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)

Have you seen Scott Reuben?

Another bit of housekeeping, this related to a promise to keep half-an-eye on ex-con physician Scott Reuben.  To read my previous posts on "doctor" Reuben, click HERE.  While we wait for him to make [up] the news again, here's the obvious question on many peoples' minds:

Big Pharma's Ghostwriters
Why Are These Fraudulent Papers Unretracted?
by MARTHA ROSENBERG

According to Science Times, the Tuesday science section in the New York Times, scientific retractions are on the rise because of a “dysfunctional scientific climate” that has created a “winner-take-all game with perverse incentives that lead scientists to cut corners and, in some cases, commit acts of misconduct.”

But elsewhere, audacious, falsified research stands unretracted–including the work of authors who actually went to prison for fraud!

Richard Borison, MD, former psychiatry chief at the Augusta Veterans Affairs medical center and Medical College of Georgia, was sentenced to 15 years in prison for a $10 million clinical trial fraud[2] but his 1996 US Seroquel® Study Group research is unretracted.[3] In fact, it is cited in 173 works and medical textbooks, misleading future medical professionals.[4]


Scott Reuben, MD, the “Bernie Madoff” of medicine who published research on clinical trials that never existed, was sentenced to six months in prison in 2010.[5] But his "research" on popular pain killers like Celebrex and Lyrica is unretracted.[6] If going to prison for research fraud is not enough reason for retraction, what is? [Please read the rest of the article HERE.]



[1] http://www.nytimes.com/2012/04/17/science/rise-in-scientific-journal-retractions-prompts-calls-for-reform.html?_r=1&pagewanted=all

[2]  Steve Stecklow and Laura Johannes, “Test Case: Drug Makers Relied on Two Researchers Who Now Await Trial,” Wall Street Journal, August 8, 1997

[3] Richard Borison et al., “ICI 204,636, an Atypical Antipsychotic: Efficacy and Safety in a Multicenter, Placebo-Controlled Trial in Patients with Schizophrenia,” Journal of Clinical Psychopharmacology 16, no. 2 (April 1996): 158–69

[4] Alan F. Schatzberg and Charles B. Nemeroff, Textbook of Psychopharmacology (New York: American Psychiatric Publishing, 2009) p. 609

[5] http://www.scientificamerican.com/article.cfm?id=a-medical-madoff-anesthestesiologist-faked-data

[6] Scott Reuben et al., “The Analgesic Efficacy of Celecoxib, Pregabalin, and Their Combination for Spinal Fusion Surgery,” Anesthesia & Analgesia 103, no. 5 (November 2006): 1271–77.

Manor Keeping and Blog Chores

There are so many housekeeping chores that need doing to get this blog back in shape.

I promised to follow three things in particular -- news and developments about missing child Lindsey Baum; news and developments about Dr. Scott Reuben; and updated information on CRPS Clinical Trials.

Now, of course, I would add the four cancer kids that I follow, as well as the continuing truth that Dr. Jose Ochoa is a Turd.

And then, well, there is my fascinated hatred for creatures like Dr. Phil and Oprah, and my desire to wrench others away from their mesmerizing bullshit.  These are people of quality who just refuse to trust themselves, who have a tendency to love being on the receiving end of domination.  (What?  It's only the truth.  Domination, even cruelty, equals attention, and they have been denied attention their whole lives.  All they want is to be seen and heard -- no matter that they are being used, pimped, fucked.)

Of course, dealing with osteomyelitis and CRPS (the biggies) has completely taken over elle est belle la seine la seine elle est belle, whether I allow a safari vacation into Amerikan politics, French politics, socialist circles, or even the wild and woolly adventures we have in the various kitchens of Marlinspike Hall. My pus-dripping bones and my wildly contorting legs and hands trump the hell out of the Militant Lesbian Existentialist Feminists, even the three of them who'd switch teams in a New York minute if it meant they could hunker down with my oblivious Fred.  I did not fall off of the produce truck recently and although I was born at night, they had to use pitocin.

I've put life in The Manor and the many fascinating details of maintaining such a landmark on the blog's back burner, too, but, O! There are reasons for that and fear not, as soon as we are covered by the expected extensions of President Obama's Dream Act to us outlanders, Tante Louise will call off the surveillance.. Okay, so we're not young, but we are illegal, and we are immigrants.

We are squatters!

La Bonne et Belle Bianca Castafiore is so head-over-heels in lust with Sven, and they both are steadfastly and stealthily kept in view by Sven's lad Cabana Boy -- and to tell the truth, this has killed some of my desire to write.  They keep the air redolent with stinky tension.

I almost and by complete ACCIDENT killed myself yesterday -- by gentle respiratory depression.  Fentanyl patches, according to the manufacturer, are to be changed every 72 hours.  My pain guru wants me to change them every 48 hours.  I, of course, allow the earlier applied one to stay on an extra day, thereby milking out, or so I hope, every bit of pink-unicorn-fart pain relief.

The things do not stick well to my skin, mostly because I constantly cycle between being hot and dry, having sweats and chills.  Also, I bathe.  I bathe a lot.

