Dr. Scott Reuben: A Slap on the Wrist, Another Lie on the Lips

This piece was originally published on 1 August 2010. I only reread it due to its sudden surge in popularity among visitors to this blog, surpassing even those obsessed with that physician turd, Ochoa. Then I realized that Scott Reuben must be celebrating, not just one of the season's holidays, but his release from court-ordered supervision. May his patients be protected, his research unfunded, and any attempt at publication, refused.

In the course of preparing the recent posts on CRPS-related clinical trials, thoughts popped up of Dr. Scott Reuben.  I was reading the background for a trial about the anti-hyperalgesic effects of Coxibs, and Reuben's name and face came to the forefront of my consciousness when I read that there was "no valid information available" on the topic.

Yes, a quick review of the original 21 fudged and fabricated articles shows the long arm of Dr. Reuben, hard at work, and featured in a peer-reviewed journal:

Update on the role of nonsteroidal anti-inflammatory drugs and coxibs in the management of acute pain.  Reuben SS.  Curr Opin Anaesthesiol. 2007 Oct;20(5):440-50. Review.
PMID: 17873597

In fact, Reuben was prolific on the subject of coxibs (COX2 inhibitors), almost as if he had a personal stake in their reception and use:

[One journal editor] 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 (celecoxib) and Merck's Vioxx (rofecoxib), for applications whose therapeutic benefits are now in question. Reuben was a member of Pfizer's speaker's bureau and received five independent research grants from the company.

On June 24, 2010, Dr. Reuben was sentenced to 6 months in prison, after pleading guilty to a single count of fraud.  Oh, but that's not all. No, he also has to pay a $5,000 fine and $361,932 in restitution.  Lord only knows how much money was made in collusion with pharmaceutical companies and [I am convinced] silent partners (also known as "co-authors").

The legal system's wink at his wrongdoing and its impact is almost as insulting and frightening as the crimes themselves.

In my first post about Reuben, I asked:  "How to accurately quantify the amount of pain this man has caused? How many 'adverse reactions,' how much permanent impairment, how many deaths?"

The title of that first post was "Follow the money." By presuming him to be a common criminal, I seem to have hit upon the truth pretty easily.

Harrumph!

What trumps my harrumph is the load of total crap that has been delivered as his "defense," and which constitutes the ultimate insult to anyone dealing with pain management based on his fraudulent research.

The poor man fudged all those research studies while MANIC... My eye!  Mon oeil!

He surely is impugning the character of people with bipolar disorder by naming the psychiatric disorder as the cause of this fraud perpetrated on his field of study, his co-workers and larger colleagues, his patients, and science, in general. 

What an ass, what a jerk, what a con.

There is a growing literature on bipolar illness and criminality, most of it written by and for a medical audience.  In strictly legal terms, however, the liaison is more tenuous, in that a mood disorder does not affect cognition.

Comorbidity of psychiatric disease with twisted conduct, in the case of Scott Reuben?  Unless the claim is that depression and mania ought to be linked with some kind of periodic antisocial disorder... Oh, please.  It's such good news that he's feeling much better now.

If the mania of bipolar disorder mitigates his guilt in committing these frauds, what explanation is there for his failure to rectify his wrongs once he had cycled on to some other affective phase, once he had begun treatment? Unless, of course, he did not think that imposing his opinions constituted a crime because of his innate superiority, because of the presumed stupidity of his colleagues (the peer-review process didn't exactly have him shaking in his boots!) and patients (he never thought they would actually consult, and weigh the value of, his purported research).

Or, it could have been all about the money.

I fear that the delusions of mania being claimed as defense and explanation by Reuben are borne of the same deluded self-image that we encourage in our physicians and researchers, though we're much more comfortable with the narcissism of a trauma surgeon than we are of the pain manager/anesthesiologist.

Looking back, it's scary to see the evidence of our willingness, as patients, to subvert what we know to be right due to our own delusions, our worship of Dr. God.  Witness this comment left after one of the first discussions of Reuben's falsifications:

Keep in mind he isn't a person off the street he's a DOCTOR and has many years of service and experience...

And this, from one of his patients, still boggles the mind:

I do know that new drugs are not passed by FDA without a certain amount of research on so many people. I do know him and he was my Dr. for many years. Those people that know him and had him as Dr. can all say the same thing, you can't find a more gentle, caring, concerned Dr. as Scott Reuben. If all he did was altar names on charts then that's not so bad. Keep in mind the HIPA law.

If this doctor (married to a psychiatrist, by the way) lacked the massive insight required to know right from wrong in an instance such as inventing test subjects for a fictive drug trial, I might wonder if his problem was not so much a persistent megalomania but more a high-functioning psychosis.

Oh, but have no fear of future wrongdoing to complement his decades of past criminality, because Dr. Reuben will undergo THREE whole years of supervision upon his release.  How it is that he retains his medical license is beyond my powers of comprehension.  And clearly wrong, given the severity of his psychiatric impairment.

