Unoriginal Sins By Neal E. Flomenbaum, MD, Editor-in-Chief

As my generation came of age in the 1960s, I remember thinking naively that we would never succumb to the ethical and moral lapses of the generations before us. Over a decade later, when the academic discipline of emergency medicine was born, I again thought naively that we could build a specialty free of all of the weaknesses that characterized the dark side of academic medicine. Our specialty would supply experienced physicians at the bedside day and night to provide clinical care, teach emergency medicine, supervise residents, and publish research untainted by the practice of borrowing words or thoughts from others without attribution. Perhaps some might feel that three out of four isn’t so bad.

Over the years I would occasionally find a table, figure, or paragraph that I had created or contributed to appearing in a competing text or journal article. In other instances, multiple peer-reviewed articles listing the same groups of authors would make me wonder how much of a role each author played in researching and writing those papers.

An incident from the mid-1980s still makes me wince. My Bellevue colleagues and I had collected six difficult cases. One involved a commercial airline pilot brought to our emergency department after an apparent grand mal seizure. Another involved a young man who had been HIV-positive for a year and was being treated for his third new sexually transmitted disease; he made it clear that the young woman waiting for him was unaware of his HIV status and he insisted it remain that way.

We called these cases “Ethical Dilemmas in the Emergency Depart-ment” and presented them to groups of students, residents, and other physicians at our hospital. I thought the presentation had enough merit to propose it as a topic for a national emergency medicine conference, so I submitted both the topic and the cases to the head of the program committee, who had encouraged me to do so. I never heard back from the committee and did not attend the conference that year.

As a guest speaker, I presented the cases at another hospital some months later. Afterward, a physician in the audience asked me if I considered it ethical to present another physician’s cases as my own. He went on to tell me that he had attended a presentation with the same title and cases at the conference that I had skipped. When I called to complain to the conference organizers, the head of the program committee told me that they considered all lecture proposals and materials submitted for consideration to be theirs to do with as they pleased. So they reassigned the Bellevue cases to another speaker (who never knew their true source), saving the expense of reimbursing me as an additional speaker. The committee head never even bothered to apologize.

The embarrassment that this incident caused is minor compared to the harm that can result from the discovery that a work is not original or that the data presented in a research paper is not real. Patient care may be compromised, careers of innocent co-investigators may be terminated prematurely, and, in some cases, the researchers truly responsible for scientific breakthroughs may never receive proper credit. Sadly, when such an incident comes to light it is frequently unclear what the “borrower” had hoped to gain from the deception.

So in this Internet era of “all infor-mation, all the time,” when it is entirely possible to see or hear something that later unintentionally becomes part of one’s work, it is especially important not to knowingly treat someone else’s works as our own. There is still time for our specialty to take the high road and if not publish quite as much as others, not perish either.

Emerg Med 39(9):7, 2007