Machiavelli's Laboratory A Satire

Page 1 of 355
Machiavelli's Laboratory
A Satire
© 2010 Jules J. Berman
Version 1.0 created April 13,
2010
Version 1.0 last modified July 21,
2010
TABLE OF CONTENTS
Chapter 0 Preface
0.1 About me
0.2 Nota bene
0.3 Book cover
Chapter 1 Falsification And Fabrication Of Data
1.1 Lessening the guilt: retractions, scapegoats, and clueless

conspirators
1.2 Elite liars
1.3 When you are caught
1.4 Advice for evil scientists
Chapter 2 Improving The Truth: The Art Of Scientific

Misinterpretation
2.1 All statistical studies are open to misinterpretation
2.2 Introducing biases into your study
2.3 Falsification of conclusions
2.4 Misrepresenting progress in the war against cancer
file://C:\DOCUME~1\jules\LOCALS~1\Temp\9YC4HO62.htm 7/26/2010
Page 2 of 355
2.5 Advice to evil scientists
Chapter 3 The Evil Writer
3.1 Co-authors
3.2 First credit
3.3 Evil books
3.4 Altering the past
3.5 Plagiarism
3.6 Plagiarism in a computer world
Chapter 4 Evil Editors And Reviewers
Chapter 5 Grantsmanship
5.1 True funding means never having to say you're sorry
5.2 Investing in science
Chapter 6 Rejection
6.1 Applauding bad science
6.2 Progress? what progress?
6.3 The consequences of rejection
Chapter 7 Complexity: The Devil Is In The Details
Page 3 of 355
Chapter 8 Scientific Globetrotting
Chapter 9 Evil Intellectual Property
Chapter 10 Evil Standards
10.1 What the standards development organizations never do
Chapter 11 Abusing Power
11.1 The department chief
Chapter 12 Governments And Evil Science
12.1 Government cover-ups
12.2 Government against the people
12.3 The power of bureaucrats
Chapter 13 Corporations And Evil Science
13.1 Erbitux and the brave new world of gene targeted therapy
13.2 It pays to advertise
13.3 Scientific organizations are instruments of large corporations
Chapter 14 Universities And Evil Science
14.1 Academic freedom is the freedom to lie to your students
Page 4 of 355
14.2 The fertile ground excuse
Chapter 15 Ethics, And The Avoidance Of Same
15.1 Consent and unconsent
15.2 Conflicts of interest
15.3 Betraying confidentiality
15.4 Evil patients
15.5 Harming animals
Chapter 16 Clinical Trials On Trial
16.1 Biases in survival data
Chapter 17 Scientific Disasters
Chapter 18 Belief And Disbelief
18.1 Mathematics is neither science nor religion
Chapter 19 Sex And Gender
19.1 Where the boys are
Chapter 20 Greed
20.1 Cashing in on cancer
Page 5 of 355
20.2 Off-label physicians
20.3 Ghost writers
Chapter 21 The Future Of Evil Scientists
Chapter 22 Final Exam
Chapter 23 Glossary
Chapter 24 References
CHAPTER 0. PREFACE
"God did not make us perfect. To compensate, he made us blind to

our faults."
-Anonymous
This is a satirical book about science and ethics. All of the advice
offered in this book is bad advice. Nothing in this book should be
taken seriously. Literal-minded readers are urged to stop reading
NOW.
Serious books cover the deep issues: the obligations of scientists to

individuals and to society, general principles of ethical conduct,
human dignity and human rights, etc. These ethics books tend to be a
bit sanctimonious, and boring. This book is focused on the
commonplace, petty, and venial misdemeanors that shape scientific
culture. Thoughtless crimes are committed by every scientist.
Cumulatively, they do more damage than the actions of rare,
sociopathic scientists.
When we think about scientific misconduct, we tend to focus on the

problem of data falsification. We are told that these cases are rare, but
nothing can be further from the truth. Misconduct creeps into every
Page 6 of 355
scientific endeavor. The reason for this is that scientists and

physicians are humans motivated by the typical human goals:
financial security, social approval, and the pursuit of pleasure. When
the selfish goals of scientists and physicians conflict with the selfless
goals of of science and medicine (the advancement of knowledge and
the reduction of the suffering and death due to disease), the selfish
goals of scientists always win out.
Here are just a few banal evils committed every day by respected
scientists:
1. Boastfulness. Touting the positive qualities of your research, while

omitting the problematic aspects.
2. Jealousy. Writing manuscripts that fail to cite the relevant and

precedential work of your competitors.
3. Irresponsibility. Receiving a large federal grant but barely working

on the project, preferring to spend your time garnering additional
grants.
4. Arrogance. Refusing to release your research data to the public,

insisting that others will misinterpret your findings.
5. Laziness. Co-authoring papers you haven't even read.
6. Deception. Hiding your financial conflicts of interest from your

research subjects, colleagues, and editors; and profiting from your
deceit.
7. Intimidation. Getting your way through an exercise of authority,

rather than through scientific persuasion.
8. Cronyism. Using your influence to help your allies (by inviting

them to speak at meetings, or by placing them in powerful positions),
while you surreptitiously work to isolate or discredit scientists whose
opinions or agendas conflict with yours.
9. Influence peddling. Using your authority and power to alter the

course of scientific advancement, in accordance with the wishes of a
Page 7 of 355
paying entity.
10. Rationalization. Justifying your actions through the self-serving

use of a seemingly scientific argument that is illogical and wrong.
You may be thinking that there must be some exceptions; scientists

and physicians who are altruistic. Actually, no, there are no
exceptions. I have been involved in dozens of research efforts
through the decades, working closely with hundreds of different
scientists. I have attended countless meetings and have spoken with
thousands of dedicated scientists who I admire and trust. But I have
never met a scientist who is driven by altruism, and I have never met
a scientist who is capable of being objective on the subject of his own
research. The hypothetical altruistic scientist would not last very long
in an environment where competing ideas are marketed (promoted in
grant applications), bought (through licenses and royalty payments
and technology transfer agreements), sold (as high-priced
pharmaceuticals and laboratory tests), banked (patented) and
destroyed (by competition).
Every scientist and physician has moments when they are asked to
forgo some personal reward for the sake of scientific integrity. This
book takes a fresh approach at examining such moments. Instead of
moralizing on the virtues of scientific integrity, I try to explain the
selfish motives that make every scientist and physician act the way
they do.
Society tends to assume that scientists and physicians are somehow

different from the rest of us. This book will prove that this is not so.
Scientists are just like everyone else, only more so.
Through the book, I recount hundreds of well-documented cases of

scientific misconduct. In many instances, the names of scientists
involved in scandal or crime, are omitted, and replaced with vague
epithets, such as "the investigator," "the junior colleague", and so on.
I see no reason to hold scientists to public ridicule. I assume that most
of the scientists involved in scandal have moved forward with their
lives, and deserve some degree of anonymity. Actual names appear in
situations that rise to the level of notoriety, or for which the person
Page 8 of 355
involved is a public figure (e.g., a leading bureaucrat in a federal

agency, a Nobel prize winner, the CEO of a corporation, etc.). I
would have preferred to exclude all names, but I'm certain that
readers would construe these omissions as sloppy journalism.
Curious readers, who insist on knowing the identities of the scientists

involved in any particular scandal, may find them in the cited
references. There are over 300 references to this book; most are
publicly available documents. I tried to make this book the most
comprehensive and accessible treatise ever written on the subject of
professional pettiness.
Indented paragraphs, printed in italics, are fictional stories or

hypothetical situations. These stories are drawn from my own
experiences, or they were told to me by other scientists, and they all
have some loose connection to reality. I have changed the names and
locations of institutions to spare anyone embarrassment. Attempts to
deduce specific real-life events, from stories in this book, will be
futile. All of these stories have occurred many times, with different
casts of characters.
Here's an example:
You have been working on a key scientific problem for the past
8 years: finding the gene mutation responsible for a terrible
disease. You are on the verge of a breakthrough. Success will
come in a week, a month on the outside. Three other
laboratories are on the same path. At meetings, you discuss
some of your results, but you only divulge enough information
to confuse your close competitors. You have worked longer
and sacrificed more than anyone else. If there is any justice in
the world, you will soon prevail. Your graduate student rushes
into your laboratory. You glance at him, unsmiling. "What
does he need from me now?" you wonder. He has just heard
that your chief competitor has isolated the disease gene, and
found its mutation. His paper was accepted and will be
published in next week's issue of Nature. Your graduate
student asks how this news will impact on his thesis timeline,
but you have already stopped listening to him. You turn white,
Page 9 of 355
and slump deeply into your chair. Fame and riches will not
come to you. The past eight years of your life were wasted.
Your research will no longer be supported. You will not
receive tenure. Your graduate students and post-docs will
move to other laboratories. Hatred and jealousy fill your soul.
The world has just received another miracle of science, and it
is the worst day of your life.
0.1 ABOUT ME
"A highbrow is a person educated beyond his intelligence."
-Brander Matthews (1852 - 1929)
After receiving two bachelor of science degrees (mathematics and

earth sciences from MIT), I entered the graduate program in
pathology at Temple University, where I began my thesis work
within the Fels Cancer Research Institute. I spent the final year of my
graduate studies at American Health Foundation in Valhalla, New
York, before beginning my post-doctoral studies in the Laboratory of
Experimental Pathology at the U.S. National Cancer Institute. I
earned a medical degree from the University of Miami, followed by a
pathology residency at George Washington University Medical
Center in Washington, D.C. I became Board Certified in Anatomic
Pathology and in Cytopathology, and served as the chief of Anatomic
Pathology, Surgical Pathology and Cytopathology at the Veterans
Administration Medical Center in Baltimore, Maryland. While
working at the Baltimore VA Medical Center, I held appointments at
the University of Maryland Medical Center and at the Johns Hopkins
Medical Institutions. In 1998, I became the Program Director for
Pathology Informatics in the Cancer Diagnosis Program at the U.S.
National Cancer Institute. In 2006, I became President of the
Association for Pathology Informatics. My name has appeared as a
co-author on hundreds of scientific contributions, and I have written,
as first author, more than 100 publications. Today I am a free-lance
author and have written extensively in my three areas of expertise:
medical informatics, computer programming, and cancer biology. At
this stage in my career, I have witnessed just about every deceitful
activity known to science.
Page 10 of 355
0.2 NOTA BENE
"Things that are new are wont to be set forward rudely and
formlessly, and then must be polished and perfected in succeeding
centuries."
-Pappus (circa 350 - 300 B.C.), one of the last Helenistic

mathematicians
This book is a work of satirical fiction and has no value or purpose

other than as a work of literature. It is distributed at no cost to the
reader, but copyright law applies. If you find any mistakes, please
send corrections to me, via the book's blog site.
0.3 BOOK COVER
"Don't judge a book by its cover."
-Anonymous
The cover illustration was prepared from Wikipedia's public domain

photograph of an oil-on-canvas painting of Niccolo Machiavelli
(1469 - 1527), by the artist Santi di Tito (1536–1603). The painting
currently appears in the Palazzo Vecchio, in Florence, Italy. The
photograph was tiled, and pasted onto a globe suspended on an
infinite rippled plane, using Pov-Ray rendering software.
CHAPTER 1. FALSIFICATION AND FABRICATION OF

DATA
"A clear conscience is the self-assured feeling that no one has found
out about you yet."
-attributed to Ambrose Bierce
Each year in the U.S., about 28,000 science and engineering

doctorates are awarded, along with about 75,000 Masters' degrees
and about 400,000 undergraduate degrees (1), (2). This is a lot of
competition. How can you distinguish yourself when you know from
the outset that just about everyone is better than you? Cheating is the
Page 11 of 355
only practical solution.
You are in your seventh year of graduate school. You have

watched as other graduate students came into the department,
completed their coursework, wrote and defended their theses,
and graduated with their PhD. You are now in debt to the tune
of $150,000. You have no respect in the department. Your
thesis advisor has hinted that the Ph.D. may not be a realistic
option for you. You tell him that you have finished all your
coursework and that the only obstacle preventing you from
collecting your Ph.D. is the thesis. Your advisor indicates that
a thesis project cannot continue indefinitely. Perhaps it would
be better if you settled for a Master's degree. You could
assemble your preliminary work into a Master's thesis and
collect the degree by June. For many, the Master's degree is
the perfect prelude to a successful career in industry or
academia. For those who have labored four years, or longer,
as Ph.D. candidates, the Master's degree is a bitter
consolation prize, and the mark of a loser. You leave your
advisor's office dejected. In the evening, you go to your
shabby apartment to contemplate your options. No soulmate
awaits you. Your girlfriend abandoned you months ago, when
she realized that you had no viable job prospects. You begin to
obsess over the unfairness of life. You are so much smarter
than the others. You have so much to offer to the world. All
you need is one break, and if the world won't give you that
break, you will give it to yourself. You pull out your lab book,
and you begin the task of fabricating the data that will earn
you the respect and credibility that comes to every doctoral
scientist.
In the U.S., allegations of research misconduct are investigated by the