When Reuben entered his guilty plea, his attorneys claimed that he had been suffering from an undiagnosed bipolar disorder during the period when he committed the fraud, the apparent result of a manic phase. Reuben was unusually prolific with “research” projects during a 2000-2001 sabbatical, having published 8 papers. Dr. Reuben’s wife, Susan Romm Reuben, MD, is a psychiatrist. Dr. Reuben attempted suicide twice in 2002, his lawyers said. His claim of mental illness has been called under question however.

Glenn J. Treisman, MD, PhD, professor of psychiatry, behavioral science and internal medicine at the Johns Hopkins University School of Medicine in Baltimore, said that although some criminals have bipolar disorder, the condition does not necessarily foster antisocial behavior. “Lots and lots of people have bipolar disorder who don’t commit fraud,” Dr. Treisman said. Equally strange is when “that person was better and knew that he did wrong but didn’t come forward.” Dr. Treisman said it was “unlikely” that Dr. Reuben’s disease would have gone undiagnosed for so long, given that he was a physician married to a psychiatrist. “By the time someone’s tried suicide twice, their psychiatrist wife would have known something was going on,” he said.

Reuben’s bogus research was published in various prominent journals including Anesthesia & Analgesia, Anesthesiology, Journal of Clinical Anesthesia, Journal of Arthroplasty and other titles, which have since retracted the papers. The journals stressed that Dr. Reuben’s co-authors on those papers have not been accused of wrongdoing. He has been accused by at least two of his co-authors of putting their names on his papers without their consent. Anesthesiology News uncovered fraudulent inclusion of one co-author by contacting the alleged research partner he claimed.

Dr. Reuben’s research helped lay the foundation for an emerging area of perioperative care known as“multimodal analgesia”. The scope of the fraud has left “a large hole in our understanding of this field,” said Steven L. Shafer, MD, editor of Anesthesia and Analgesia, “It will take a while for science and practice to sort this out.”Anesthesia and Analgesia published more of the tainted papers than any other journal and quickly announced changes to its guidelines to avoid similar incidents. Allegations of rampant fraud involving Dr. Reuben’s research and the retraction of papers were first reported by Anesthesiology News (March 2009) after Baystate Medical Center officials uncovered evidence of wrongdoing following a routine audit. Falsified reports involved at least 21 articles dating back to 1996. The “research” was funded by grants from Pfizer, Merck & Co. and Wyeth/Rays of Hope for the drugs Celebrex, Vioxx and others.

For what it is worth, I cannot fathom how the pharmaceutical companies with which he colluded (there *had* to be collusion -- you know it, I know it) are walking away unscathed from the revelations of bad and evil science;  Nor do I understand how "co-authors" claim to be unaware of their publishing histories!  Academic publishing is highly insular... Who publishes, when, and where, is common knowledge, fodder for everyday gossip and little things like job retention and the granting of tenure. 

Maybe these hapless co-authors don't read some of the foundational journals in their field?  Is that their explanation?  Or -- maybe -- they were all so lost inside of a huge cloud of clinical depression that they just couldn't find the energy to care? 

More likely?  The Mysteriously Published were too busy meeting the needs of nymphomania, screwing their colleagues, right and left...

The Powers That Be may have blinked, and winked -- but not everyone has lost the capacity to unscramble the plots of this tragicomedy:

Pfizer: The Drug Giant That Makes Bank from Drugs That Can Kill You
 
To say Pfizer’s been accused of wrongdoing is like saying BP had an oil spill. Other drug companies have a portfolio of products, Pfizer has a portfolio of scandals including, but not limited to, Chantix, Lipitor, Viagra, Geodon, Trovan, Bextra, Celebrex, Lyrica, Zoloft, Halcion and drugs for osteoarthritis, Parkinson’s disease, kidney transplants and leukemia.

During one week in June Pfizer 1) agreed to pull its 10-year-old leukemia drug Mylotarg from the market because it caused more, not less patient deaths 2) Suspended pediatric trials of Geodon two months after the FDA said children were being overdosed 3) Suspended trials of tanezumab, an osteoarthritis pain drug, because patients got worse not better, some needing joint replacements (pattern, anyone?) 4) Was investigated by the House for off-label marketing of kidney transplant drug Rapamune and targeting African-Americans 5) Saw a researcher who helped established its Bextra, Celebrex and Lyrica as effective pain meds, Scott S Reuben, MD, trotted off to prison for research fraud 6) was sued by Blue Cross Blue Shield to recoup money it overpaid for Bextra and other drugs 7) received a letter from Sen. Charles Grassley (R-Iowa) requesting its whistleblower policy and 8 ) had its appeal to end lawsuits by Nigerian families who accuse it of illegal trials of the antibiotic Trovan in which 11 children died, rejected by the Supreme Court. And how was your week?

To read all posts about Scott Reuben on elle est belle la seine, click HERE.
Graphic credit: Clinical Guidelines for the Use of Coxibs in Osteoarthritis (OA) and Rhematoid Arthritis (RA)