Okay, this bothers me, so just let me get it out of my system, as if it were a bit of toxic fentanyl floating around in my psychic innards.  I love a bath.  I haven't been able to take a bath since... 2000.  I shower.  I use a shower chair and one of those wunnerful, wunnerful wand shower heads.  I leave the bathroom sobbing and usually have to take a rescue dose of endocet and climb in bed, praying and crying, snot all over the place, sweating, destroying that fresh, clean feeling a shower is supposed to impart.  Now, due to weakness and spasms, I shower twice a week.  I bathe at the bathroom sink twice a day, usually more often.  I use various antiseptic products, especially the ones that are commonly used as preop washes, trying to destroy any goddamn p. acnes bacteria hanging around.  I've been told this is a ridiculous thing to do, as well as impossible and perhaps undesirable... but I do it anyway.  I stomp on those toxic bastard bacteria.

Whew.  Okay.  Yeah, so bless my Stepmother who inculcated in me an obsession for cleanliness.  Captain Haddock sure gets his money's worth out of my hyperfocus -- there are no cleaner medieval tapestries than the ones hanging on his manor's walls.  I was born a maid.

Okay, let's reword that:  I was born with maid tendencies.  When I took career assessment testing in junior high school, the answer was always, "be a maid."

There are twisted ways that could have gone.  I clean up.  I believe I'd also have been a great assassin.  I used to maintain a list of People Who Need Killing -- but someone, somewhere, must have snagged a copy, because they all just sort of started dying without me doing a doggone thing.  And now, the world has changed so much, so quickly, that I am scared of making a mistake -- so no one has been added to the People Who Need Killing List since Pinochet died.  Six years of no entries.  A rusty assassin is a useless assassin.  Just ask Clint Eastwood, or the chair.

I spent the night screaming.  Pain. Muscle Deformations.  I kept dreaming that my Father, recently deceased, who had been dreamily safely ensconced in a federal prison, had been released and no one knew where he was.  I dreamt he was comin' after me.  Then I would wake to find my right leg jammed into the wheelchair, and my body turned on my left non-existent shoulder.  And so on and so forth.  I finally got up at 3 am, mad.  Mad at whom, I've no idea, but Fred was up, so I treated him to some of the door-slamming he so loves.  He didn't notice a thing, the benevolent abstraction!

So I decided to calm myself and quiet down the door banging by taking a shower.

At which time I discovered FOUR fentanyl patches, all firmly adhering to my skin.  All should have been neatly labelled with the day applied (I put a bandaid over them to help keep them on when the sweats and chills kick in, and write the application date onto the bandaid).

To the best of my muddled recollection, twice I thought the thing had fallen off, and so twice had replaced the supposedly missing pain patch with a new one.  And in each case, it was the bandaid that was gone, not the patch.  Yes, I had opened a new box of Made in the USA bandaids, a pharmacy brand that shall be henceforth banished from this usage, at least.

Yes, my eyes are that bad, also the patches are pretty much translucent.  I had been fretting about the cats, fearing that they'd find the fallen fentanyl "pain systems," lick them, play with them, and promptly die.  Sven, Bianca, and Cabana Boy?  They are more drinkers than druggies.  And Fred laughs at the idea that exposure to fentanyl could harm him.  I also had a good fret or two over the koi, thinking that maybe the patches went flying out some window and down into the moat.

We've banned the carnies and Cirque du Soleil habitués from entering The Manor, so I couldn't see how the true fierce addicts around me could have gotten hold of them -- and lately, they've all been confined to The Barn.  Long story.

Yeah, so I almost died, sorta.  I mean, I guess I could have.  I was certainly drowsy enough and snoring like a giraffe troubled by amplified adenoids -- before all the pain (despite four fentanyl patches) and contractions pushed me from the bed, to work, to a good sweat, to another shower.

The irony is that this week I am meeting with a lawyer to rework my living will, my standard will, my various powers of attorney, and seeking guidance on getting a DNR.

I can tell you that there is NO news about Lindsey Baum, that Scott Reuben chafes under the restrictions placed upon him (I'm sure it is a mystery to him why trust is so hard to come by), and if you want the latest CRPS clinical trials, it's easy -- just go HERE.  The only extra gifts I ever offered in my listings of the clinical trials were my not-so-expert opinions, and adding some suggested reading to better understand what was at stake.  But you, Dear Reader, don't require that.  It was more along the lines of me, as a high school sophomore, "showing my work" on a geometry test.  Yes, a "proof" of some kind.

Of the four young ones fighting cancer that I follow, Hannah is doing great, as is Kate (she shows no evidence of *any* tumor!), Braydon struggles, and the last young man will not live much longer.  I am also following a teenager, mostly because I saw her picture after she had died her hair a beautiful punk pink -- before losing it all, of course, by a new course of chemotherapy. She has relapsed but is kicking cancer's big fat butt by a punked out perky attitude, and by loving parents who never leave her side, and who pray all the live long day.  There are others -- you cannot help yourself, because the kids you follow all have blogging parents who do not cease to ask for your consideration for the kid in the room next door, or for so-and-so who has developed a nagging pain but whose MRI is not scheduled until October...  I can tell you that pediatric oncologists must have a healthy respect for parents and their "gut feelings," their intuition, their "something is not right with my child." In short, my cancer kids are doing better, as a group, than they usually are, and they are inspiring and uplifting, each and every one.