The Office of Research Integrity (ORI). Other U.S. agencies, and
funding agencies in other countries have similar watchdog
institutions. The ORI makes its findings a matter of public record.
You can visit their web site and read the individual reports of
misconduct (3). Here are just a few examples:
Page 12 of 355
1. "[A] research program coordinator in the Oncology Center, The

Johns Hopkins University School of Medicine, engaged in scientific
misconduct by fabricating patient interview data for a study of quality
of life measures in cancer patients. Further, the same research
program coordinator, "engaged in scientific misconduct by falsifying
patient status data by failing to update the status of treated breast
cancer patients and misrepresenting data from previous contacts as
the updated status for a study." (4)
2. An Assistant Professor in the Department of Psychology at

Harvard University was found to fabricate data in a number of
different experiments that were described in journal publications. The
doctor retracted the published papers in a letter that included the
following language, "because I improperly excluded some
participants who should have been included in the analyses and that
this exclusion affected the reported results. Moreover, the improper
exclusion of data was solely my doing and was not contributed to or
known by my coauthors." (5)
3. An Assistant Professor in the Yale University School of Medicine

"committed scientific misconduct by plagiarizing and intentionally
misrepresenting research in an application for Public Health Service
(PHS) funded research supported by grant application 1 R24
RR05358-01" (6).
Between the years 1993 and 1997, the vast majority of Office of
Research Integrity cases involved data falsification (modifying the
true data to suit your own purposes), data fabrication (inventing data
from thin air) or both. Less frequently, allegations of plagiarism were
investigated. Of 150 cases investigated, all but one case had an
alleged component of data falsification, fabrication or plagiarism (7).
In 2007, of the 28 investigated cases, 100% involved allegations of
falsification, fabrication, or both (8).
What can we infer from this revelation? If you commit a type of

misconduct other than falsification and fabrication of research data, it
will almost certainly be ignored by the ORI. Here are just a few of
the kinds of misconduct that you can commit with impunity:
Page 13 of 355
1. Stealing ideas from students, post-docs and coworkers.
2. Stealing all the credit for a project where your participation was
marginal.
3. Selling another person's or another entity's property, as though you

owned it (i.e., piracy).
4. Excluding co-workers from the author list of the publications.
5. Not citing prior work that would reduce the importance of your
contribution.
6. Failing to complete your funded grant research.
8. Making mistakes. Scientists are expected to make mistakes, even

when those mistakes have terrible consequences for others. ("True
science means never saying you're sorry").
9. Embellishing your research papers with self-serving

misinterpretations.
You do not need to worry about the ORI, so long as you confine your
dishonest activities to areas outside their purview. Moreover, you
need not worry too much about being detected by your colleagues.
Experience has shown that many instances of data fabrication go
unnoticed for a very long time.
Walt Bogdanich, in a New York Times article, recounts six years of

non-stop medical misadventures occurring at the Philadelphia VA
Hospital (9). In 2002, the VA funded an ambitious brachytherapy
clinic for patients with prostate cancer. Brachytherapy involves the
implantation of radioactive seeds in the prostate, at the site of cancer.
The localized seeds deliver a toxic dose of radiation directly to the
tumor, sparing normal tissues and adjacent organs. Performed
correctly, brachytherapy is a very good method for treating cancer
confined to the prostate. The administrators at the VA turned to the
prestigious University of Pennsylvania to provide the professional
staff for its brachytherapy unit, ensuring, they thought, the highest
Page 14 of 355
possible level of care for VA patients.
Over the next six years, systemic problems arose involving the way
that the brachytherapy unit conducted surgeries, implanted
radioactive seeds, visualized the seeds, measured the success of the
seed implantations during surgery, reported the outcomes of surgery,
and handled external review of unit procedures and activities. The
unit botched 92 cases, out of 116 cancer treatments, over a period of
six years. Among the most common errors, seeds were implanted into
organs other than the prostate (e.g., bladder and rectum), and prostate
cancers were under-seeded. Questions were raised regarding a cover-
up; specifically, alterations in records and protocols intended to hide
errors. When the case finally broke, the brachytherapy unit was shut
down, a Senate hearing was called, and VA policy changes were
recommended (10). The complete medical and legal consequences of
activities at the former VA brachytherapy unit will unfold in years to
come.
Scientists produce errors all the time, and at great frequency. The
Institute of Medicine reports that between 44,000 and 98,000 people,
die each year in U.S. hospitals from preventable medical errors (11).
The astonishing feature of the brachytherapy unit is that a remarkably
high rate of systemic errors occurred in a crucial medical setting,
without any hint of public scandal for six long years (9).
A little digging uncovers scientific scandals that have endured much

longer than six years, often extending beyond the death of the
perpetrator.
John Seabrook chronicled the efforts of ornithologist Pamela

Rasmussen (born 1959), who uncovered a fraud, committed
throughout the first half of the twentieth century, involving numerous
bird specimens collected through the latter half of the nineteenth
century (12). The culprit was Colonel Richard Meinertzhagen (l878 -
1967). He stole bird specimens from historical collections and
annotated them with fabricated data (Figure 1-1). The scientific
mischief came to light in the early 1990s by Pamela Rasmussen and
Robert Prys-Jones, who found inconsistencies in curated bird
specimens. There were bird species reported to come from areas
Page 15 of 355
where the bird species did not exist, and there were were bird
specimens prepared with materials consistent with collections that
predated Meinertzhagen, using techniques that were different from
those employed by Meinertzhagen himself. After the investigation,
dozens of taxa had to be removed from the British list.
Meinertzhagen was a soldier, intelligence officer, diarist, nature
writer, and ornithologist. Throughout his long life, his many scientific
fabrications went undiscovered.
Figure 1-1. Richard Meinertzhagen. Source: Wikipedia, public

domain.
Gregor Mendel (1822 - 1884), the father of genetics, studied inherited

traits in hybridized peas (Figure 1-2). His seminal work, published
1865, was received with underwhelming enthusiasm by the scientific
community (13). Mendel lived out his days as an Augustinian priest,
in near-total scientific obscurity. In the twentieth century, his work
was rediscovered, and Mendel attained immortality, though
posthumously. In 1936, RA Fisher, the celebrated statistician,
published a paper in which he questioned the accuracy of Mendel's
data: specifically, the data were much too accurate to be true (14).
Mendel's data showed a near-exact proximity to the theoretically
expected trait ratio of 3 to 1. Statistical sampling theory and
experience with actual modern measurements suggest that Mendel
almost certainly tweaked his data to best fit his hypothesis; a practice
Page 16 of 355
known today as data fudging. Though subsequent studies have fully

validated his hypotheses; there is suspicion, but no actual proof, that
Mendel took liberties with his data.
Figure 1-2. Gregor Mendel. Source: Wikipedia, public domain
In 1912, Charles Dawson (1864 - 1916) , a solicitor and an amateur

archaeologist, announced the discovery of a jawbone in the digs at
Piltdown, England. The jawbone, estimated to be about 500,000
years old, when matched with other bone fragments from the same
site, was assembled into a humanoid skull (Figure 1-3). The skull was
promoted as the missing link between earlier primates and humans,
and given the scientific eponym Eoanthropus dawsoni (Dawson's
dawn man); also known as Piltdown man. Though the Piltdown man
had detractors, it also had powerful champions, including Arthur
Keith (1866 - 1955), an influential anatomist and anthropologist, and
Pierre Teilhard de Chardin (1881 - 1955), a famous philosopher and
Jesuit priest. Dawson died four years later, enjoying celebrity and
scientific respect. In 1921, Arthur Keith received British knighthood.
Page 17 of 355
Figure 1-3. From the reconstruction by J. H. McGregor. Source: The

Outline of Science by J. Arthur Thomson, Putnam and Sons, New
York, 1922.
In 1949, 37 years following the discovery of Piltdown man, Dr.

Kenneth Oakley (1911 - 1981) used newly developed dating to
determine that the age of the Piltdown skull was only 50,000 years.
Further tests showed that the bone fragments had been exposed to
potassium dichromate, an agent that made the fragments seem
ancient. The molar teeth of the skull had a non-human appearance.
On close review, the non-human appearance resulted from someone
deliberately filing the crowns. A visit to the Piltdown site indicated
that the type of soil at the site could not have formed and preserved
fossils. In 1953, the Piltdown man was declared a hoax. Today,
nobody knows who perpetrated the hoax, but everyone can agree that
it had a good run.
If you're looking for data to falsify, there's no better place to start

than with your own history. Improving your past can lead to a better
future. Concentrate on the four credentials you will need if you want
to be hired into a high-level scientific position:
1. You will need an advanced academic degree (usually a Ph.D. or a

D.Sc. or a Master's Degree), or a Medical Degree.
2. You will need a substantial number of publications. Some should

appear in high impact journals, and some should list you as the first
author.
3. You will need to establish a relationship of trust with a person in

power at the institution where you wish to be employed. This is best
achieved by displaying some kind of loyal and obsequious behavior
Page 18 of 355
towards a member of the search committee. If you come with a

strong personal recommendation from someone trusted by the search
committee, you might squeak by. Don't worry about better qualified
competitors. The most qualified candidate, with no friends on the
search committee, cannot compete against the pleasant fool who
plays golf with the department chief.
4. You must be physically attractive. Scientists, like other varieties of

people, are as shallow as piss on concrete. Lose the pounds. Dress for
success. When you walk, heads should turn towards you, not away
from you. Seek the services of a plastic surgeon, if necessary. Keep
in mind that we must make certain sacrifices for Science.
If you have these four credentials, the job will be yours for the taking.
Other characteristics (e.g., competence, intelligence, curiosity, strong
moral character) are seldom helpful and may actually work against
you if your interviewers are envious, insecure, or easily intimidated.
If you are lacking an academic degree, you may choose to lie on your
job application. A former Dean of Admissions at MIT had lied on her
job application (28 years earlier), when she reported that she had
earned bachelor's and master's degrees in chemistry and biology from
Rensselaer Polytechnic Institute, Albany Medical College, and Union
College (15). She landed the job, thanks to her false credentials. Once
employed by MIT, she rose through the ranks to become the Dean of
Admissions. Twenty-eight years later, the lies were discovered. The
dean was forced to resign, but this cautionary tale certainly has an up-
side. Here is a woman, without formal credentials, who had the
opportunity to become a dean at one of the most prestigious
institutions in the world, thanks to a small personal embellishment.
The sweet ride lasted twenty-eight years. Two and a half years after
the scandal broke, she was back in the game, running her own college
admissions consulting firm in New York City (16). She owed her
success to a lie.
If you are going to lie about your college credentials, make it difficult
for the human resources to discover the crime. It is sometimes
impossible to verify credentials claimed on an application. Colleges
can close, professors can retire or die, whole record departments can
Page 19 of 355
be destroyed in fire or flood. A list of defunct universities and

prominent, deceased professors can be very helpful for anyone who
chooses to fake college degrees and recommendations.
An alternative plan is to pay for a degree from a college or university

with low standards. Most employers will require you to hold a
degree, but very few employers will care where it came from. Try to
find an on-line, off-shore college with matriculation standards that
are closely aligned with your ability to pay their tuition.
Padding your curriculum vitae with fabricated citations is another

task that can be achieved without much effort. Most human resource
departments will only check to see if you've listed publications; they
don't check to see if the listed publications actually exist. To be safe,
when you list your publications, cite them as being "in press". An "in
press" publication has been accepted for publication but has not yet
appeared in print and does not have a publication volume, page, or
date. Because "in press" publications have not yet appeared in print,
there is no easy way to determine whether the citation is legitimate.
When listing a fictitious manuscript on your CV, it is best to assign

yourself as the second author. The first author should be an ally, or a
made-up name, or the name of a deceased scientist, or someone who
would be difficult to find. This way, if anyone questions you about
the likely date of publication for the paper, you can simply say that
the first author is dealing with the publication process, and that you
are out of the loop. If, after you land the job, people persist in asking
when your "in press" papers will be published, just shrug your
shoulders and say that you are as baffled as they. Indicate you have
placed several calls to the first author and to the editor, with no reply.
Strange as it may seem, your colleagues will believe this concocted
story, because thoughtless behaviour is commonplace among
scientists.
A young medical researcher came to America, from Italy, in

search of an academic position. Unfortunately for him, he
lacked prior publications. Fortunately for him, his uncle was a
prominent researcher in Italy; he and his uncle shared the
same initial of their given name, and the same surname. The
Page 20 of 355
younger scientist larded his own CV with recent publications

of his uncle, including the surname and first initial of the
given name in each citation. The search committee mistakenly
attributed the publications to the applicant, and was
impressed that a young researcher could have accomplished
so much. He got the research position, and soon started to
apply for grants. Soon, he had his own funding, and was doing
quite well in the department. A few years later, his deception
was found, but by this time, he was bringing substantial grant
money into the department. The department leadership
decided to keep him, though they knew he had cheated on his
application. Perhaps they felt that he had proven himself the
only way that real scientists every prove themselves; by
getting funded. Perhaps they felt that if they could fire him at
any time; why would they want to fire him when he was
bringing in grant funds? Perhaps they wanted to avoid a
scandal that would diminish the department's ability to bring
in future grants? Perhaps they felt that they could hold the
secret over his head, keeping him as a virtual slave to the
department, forever. Most importantly, the department knew
that they would be required to return the grant funds to the
granting agency, if his secret got out. The lesson learned here
is that even a feeble deception on a job application can lead to
a successful career in science.
It may seem counter-intuitive, but lying works best when the

