Follow the Money: Scott Reuben, MD

Scott S. Reuben, MD.

Amazingly, I actually knew who he was before the news of his many years of academic fraud recently broke. There are not many authoritative researchers in the field of pain management, in general, and even fewer who further subspecialize in the treatment of CRPS/RSD.

Pain management doctors (most being anesthesiologists), physiatrists, and neurologists all probably refer to his "work" as justification for refusing to treat CRPS pain with opiates, opting instead for some "multimodal" (Dr. Reuben's buzz word) combinations that usually included Lyrica and anti-depressants.

Sad to say, he has "made" Wikipedia due to infamy rather than achievement.

His fabricated results date back to 1996 and did not actually perform *any* of the clinical trials upon which his voluble opinions were based. Colleagues and fellow researchers struggle to understand the reasons for this incredible case of academic dishonesty, named "misconduct"; Really, though, if investigators "follow the money," I am sure Dr. Reuben's reasons will become as clear as they are commonplace to most criminal activity.

One possible avenue of investigation springs readily to mind:

A cornerstone of Dr. Reuben’s approach has been the use of the selective
cyclooxygenase-2 inhibitor celecoxib (Celebrex) and the neuropathic pain agent
pregabalin (Lyrica), both manufactured by Pfizer. Dr. Reuben has received
research grants from the company and is a member of its speakers’ bureau.
However, a source told Anesthesiology News that Pfizer recently alerted its
speakers to remove any reference to Dr. Reuben’s data from their presentations.
Pfizer was unable to comment by the time this article went to press. The company
has not been accused of wrongdoing in the matter.

The extent of his fraud is hard to comprehend. He published influential research for 12 years about clinical trials that he never conducted. (I know I am repeating myself. It is just almost impossible to believe. How did he do it? He cannot have done this alone. Could he?) Decisions about anesthesia protocol and trends in treatment of chronic pain syndromes were based on his "work." He seems to have targeted the orthopedic community above others -- are OS less likely than others to look under rocks, to question the validity of research? I think not! Maybe it is simply that chronic pain is a common result after orthopedic surgery -- from osteoarthritis to CRPS -- and, like any surgery, a short period of acute pain is virtually guaranteed. And since he was purportedly conducting clinical trials, orthopedics would offer a good sized cohort of patients having similar surgeries -- anterior cruciate ligament repairs and other knee surgeries seemed to his liking, as well as amputations and spinal fusions.

In addition to Lyrica and Celebrex, Reuben was pushing Bextra, Effexor, and Vioxx:

The hospital has asked the journals to retract the studies, which reported favorable results from painkillers including Pfizer Inc.'s Bextra, Celebrex and Lyrica and Merck & Co. Inc.'s Vioxx. His studies also claimed Wyeth's antidepressant Effexor could be used as a painkiller. Pfizer gave Reuben five research grants between 2002 and 2007. He was a paid member of the company's speakers bureau, giving talks about Pfizer drugs to colleagues. Reuben also wrote to the Food and Drug Administration, urging the agency not to restrict the use of many of the painkillers he studied, citing his own data on their safety and effectiveness. "Doctors have been using (his) findings very widely," said Dr. Steven Shafer, editor of Anesthesia and Analgesia, a scientific journal that published ten articles identified as containing fraudulent data. "His findings had a huge impact on the field." Paul White, another editor at the journal, estimates that Reuben's studies led to the sale of billions of dollars worth of the potentially dangerous drugs known as COX2 inhibitors, Pfizer's Celebrex and Merck's Vioxx, for applications whose therapeutic benefits are now in question.

This biographic blurb describing Dr. Reuben and his work is frightening to read, knowing the truth:

Scott S. Reuben, MD is Director of the Acute Pain Service and Professor of
Anesthesiology and Pain Medicine at Baystate Medical Center and the Tufts
University School. He performed his anesthesia residency and fellowship in pain
management and regional anesthesia at Mount Sinai Medical Center in New York.
Dr. Reuben has authored over 100 articles and dozens of abstracts in peer reviewed anesthesia, pain medicine, surgery, and orthopedic journals. He has presented his papers and lectured at both the national and international level
speaking on all items of interest for the pain management practitioners and scientists, including acute pain management, pre-emptive analgesia, and the use
of various analgesics to manage pain. Dr. Reuben has served as an advisory board
member for the JCAHO, ASA Task Force for Acute Pain Management, and currently serves as a journal reviewer for Anesthesiology, Anesthesia & Analgesia,
Journal of Pain and Symptom Management, Journal of Clinical Anesthesia, Journal of Bone and Joint Surgery, Arthroscopy, Journal of Pharmacology and Therapeutics, and Lancet. In June of 2007 he authored the Current Concepts Review article in the Journal of Bone and Joint Surgery.

Advisor to JCAHO!

Journal reviewer!

Author of Current Concepts Review!

In a field where one hopes that reproduction of results -- basic to scientific method -- holds sway, how is it that these fictions were allowed to circulate and be emulated for so long? "Peer review" certainly should not be the sole arbiter of validity. Essentially, Reuben's work was rubberstamped by his "peers," or else he served as his own judge, and we see how well that worked out...

How to accurately quantify the amount of pain this man has caused? How many "adverse reactions," how much permanent impairment, how many deaths?