I posted a piece called "Billy" on September 5.  He's not a cancer kid, he's a cancer grown-up!  He has stage 4 lung cancer, and I will save my speeches on smoking, because, as an ex-smoker, I do understand.  No, not true, he continues to smoke, and THAT, I cannot fathom.

Anyway, Dear Readers, Billy and Joyce are an odd couple, getting closer now that it is too late to say their marriage was a good one.  But they do understand one another and they do love each other.  She has carried on her back the welfare of two grown daughters, both of whom refused to leave home, one of whom has three boys, all with what we like to call "issue." Joyce's siblings and other close relatives all struggle with addiction.  She is raising one of her sister's children, which is the working miracle in that child's life, because Joyce never gave in to addiction, never gave in to the lifestyle and values around her.  So Shawna is a star student with a bright future.  Joyce is disabled now, living entirely on entitlement programs, as is everyone in the family, really.

Billy is schizophrenic.  He is a U.S. military veteran.

They have *nothing* but the items in their apartment, in material terms.  No vehicle.  The vast wealth of their benefits tend to run out before the month does.

And now he has been dumped there, in a hospital bed, with oxygen, a walker, and all that good stuff.  Hospice is supposedly on the case, but mostly they have dumped him, too -- telling Joyce to do this, this, and this... and Joyce is sick and tired, and also still overseeing her girls and her three grandsons.  She has to walk everywhere, and most of her pain is centered in her legs and back, so those walks, that she used to love, are now akin to traipsing from Bataan to Corregidor.

Give them some money.  Christina, one of Joyce's daughters, has set up a fundraiser through the very legitimate FundRazr.  Ask questions, if you are dubious.  Give a dollar, two, or three.  That's more than they have, even after digging under the cushions on the sofa.

Listen -- they save stray cats.  They keep those sons and grandsons in scouting, in church.  They guard their innocence fiercely.  They tend to Billy as best they can but are obsessed with not having the money to bury him.  Joyce hates vegetables.  Her other daughter is mentally ill but helping out as best she can.  Shawna's biological mom is back on drugs and as recently as yesterday, Joyce forced her off the premises with the instincts of a good, protective parent.

The problems are a burden even to listen to.  But they're real... and Joyce has begun to turn her life around, and where her life goes, all those other lives glommed onto her for sustenance?  They get turned around, too.
I don't want to see one iota of the beautiful progress this beautiful woman has made degraded by something as obscene as CANCER and a Veteran's Administration that just doesn't give a hoot.

That's about it for me right now.  One of the 843 smoke and carbon monoxide detectors in Marlinspike Hall is chirping, letting me know it's in need of a fresh battery.  I'm going to get The Gun and shoot it.  As soon as I find it....

Additional Sanctions Against Scott Reuben

Scott S. Reuben: Debarment Order

A Notice by the Food and Drug Administration on 11/16/2011

SUMMARY

The Food and Drug Administration (FDA) is issuing an order under the Federal Food, Drug, and Cosmetic Act permanently debarring Scott S. Reuben, M.D. from providing services in any capacity to a person that has an approved or pending drug product application. FDA bases this order on a finding that Dr. Reuben was convicted of a felony under Federal law for conduct relating to the regulation of a drug product under the Federal Food, Drug, and Cosmetic Act. Dr. Reuben was given notice of the proposed permanent debarment and an opportunity to request a hearing within the timeframe prescribed by regulation. Dr. Reuben failed to respond. Dr. Reuben's failure to respond constitutes a waiver of his right to a hearing concerning this action.Show citation box

TABLE OF CONTENTS

• DATES:
• ADDRESSES:
• FOR FURTHER INFORMATION CONTACT:
• SUPPLEMENTARY INFORMATION:
• I. Background
• II. Findings and Order

Scott Reuben "MD": His Unmitigated Gall

Twenty-six thousand patients die each year in the US from NSAID induced complications. Paul White, an A & A Editor, has estimated that billions of dollars of Cox-2’s were sold based on Dr. Reuben’s papers and he adds,  “For now, at least, neither the drug companies nor Reuben’s co-authors are officially sharing in the blame, but that’s expected to change."

“There’s a lot of responsibility to pass around,” White says. “It’s all being focused on Scott Reuben, but the reality is there are many other responsible parties." We will never know how many patients received NSAIDs during a very stressful and high risk time and how many may have been injured or died from Cox-2 related complications.

-- "Welcome to the Fraudosphere," PainPoints

The Affordable Care Act contains some interesting, little known provisions, among them a strengthening of the preexisting federal False Claims Act.  As one article put it, "experts warn that doctors need to be ready." Guffaw!


It was this expansion of liability that resulted in GlaxoSmithKline's $750 million in penalties for having sold "mixed-up products, diabetes drugs with too much or too little of the clinically effective ingredient," and for manufacturing drugs in "a nonsterile area of the facility that was used to make injectable drugs and [using] a water system contaminated with microorganisms."

In 2009, the Health Care Fraud Prevention and Enforcement Action Team (HEAT) in the first six months of operation recouped almost $3 billion in penalty payments.  The ACA provides $350 million over the course of a decade for the work of the HEAT Task Force.  That's a pretty decent return.

All of that reading and talk of fraud made me wonder what the inimitable Scott Reuben, MD might be up to these days, now that he's out of prison and all.