competition is fierce. Good jobs may have hundreds of applicants for
a single position. With so many applications to review, you can be
certain that nobody will be making a thorough check on your
accuracy.
One of the most competitive types of positions are medical specialty

fellowships. Such fellowships almost always lead to highly lucrative
careers. Studies have been conducted to gauge the honesty of medical
specialty applicants (17), (18), (19). Not surprisingly, about 30% of
applicants for gastroenterology fellowships were found to
misrepresent their accomplishments. Misrepresentations included
citations of nonexistent articles in actual journals, articles in
Page 21 of 355
nonexistent journals, or articles noted as "in press," that were not

published.
Among 280 applicants for orthopedic fellowships, 151 claimed that

they had authored journal publications. It was found that 16 (10.6%)
of these 151 applicants had misrepresented their citations (18). The
results were similar among the applicants for radiology fellowships.
A minimum of 16% (14/87) of applicants to the body and breast/body
imaging fellowship programs who cited publications misrepresented
their publication record (19). A similar pattern of dishonesty was
found among the applicants for Emergency Medicine residency
positions, the very same breed of doctors glorified in the TV show,
ER (20).
What happens when a dishonest applicant is discovered? Does the

university contact other universities, warning them the doctor has
falsified his application? Apparently not. The authors of the study
found no instances wherein the National Residence Matching
Program (NRMP), the clearinghouse for residency applications, was
apprised of falsified applications (20). Once a falsification has been
found, why wouldn't the University notify the NRMP? Institutions
fear that reporting a falsification would violate the ethics and rules of
the National Residency Matching Program (NRMP) match, which
prohibit schools from sharing information that would alter the
applicant's standing in the selection process. In addition, the applicant
might actually have a plausible defense for what would seem to be a
blatant case of cheating. You wouldn't want to be sued for ruining an
innocent medical student's chance to earn a living.
Suppose you were a medical student who was caught falsifying his
residency application. What would you do? You would simply claim
that any error was unintended. If you credited yourself with a
fictitious journal article, you would simply say that you thought that
the paper had been published, and that you were never informed by
the co-authors that the paper was rejected. This kind of thing happens
all the time.
The key thing to remember about false credentialing is that it has a

single purpose: to give you an advantage over your stronger, more
Page 22 of 355
deserving, competitors. It should never be used to establish a

completely false persona. The full-time imposter destroys his own
identity, and this is simply not in the interests of any self-respecting
evil scientist. A story that unfolded at the Stratton VA Medical
Center, in Albany, NY, demonstrates the point (21). The Stratton VA
hired a man for a cancer research position despite his prior felony
conviction for forging a medical license application. Once hired, the
cancer researcher, with no medical degree to his name, presented
himself to patients as a physician, and participated in their care. By
modifying medical records, he contrived to enroll patients in cancer
studies inappropriately, and without informed consent. These
nefarious activities fed patients into a financed arrangement between
the VA and the pharmaceutical companies that paid a fee for each
subject entered into clinical trials (22).
Two Stratton researchers complained that patients were being placed

at risk. Nobody likes a tattle-tale. The institution ignored their
warnings, and retaliated against the two whistleblowers. Affairs came
to a head when a decorated and popular veteran died two weeks after
receiving an experimental cancer drug. There was a trial, and the
fraudulent researcher was sentenced to nearly six years in prison after
pleading one count each of mail fraud and criminally negligent
homicide (21).
1.1 LESSENING THE GUILT: RETRACTIONS,

SCAPEGOATS, AND CLUELESS CONSPIRATORS
"Everybody lies, every day; every hour; awake; asleep; in his dreams;
in his joy; in his mourning."
-Mark Twain (1835 - 1910)
How often have you heard a scientist admit that he was mistaken?
There is hardly a single scientific area that is not steeped in
controversy. For every scientific hypothesis, there is an equal and
opposite hypothesis promoted by a rival scientist. You would think
that the progression of scientific knowledge would inevitably result
in a never-ending parade of retractions from those scientists who
championed discredited ideas. This is simply not how science works.
Page 23 of 355
Scientists are not morally superior beings; they seldom confess to

their mistakes. In almost all instances, retractions occur only after the
scientist has been proven wrong decisively and publicly.
Dr. Kilmer McCully's scientific career was built on his hypothesis,

first proposed in 1969, that homocysteine played an important role in
heart disease. Dr. McCully's hypothesis predicted that by reducing
the blood levels of homocysteine, with B vitamin supplements, the
incidence of heart disease would decline. Clinical studies failed to
validate his hypothesis. An evil scientist would have dissembled,
suggesting that the clinical study was poorly designed and would
require a much larger, lengthier study to test his hypothesis.
Alternatively, an evil scientist might choose to tweak the hypothesis
slightly, requiring new tests. Procuring funding for another clinical
test, poorly conducted and analyzed by allies with a stake in the
success of the original hypothesis, is the kind of subterfuge that
usually meets with some measure of success.
Dr. McCully, in a stunning act of honesty and scientific humility,

responded "The evidence is clear that this type of vitamin therapy is
really not effective in reversing or benefiting advanced vascular
disease" (23), (24).
All hypotheses are tentative propositions. It is the scientist's job to

develop and objectively test hypotheses. The perfect scientist does
not really care whether the hypothesis is proven to be true.
Dr. McCully is a rare exception to the general rule that scientists

never admit when their hypotheses are wrong. Most retractions occur
when something goes terribly, terribly wrong, and the best course of
action is a public apology.
Here is an example, reported in Nature under the banner, "Agony for

researchers as mix-up forces retraction of ecstasy study." (25) A
group of scientists at the Johns Hopkins University School of
Medicine had reported in the journal Science that the drug ecstasy, in
small doses, damaged the dopamine-producing brain cells in monkey.
As it turned out, the Science article was retracted when it was
determined that the wrong drug had been injected during the
Page 24 of 355
experiment (i.e., no ecstasy) (25). How could such a mistake occur?

We would all like to believe that scientific experiments are repeated
over and over, with fresh reagents, and with results scrutinized by
every member of the scientific team. We tend to forget the basic truth
that scientists are no different than any other people. Nobody
questions findings that confirm their own beliefs. If your original
hypothesis is that ecstasy is toxic to dopamine-producing cells, a
normal person will most likely accept results that validates his
hypothesis.
Some retracted papers are highly cited. The journal Science retracted
one of its published papers when it was discovered that an author had
fabricated data (26), (27). The paper had been cited 227 times. Most
research papers are never cited by anyone other than the authors. To
be cited 227 times is an indication that the scientific world had fully
embraced the conclusions of the bogus paper. In 2006, the Office of
Research Integrity came to the conclusion that the same author had
falsified data in four grant applications and in eight publications and
one published manuscript. In addition to the Science paper,
retractions appeared in other highly influential journals, including
Mutation Research, the Proceedings of the National Academy of
Sciences (PNAS) and Molecular and Cellular Biology. This indicates
that serial fabricators can have a pervasive influence within a field,
by planting pseudo-facts into the scientific literature, and by tainting
works, written by other scientists, that were predicated on false
findings.
One of the greatest cultural inventions was the scapegoat, an animal

to which human sins can be transferred. When the transference is
completed, the scapegoat is conveniently sacrificed to the gods, and
the humans are absolved from guilt.
In October, 1996, Dr. Francis Collins, a well known genetics

researcher, retracted five papers that he co-authored with a junior
colleague. A New York Times article reviewed the events leading to
Dr. Collins' revelation (28). Earlier that year, one of Dr. Collins' co-
authored papers had been submitted to the journal Oncology. The
reviewer for the journal found problems with some of the submitted
Page 25 of 355
data, and raised suspicions that the data had been deliberately
falsified. When Dr. Collins was notified of the problem, he reviewed
other papers co-authored with the same colleague and found a trail of
falsified data. When confronted, the colleague confessed. Much to his
credit, Dr. Collins immediately retracted the papers and sent
notifications to about 100 scientists in the field. This quick and
decisive action far exceeded the cryptic notices that characterize most
scientific retractions. Eventually, seven papers were retracted, and the
final deliberations of the Office of Research Integrity are now public
record (29). Full blame for the deceptions was placed on the junior
colleague.
There are a number of puzzling details concerning this episode. One

of the falsified papers was a two-author work written by Dr. Collins
and the junior colleague. When a paper has 30 authors, it is easy to
see how some of the authors might be unaware of every detail found
in the final manuscript. In a two-author paper, it is difficult for one
author to hide the experimental details from the other author. In his
interview with the New York Times reporter, Dr. Collins was quoted
as saying, "My bottom-line answer is very unsatisfying, but there is
no fail-safe way to prevent this kind of occurrence if a capable,
bright, motivated trainee is determined to fabricate data in a
deceptive and intentional way, short of setting up a police state in
your laboratory. (28)" If this were the case, how was it possible for
the journal reviewer to find the deception in the data?
This short episode in Dr. Collins' career illustrates the venial

character of data fabrication, when there is a scapegoat. Nobody will
push very strenuously for reforms in the way that group efforts are
conducted. Nobody will require every author on a multi-author work
to take full responsibility for the data included in their manuscript. If
you have a scapegoat, you have an alibi. Parenthetically, today Dr.
Collins is the head of the National Institutes of Health (i.e., the top
medical researcher in the U.S. government).
In another case, Charles Turner, an NIH funded investigator, used

interviewers to collect sociological data on 1800 Baltimore residents
(30). Eleven months into the study, Turner was informed that one of
Page 26 of 355
the staff interviewers was much more productive than the others.
Turner investigated and found that the overproductive worker had
been fabricating data. A grueling six months of data review followed,
during which Turner discovered multiple instances of data
fabrication, committed by several staff members (30). After the
incident, the investigator could have shrugged away the problem,
insisting, that it would be impossible to prevent fraud without setting
up a research police state. The investigator, in this case, owned up to
the problem, and affirmed that researchers, must validate, for
themselves, the work they delegate to others (30).
If you are the first author of a paper, and you have falsified the data
in your manuscript, how might you protect yourself? One approach is
to add a lot of superfluous co-authors. If the paper is discredited, the
blame can be diffused over a great many people. If the paper is well-
received, you can claim full credit for yourself. So-called "big
science" projects can produce manuscripts with over 100 co-authors
(31). In these cases, it becomes meaningless to blame every co-author
for a falsified study.
In the late 1990s, Dr. Wu Suk Hwang was a world-famous cloning

researcher. He was the pride of South Korea, and a commemorative
stamp was issued to celebrate his laboratory's achievements (Figure
1-4). Hwang's status drastically changed when fabrications were
discovered in a number of the manuscripts produced by his
laboratory. Dr. Hwang had a habit of placing respected scientists as
co-authors on his papers (32). When the news broke, Hwang pointed
his finger at several of his collaborators.
Figure 1-4. South Korean stamp celebrating Dr. Hwang's research,

depicting the direct route from stem cell cloning to the cure of
disease.
A remarkable aspect of Dr. Hwang's publications was his ability to
Page 27 of 355
deceive the coworkers in his own laboratory, and the co-authors

located in laboratories around the world, for a very long time. Dr.
Hwang used a technique known as compartmentalization; dividing
his projects into tasks distributed to small groups of scientists who
specialized in one step of the cloning process. By so doing, his
coworkers never had access to the entire project. The final
achievement of the research, new embryonic cells, was never
examined by the majority of scientists involved in the project. (33),
(32).
For several years, South Korean politicians defended Dr. Hwang,

labeling his critics as unpatriotic. Over time, additional violations
committed by Dr. Hwang were discovered. In 2009, Hwang was
sentenced in Seoul, S. Korea, to a two-year suspended prison
sentence for embezzlement and bioethical violations; but he was
never found guilty of fabrication.
1.2 ELITE LIARS
"The best is the enemy of the good."
- Voltaire
Every night, throughout the world, parents go to sleep dreaming that

one of their sons or daughters will get an education in Harvard, or
MIT, or CalTech or Johns Hopkins. They know that when someone
receives a degree from a top U.S. University, a bright future is
guaranteed. Respect, wealth, and happiness always come to these
lucky graduates.
If that were the case, why does it seem that the most contemptible
acts are committed at the best universities? Here's an example. On
January 23, 2009, the Office of Research Integrity made public their
findings of scientific misconduct concerning a doctor who fabricated
data for several grants projects funded by the NIH (34). The doctor
was a former graduate student in the Department of Pathology,
Harvard Medical School, a former research fellow and Instructor of
Pathology, at Brigham and Women's Hospital in Boston, a former
postdoctoral fellow in the Department of Biology, at the California
Page 28 of 355
Institute of Technology, and a former Associate Professor in the

