Introduction
In previous publications we presented several cases of plagiarism and manipulation
with statistics in the former Soviet Union [1,2]. Along with plagiarism, partial isolation
from the rest of the world gave rise to another phenomenon: extensive criticism of
foreign publications. This practice has been preserved until today. Here we are presenting
several quotations from English summaries of recent articles. The summaries are quoted
verbatim, exactly as they are printed in the journal.
„Negative consequences of treatment are observed at least in 16% patients at multidisciplinary
hospitals and may result from the causes that are independent of medical staff, but
more frequently from errors and inadequate treatment standards due to human factors.
Systematic improvement of professionalism, which should be started from some educational
reforms at medical institutes, is needed“ [3].
Comment: This is a review of foreign literature with extensive criticism of the complications
of therapy and professional misconduct in medicine in the U.S.A. and other countries.
Materials of the Agency for Healthcare Research and Quality, the National Patient
Safety Agency, the American Iatrogenic Association, and other sources are used. Analogous
phenomena in Russia are not discussed.
„The experience by pathologists and clinical physicians in using the classification
of tubulointerstitial lesions of the kidney, which was developed in the 1980s, has
shown that it adequately reflects the structure of this important section of renal
pathology. At the same time the classification is proposed to be modified on the basis
of the actual current spectrum of renal pathology“ [4].
Comment: A critical review, written by one of the leading Russian specialists in renal
pathology, quotes only one foreign source, apart from two books translated into Russian.
This reference is given without authors’ or editors’ names: „Renal disease. Classification
and Atlas. Vol. 2: Tubulo-inter-stitial Disease. New York: Tokyo, 1982.“
Furthermore, we would like to present some quotations (verbatim translation from Russian)
from textbooks and manuals bearing official recommendations of the Ministry of Health.
In the textbook of general pathology [5], officially recommended for medical students,
extensive discussions against unnamed foreign authors are led (verbatim translations
from Russian):
“Some authors declare that most important are local changes of organs and tissues,
others advocate with the same persistence paramount importance of the general condition
of the organism… both do not see the main thing”
(p. 26).
“They [unnamed foreign authors] erroneously think that the final diagnosis was, is,
and will be morphological”
(p. 224).
“…many large modern foreign manuals of general pathology provide little if any information
about etiology, pathogenesis and theory of disease. They elucidate exclusively factual
achievements of ultrastructural and molecular pathology, not trying to make broad
generalizations”
(p. 35).
Another hallmark of this textbook is extensive criticism of generally accepted terminology
from the International Classification of Diseases, for example, such terms as ischemic
heart disease, cerebrovascular disease (pp. 261–270), or some terms with the ending
-itis, e.g., gastritis, pancreatitis, hepatitis (p.154), which is a hardly suitable
discussion in a textbook for medical students. At the same time, neologisms are invented:
functiogenesis, morphofunctiogenesis, amiloidoblast, amiloidoclast etc. The new edition
of this book [6] was enriched with plagiarism from Robbins’ Pathologic Basis of Disease
[7] (pp. 53–55 vs. 20, 27–29) and renamed Rukovodstvo (Manual).
Former functionaries, promoted to high positions in science and education, do not
always maintain a duly high level of educational publications. Some quotations from
the Tests in Pathological Anatomy (Figure 1), an edition that was used at the Peoples’
Friendship University of Russia, are presented below [8]. Outdated and erroneous information
from this edition was noticed by students. We received no response to our letter to
the Dean of the Medical Faculty (Figure 2) Verbatim translations:
“Insufficient erythropoietic function of brain is a possible cause of anemia.”
“A focus of extramedullary hemopoiesis is named leukemic infiltration.”
“In exudative glomerulonephritis, serous, fibrinous or hemorrhagic exudate can accumulate
within Bowman’s capsule.”
”Chronic pyelonephritis is a disease with predominant involvement of glomeruli (glomerulopathy).”
“Primarily contracted kidney is typical for arterial hyper-tension.”
“Reddish color of the liver in cirrhosis depends on the blood flow impediment in the
portal vein.”
“Hepar lobatum belongs to infectious cirrhosis.”
“Abundance of mucus in the stomach is typical for atrophic gastritis.”
“Renal insufficiency (amyloidosis) is one of the main causes of death in chronic obstructive
lung diseases.”
“Necrosis of tonsils and underlying tissues is typical for scarlet fever.”
“Necrosis of lymph nodes is typical for scarlet fever.”
Previously we reported on scientific misconduct with the example of the Chancellor
of Moscow I.M. Sechenov Medical Academy, Mikhail A. Paltsev, who simultaneously officiated
as a Head of the Department of Pathology (named Pathological Anatomy in Russia) of
the same Academy [1, 2]. In the year 2009, Paltsev abandoned both of his offices,
but before doing so he provided employment for several functionaries (or their relatives)
that did not have much experience in research or practice at the Department of Pathology.