By the evidence, he is no closer to renouncing the self-serving tendencies that got him to the Big House of Correction to begin with.  He continues to offer the transparent excuse that he was out-of-control due to undiagnosed bipolar disease.  Undiagnosed (and unremarked upon) for well over a decade!  Even his wife, a psychiatrist, failed to pick up on it during all those years that he spent assiduously committing one of the worst known cases of medical and academic fraud.

I guess we should file the following document under "Unmitigated Gall," next to my previous ten posts about Scott Reuben, the Medical Madoff.


Department of Health and Human Services
DEPARTMENTAL APPEALS BOARD
Civil Remedies Division


Scott S. Reuben, M.D.,
(O.I. File No.: 1-09-40105-9),
Petitioner,

v.

The Inspector General.
Docket No. C-11-664
Decision No. CR2481
Date:  January 6, 2012

DECISION


Petitioner, Scott S. Reuben, M.D., asks review of the Inspector General’s (I.G.’s)
determination to exclude him for five years from participation in the Medicare, Medicaid,
and all federal health care programs under section 1128(a)(3) of the Social Security Act
(Act).  For the reasons discussed below, I find that the I.G. is authorized to exclude
Petitioner and that the statute mandates a minimum five-year exclusion.

Discussion 
The sole issue before me is whether the I.G. has a basis for excluding Petitioner from
program participation.  Because an exclusion under section 1128(a)(3) of the Act must be
for a minimum period of five years, the reasonableness of the length of the exclusion is
not an issue.  Act § 1128(c)(3)(B); 42 C.F.R. § 1001.2007(a)(2).

The parties have submitted their written arguments (I.G. Br.; P. Br.), and the I.G. filed a
reply.  With his brief, the I.G. submitted four exhibits (I.G. Exs. 1-4).  In the absence of
any objections, I admit into evidence I.G. Exs. 1-4.


I directed the parties to indicate in their briefs whether an in-person hearing would be
necessary and, if so, to describe the testimony it wishes to present, the names of the
witnesses it would call, and a summary of each witnesses’ proposed testimony.  I
specifically directed the parties to explain why the testimony would be relevant.  Order
and Schedule for Filing Briefs and Documentary Evidence, Attachment 1 (Informal Brief
of Petitioner ¶ III) and Attachment 2 (Informal Brief of I.G. ¶ III) (Sept. 9, 2011).  The
I.G. indicates that an in-person hearing is not necessary.  Although Petitioner does not
directly respond to the question, he does not contend that an in-person hearing is
necessary and lists no potential witnesses.  I therefore conclude that an in-person hearing
is not required.

Petitioner must be excluded for five years because he was 
convicted of felony fraud in connection with the delivery of 
a healthcare item or service. 1

I make this one finding of fact/conclusion of law


Petitioner was a Massachusetts anesthesiologist who contracted with the drug
manufacturer, Pfizer, Inc., to conduct clinical studies on patients to determine the efficacy
of a certain drug in treating post-operative pain.  Pfizer paid for the studies.  Petitioner
subsequently claimed to have conducted the studies, administering the tested drug to 100
post-surgical patients and a placebo to another 100 post-surgical patients.  He published
papers in a scientific journal claiming to have achieved success with the tested drug.  In
fact, he had not enrolled any patients in any study, and he fabricated the “results.”  I.G.
Ex. 3 at 12-16.

On June 24, 2010, Petitioner pled guilty in federal district court for the District of
Massachusetts to one count of felony health care fraud, 18 U.S.C. § 1347.  Under that
provision, a person commits health care fraud if, “in connection with the delivery of or
payment for health care benefits, items, or services,” he “knowingly and willfully
executes, or attempts to execute” a scheme 1) to defraud a health benefit program or 2) to
obtain, “by means of false or fraudulent pretenses, representations, or promises,” money
or property owned by a health benefit program.

The court accepted Petitioner’s plea and entered judgment against him. I.G. Exs. 2, 4.
In a letter dated June 30, 2011, the I.G. advised Petitioner that, because he had been
convicted of a felony offense related to fraud, theft, embezzlement, breach of fiduciary
responsibility or other financial misconduct in connection with the delivery of a
healthcare item or service, the I.G. was excluding him from participation in Medicare,
Medicaid, and all federal health care programs for a period of five years.  I.G. Ex. 1.


Section 1128(a)(3) provides that an individual or entity convicted of felony fraud, theft,
embezzlement, breach of fiduciary responsibility, or other financial misconduct in
connection with the delivery of a health care item or service must be excluded from
participation in federal health care programs for a minimum of five years.  See 42 C.F.R.
1001.101(c).  Because Petitioner was convicted of felony health care fraud, he is subject
to exclusion.

Petitioner does not deny that he was convicted of felony fraud in connection with the
delivery of a health care item or service.  Instead, he attributes his misconduct to mental
illness, points out that his practice as a clinician is unblemished, argues that he has paid
his debt to society, and maintains that he is ready to resume his medical career.  These are
simply not bases for overturning a mandatory exclusion.

Conclusion
For these reasons, I conclude that the I.G. properly excluded Petitioner from participation
in Medicare, Medicaid and all federal health care programs, and I sustain the five-year
exclusion.