Department of Biology and the Center for Cancer Research at the
Massachusetts Institute of Technology. He had worked on numerous
NIH grants, and was found to have fabricated data supporting
applications for five NIH grants.
It is difficult to imagine a person better prepared for a life of

scientific integrity. From his pre-doctoral training, through his post-
doctoral research and his academic appointment, he was nurtured in
the finest environments, by some of the most respected scientists on
the planet. Throughout this book, we will be shocked by the most
respected universities and corporations (35), (28), (29), (36), (37),
(38), (15), (39), (40), (41). The reason is obvious: if you want
prestige and money, you go to the places where the prestige and
money are found.
1.3 WHEN YOU ARE CAUGHT
"Of all the thirty-six alternatives, running away is best."
- Chinese proverb
Most scientists who falsify data never get caught. If you are one of
those few cheaters unlucky enough to be discovered, use one or more
of the following tried-and-true methods to avoid punishment:
1. Deny that any offense was committed. You will be surprised that
most dishonest or otherwise unethical behavior is permitted under the
law. Furthermore, most institutions never bother to write regulations,
policies, or even guidelines that cover the vast majority of the
offenses covered in this book. The logic works like this: if it's not
illegal, it must be legal, and if it's legal, it can't be wrong.
Characterize your accusers as ineffectual whiners. Remind them that
America is a free country, and that you will not allow them to abridge
your freedoms.
2. If, in fact, you actually broke some law, deny that the statute has
legitimacy. Argue that the law is unfair, archaic, ambiguous, and
never enforced on your colleagues. Say that you are a victim in a
ruthless plan to promote an unfair and unnecessary law that would
Page 29 of 355
never have been approved by a responsible legislature. Appeal to the

public to overturn the law.
3. Deny knowledge of the law. They say that ignorance of the law is
no excuse. Nonetheless, it is always worth a try. If the average person
has never heard of the law, you can gain public sympathy.
4. Impugn the integrity of your accusers. Say that your accusers have
themselves broken the same law, among many others.
5. Assert that you are the victim of a personal vendetta. If you can
show that your accuser has a personal agenda, you can undermine his
credibility, his moral superiority, and his authority. You can take
advantage of the situation by transforming yourself into the victim.
6. Blame someone else. If you were smart, you have maneuvered

someone else into committing the actual offense.
7. Share the blame. If there are fifteen co-authors on a falsified

report, particularly if some of those co-authors are powerful
authorities in the field, it is unlikely that punishment will fall on any
one participant.
8. Get a lawyer. Lawyers are trained to help guilty people get off free.
Sometimes it is best to let the professionals do their job.
9. Lie your head off. Lying often helps. It is best to confine yourself
to a few carefully chosen lies that will hold up under scrutiny. Be
careful not to include lies that contradict other lies. Once you've
settled on a set of lies, stick to the script. The more you improvise or
embellish, the less likely the lies will hold.
10. Use one of these general-purpose excuses:
a. "I did it for my kids." This works for almost everyone, even those
with children from former marriages whose child support is in
arrears.
b. "I did it for my family." Almost everyone has family: a mother,

father, sibling, or cousin. Even if you are completely estranged from
Page 30 of 355
all of your relatives, you can use this excuse. Nobody will bother to
check.
c. "I had to pay the mortgage." This excuse can summon a vision of
the destitute scientist, with his wife and children, shivering, in the
night, in a Chevy.
d. "I was under enormous pressure from my supervisor." This often-

used excuse works if everyone believes the premise. Should anyone
point out that your pressures were par for your profession, and that
thousands of your peers manage to conduct themselves with integrity,
the excuse evaporates. If everyone knows that your supervisor is a
major head case, go for it.
e. "I was not myself." This completely irrational excuse is remarkably

effective. It requires an external object (drugs, alcohol, drugs and
alcohol, video games, twinkies) that transforms the person into
someone with a different personality, for some convenient length of
time. Dr. Jekyll cannot be held responsible for the actions of Mr.
Hyde.
f. "I infiltrated the group of conspirators and was collecting evidence

on them." Though this excuse is almost never credible, it is
sometimes hard to disprove.
g. "I would have been destroyed if I did not cooperate." This excuse
works best if you can demonstrate that other scientists, who did not
cooperate, were actually destroyed.
h. "I'm no fool. I just played the game like everyone does." This
excuse builds the guilty party into someone who is a realist (not an
idealist), and who follows a set of rules imposed by harsh reality.
If all this fails, don't sweat it. In virtually all cases of simple data
fabrication, the worst that might happen is that you will lose your job.
It seems that nobody is ever asked to repay the federal government
for the cost of a grant. Nobody goes to jail for writing bad
manuscripts. Throughout this book, you'll see numerous examples of
scientists, tainted by misconduct, who emerged from the ordeal to
become powerful leaders in their fields. Don't be surprised. If we
Page 31 of 355
disposed of every blemished scientist, all scientific activities would

come to a screeching halt.
1.4 ADVICE FOR EVIL SCIENTISTS
1. Truth is an over-rated commodity. If truth had any value, we'd get

paid to be honest.
2. When you think about it, there are so many risk-free ways to be a
successful evil scientist, data falsification is seldom worth the peril.
Remember, being an evil scientist should not involve gambling with
your own career. Being an evil scientist involves gambling with the
careers of your competitors.
3. When you absolutely positively must falsify your data, there are a
few common sense precautions that you should take. First and
foremost, get someone else to do the dirty deed. Find someone who is
insecure, lazy and dishonest. Never order anyone to cheat; let your
subordinates figure it out for themselves. In the unlikely event that
you are caught, immediately apologize for the unauthorized and
regrettable actions of the guilty subordinate. The scientific
community will forgive you, so long as your apology is sincere.
Sincerity, like everything else, can be faked.
4. A job application is an advertisement for yourself. All advertising

is rife with hyperbole. Anyone who reviews job applications should
expect serious applicants to exaggerate their accomplishments. When
applying for a job, do not hesitate to pad you CV with fictitious
accomplishments.
5. Do not worry about institutions putting you on some kind of black-

list, if they catch you falsifying your CV. Such black-lists do not
exist. Most institutions are content to let some other institutions hire
bad scientists. Moreover, some institutions have a very short memory
for these kinds of things. After a change in department chairs, you
can re-apply to the very same institution that caught you lying on
your CV. You can even include the same falsifications. Just because
they caught you once, doesn't mean they'll catch you a second time.
CHAPTER 2. IMPROVING THE TRUTH: THE ART OF
Page 32 of 355
SCIENTIFIC MISINTERPRETATION
After a crushing defeat at the hands of their arch-rivals, the local

newspaper displayed the following banner headline, "Home team
takes second place. Visitors finish next to last."
-Anonymous
You are the chief scientist for a major cigarette manufacturer.

You have devoted your career to developing a safe cigarette.
You knew, going into the project, that your task was
impossible. But the pay was excellent, and your company
offered an excellent retirement package. Although you might
never produce a safe cigarette, you might one day produce a
cigarette that is safer than other brands. Today, you are
testifying for a Congressional committee investigating your
employer. As chief scientist, you are asked some very blunt
questions about the biological effects of cigarettes. A
particularly self-righteous congressman asks you THE
QUESTION: "Is cigarette smoking addictive?" You pause, for
a moment, to think. You know that some people quit smoking
permanently by going cold turkey, without suffering
withdrawal symptoms. These people had no addiction;
smoking was just a habit, for them. Thinking this way, you
answer, without perjury, "No, smoking is not addictive."
All scientists demand the unadulterated truth; from other scientists.

They tend to set a much lower bar for themselves. When truth
interferes with fame, fortune, or vanity, the most focused scientists
somehow draw on inner-strength, opening their minds to a rich
variety of dependable, truth-independent alternatives.
Every observation can be misinterpreted, and no scientist has ever

been found guilty of any criminal or ethical offense because his
interpretation was incorrect. If you want to eliminate any chance of
punishment, stick with falsifying your conclusions, not your data.
Many a research career has been fueled by drawing stunning
conclusions from the flimsiest of data. At worst, some of your
competitors will say that your are a bad scientist. Counter by saying
Page 33 of 355
that your accusers are losers who are jealous of your hard-earned
success.
Though many books have been written on data interpretation, no evil

scientist has tackled the broader question: "What is the best way to
misinterpret data?" Each new generation of scientists have been
forced to master the subject of data misinterpretation anew, through
trial and error. This chapter is designed to rectify this omission and to
shed new light on a dark area of scientific gamesmanship.
2.1 ALL STATISTICAL STUDIES ARE OPEN TO

MISINTERPRETATION
"There are three kinds of liars - liars, damn liars and statisticians."
-Attributed to Mark Twain and to Benjamin Disraeli
It is said that you can prove almost anything with statistics. This is
not an exaggeration. Statistics, at best, summarize some aspect of the
truth, leaving you to commit mayhem with other aspects of your data.
Every statistician learns the parable of the mathematician who
drowned in a lake of average depth two feet!
Consider the analysis of vaccination effectiveness. Brisson has

shown, quite convincingly, that you can statistically demonstrate that
vaccinations are effective in a population, or ineffective, without
altering your data (42). It's done by modifying the model, choosing a
different analytic question (e.g., examining cost-effectiveness or cost-
benefit), and introducing a bit of uncertainty in the results. The
results can be anything you desire.
Simpson's Paradox (published 1951) is named after the British

mathematician Edward H. Simpson (43). Simpson provided an
example wherein two sets of data, considered separately, supported a
particular conclusion, whereas the two sets of data, combined,
supported the opposite conclusion. Here is how Simpson's paradox
operates. Let's say that a drug trial shows that drug A is effective in
10 out of 100 patients (10 per cent), and drug B is effective in 200 out
of 1,000 patients. (20 per cent). We conclude that drug B is more
effective than drug A. In a second trial, drug A is effective in 400 out
Page 34 of 355
of 1,000 patients (40 per cent), and drug B is effective in 60 out of

100 patients (60 per cent). Again, drug B proved more effective than
drug A. When we combine the results of both trials, drug A is
effective in 410 out of 1,100 (37 per cent), and drug B is effective in
260 out of 1,100 (24 per cent). The combined data indicates that drug
A is more effective than drug B; the opposite result from either of the
individual trials.
Statistics is the most malleable of the analytic sciences, and

statisticians are highly adept at interpreting data to suit their own
agendas. In a just world, when a man drowns in a lake of average
depth two feet, that man will be a statistician.
2.2 INTRODUCING BIASES INTO YOUR STUDY
"A mathematician is a person who says that, when three people are
supposed to be in a room but five came out, two have to go in so the
room gets empty"
-Origin unknown
Every evil scientist must carry a bag of tricks. Statistical biases will
be among your most trusted deceptions. For the sake of brevity, the
biases are listed here. In-depth explanations are found in Chapter 16
(Clinical Trials on Trial).
Accrual bias, Apples-oranges bias, Cherry-picking bias, Co-

morbidity bias, Confounder bias, Demographic bias, Diagnosis bias,
Eligibility bias, Income bias, Lead-time bias, Marketing bias,
Meaningless bias, Measurement bias, Medical record bias, Negative
study bias, Population bias, Prayer-based bias, Re-abstraction bias,
Record bias, Second trial bias, Stage bias, Stage treatment bias,
Statistical method bias, Under-reporting bias, and Zipf bias.
How are these biases used in experimental studies? Lead-time

survival bias serves as an example. Suppose there were a cancer, Y,
that is uniformly deadly. Once it is diagnosed, the average survival,
after the best available treatment, is three years. Nobody who has this
cancer lives beyond five years.
Page 35 of 355
Dr. Detecto is a pathologist who has invented a very sensitive method

for detecting cancer Y at a very early stage. Dr. Detecto can detect
cancer Y a full four years earlier than any previous method of
detection. Unfortunately, there is no effective treatment for cancer Y,
even when it is detected early. All patients with cancer Y will die.
Because cancer Y patients are now detected four years earlier, the
natural course of disease results in an expected death 7 years (3 years
plus the 4 years lead time) later. When we study 5-year survival after
diagnosis, we find that the five year survival is now 90%.
The newspaper headline reads, "New, improved detection technique

for cancer Y improves 5-year survival from 0% to 90%."
Of course, detecting the cancer four years earlier only increased the
time between diagnosis and death. It did not extend, by even a single
minute, the age at death of patients with cancer Y.
Has Dr. Detecto made a useless discovery, and is the survival data
fraudulent? No. Tumors are best treated when they are detected early.
In the case of cancer Y, there was no immediate benefit for early
detection. Nonetheless, the set of early cancers provides cancer
researchers with a group of tumors that might have an improved
response (compared to late-diagnosed cancers) to newly developed
cancer therapies.
2.3 FALSIFICATION OF CONCLUSIONS
"If any question why we died, Tell them because our fathers lied."
-Two-line poem, by Rudyard Kipling, commemorating World War I
"if one reads the literature, one often discovers that a finding reported
in the Results section studded with asterisks implicitly becomes in the
Discussion section highly significant or very highly significant,
important, big!"
-Jacob Cohen (44)
Everything in life can be improved, including the truth. The easiest
Page 36 of 355
way to improve the truth is to interpret your results to support the

outcome you prefer. Nobody in the history of science has ever gotten
into any serious trouble for misinterpreting their research results. In
fact, misinterpretation is the most prevalent form of falsification in
science. If your data is collected honestly, and you draw conclusions
that are not strictly supported by your own data, the most likely
results (in descending order of probability) are:
1. When your conclusions support the current popular paradigm of

