Conclusion

The examples presented in the chapters of this booklet might appear poorly
coordinated, but all of them can be seen, to some extent, within the scope of scientific
misconduct. Since 1998, we have criticized scientific misconduct in medical research
from the former Soviet Union (SU) including self-criticism, reports on plagiarism,
misquoting, invasive procedures without sufficient indications, etc. [1-4]; more
references are in [5]. As discussed in this booklet, a special trend of scientific
misconduct is marketing of placebos and substances with unproven effects under the
guise of evidence-based medications, corroborated by dubious research. The criticism
has partly remained unnoticed or replied with some arguments left uncommented.
The published examples are only a tip of the iceberg. It does not mean that in the
former SU no integer medical researchers are remaining. Essential point is that some
former party and military functionaries, their children and dependents, occupying
leading positions in academies and universities, have become involved in research of
poor quality. They also travel much abroad misrepresenting Russian scientific
community. The younger generation can learn from them that scientific misconduct
brings scientific degrees, profit and success. In fact, scientific misconduct has
become an ingrained habit in the former SU, at least in some fields of medical and
biological science. One of the reasons thereof is that medical education and research
require hard and meticulous work leaving almost no leisure time. Some of the
functionaries' children are not accustomed to it. Besides, military and medical ethics
are not the same. The relatively low life expectancy in Russia especially for men [6],
who usually do not sit with grandchildren, is a strategic advantage: less health care
investments, fewer pensions to be paid, etc. Accordingly, middle-aged and elderly
men are sometimes visibly unwelcome in governmental polyclinics. Besides, a wellknown Russian medical term "football" should be mentioned: it means sending an
elderly patient from one physician to another to drag out time and to avoid an
operation. Malignancies are known to be diagnosed in some countries of the former
SU relatively late [7]. It appears probable, that placebos and other inexpensive



substitutes of evidence-based medications are planned by some policy makers for the
treatment of unprivileged pensioners.
Moreover, during the last decades, unscrupulous authors have perfected themselves
in tangling and befogging of their writings, making evaluation of their articles
increasingly difficult. Mutual cover-up is usual practice. Considering the ongoing
"improvement" of fraudulent skills, scientists, editors, and authorities must jointly
combat scientific misconduct. Besides, whistleblowers should be protected from
revenge. A response to scientific misconduct requires a national body to provide
leadership and guidelines, while whistleblowers need a safe, confidential place to
report scientific misconduct [8].
In spite of the economic upturn in Russia, it would be naive to think that matters will
improve spontaneously in the near future. Considering the drawbacks in medical
research and education, a simple increase of funding would not bring a solution. It
has always been possible to obtain a medical diploma in Russia without much
learning efforts [9]. Quality of teaching was uneven, poor quality lectures being
avoided by many students. Some courses were in fact lost in spite of their figuring in
the program. The author of this letter, who graduated from the Moscow I.M.
Sechenov Medical Academy in 1983, witnessed how certain courses, for example,
that of clinical pharmacology and gynecological pathology (for future pathologists)
were completely bungled, in spite of being present on the official program. Students
were compulsorily sent during semesters to collective farms to harvest potatoes and
other vegetables. In the I.M. Sechenov Medical Academy it usually happened during
the 3rd year of education, so that many topics in pathology, surgery and internal
medicine were lost. Besides, there have always been privileged students such as the
Party and Komsomol activists, who often passed examinations without due
preparation. Some of them used their privileges and missed lectures whenever they
wanted [10]. Students almost exclusively used the Russian-language literature; its
quality was uneven, many books were out-of date [7]. Hopefully, today the situation




is improving. Although most of the examples presented in this book are from Russia,
similar phenomena can be observed also in other parts of the world.
In conclusion, deception is objectionable on the grounds that it limits autonomy and
breaches trust; these grounds possibly do not apply to placebos when they are
prescribed within appropriate ethical limits [11], although it can be problematic both
on the professional and the ethical level [12]. Placebo therapy with misinformation of
a patient can be beneficial and ethically justifiable [13]; but it is still not a sufficient
reason to publish biased and misleading information. It is time now to purify science
from commercial influences and different kinds of misconduct.
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