Carolyn Cozad Hughes
/s/
Administrative Law Judge



Photo credit:  Details

The One Where I Hum "Qué Será, Será" Like Doris Day On Ketamine

Hullo, all. It's been a busy week; I'm exhausted. So straight to the most recent CRPS MedWorm offering. It's a case study, is all, but a good reminder that sometimes the "cause" of CRPS can be a seemingly insignificant event:

Summary
Complex regional pain syndrome (CRPS) is a chronic progressive disease characterised by severe pain, swelling and changes in the skin. Precipitating factors include injury and surgery, and a variety of causes have been described. We present the case of a 68-year-old lady who presented with features indicative of a CRPS following steroid injection for a ‘trigger’ thumb.
--Published in the October 2010 issue of the Journal of Plastic, Reconstructive and Aesthetic Surgery, Volume 63, Issue 10

Something equally innocuous can cause "spread" of CRPS, as well, which is why someone with the disease can be particularly anxious about injections, blood draws -- and, needless to say, things like surgeries.

I have wanted to politely bop a few nurses and lab techs on their pointy little heads for rolling their eyes at my concerns about being stuck in a CRPS-afflicted limb. Even my top-notch, worldclass, wunnerful::wunnerful surgeon doesn't follow all the established precautions for preventing spread... I have shared with him the protocols I find, which include early admission for i.v. infusions and pain meds (yes, ketamine is involved!) and similar infusions afterward -- something that purportedly stops spread and prevents "flare." [These are the recommendations at the Hospital for Special Surgery, an orthopedic Mecca.]

If anyone doubts how far reaching the Dr. Scott Reuben scandal is? One of the often recommended articles on prevention of CRPS spread during/after a surgical procedure is called, nattily enough: Preventing the Development of Complex Regional Pain Syndrome after Surgery
and yes, the author is "Reuben, SS."

He pops up again with Perioperative Pregabalin Reduces Neuropathic Pain at 3 Months after Total Knee Arthroplasty (TKA) and if you are certain that he is not simply a mercenary in his promotion of Pregabalin, then you are a trusting, simple, stupid soul.

On the other hand, the level of my distrust might be excessive.

[It could happen.]

The ideas posited in Surgery on the Affected Upper Extremity of Patients with a History of Complex Regional Pain Syndrome: The Use of Intravenous Regional Anesthesia with Clonidine are considered indisputable, or were, given Reuben's ghoulish signature on the work.

I look forward to the day when baby and bathwater can be carefully and correctly identified, separated -- and the cold, scummy liquid discarded.

In the meantime, take all the precautions that you can when someone approaches your CRPS-afflicted regions. At the very least, say "Stop! Don't touch..." and then take a moment to talk things out with the person in front of you, readying to wield some invasive tool -- because as much as I have maligned nurses and phlebotomists, I have encountered some who were very well informed and who promptly took preventive measures (using the smallest of butterflies, avoiding nerve-rich areas, etc.).

What is immeasurably valuable is the relief that comes from dealing with a health care professional who is familiar with this bug-a-boo syndrome.

The very best advice about surgery in people with CRPS? Avoid it.

Don't get me wrong... You *can* rely on certain truths in this world, in this life.

Scott Reuben is still a dirtbag, and Jose Ochoa remains a big, fat turd.

FAIL Blog

there are things that just should not be.

someone entering the following searches should not be directed to this piece-of-fluff, navel-gazing blog:

CRPS + facial pain
new wheelchair
laxative XXXporn**
andrea gianopoulos lancaster pa*
andrea gianopoulos and laura beckett, ketamine kills*
scott reuben
tennis undies
severe bras
xxxporn**
belle sex positions**
rsd/crps law suits
fear fire famine foes
crps rsds cure
amputation cures rsd
marqueterie fraud
boobs whishes
lindsey baum
mrsa and paralyzation
crps 10 pain
laura beckett*
rsd on fire
gambling your heart away near the seine
i know where lindsey baum is
wheelchair lift honda
what kind of cancer killed leslie scalapino

and the one that prompted this failed post, in this failed blog -- the one that logged in at 3:03 in the morning, some woman, some man, sitting, nursing a cup of cold, burnt coffee, elbows propped on that red formica dinette table, long in the family, forehead damp from humidity, not heat, god damn it:

doctors in sedalia missourri that takes wellcare

*Months after posting about Andrea, her father and sister wrote me, very angry. In their eyes, I defamed her and said hateful things. They were very hurt by what I wrote, and reminded me how little I actually knew about her, her life, and her death. I have left the posts untouched but want to acknowledge their deep and abiding pain at seeing her name in a silly blog maintained by a silly blogger. Good things will continue to be born through their daughter, their sister, by virtue of the work she did, and the example she set. And Laura Beckett? I wait in pregnant silence for some lecture or outburst about my rude insinuations... but the lectures and the outbursts never come, and that only seals the seams of my knowledge, that only leaves her in unresolved expectancy, that only means she gambled, and she's been punished. I hope to hear of her dancing her way out of the rehab center one day, pain free. More selfishly, I hope the ketamine coma is perfected, and proves to be a real, accessible answer.