your field, they will be accepted for publication, even when your data
does not support your conclusions. There was a time when blatant
racism, the belief that some races were superior to other races, was
accepted as established scientific fact. Racist papers sailed through
peer review and were published in professional journals. Eugenics
seemed like a quite reasonable method to improve the racial stock.
Between 1921 and 1964, over 33,000 Americans deemed unfit for
procreation, were sterilized against their will (45). Most scientists
today recognize that these respected journal articles, written by
respected scientists, and published in respected journals, were all
nonsense; nonsense that conformed to a paradigm that was once
popular.
2. After your paper is published, nobody will read your paper or care
that your conclusions are nonsensical. Yes, the vast majority of
journal articles will be totally ignored by your peers. The scientific
literature serves as a vast cemetery, where dead ideas are buried.
3. The publication, though of no scientific merit, will establish your

credentials in the field. Yes. Every publication adds two centimeters
to your Curriculum Vitae.
4. Your conclusions will stir controversy among a small minority of

the scientists in your field, who have nothing better to do than to
discredit your feeble contribution. This might draw some small
amount of attention to you, but in the long run, it will have no
negative consequences.
The Discussion section of any manuscript is always the dumbest

section, because it includes all of the subjective, prejudiced,
Page 37 of 355
dogmatic, self-serving, and unscientific thoughts that motivate the

authors. You might be wondering why reviewers do not delete such
comments. Reviewers never delete comments that support the general
scientific paradigm held by the reviewer. Suppose that your are an
astronomer who believes that bacteria grow on mars. You are
charged with reviewing a paper indicating that meteorites contain
microscopic shapes. The author of the paper indicates that the shapes
might be bacterial fossils and that this indicates that bacteria may
grow on planets, such as mars. What is the likelihood that you will
insist that the author delete such remarks on the basis that they are
purely speculative? More likely than not, you will accept the paper,
and you will use the "findings" to promote your own scientific
agenda.
In many cases, you will learn that no useful conclusions can be drawn
from your work. Your data can neither establish or abolish a
hypothesis. Basically, you have wasted time and money working on a
project that has produced no meaningful results. Do not despair. Here
are a few standby conclusions that you can apply to the flimsiest of
findings, without any serious challenge:
1. "These findings indicate that it is feasible to...." Comment.

Demonstrating feasibility is a low hurdle. Just about everything is
feasible.
2. "These findings demonstrate the enormous potential of...."

Comment. Every idea has potential. So what?
3. "One possible interpretation of these findings is...." Comment. You

cannot go wrong by offering a possible explanation.
4. "These findings raise several important questions..." Comment.

When your findings provide no answers, perhaps they raise some
questions.
5. "These findings cannot be explained using the prevailing

paradigm...." Comment. This technique will work if your reviewer is
an opponent of the prevailing paradigm.
6. "Prior studies have overlooked these and similar observations...."
Page 38 of 355
Comment. Most poorly executed experiments produce results that

have not been observed previously. Try to turn your ineptitude into a
virtue by drawing the reviewer's attention to the mysterious quality of
your data.
7. "Whereas further research is needed before this technique can be

applied...." Comment. One of the most useful qualities of bad
research is that it always requires further study.
If you are a journalist, assigned to report on research that has no real

significance, try one or more of these encouraging
mischaracterizations:
1. "Scientists are one step closer to finding a cure for..." Comment.

You need not burden the reader with the total number of steps needed
to find a cure.
2. "Scientists hope that future clinical trials will confirm...."

Comment. Scientists are a hopeful bunch.
3. "If these preliminary findings are validated in clinical..."

Comment. You need not point out that unvalidated preliminary
findings have no value.
4. "Exciting new research promises that relief may be close at hand

for millions of patients suffering from..." Comment. Relief may also
be distant, but it helps to be optimistic.
5. "New hope for sufferers of ...." Comment. Nobody will ask what
might have happened to the old hope.
2.4 MISREPRESENTING PROGRESS IN THE WAR

AGAINST CANCER
"Adverse alike to ethical propriety and to medical logic, are the

various popular delusions which, like so many epidemics, have, in
successive ages, excited the imagination with extravagant
expectations for a cure of all diseases and the prolongation of life
beyond its customary limits, by means of a single substance.
Although it is not in the power of physicians to prevent, or always to
Page 39 of 355
arrest, these delusions in their progress, yet it is incumbent on them,

from their superior knowledge and better opportunities, as well as
from their elevated vocation, steadily to refuse to extend to them the
slightest countenance, still less support."
-The American Medical Association Code of Ethics of 1847
It is difficult to pick up a newspaper these days without reading an

article proclaiming progress in the field of cancer research. Here is an
example, taken from an article posted on the MedicineNet site (46).
The lead-off text is: "Statistics (released in 1997) show that cancer
patients are living longer and even "beating" the disease. Information
released at an AMA sponsored conference for science writers,
showed that the death rate from the dreaded disease has decreased by
three percent in the last few years. In the 1940s only one patient in
four survived on the average. By the 1960s, that figure was up to one
in three, and now has reached 50% survival."
Optimism is not confined to the lay press. In 2003, then NCI Director
Andrew von Eschenbach, announced that the NCI intended to
"eliminate death and suffering" from cancer by 2015 (47). The book
you are now reading was written in 2010. If you believe the Director
of the National Cancer Institute, people will stop dying from cancer
just five years from the publication date!
These optimistic reports on our progress against cancer are grossly

misleading. There is ample historical data showing that the death rate
from cancer has been rising throughout the twentieth century, and
that the burden of new cancer cases will rise throughout the first half
of the twenty-first century (48). If you confine your attention to the
advanced common cancers (the cancers that cause the greatest
number of deaths in humans), we find that the same common
advanced cancers that were responsible for the greatest numbers of
deaths in 1950 and 1978 are the same cancers killing us today, and at
about the same rates (49), (50).
Despite the many billions of dollars spent on research and treatment

for cancer, we have made negligible progress toward reducing the
number of people who die each year from cancer. The reason that
Page 40 of 355
cancer organizations can announce major gains against cancer and

can promise to eliminate cancer deaths by 2015 is due entirely to the
magic of data misinterpretation!
To see how the deception works in the cancer field, you need to start
with the definition of "survival." To a layperson, the term "survival"
indicates avoidance of death. For example, the survivors of a plane
crash are the people who did not die in the crash. To an oncologist,
survival is the time interval between diagnosis and death. The
difference between survival (to an a layperson) and survival (to an
oncologist) is the difference between winning and losing the War on
Cancer.
Suppose that oncologists announce that a new treatment of pancreatic

cancer produces a 1% increase in survival. Layman will interpret this
to mean that a person with pancreatic cancer will have a 1 in 100
chance of being cured of his cancer above and beyond his chances for
cure with the older treatment. To most people with cancer, that 1 in
100 improvement, though small, is worth any price. Unfortunately,
this is not the case at all. To the oncologists who made the
announcement, a 1% increase in survival indicates that if the life
expectancy following diagnosis of pancreatic cancer is 100 days, then
the life expectancy following diagnosis with the new treatment is 101
days. In either case, virtually every patient with advanced pancreatic
cancer will die. The patients receiving the new treatment may
reasonably expect to live an average of one day longer.
In 1971, President Richard M. Nixon signed the National Cancer Act

into law, marking the year that the United States launched its War on
Cancer. For the next two decades, the U. S. cancer death rate rose
steadily. Then in 1991, the U. S. cancer death rate began to decline,
incrementally. It is tempting to conclude that 1991 marked the
beginning of victory in our war against cancer, and that the steady,
incremental declines in U. S. cancer death rates will continue in
future decades, until cancer is fully eradicated.
This is simply not the case. There has been almost no decrease in the
U.S. cancer death rate in the past half century (51). The small decline
in the cancer rate since 1991 is counter-balanced by a small rise in
Page 41 of 355
the rate of cancer deaths between 1975 and 1991. Today, the cancer
death rate is just about where it was in 1975. What accounts for the
rise in cancer deaths after 1975 and the restoration of the 1975 rates
following 1991? There's not much mystery. For the most part, the rise
was due to smoking; the fall was due to smoking cessation (48). Lung
cancer is the number one cause of cancer deaths in the U.S. About
90% of lung cancers are caused by exposure to cigarette smoke. It
can take twenty years or more for a smoker to develop cancer.
Changes in the smoking habits in a population will result in changes
in the overall cancer death rate over the following decades. We can
expect that the small drops in the cancer death rate will continue, as
women catch onto the trend toward smoking cessation.
Advances in the treatment of advanced common cancers do not

contribute to the current small drop in the cancer death rates. You
may be asking yourself about the validity of claims that we can now
cure many childhood cancers that could not be cured in prior
generations. This is absolutely true. Many children with cancer can
now be cured. However, the overall incidence of childhood cancers
has risen 36% since 1976 (52). This rise in cancer has erased most of
the overall benefits from the rising cure rates.
We've seen some progress made in curing a few rare cancers. It is

only reasonable to hope that these advances will carry over into the
treatment of the common cancers. Unfortunately, recent advances in
cancer genetics point to an opposite conclusion. Research into the
genetics of tumor cells has shown us that some cancers are
characterized by simple genetic errors. It turns out that the tumors
with simple genetic errors coincide with the rare tumors of childhood
and certain rare tumors of adults. The small number of gene
alterations in these rare tumors permits us to target chemotherapeutic
agents against a single vulnerable metabolic pathway. The successes
against childhood cancer and other rare cancers are due, in no small
part, to the simplicity of the gene alterations that characterize rare
tumors.
If you speak to any cancer researcher, he will tell you that we have
made great advances in understanding cancer genetics: the mutations
Page 42 of 355
in DNA that contribute to the development of cancers. What they do

not say is that all of the advances in our understanding of cancer
genetics come in the form of bad news. We now know, thanks to
billions of dollars of funding, that cancer cells are remarkably
complex, often containing thousands of genetic alterations. No two
genetically complex cancers can be characterized by the same set of
mutations, and no two tissue samples of any one cancer will be
genetically identical. The complexity of cancer far outstrips our
ability to characterize the alterations in a cancer cell.
The lesson we learn from the genetic analysis of cancer is profoundly

discouraging. The genetic complexity of common cancers would
suggest that treatments that work against rare tumors will have
limited effect on the common cancers. You won't hear this from
funded cancer researchers; nobody wants to kill the goose that lays
the golden egg.
Cancer projections provided by the NCI's SEER program (the

National Cancer Institute's Surveillance, Epidemiology, and End
Results), indicate that between the years 2000 and 2050, the number
of new cancer cases per year will more than double, from 1.3 million
new cases in 2000 to 2.8 million new cases in 2050 (53). The
projected yearly increase in cancer cases, if unchecked, will put
additional strain on the wobbly American healthcare system.
After hundred of billions of dollars spent on cancer research and

cancer treatment, with almost nothing to show for the effort, why do
we believe claims that the dying will stop by 2015? Humans live in
hope; we would rather believe a hopeful lie than a hopeless truth.
2.5 ADVICE TO EVIL SCIENTISTS
1. If you think about it, you'll realize that every paper is

misinterpreted. Sometimes misinterpretations result from stupidity.
More often, they result from efforts to bend the truth. Sometimes,
misinterpretations occur because everyone as their own unique
interpretation of reality. Whenever you misinterpret your data, be
sure to provide a conclusion that people want to hear.
Page 43 of 355
2. Daniel Moynihan once said, "People are entitled to their own

opinions, but not their own facts." So long as you stick to opinions,
and keep your distance from facts, you can get away with saying
anything.
3. Misinterpretation is safe. Nobody has ever been prosecuted for

misinterpreting data. If you are a serious evil scientist, searching for a
risk-free escape from the unproductive efforts in your laboratory, the
burgeoning field of data misinterpretation will be your salvation.
4. The person who interprets the data determines the outcome of the
study. Never let others interpret your data. They will always
misinterpret your data to suit their own agenda (just like you do).
5. There are no rules that specify what must be included in the results
section of a scientific paper. That being the case, feel free to include
only those findings that support your own agenda. Any data that
might an opposing hypothesis can be omitted from your results
section.
6. There are no rules that limit the number of experiments performed

by a scientist. When your data does not support your preferred
hypothesis, repeat your experiment over and over again, until the data
is more to your liking. In the unlikely event that a co-worker, with
access to your lab reports, notices the omitted experimental data,
simply indicate that the earlier experiments (the ones with the non-
supportive data) were not included because they were flawed.
7. In the Discussion section of your papers, you will be expected to

compare and contrast your results with the results of other
contributors to the field. You can selectively cite works that support
your findings, while omitting any mention of opposing works. You
can misrepresent the conclusions found in the works of others. You
can bolster your discussion with citations that bear no relevance to
your assertions. Nobody will check the citations against your
statements.
8. Every field of science has jargon terms that mean something very
specific to the people within the field. The same words will mean
Page 44 of 355
something very different to laypersons. To a layman, survival is an

indication of cure. To an oncologist, survival indicates the interim
between diagnosis and death. An evil scientist can play one meaning
against another to manipulate the way data is interpreted.
9. Nobody will doubt your misinterpretation of the data, if you tell