In fact, the Department of Pathology was regarded as a place where anyone (with permission
from the nomenklatura could become a professor, a researcher, forge scientific papers,
publish plagiarized textbooks, etc. Some experienced specialists were dismissed to
clear places for them, which was harmful to the quality of biopsy reporting. With
time, the former functionaries accumulated some knowledge of pathology, and the system
worked somehow. This phenomenon has been widespread since the late 1980s: many former
functionaries were allowed into educational and scientific institutions, lowering
the quality of academics there. Among those employed by Prof. Paltsev at the Department
of Pathology of Moscow I.M. Sechenov Medical Academyare the former Komsomol activist
Andrei B. Ponomarev (a relative of Paltsev, according to some witnesses) and Yuri
A. Kirillov, who has been manager at the Ministry of Health responsible for pharmacological
research. In the past, Kirillov used incisional renal biopsies (6–10 mm in size),
taken during kidney-preserving operations (e.g., lithotomy) from patients with acute
or chronic pyelonephritis, for research of questionable quality. For further details,
see http://www.freewebs.com/ruspat1/reviewofliterature.htm. Moreover, following the
model of the Head of the Department, Paltsev, some other lecturers and researchers
of the Department were involved in scientific misconduct (E.A. Kogan, L.V. Lysenko,
P.V. Yushkov, E.M. Paltseva and others). We wrote about these facts to the present
Chancellor of Moscow I.M. Sechenov Medical Academy (recently renamed I.M. Sechenov
First Moscow Medical University), Prof. P.V. Glybochko, but received no response.
Extensive misquoting was demonstrated in the Glybochko‘s doctoral dissertation (see
http://www.freewebs.com/ruspat1/apps/photos/album?albumid=3392303). The only person
who criticized some of the forged scientific works and dismissals of the specialists
experienced in diagnostic pathology was Prof. Tatiana N. Hansen (T.N. Ganzen according
to the Russian spelling). For that reason she was dismissed from the Academy early
in the 2000s. Prof. Hansen was one of the best specialists in biopsy and autopsy in
the Department and a good lecturer. Her dismissal hurt the quality of biopsy reporting
and even the caliber of teaching itself.
Some publications [9–11], obviously based on fabricated or modified data, are contradictory
to generally accepted knowledge and can be misleading for practice. For example, immunohistochemical
evidence of the gene p53 mutation was reported in all 36 studied cases of differentiated
thyroid carcinoma, including 11 cases of follicular, 6 cases of papillary, 5 cases
of medullary, and 14 cases of ‘papillary-follicular’ (absent in modern classifications)
carcinoma; whereas in all cases of adenoma and other benign thyroid conditions (26
cases) no evidence of p53 mutation was found (Figure 3) [10]. Resulting statistical
significance of the difference is extremely high (36/36 vs. 0/26, P<0.0001). In literature,
p53 mutation is regarded to be a late event in thyroid carcino-genesis, associated
with undifferentiated or anaplastic carcinomas, usually not occurring in differentiated
tumors [12, 13]. Therefore, the statement (verbatim translation): “High degree of
expression of p53 in carcinomas and its absence in adenomas allows concluding that
p53 can serve as a marker of thyroid carcinoma” [9] can lead one to overdiagnosis
of malignancy, especially today, when the improved economy in Russia enables the purchase
of modern immunohistochemical kits and other new laboratory methods. The journal Arkhiv
Patologii, where these materials were published, is the only Russian journal intended
for practical pathologists. Our critical letter on this topic was rejected by Arkhiv
Patologii.
Access to foreign professional literature remains limited in Russia [14], which is
harmful for practice and research. The widely used manual of tumor pathology [15]
is outdated, imprecise, and in many fields (bone marrow, lymph nodes, thyroid, soft
tissue tumors, and others is hardly suitable for diagnostics. Some passages from the
section on thyroid tumors [16] deserve to be quoted in verbatim translation:
In the section “Follicular Carcinoma” on p. 356, it reads: “In highly differentiated
form [of the follicular thyroid carcinoma], cancerous elements more or less resemble
the follicles of mature thyroid. They have different form and size; the covering cells
can have hyperchromic nuclei, crawling onto one another like ground watch glasses.”
Comment: The term “ground watch glasses” (yadra v vide pritertykh chasovykh stekol),
a mistranslation of “ground-glass nuclei,” can be found in many Russian-language publications.
It is a diagnostic criterion of the papillary thyroid carcinoma but not of follicular
carcinoma. Nuclear changes, characteristic of papillary carcinoma, are not visible
in the illustrations (Figure 4). In the section about follicular thyroid carcinoma,
the most significant diagnostic criteria, such as the capsular and vascular invasions,
are not mentioned (Figure 5). Using this most authoritative manual of tumor pathology,
issued by the N.N. Blokhin Cancer Research Center in Moscow, it is not always possible
to differentiate follicular thyroid carcinoma from adenoma. For many pathologists,
especially outside Moscow and St. Petersburg, this two-volume edition has been the
main source of information on many topics. Another example from the same edition is
found in the section on nasopharyngeal pathology [17], where no stromal atypia of
nasal polyps [18] is described. We know of a case of a false-positive diagnosis of
sarcoma as a consequence of it.