**Okay, so I find that kind of... tittilating. La Bonne et Belle Bianca Castafiore, Fred, and The Four-Now-Three Felines cannot stop their giggles, and -- very strangely -- keep checking themselves out in the Roman mirror of blown glass coated with molten lead, that serves as a sort of night light for the passageway to The Laundry Suites. The thing dates from the first century AD and we've no idea how The Captain's family got their sticky little hands on it. Undoubtedly it involved stuff like "swashbuckling," and "booty." I still don't know how to clean it... but have watched enough Antique Roadshow to know that leaving it as is is probably the best thing. Should you know the proper cleaners to use on first century AD Roman mirrors? Leave me a note.

But I digress (because sometimes, most times, that's all I know to do).


[a slightly revamped repost]

Scott Reuben, Come on down! Let's Make a Deal!

Newsflash -- courtesy of WSJ Health Blog:

It looks like Scott Reuben, the Massachusetts anesthesiologist said to have used phony research data in 21 published papers, has reached a plea deal with
the feds.


Federal prosecutors accused Reuben of health-care fraud for allegedly
faking data that suggested after-surgery benefits from painkillers including
Merck’s Vioxx and Pfizer’s Bextra and Celebrex, the Justice Department said yesterday. The Justice announcement said he faces as much as a 10-year sentence and a $250,000 fine.

But the Associated Press said Reuben, the former chief of acute pain at Baystate Medical Center in Springfield, has agreed to plead guilty in exchange for prosecutors recommending a more lenient sentence. The sentence
would also reportedly include forfeiting assets of at least $50,000 that Reuben
received for the allegedly phony research. The Republican, a Springfield newspaper, said Reuben has signed a plea agreement under which he must pay $420,000 in restitution to pharmaceutical companies.

Reuben is accused with taking pharma money for doing research, then fabricating results and getting studies published in anesthesiology journals.The tale began to unravel last year as Baystate said it found Reuben had faked data and the Boston U.S. attorney began looking into the case. (For refreshers, see our posts here and here.)

Reuben’s attorney has said in the past his client cooperated with the hospital review and expressed regret. The lawyer didn’t immediately return a call for comment after Thursday’s federal complaint, the AP said.

Trinity

There are three topics that I hope to keep alive on this blog until such time as it is no longer necessary: the missing child Lindsey J. Baum, updates on CRPS clinical trials, and the infamous case of Dr. Scott Reuben.

The hopes, of course, are that Lindsey will be found, the clinical trials will end up being unnecessary, and Dr. Reuben will be in jail.

Then, too, I continue to find interesting related information in the process, like this article on the frequency of scientific fraud that popped up when I updated my googling of Scott Reuben this morning. I found it at an odd site for archived group mail -- the group in this instance being one about Sustainable Fuels! It was originally published at Natural News but it is worth taking a look at it where I first found it -- just for the supporting articles added at the end.

So -- one in seven "scientists" say that their colleagues falsify the data in their research. If that's the ratio among those willing to admit such a thing -- the actual numbers are awful to contemplate.

One in seven scientists report that they have known colleagues to falsify or
slant the findings of their research, according to a study conducted by
researchers from the University of Edinburgh, Scotland, and published in the
journal PLoS One.

A number of scientific data falsification scandals have emerged in recent years, such as the case of a South Korean researcher who invented data on stem cell research. At the same time, increasing controversy over close industry ties to medical research has called into question whether researchers who take money from drug companies might be induced to falsify their data.

"Increasing evidence suggests that known frauds are just the tip of the iceberg and that many cases are never discovered," said researcher Daniele Fanelli.

The researchers reviewed the results of 21 different scientific misconduct surveys that had been performed between 1985 and 2005. All respondents were asked whether they or anyone they knew of had taken part in either fabrication (outright invention of data) or "questionable practices."

Questionable practices were any improper procedure short of fabrication, including failing to publish results contradicting one's prior research, modifying data based on a "gut feeling," changing conclusions after pressure from a funder or selectively choosing which data to include in an analysis.

One in seven scientists said that they were aware of colleagues who had engaged in fabrication, while nearly half -- 46 percent -- admitted to knowing of colleagues who had used questionable practices. Only two percent, however, admitted to fabricating results themselves.

While two percent is higher than previous estimates of the prevalence of data fabrication, researchers believe that the number is still too low. In all likelihood, it reflects both a reluctance by researchers to admit to serious misconduct and a tendency to interpret one's behavior as favorably as possible -- questionable instead of fabrication, or acceptable rather than questionable.

Researchers in the medical and pharmacalogical fields were the most likely to admit to misconduct than researchers in other fields.

Well, thank goodness that medical and pharmacological fields lead the pack in fraud! Jeez... And to round out my failing opinions of those industries:

Six prominent medical journals "published a significant number of articles in 2008 that were written by ghostwriters financed by drug companies," according to a New York Times story. The story cites a study by JAMA editors presented at an international meeting of journal editors.

Overall, 7.8% of the authors who responded anonymously to an online questionnaire "acknowledged contributions to their articles by people whose work should have qualified them to be named as authors on the papers but who were not listed," according to the Times.

Here is the "ghostwriting" rate by journal:

New England Journal
of Medicine – 10.9%;
JAMA – 7.9%;
Lancet – 7.6%;
PLoS Medicine – 7.6%;
Annals of Internal Medicine – 4.9%;
Nature Medicine – 2%.

The editors of the NEJM objected that the study "used an improperly broad definition of ghostwriting," according to the Times, an objection that one of the study's authors dismissed.