people what they want to hear.
10. Your job, as an evil scientist, is to make the world believe that
your research is more important and more fundable than everyone
else's research. Over 99% of research has no real value, and your
research is certainly no exception. All of your creativity, effort, and
cunning should be focused on promoting your own work; data
misinterpretation will be one of your most useful tricks.
CHAPTER 3. THE EVIL WRITER
"I try to leave out the parts that people skip."
-Elmore Leonard
"A metaphor is like a simile"
-Anonymous
Here is a popular story passed down from generation to generation of

scientists:
A renowned biologist dies and finds himself in a mist-

enshrouded world, bathed in an ethereal, opalescent light.
Next to him stands a tall, hooded figure garbed in a monk's
robe. Further on, a young, beautiful blond woman, in a bikini,
sits at a desktop covered with journal articles. The hooded
figure nods in her direction and says, "Go see what this
woman is doing." The dead scientist walks to the woman, who
is deeply absorbed in her reading. He picks up one of the
articles from the stack, and sees that it is a scientific journal
that he had published, many years ago. With growing
excitement, he thumbs through the other articles and sees that
they are all his works. Turning to the hooded figure, he says,
Page 45 of 355
"Ah. I understand now. I'm in heaven, and my reward is to

have a beautiful, adoring woman spending eternity reading
the products of my earthly endeavors." The hooded figure
responds with undisguised exasperation and contempt, "Fool.
I have not shown you your heaven! I have shown you this
woman's hell!".
Publication is a topic that cannot be avoided. If you are planning on

an academic career, you must publish manuscripts in science
journals.
Preparing a journal article is much like filing your income taxes. Lots
of boilerplate, a list of hastily assembled numbers, a disappointing
conclusion, and a choice of post office or electronic submission.
If you lack a creative spirit, and are worried that you will have
trouble writing your paper, do not be alarmed. No creativity is
involved. The stylistic restraints imposed on journal articles, by
editors and reviewers, have removed all of the attributes you would
normally associate with stimulating prose.
Every journal has an "Instructions for Authors," page, providing a

manuscript template, and a list of commonly encountered features
that the editor would prefer not to encounter. The template usually
takes the following form:
Title - Always in the form of a specific topic, not as an assertion of

your findings. It's best to keep them guessing.
Authors - If you're under 35 years old, take the first author spot.
Otherwise, take the last author spot.
Abstract - Two-sentence condensation for the Background, Methods,

Results, and Discussion section. This is the part of the paper that will
pop up with a PubMed search, and is the only part of your manuscript
that anyone is ever likely to read.
Background - This section is intended to contain the conceptual

information that justifies your hypothesis, and an explanation of the
experiment that will test your hypothesis. In actuality, the
Page 46 of 355
Background section is used to impress upon the readers that the topic
you have chosen is important, and that anything written on the topic,
no matter how trivial, deserves to be published.
Methods - This is the easiest part of the manuscript to write. It

consists of references to a few standard papers that describe precise
steps for complex techniques known to everyone in your field. Of
course, you have modified the techniques to produce the results you
desired, but nobody needs to know that.
Results - No doubt, while conducting your studies, you and your

colleagues performed many experiments that failed to yield the
correct results (i.e., the results that confirm your hypothesis). You can
safely ignore this data, selecting only confirmatory data for the
precious space allotted to Results. Within your confirmatory data,
there will be some data points that do not "fit" with the other data
points. This data can be omitted. Prepare a table that contains your
favorite data points, overlaid with statistical ranges that appear to
confirm your conclusions. Convert your table into a pie chart or some
visually misleading graphic that distracts your readers from the actual
data. In the textual portion of the Results section, interpret the pie
chart to suit your own agenda.
Discussion - Use this section to explain how your now-proven

hypothesis confirms the currently popular paradigms in your field. Be
sure to cite prior works that complement your findings. Cite your
own publications freely, even if they bear no relevance to your
current paper. Never cite papers written by your competitors.
Summary or Conclusion - This is the section where the author

includes exculpatory language, such as "Awaits clinical trials in
humans," "Requires confirmation in an in vivo system," and the old
stand-by, "Further study is needed."
Once the paper is prepared, in draft form, you can begin the
humiliating process that leads up to submitting the final version to a
journal. Send a copy of the first draft to each of your co-authors and
ask them for constructive feed-back. Only one of the co-authors will
provide a quick turn-around with helpful suggestions. The others
Page 47 of 355
really do not care about you or your paper, and will not reply. Wait
two weeks, make a few of the changes suggested by the single
respondent, and send the second draft to all of the co-authors, with a
cover letter thanking them for their input on the first draft. Repeat the
process one more time. Send all of the co-authors a copy of the final
draft, indicating that you have incorporated all of the changes
requested by all of the co-authors. Remember to thank them for their
guidance and indicate that working with them was a privilege and an
honor.
You are now ready to send three copies of the final manuscript to the
editor.
Here are a few tips for enhancing the likelihood that your paper will
be accepted for publication:
1. Be sure to include an ingratiating cover letter with your

manuscript. Indicate that the topic of the paper has great importance
to the readers of the journal.
2. Use the Background section of your manuscript to sell the paper to

the reviewers. If you are publishing in the cancer field, be sure to
include the number of people who die each year from cancer. Readers
will subconsciously transfer the general topic (e.g., cancer research,
saving lives) to your manuscript. This trick works well, even when
your study has no merit and adds nothing to the sum of knowledge on
the topic.
3. From time to time, you'll choose a field of study that has been
thoroughly plowed by your betters. If your results agree with the
results of prior studies, then you must pose your paper as a validating
study. If your results disagree with prior studies, then you must
promote your paper as a controversial re-examination of an important
research question. If the prior work was done in the remote past, then
you must promote your work as a historical investigation, that brings
new techniques to bear on an topic of enduring interest. If the only
justifiable reason for your paper is that it answers a previously
unsolved problem, then it's best to simply ignore the preceding
manuscripts. Odds are, nobody will notice that it was all done before.
Page 48 of 355
4. In every field, there are some journals that have a backlog of

accepted papers waiting their turn to be included in a forthcoming
issue. Never submit your papers to these journals; the editors are
looking for an excuse to reject papers and reduce their backlog.
Submit your paper to a journal that can barely assemble a sufficient
number of papers to justify the next issue. Editors of these journals
are desperate and will accept almost any submitted paper. A sure sign
of desperation is the "Call for Papers," often sent by editors who are
beating the bushes for fresh material. Never hesitate to answer the
"Call." On a lark, Philip Davis and Kent Anderson sent a patently
ridiculous paper, from a fictitious institution (Center for Research in
Applied Phrenology, or CRAP), under pseudonyms, to a journal that
had solicited papers. The paper was accepted (54). After the hoax
was publicized, the journal's editor resigned (55).
5. Be certain to include a co-author who is respected by the readers of

the journal or by the editor of the journal. Scientists, just like non-
scientists, will believe anything, if it comes from a trusted authority.
6. Include a statistician as a co-author. Most editors and reviewers are

unfamiliar with statistical methods. Adding a statistician to the author
list adds a comforting layer of credibility to your dubious results.
7. Include elegant graphics. For editors and reviewers, style beats

substance.
8. When writing your conclusions, interpret your results in such a

way that they support the journal's agenda. For example, if you have
a manuscript on the topic of capital punishment, and you are
submitting the paper to an ethics journal that has published numerous
research articles and editorials on the evil of the death sentence, you
should interpret your data to suggest that capital punishment is
without societal value, or (better yet) detrimental to law enforcement
efforts.
9. If your paper is rejected, re-submit your rejected paper to another

journal. Eventually, you will find an editor who will publish your
paper (54), (55).
Page 49 of 355
10. When it seems as though no journal will ever publish your paper,
just put the paper aside for a time. Eventually, an editor will invite
you to submit a paper on a topic related to the rejected manuscript.
Invited papers are often reviewed in-house (by the editor or by a
colleague of the editor) and the reviews, no matter how negative, are
never taken as a serious impediment to publication. In many cases,
invited papers are not reviewed at all. Use the invitation as an
opportunity to publish your otherwise unpublishable manuscripts.
Let's jump ahead. You've just gotten your first paper accepted for
publication. Your evil work has finally come to a successful close. Or
has it? Once your paper has been accepted for publication, it enters
publication limbo. Some journals are severely backlogged, having
accepted many more papers than can fit into their print issues. In this
case, a paper can wait for more than a year before the print version
appears. This backlog problem is alleviated somewhat when journals
publish an electronic version of the article that appears prior to the
release of the print version. However, there is a limit to number of
months that an e-publication can precede the print version. The
problem remains that after acceptance, a journal article can languish
for a very long time before its official publication date. During this
time, a number of unfortunate events may occur that crush the hopes
and careers of the hapless authors.
1. The editor may decide not to publish your paper (56). Yes,
acceptances can be revoked. This can happen when the editor who
accepted your paper vacates his position, and a new editor arrives
who wants to move the journal into a new direction. Specifically, the
new editor may specifically want to exclude papers such as yours.
2. The publisher may discontinue the journal. Yes, journals that are
unprofitable can die. Backlogged, unpublished papers will fall into a
dismal void.
3. The editor may be forbidden to publish your paper, by the

marketing department. This can happen when your paper criticizes a
journal advertiser (57).
Page 50 of 355
4. The editor may stop or delay publication of your paper if he likes

your competitor more than he likes you. If others in your field
become aware of the imminent publication of your paper, they might
prevail upon the editor to delay publication until their own paper has
been published in the same journal or in another journal. The first
publication of a scientific finding confers discoverer status on its
author. By delaying publication, editors can determine who gets the
credit for a scientific breakthrough. The competitors who are in the
best position to learn about your pending publication are your
reviewers, who are almost always working in your field, and the
editor himself, who often conducts research in one or more of the
areas covered by the journal. Reviewers have been known to
plagiarize findings taken from the works they review (58). It is quite
possible for your reviewer to duplicate your work, write a
manuscript, and have the manuscript accepted and published before
your manuscript appears in print.
You might be wondering how editors get away with treating authors
so badly. The reason is simple. Journals, like all businesses, exist for
the purpose of attaining wealth and perpetuating their own existence.
Journals attain wealth by attracting subscribers, and all journals are
focused on increasing the number of paid subscribers. Authors are
pathetic people who beg editors to publish their papers, and who
foolishly sign away the copyright for their work, without asking for
any compensation. Authors are so stupid that they will often pay
thousands of dollars to publishers to have their papers published. Is it
any wonder that authors are treated with contempt by editors?
To add insult to injury, remember that most published papers are

totally ignored; never cited, never read, by anyone. One of the most
effective ways of burying a scientific discovery is to publish it in a
scientific journal.
3.1 CO-AUTHORS
"I love being a writer. What I can't stand is the paperwork."
-Peter De Vries
Page 51 of 355
One of the more delicate tasks in journal writing involves the

selection of co-author. Once selected, you will need to assign the
order of appearance of their names, under the title banner. If you
complete these tasks correctly, you will gain new allies, and you will
be virtually assured that your paper will be accepted for publication.
Choosing the wrong co-authors, or placing their names in the wrong
order, may ruin your career.
It is customary for authors to include a collection of co-authors who

are barely aware of the project. The compulsory co-author list
includes the principle investigator of the grant whose funds were used
in your research, and any high-ranking professionals who provided
any assistance toward the final product, no matter how small. If you
are part of a team whose members are have not directly helped you
with your work, be sure to list all of these people as co-authors.
Otherwise, they will omit listing you as a co-author on their papers. If
you had helpful conversations, or email exchanges with influential
scientists, add them to the list of co-authors. Influential co-authors
increase the likelihood that your manuscript will be accepted. If there
are any fellow scientists who have included your name on a paper,
undeservedly, be sure to return the favor. With luck, you can build of
network of allies who list each other on papers, for no justifiable
reason. Your love interests or spouses can be co-authors as well.
By this point, you must be asking yourself whether adding bogus co-
authors to your manuscripts will have negative consequences. Don't
worry; this never happens. Though editors love to write strict
guidelines for the inclusion of co-authors on manuscripts, they
basically don't care what you do. Here is an example of a universally
ignored instruction from the International Committee of Medical
Journal Editors: "Acquisition of funding, the collection of data, or
general supervision of the research group, by themselves, do not
justify authorship (59)." If you check against published papers in the
biomedical field, you will find that just about every paper includes
co-authors whose only contributions were data collection,
supervision, or funding acquisitions.
Few if any scientists follow authorship guidelines. In a study by
Page 52 of 355
Flanagin and coworkers, 1 in 4 articles assigned authorship

inappropriately (60). Their findings were similar to those of Shapiro
and co-workers, who found that 26% (268/1014) of co-authors listed
in research papers fail to merit authorship (61). These analyses are
grossly underestimate the prevalence of non-meritorious co-authors.
Basically, there is no way to identify every non-performing co-
author.
Nobody really cares if the co-author list includes bogus names.

