing to learn from this book that a number of one's one colleagues are crooks. "Fraud and misconduct" are the terms used to describe a variety of falsification of medical data. The designation is reminiscent of Crimes and Misdemeanours, the title of a recent film of Woody Allen. In this the protagonist was an ophthalmo- logist and the misdemeanour in his case was murder. Interestingly, he was undetected.

The purpose of the book under review is to expose an under-reported species of medical misconduct, to enable prevention and reasonable retribution. The motivation to falsify data appears to be driven by the sins of greed and of pride. These are influenced by demographic factors. General practitioners are apparently avaricious, whereas academics are vainglorious. Whether these represent moral truths or the effects of opportunity deserves consideration. Financial pressures are more likely to influence a general practitioner to falsify therapeutic data in the U.K., whereas prestige is more likely to prompt the academic to rig scientific results in the U.S.A. The large rewards, for patients entering into therapeutic trials, made by the pharmaceutical industry, and the highly compe- titive stakes of medical science, especially in the U.S.A., are powerful, if not mitigating, forces in corrupting doctors. Temptation may set in when the general practitioner accepts the free lunch and conference expenses to a ski resort and when the senior academic appends his authorship to a paper, exempt from his contribution. Less venial sins of scientific fraud would seem to be based, as Peter Medawer believed, on scientific delusions

or self-delusions concerning a theory, rejected by the medical establishment.

The book grew out of a Royal College of Physicians' report Fraud and Misconduct in Medical Research, prepared by Stephen Lock, ex-editor of the British Medical Journal. He has been joined by Frank Wells, Medical Director of the Association of The British Pharmaceutical Industry, to extend the scope of the enquiry. Contributions are made from general practice, the pharmaceutical industry, medical statistics, lawyers, academics and journalists. There are contributions from France and Denmark. Questions are raised as to how to prevent fraud by reducing the obvious incentives and by introducing procedures to ease the detection of malpractice. Punishment would seem to lie properly with the General Medical Council in the U.K.

One would like to suppose that only a small and fixed proportion of one's colleagues are culpable, since healthy optimism and confidence in one's profession are the bonding agents by which we collectively make progress. As Peter Medawer has s t a t e d . . . "the critical scrutiny of all scientific findings - - perhaps especially one's own - - is an unqualified desideratum of scientific progress. Without it science would surely f o u n d e r - - but not more rapidly, perhaps, than it would, if the great collaborative enterprise of science were to be subjected to an atmosphere of wary and suspicious disbelief".

O. NEARY Professor of Neurology

Manchester Royal Infirmary

Brain's Diseases of the Nervous System, 10th Edn. Edited by JOHN WALTON. Published 1993 by Oxford University Press, Oxford, ISBN 0 19 261969 l, 801 pp. Price £95.

Comparing this latest edition of "Brain" with earlier editions (the first was published in 1933) is

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