*Oh, and there was no updated news on either Lindsey Baum or Scott Reuben. But an updated list of clinical trials can always be found here.

photo credit: US Dept. of Energy, The Manhattan Project, The Trinity Test

Scott Reuben, Still At Large

I've not lost interest in the doings of one Scott Reuben, M.D. Some amazing damage control is in play, as there is virtually no new information to add to the astounding material that initially brought him infamy.

You would think, or at least, I would, that he'd have made The List by now -- the HHS-OIG Fraud Prevention and Detection, finely tuned to his state of Massachusetts. A space awaits him between James Regan and Robert Reynolds.

Over at vitals.com, where his list of publications tops off at a mere 72 (none of which should inspire any confidence), there is also this, called a "Personal Statement":
I AM CURRENTLY PRACTICING MEDICINE IN MASSACHUSETTS. MY NYS LICENSE WAS OBTAINED FOR POSSIBLE RELOCATION PURPOSES.

I was unable to find him listed as a treating physician at either Baystate Medical Center in Springfield or Mary Lane Hospital in Ware, also a Baystate Health facility, which ought to be of some comfort...

Every time I see or hear his name referenced as an "expert" on CRPS? I want to tweak his little nose, bop his teeny ears, tap dance on his scuzzy little soul...

What is it that keeps him from being criminally charged? Hmm?

If any of you, Dear Readers, have updated information on Dr. Reuben, please clue me in. Thanks.

Doctor Scott Reubin: Reprise

I bet you thought he'd faded from my memory -- me and my mind like a steel trap. Wrong! There is just a dearth of information out there, which means, I fear, nothing good.

It is odd to me that only non-medical people seem to be urging the precise and intense application of criminal charges on the hide of Dr. Scott Reuben, fraud extraordinaire.

Tufts, where do they stand? Patients, colleagues? Those innocent "co-authors"? The, cough, innocent, gag, drug companies? The FDA?

Who really believes that he did all the work of conducting fake clinical trials and the resultant fake articles and fake peer reviews and all the other fakiness... without help?

We cannot afford to let this case fade from attention.

To refresh the particulars of the case, here is an excellent take on the crime, found over at e-patients.net, "Dr. Reuben deeply regrets that this happened."

"Dr. Reuben deeply regrets that this happened." Isn't that a riot? Isn't that the most insulting response imaginable?

Back on March 23, Gilles Frydman put together a post on what he tongue-firmly-in-cheek called
"the third... in the unfortunate series about conflicts of interest":

In truth the quote is from one of his attorneys. Dr. Reuben, a world-famous anesthesiologist and former chief of acute pain management at Baystate Medical
Center, Springfield, Mass, one of the campuses of Tufts University School of Medicine is accused to have fabricated over 13 years at least 21 medical studies
(and perhaps many more among the 72 papers written by the good doctor) that
claimed to show benefits from painkillers like Vioxx and Celebrex, 2 drugs since
withdrawn from the U.S. and worldwide market due to safety concerns of an
increased risk of cardiovascular events (including heart attack and stroke).
Most, if not all, of these articles are in the process to be retracted. The
wonderful Dr. 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 fabricated data to prove their safety and effectiveness....

Even better Dr. Reuben published fabricated studies showing the great effectiveness
of a combination treatment using 2 drugs from Pfizer, Celebrex and Lyrica. No
one paid attention to the fact that, like Dr Robinson and Dr. Ridker et al. Dr.
Ruben was regularly paid by pharmaceutical companies. In fact he was active as a
member of Pfizer speakers bureau until recently and received, from 2002 to 2007,
5 research grants from that company. Besides the evident culture of greed that
has infected a lot of the medical research activities, there must be something
even deeper that can convince doctors that it is OK to put many lives at risk by
falsifying results.

Flummoxed? Wait, there is more! Dr. Reuben’s attorney also said there were extenuating circumstances! I kid you not. As usualno one is really talking. Dr. Reuben is on extended medical leave. Tufts University doesn’t seem to know him anymore. I guess everybody is trying to get the story to disappear under some heavy duty carpet. But this story cannot disappear....

The fraud didn’t stop at the published articles but was also used in
multiple letters in response to valid scientific articles to destroy the
scientific findings of honest researchers....

The clinical impact of the fraud will be profound. Jacques Chelly, MD, PhD,
MBA, director of the Division of Regional Anesthesia and Acute Interventional
Perioperative Pain at the University of Pittsburgh Medical Center (UPMC), said
that the fraud has left multimodal analgesia “in shambles”. He added

“the big chunk of what people have based their protocol on is gone.
we have stopped giving celecoxib and pregabalin to surgery patients until we
have some very formal evidence that we should do something else. In this day and
age, doing multimodal [therapy] is expensive. Any institution is going to look
at evidence-based clinical decisions, and unless we have very strong data, it is
a problem. Since most of evidence is now unreliable you really don’t have any
evidence that the combination is working...."

Revisiting Dr. Reuben's Wild Ride

I had a few free moments in between waterproofing the drawbridge and tucking in some rock-loving plants around the moat edge (This year? Mersea Yellow, Creeping Penstemon and three different varieties of Creeping Phlox), and so I idly checked in on the state of the Scott Reuben, MD -- that's DOCTOR to you -- Affair.