Editors don't want to get involved in fruitless investigations to
identify deadbeat co-authors. Who would benefit from the effort?
The flip side of the co-authorship issue involves choosing the names
of valid co-authors who you must exclude from attribution in your
manuscript. Sometimes, you will find it necessary to drop from the
author list a colleague whose efforts were instrumental to the
completion of your project. This happens when the head of your
laboratory, or someone of even higher influence, indicates that he
does not want particular names to appear on the final manuscript. He
may be holding a grudge against the person in question, but more
often, he simply doesn't want the person to take a job at another
laboratory. If this person were included as a co-author, it might help
him find an alternative position in another laboratory. Can scientists
be this petty? Of course they can. When a good technician or scientist
leaves a laboratory, they take their expertise with them. In many
cases, an important technique will be lost, or a secret technique will
be acquired by a competing laboratory. When you drop a co-author
from a publication, you will need a false but credible reason. Here are
a few options:
1. Assign responsibility to un-named conspirators. Tell the excluded

co-author that you wanted to include him, but there was pressure to
keep him off the paper.
2. Tell the excluded co-author that the editor insisted that the author
list was too long and had to be reduced.
3. Tell the excluded co-author that the omission was an oversight,

and that he will be included on the next paper.
Page 53 of 355
4. Tell the excluded co-author that he has so many publications in

quality journals, you didn't think he would want to be included on
this paper.
5. Tell the excluded co-author that he had not indicated that he

wanted to be included on the author list.
6. Don't tell the excluded co-author anything. It may take several

years before the paper appears in print. By that time, the matter may
be forgotten.
After you've selected the co-authors on your paper, how do you

determine the order in which their names appear? Many different
ways have been suggested. Perhaps the most common is to list the
person who wrote the paper as first author; the head of the laboratory
as last author, and every other co-author is listed by the relative sizes
of their contribution, in descending order. Some groups list the co-
authors in strict alphabetic order. In this case, it might be worthwhile
to change your name, early in your career, to Dr. Aaaaa. Authors and
tenure committees all agree that the order of authorship is
meaningless (61), (62). Editors provide no real guidance in the
matter. The International Committee of Medical Journal Editors
passes the problem back to the authors: "The order of authorship on
the byline should be a joint decision of the coauthors (63), (64)."
In these days of collaborative science projects, it is not unusual to

find papers with over 100 listed co-authors. When scientists create
their Curriculum Vitae, they routinely list every paper on which they
appeared as a co-author, regardless of the number of co-authors listed
on the paper. A person who is one of 100 co-authors on each of ten
published papers, will have the same number of publications to his
credit as the person who wrote 10 single-author papers. Does this
make any sense? Does each construction worker who helped build
the Golden Gate Bridge take full credit for building the bridge? No. If
there are 100 co-authors on a paper, each co-author should claim
credit for writing 1/100th of a paper.
Many scientists spend their entire careers without every writing a
Page 54 of 355
single full-length, peer reviewed, original research manuscript. They

are content being one co-author among many. They take some
comfort in knowing that search committees and tenure committees
have never devised a satisfactory method of determining who, among
a list of co-authors, played a key role in the development of a
scientific advancement.
3.2 FIRST CREDIT
Stigler's law of eponymy, "No scientific discovery is named after its

original discoverer."
-SM Stigler (65)
"If you want to make an apple pie from scratch, you must first create
the universe."
-Carl Sagan
According to Stigler, credit always goes to the wrong person, and this
is the essence of Stigler's law of eponymy (which, according to
Stigler, must have been invented by someone other than Stigler).
Stigler provides numerous examples of credit going to the wrong
scientist (65). "Laplace employed Fourier Transforms in print before
Fourier published on the topic, that Lagrange presented Laplace
Transforms before Laplace began his scientific career, that Poisson
published the Cauchy distribution in 1824, twenty-nine years before
Cauchy touched on it in an incidental manner, and that Bienayme
stated and proved the Chebychev Inequality a decade before and in
greater generality than Chebychev's first work on the topic."
Yes, misleading eponymous terms are commonplace in the medical.

Marcello Malpighi (1628 - 1694) was an Italian physician who was
one of the earliest scientists to use the microscope to describe tissues
and their diseases (Figure 3-1).
Page 55 of 355
Figure 3-1. Marcello Malpighi. Source: Garrison FH. History of

medicine. WB Saunders, Philadelphia, 1921.
Malpighi was the first to describe lymphoadenoma, the lymphoma

known today as Hodgkin's disease. More than a century later,
Thomas Hodgkin (1798 - 1866) wrote a manuscript and credited
Malpighi with the first description of the disease. Nonetheless, the
eponym for the lymphoma went to Hodgkin (Figure 3-2).
Figure 3-2. Thomas Hodgkin. Source: Garrison FH. History of

Likewise, the Wheatstone bridge, introduced in 1843, was not

invented by Charles Wheatstone (1802 - 1875). Wheatstone, working
from the prototype, improved and popularized the device. The
eponym was bestowed on Wheatstone, despite his protestations. The
original bridge was invented by Samuel Hunter Christie (1784 -
Page 56 of 355
1865), in 1833.
Simpson's Paradox was named, in 1972, for Edward H. Simpson's

work published in 1951 (43). Karl Pearson and colleagues, in 1899,
made the same observation as Simpson, 52 years earlier (Figure 3-3).
Figure 3-3. Karl Pearson, the statistician who discovered Simpson's

Paradox. Source: Wikipedia, public domain.
Karl Pearson, incidentally, was author of The Grammar of Science,

first published in 1892, with an expanded second edition in 1900
(Figure 3-4) (66). Pearson's book described relativity, speculating
that an observer moving at the speed of light would see an eternal
now. The Grammar of Science was studied by Albert Einstein, whose
annus mirabilis occurred in 1905.
Page 57 of 355
Figure 3-4. Cover of the second edition of Pearson's The Grammar of

Science, Adam and Black, London, 1900.
Antonie Philips van Leeuwenhoek (1632 - 1723) is sometimes

credited with inventing the modern microscope (Figure 3-5). Not so.
Leeuwenhoek improved the microscope with his superb lens grinding
technique, but he did not invent the microscope and did not make any
particularly important modifications to the design of the microscope.
Figure 3-5. Antonie Philips van Leeuwenhoek. Source: Garrison FH.

History of medicine. WB Saunders, Philadelphia, 1921.
In 1595, fifteen year old fledgling Dutch lens grinder and part-time
counterfeiter, Zacharias Jansen (1580 - 1638) placed two lenses in a
tube, and created the first compound microscope (Figure 3-6).
Page 58 of 355
Figure 3-6. Zacharias Jansen. Source: Garrison FH. History of

This amazing invention sat dormant until 1667, when Robert Hooke
(1635 - 1703) studied insects and plant material with this 72-year-old
invention. Hooke used the word "cell" to describe the complex, living
structures that compose every organism. In 1675, with improved
lenses, Leeuwenhoek studied micro-organisms in water and cells of
the human body. Hooke and Leeuwenhoek kick-started modern
microscopy, but Zacharias Jansen invented the microscope.
Smallpox was the first disease for which vaccination was successful.
As early as 200 B.C.E. in China and 1000 B.C.E. in India, physicians
knew that infection with smallpox conferred immunity against
subsequent infection. Based on this observation, they were the first to
develop a vaccination, administered nasally, of attenuated virus.
Arabic doctors developed their own treatment, consisting of
transferring material from an infected pox blister to another person
via a small cut. Emmanuel Timoni (1670 - 1718) was a physician
practicing in Constantinople. He introduced the Arabic vaccination
process to the West, in 1717. In 1796, Edward Jenner (1749 - 1823)
developed a new vaccine, from a bovine pox virus (vaccinia) that
seemed to confer cross-immunity against smallpox (variola) (Figure
3-7). When you consider that the word, "vaccine", derives from
Jenner's choice of inoculum (vaccinia), it seems reasonable to give
Page 59 of 355
Jenner the credit for developing the first effective vaccine.

Incidentally, Jenner's paper describing his smallpox vaccine was
rejected, in 1976, by a peer-reviewed journal (67).
Figure 3-7. Edward Jenner. Source: Garrison FH. History of

If you want to give credit to the first person to save European lives by
immunizing against smallpox, you would need to go 80 years earlier
than Jenner; to Timoni. To be really fair, you would need to go back
many centuries, to the Chinese, Indian and Arabic physicians to find
the origin of human immune treatments.
Carl Wilhelm Scheele (1742 - 1786) lived a scant 46 years, but he

found time to make several of the most important discoveries in the
field of chemistry. Unfortunately, through a series of bad breaks, he
lost first credit for every one of them (Figure 3-8). Scheele
discovered Oxygen a full two years before Priestley, but Scheele sent
his manuscript to a publisher who held the work for several years,
during which time Priestley got his discovery into print. Today,
Joseph Priestley (1733 - 1804) is widely held to be the discoverer of
Oxygen. In 1774, Scheele laid the groundwork for the discovery of
Manganese, but Johan Gottlieb Gahn (1745 - 1818) finished the task
and received the credit. Also in 1774, Scheele isolated chlorine.
Unfortunately, he failed to identify chlorine as an element, the credit
for which eventually went to Humphry Davy (1778 - 1829).
Page 60 of 355
Figure 3-8. Carl Wilhelm Scheele. Source: Wikipedia.
Johann Franz Encke (1791 - 1865) is given credit for the discovery of
[Encke's] comet (1818), but Encke merely calculated the orbit, using
a technique first developed more than a century earlier by Edmond
Halley (1656 - 1742). In 1705, Halley applied Newton's laws of
physics to correctly predict that a particular comet (known today as
Halley's comet), observed in 1531, 1607, and 1682, would return in
1758. The comet known today as Encke's comet was named after a
person who neither first-sighted the comet nor discovered the
methodology to predict the comet's orbit (Figure 3-9). The person
who made the first sight of the comet has descended into scientific
obscurity.
Figure 3-9. Johann Franz Encke. Source: Wikipedia.
Page 61 of 355
It often happens that a new discovery is made by multiple

independent researchers, simultaneously. For example, sunspots were
discovered by Thomas Harriot (England, 1610), Johannes and David
Fabricius (Frisia, now parts of The Netherlands and Germany, 1611),
Galileo Galilei (Italy, 1612), and Christoph Scheiner (Germany,
1612).
In the 1830s, Janos Bolyai (1802 - 1860), Johann Carl Friedrich

Gauss (1777 - 1855) and Nikolai Ivanovich Lobachevsky (1792 -
1856) independently developed the field of non-Euclidean geometry,
a quickly obscurated achievement. It was not until the late 1860s,
after all three had died, that other mathematicians paid the slightest
attention.
Louis-Paul Cailletet (1832 - 1913) and Raoul-Pierre Pictet (1846 -

1929) independently manufactured liguid oxygen, the same year
(1877).
Alfred Russel Wallace (1823 - 1913) and Charles Darwin (1809 -

1882) independently developed an equivalent theory of evolution, in
the years preceding the 1858 publication of Darwin's Origin of the
Species.
Sometimes synchronous discoveries can be calibrated against the

lives of the inventors. Charles M. Hall (United States) and Paul
Louis-Toussaint Heroult (France) were born the same year, in 1863.
In 1886, when each man was only 23 years old, they independently
made one of the most innovative and important advances in industry:
the extraction of aluminum from bauxite. The process involved
heating alumina (from bauxite) with cryolite, and passing an electric
current through the molten product. Aluminum emerges. Aluminum
is one of the most abundant metals in the earth's crust, but pure
aluminum was virtually impossible to obtain, in any useful quantity,
until Hall and Heroult arrived on the scene. They led lives separate
but parallel. Both men died the same year, 1914, at the young age of
51.
Elisha Gray (1835 - 1901) and Alexander Graham Bell (1847 - 1922)
Page 62 of 355
both invented the telephone at the same time, and both filed their
inventions in the U.S. patent office, on the very same day (February
14, 1876). As the story is told, Gray's patent was filed a few hours
before Bell's, but Gray's sat at the bottom of the "in box" while Bell's
was processed promptly. Bell took first credit.
Sometimes, credit falls on the person who least understood the

significance of his own work. In 1771, Charles Messier (1730 -
1817) , selected 103 heavenly objects that have captured the rapt
attention of astronomers for nearly two and a half centuries (Figure 3-
10). Messier selected regions of space that were nebulous, thus
obscuring his view of comets (his sole interest). He made a point of
categorizing the Messier objects as areas of space that should be
avoided by serious cometologists. In 1771, his chosen spots might
have been accurately called the Messier non-objects.
Figure 3-10. Charles Messier. Source: Wikipedia.
Today, the Messier objects are credited with holding some of the
most fascinating galaxies and cosmologic curiosities in the known
universe (Figure 3-11). Though Messier was completely wrong, he
achieved scientific immortality, just the same.
Page 63 of 355
Figure 3-11. Messier object 51. Source: Wikipedia, public domain