In the new Atlas of Tumor Pathology [19] the following is written in the section about
thyroid carcinoma (p. 402) it reads (verbatim translation): “In severe dysplasia appear
cell groups with clearly visible atypia. Therefore, third grade dysplasia is considered
as an obligate pre-cancer, which histologically is hardly distinguishable from carcinoma
in situ. At the same time, it is believed that severe dysplasia differs from non-invasive
cancer because it is reversible” (Figure 6). Nuclear atypia (enlargement, hyperchromatism,
pleomorphism) is not considered in modern literature as a criterion of malignancy
in follicular and papillary thyroid nodules, and the concepts of dysplasia and carcinoma
in situ are not applied to them [20]. Cases of false-positive diagnoses of thyroid
carcinoma, caused by misinterpretation of nuclear pleomorphism as a criterion for
malignancy, are known. Overdiagnosis of malignancy (cases of false-positive diagnoses
of thyroid carcinoma in children with corresponding overtreatment) has obviously been
one of the overestimation mechanisms of the consequences of the Chernobyl accident,
in particular, thyroid cancer incidence [21, 22].
Finally, thanks to the economic upturn in Russia, some institutions started purchasing
foreign literature, but it has not sufficed. On the other hand, acquisition of literature
by medical libraries has decreased since the 1980s [14]. It comes as no surprise that
foreign publications are, scarcely quoted in Russian scientific articles; well-known
phenomena, disease entities, morphological changes etc. are described without referring
to foreign publications, which can be misunderstood as something new from Soviet scientists
[23, 24].
The following are two quotations from English summaries of articles recently published
in Arkhiv Patologii. The summaries are available also on PubMed.
„The structure, clinical manifestations, behavior of cavernous hemangioma of the skin
of the face and neck, and the oral soft tissues were studied, by using biopsy specimens
from 229 patients. Three types of cavernous hemangioma of these areas were identified.
Their preferred treatments were defined and pathogenetically warranted“ [25].
Comment: In describing such a well-known lesion as cutaneous hemangioma, the authors
did not quote a single foreign source. The volume, Pathological Anatomy by Paltsev
and Anichkov [26], largely plagiarized from Robbins’ Pathologic Basis of Disease [1,
27], is quoted instead.
Another example reads, „The authors present the incidence and specific features of
specific bone marrow lesion and the state of normal hemopoiesis and stroma. The criteria
for the differential diagnosis of reactive polyclonal lymphoid proliferation in the
bone marrow that may accompany many haematological and non-haematological diseases
with specific bone marrow lesion in lymphoproliferative diseases are outlined“ [28]/
The article continues, „According to our results, several histological types of bone
marrow involvement in lymphoproliferative diseases can be distinguished: diffuse,
interstitial and focal“ [28]. Then follows the usual description of bone marrow involvement
patterns by lymphoma that can be found in many textbooks, which are not referred to.
The text can be misunderstood as an original description of bone marrow involvement
patterns by lymphoproliferative disorders.
In conclusion, in the Russian-language handbook of immunohistochemistry [29] cannot
substitute for internationally used manuals [30] because it contains references to
dubious publications. Scientific misconduct was proven also in a series of publications
from the Cardiology Research Centre in Moscow [31]. Further examples and illustrations
can be found at http://www.freewebs.com/ruspat1/.
In summary, there are many positive changes in Russian pathology. There is a spirit
of cooperation among Russian pathologists. There are talented medical technologists
producing thin slides using old sledge microtomes. The improved economy allows the
purchase of modern equipment and the introduction of new methods into practice and
research. Hopefully, this article will be only of historical interest in the near
future.
Summary
There is a persisting interest in the topic of scientific misconduct. The following
main forms of scientific misconduct are known: plagiarism, falsification or fabrication
of data, manipulations with statistics, misquoting, false or gift authorship, as well
as revenge on the whistleblowers revealing and exposing such cases. Of particular
concern is plagiarism, which is spreading today. Former functionaries, promoted to
high positions in academies and universities in the former Soviet Union, are often
unable to maintain a duly high academic standards in publications. Some textbooks,
manuals and journal articles are imprecise, contain plagiarism or misleading information
that lead to overdiagnosis of malignancy, and examples are provided in this article.
In spite of remaining shortages and drawbacks, there are grounds for optimism. The
upturn of the economy in Russia is making possible the purchase of foreign literature
and modern equipment, introducing new methods into research and practice. Therefore,
we hope that this article will be only of historical interest in the near future.