So how did this simply marvelous traditional Belgian cocktail get into my hands?

[Ever solicitous of My Dear Reader, should you wish an orgasm of your own, screaming or otherwise, use equal parts Baileys, Kahlua, and Amaretto -- then double up on the Cointreau -- shake with crushed ice. Some add a few cubes of ice to the glass -- moi? No. To each one's own Screaming Orgasm.]

Ah, well, it is here, so I'll drink it.

Scott. Reuben. He is actually being *defended* in the comment sections of some blogs and news articles. His apologists are sad creatures.

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

There's no need to unpack that ringing endorsement, is there? It's a Teflon Profession, although change is in the air.

It is tragic the lengths medical professionals will go to to continue receiving funding from big pharmaceutical companies. This story demonstrates the corruption in the medical community which stems from pharmaceutical companies having too much influence and political power. Of course it was the unethical practice of Dr. Reuben that is featured in this story, but he is just a symptom of a much larger problem - not that I am excusing his behavior in any way.

The number one cause of Exploding Hemorrhoids? Straddling fences and crotch-flossing. Way too many people -- the majority of them "professionals," some even DOCTORS -- are quick to pull out the Big Pharma Stick and shakeshakeshake it all around. This stick, according to my numerous studies, emits powerful pixie dust that addles the brains of non-DOCTORS, causing them to forget the Natural Laws of Agency -- you know, like: The Man lied to his wife. Who lied to the Little Woman? Not The Man, no, not really. It was The Boss of the Man-who-lied-to-his-wife who encouraged, and funded, with the United States' preferred currencies of dollars and renown, an atmosphere of near-complete moral relativity. The Man really did NOT lie to his wife -- see?

I can just hear Captain Haddock now: Miserable blundering barbequed blisters! Scoffing braggarts! Squawking popinjays!

There is a blog -- Fibromyalgia Haven -- that caught my attention in the long line of Scott Reuben by-products. She makes an insightful comparison between Fibromyalgia Schtuff and Dr. Kellog''s doings, as fictionalized (hardly by much, I'd wager... if only I knew a good bookie) by T.C. Boyle's The Road to Wellville.

In The Road to Wellville, T.C. Boyle shines a bright and comical light on commercialism in the healthcare industry. It is a fact, and it is nothing new. Every time I see a commercial for the new Fibromyalgia wonder drug, Lyrica, I wince. Not because of the drug itself, but because now that Fibromyalgia is becoming an accepted and recognized disorder, it will also become a profitable disorder. More and more drug companies will be coming out with prescription drugs to TREAT Fibromyalgia, but not to CURE Fibromyalgia. Why would they want to find a cure, when the alternative is so much more lucrative?

Where is my Screaming Orgasm? Oh, ah. Okay. I am fed up with people not understanding the basics of the disease process with which they are dealing. {sip, sip, gulp} Surely it is not that difficult to understand the difficulties of treating s.y.n.d.r.o.m.e.s? How hard is it to get that talking about silver bullet cures in such instances is a clear sign of idiocy -- or early onset dementia, if you need a DOCTOR'S note. {slurp}

I wince at those commercials, too. Particularly because there is an apparent need for them to begin with some apparently well-off, late-middle-aged, thin, white woman saying: "My fibromyalgia pain is real." That is just... weird.

Anyway, Fibrohaven, the blog owner, apparently has it in for Big Pharma. Big Pharma is keeping her down on the farm, barefoot, in pain, and pregnant. No, wait. That ain't right. Well, you get my drift.

I believe fibromyalgia, as a collection of symptoms, exists. I do not believe it is a disease, per se.
The syndrome causes such frustration for apparently well-off, late-middle-aged, thin, white women who are kept down on the farm, barefoot, in pain, and pregnant, that The Bogey Man seems to be crouched down in every corner. It's the Baptism by Fire of every Disease du Jour, and will remain that way until science catches up with experience, and the Fucked-Up Ones decide to move on to another poorly treated disorder, leaving behind the true sufferers, who, we will discover, can be found in almost any demographic. God bless them for hanging in.

Fibrohaven is spot on, though, about Money As Prime Mover, as that which drives research. Which, thankfully, brings me back to Scott Reuben.

Dear SparklesLori-the-Deluded. She was one of his patients at the Pain Center at Baystate Medical Center, and she is determined to worship her DOCTORS, because her DOCTORS love and care for her, and they do it gently. Bless her ignorant and needy self.

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.

I cannot remember (thank you, Screaming Orgasm!) who said it -- maybe it was SparklesLori, though I think not -- but someone said that perhaps Reuben's error was not so much the pure invention of research, research protocols, research subjects and clinical trial results -- no way! Rather, he did what he did because he possessed the knowledge of what was right and true, and simply took the shortest route to share His Rectitude with the World of Drugs and Doctoring.

It boggles the mind. Well, that and the Screaming Orgasm.

I haven't had a new thought on the Scott Reuben Affair beyond this: Why is he not under arrest? The comparison with Bernie Madoff -- frequently being made -- is quite appropriate, at least judging by the amount of acid in my stomach. I could not fathom why Mr. Madoff was walking around free. I also cannot fathom why no one even suggests that Dr. Reuben has committed criminal offenses. I keep running into this comment: "They should take his license away!"

That would be a start.

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?