NASA image.
The first observation of a particular type of anemia associated with

sickled red blood cells, was made by Ernest E. Irons (68). Dr. Irons
was a young intern when he encountered a patient, Walter Clement
Noel, and made his historic observation. He alerted his attending
physician, James B. Herrick. Irons sketched the shape of the cells
directly into the patient's hospital record. Herrick wrote the 1910 case
report as a single author submission, excluding Irons (69). To this
day, the disease sickle cell anemia carries the eponym, Herrick's
disease (not Irons disease).
Sometimes first credit goes to the wrong species. Acetylsalicylic acid

has been used as a medicinal by several different ancient cultures. In
the western tradition, Hippocrates (5th century BC) claimed that a
bitter powder extracted from willow bark could ease aches and pains.
How did the ancients know that willow bark would relieve pain?
Bears were observed rubbing against the bark of willow trees when
wounded. Humans stole credit for an ursine discovery.
In the future, first credit may go to a non-living entity. Adam, a robot

gainfully employed at Aberystwyth University, has made an
independent discovery in the field of Saccharomyces cerevisiae
genetics (70). We can expect much from our robot colleagues in their
future endeavors.
3.3 EVIL BOOKS
"The person who does not read has no advantage over the person who
cannot read."
-Mark Twain (Figure 3-12)
Page 64 of 355
Figure 3-12. Mark Twain's library, in the Twain House, 351

Farmington Avenue, Hartford, Hartford County, CT. Photograph by
Jack. E. Boucher, for the U.S. National Park Service.
You are a third year undergraduate biology major. You have

just registered for Course 305, Molecular Biology Lab,
required for all molecular biology majors. The coursebook is
a 435 page book of protocols, with laboratory exercises at the
end of each chapter. The book is in its sixteenth edition. A new
edition comes out every year. All students must buy the latest
edition of the book (the protocols are the same, but the
exercises are somewhat different in the newest edition). The
book costs $224.95, retail. It is impossible to buy a used copy
of the book, because the required new edition was released the
month before course registration. When the course it finished,
you will not be able to re-sell your book, because the next
group of students will be required to buy the forthcoming
seventeenth edition. The author of the book is the course
instructor and the head of the biology department. The book is
used exclusively in your university. Biology departments
across the world use a different book, sold at half the price of
your book. You've had a chance to read the competing book,
used by students in the other area colleges. It is a much better
book than yours, with full explanations of the protocols,
covering a greater range of techniques. You resign yourself to
buying the instructor's book, rationalizing that it is an honor
to be taught by the book's author.
Great science books are written for an intelligent audience of

professional scientists; virtually guaranteeing financial disaster for
Page 65 of 355
the author. Do the math. The difficult disciplines of science are

sparsely populated, with just a few hundred serious scholars in their
ranks. This means that the publisher will only print a small number of
copies of your book (maybe 600). Science books produced in low
quantity invariably have big price tags. Most of your colleagues will
not be able to afford the book. Sales will go primarily to university
libraries. You'll be fortunate if 400 copies are sold. As author, your
royalties may come to $20 dollars per book, bringing in a total of
$8,000 income spread out over the three or four years for which your
book is "in print." Figuring that you spent about 2,000 hours writing
your opus, this comes to a salary equivalent of $4 per hour. The
monetary reward does not justify the effort.
The solution, of course, is to write a not-so-great science book, and

gear it to your students. Students are people who read what they are
told to read, when they are told to read it. The only way to make
money writing a science textbook is to make the book a course
requirement.
Once a book has become a course requirement, you can milk the
same book throughout your entire career by writing new editions that
appear annually. It won't take much work. Most new and revised
book editions are much like the old and un-revised editions. The key
difference is the price of the book; it goes up with each minor version
change. When the professor requires students to buy the newest
edition of a book, he guarantees himself a stream of royalties to
supplement his more-than-adequate staff salary.
3.4 ALTERING THE PAST
"It is an amazement, how the voice of a person long dead can speak
to you off a page as a living presence."
-Garrison Keillor, essay in Washington Post Book World Dec 2, 2007
Sometimes publication is less a matter of making a new contribution

to your field, and more a matter of altering the written past. There are
moments in every scientist's professional life when he wishes he
could travel back in time and retract, modify, or add text to the
Page 66 of 355
scientific record. Impossible, you say? Not for evil scientists. A

surprisingly large portion of the scientific record is neither verified,
authenticated, or time-stamped. This means that you can change the
past, to produce a better future for yourself.
If you want to tamper with documents, you must understand three

concepts: verification, authentication, and time-stamping.
Verification means that the contents of a document have been
verified to be true, according to a person who takes responsibility for
the document. This usually means that somebody signs the document,
indicating that it was read and the contents were approved by the
signator. Authentication means that the document you're reading is
really the document you intended to read, and not some other
document that somebody else might want you to read. Time-stamping
ensures that the document was created at a certain specified date and
time.
When documents are not verified, authenticated or time-stamped, you

can create bogus documents, changing the name of the author or the
date on a pre-existing document. In the world of medical charting,
doctors have been covering their errors, for hundreds of years, by
deleting, modifying or inserting notes into the old patient record. A
month-old doctor's order for a toxic dose of pain-killer can be
changed into a less murderous dose, by moving the position of a
decimal point.
Retro-noting is a time-tolerant tradition. A doctor who hasn't seen his

hospitalized patient in a month can make a short visit to the ward,
pull the patient's medical chart, and insert short notes, for each day
that the patient was in the ward, indicating something such as,
"Patient visited 8:20 a.m., no change in status, vital signs stable,
continue current treatment plan." Retro-noting permits lazy
physicians to comply with standards of timeliness, and to bill for
"visit" fees.
Has the computerized medical record eliminated retro-noting and

other efforts to alter the contents of personal records? Not really. It is
not easy to build reliable computerized systems that guarantee
verification, authentication, and time-stamping for complex
Page 67 of 355
transactions. The rare, well-designed hospital information system is

often thwarted by the limitations of computer-human interactions.
For example, it is difficult to force a doctor to complete a discharge
summary on the same date that the patient is actually discharged.
Consequently, hospital information systems may allow physicians to
assign dates that are different from the true transaction times.
Furthermore, doctors may delegate verification tasks to their
assistants. When the system allows staff to alter verification,
authentication and time-stamping protocols, the electronic medical
record quickly becomes a work of fiction.
If you decide to manipulate the past, you may as well do it with a

minimum of effort. With a computer, it is possible to paste a favorite
block of text, or a template requiring minor customization, into many
different records. In one study, instances of careless insertions into
electronic medical records occurred in one in ten charts (71).
3.5 PLAGIARISM
"Imitation is the sincerest form of plagiarism."
-Oscar Levant (1906 - 1972), (Figure 3-13).
Figure 3-13. Oscar Levant, from Rhapsody in Blue trailer. Source:

Wikipedia, public domain.
If you want author credit on scientific publications, but you want to

avoid all the paperwork involved in writing, then plagiarism might be
just the ticket. Plagiarism involves taking credit, through a literary
device, for another person's intellectual contribution. Plagiarism is
often confused with intellectual piracy. When you take an idea,
Page 68 of 355
developed in a book that someone else published, and you include it

in your book, as though it were your original idea, without citing the
published source of the idea, that would be plagiarism. Publication
piracy is the copy-theft of a literary work. If your take someone else's
book, re-print it, sell copies of the re-printed work, and keep the
proceeds; that would be piracy. Perhaps the easiest way to distinguish
these activities is: the plagiarist steals your name, while the pirate
steals your money. As books go, scientific works have negligible
value, and are seldom pirated. The ideas contained in published
scientific works are the prized possessions of academic scientists, and
good ideas are routinely plagiarized.
Any society can reach a point where the most corrupt activities are
considered standard operating procedure. In 18th century European
academia, casual plagiarism was routinely tolerated. In 1731, Carl
Linnaeus (1707 - 1778) wrote the doctoral dissertation for Johan Olaf
Rudbeck, for which Linnaeus was paid a customary fee (72) (Figure
3-14). Twenty-first century plagiarism is less blatant, but equally
common.
Figure 3-14. Carl Linnaeus, posing in "Laplander" garb, to emphasize

his credentials as an explorer/naturalist. It has been remarked that no
Lapp would have been caught dead in the ridiculous costume that
Linnaeus assembled for his portrait (72). Source: Wikipedia, public
domain.
Page 69 of 355
Everyone wants to know how powerful people achieved their

success. When you study the lives of the most powerful people
throughout history, you find that most were ruthless villains who
seized power, often by brutal force, and who held onto power by
murdering their challengers. No mystery there. Nonetheless, people
remain eternally curious, and are eager to learn the particulars. The
CEO of Raytheon, William H. Swanson, published a short, popular
book, humbly titled, "Swanson's Unwritten Rules of Management." It
turns out that Swanson's 2004 book is composed in large part of rules
written over a half-century earlier, by W.J. King (73), (74). King's
book was entitled, "The Unwritten Laws of Engineering." Here's just
one of many examples of the remarkable similarity between the two
books. Rule 21 (Swanson's book) states, "Don't get excited in
engineering emergencies: Keep your feet on the ground." King's 1944
book states, "Do not get excited in engineering emergencies - keep
your feet on the ground."
Mr. King's earlier book is not cited in Mr. Swanson's later work.
According to the Boston Globe, Mr. Swanson, author of Swanson's
Unwritten Rules of Management, said, "You should understand I'm
not a writer. It's not my profession, and I don't know how to do
it" (74). We have a situation where a person writes a book, on the
rules of business management, assigns exclusive attribution of the
book's contents to himself (in the title of the book), and later claims
that he did not understand the rules.
It turns out that not all of the content in Mr. Swanson's book was
taken from Mr. King's earlier work. Four of his rules came from an
article written by Donald Rumsfeld, and one of the rules came from a
book written by Dan Barry (75). Was Mr. Swanson guilty of
plagiarism? We do not really know. He was never charged with
plagiarism in a court of law. Mr. Swanson's employer, The Raytheon
Corporation, applied Solomonic wisdom and ended the controversy
by reducing Mr. Swanson's executive compensation (i.e., recycling
some of Mr. Swanson's money by returning it to themselves) (75).
Plagiarists tend to be cavalier, greedily snatching text and ideas

without fear of the consequences. For example, the Office of
Page 70 of 355
Research integrity found that an instructor at Harvard Medical School

and the Massachusetts General Hospital, "engaged in 15 acts of
scientific misconduct by plagiarizing and falsifying research data
taken from another scientist's different experiment in a published
journal article for use in a program project grant application
submitted to, and funded by, the National Institutes of Health
(NIH)" (76). At one point, the investigator's application was
temporarily halted by a grants official. No problem. The Office of
Research Integrity explains that he "forged the signature of the
institutional official for the MGH Grants and Contracts Office" (76).
3.6 PLAGIARISM IN A COMPUTER WORLD
"Computers are like Old Testament gods; lots of rules and no mercy."
-Joseph Campbell
The computer is a fascinating tool for plagiarism. It's easy to copy

text from existing articles and paste it into your own. It's just as easy
to detect plagiarism, if you care to do a little research. Just read the
text, and wherever you read an idea conveying more intelligence than
you would credit to the author, paste the text into a Google search. If
the text was lifted from any other published work, Google will find it.
Many acts of scientific plagiarism are discovered through Google
searches, launched by a suspicious colleagues.
If you're serious about detecting plagiarism, you might want to

pursue your suspects with software designed for the task. In the early
1980s and 1990s, two NIH scientists, Walter Stewart and Ned Feder,
invented a so-called "plagiarism machine (77)." Their software
compared large volumes of literature against a chosen document. One
of their targets was an historian who had written, in 1977, a book
purported to contain numerous passages from another book, written
in 1952. The accused plagiarist posed a thoughtful question: Why, he
wondered, were NIH scientists investigating a somewhat dated, non-
scientific work, that had been written without the benefit of
government funding? Shouldn't NIH investigators be occupying their
time with projects related to medical science? To the leadership at
NIH, it seemed a compelling question. Stewart and Feder were told to
Page 71 of 355
stop annoying people.
A period of indignant acrimony followed, wherein Stewart and Feder

asserted their academic rights. The NIH leadership countered that the
researchers, both civil servants paid by taxpayers, were obliged to
work on projects relevant to the NIH mission (i.e., conquering
disease through research). Stewart and Feder were blocked, but not
defeated. The crusading duo focused their attention on medical
researchers, and, to this day, the two are exposing misconduct
wherever found (78), (79).
In 2006 the novel "How Opal Mehta Got Kissed, Got Wild, and Got a
Life," written by a Harvard sophomore, was pulled from stores after
the author admitted plagiarizing portions of the book (80). Four years
later, a similar act committed by another young writer, was perfectly
acceptable to the book establishment. A 17 year old German prodigy
wrote "Axolotl Roadkill," a book that swiftly rose to number 5 on the
Spiegel's hardcover-seller list. A reader noticed that numerous
passages in Axolotl Roadkill seemed to be plagiarized from another
book, "Strobo." In one example, an entire page was lifted from
"Strobo" (81). Nonetheless, Axolotl Roadkill was not pulled from the
German bookshelves. Instead, the disputatious book was nominated
for the fiction prize in the Leipzig book fair. One of the jurors noted
that he was aware of the plagiarism accusations, but said, "I believe
it's part of the concept of the book" (81). Plagiarism has became the
"in" thing for young writers.
The most successful plagiarists are often self-plagiarists; people who

re-invent the same idea in every paper they write. The scientific
world cannot distinguish the scientist who publishes 500 research
papers from the scientist who publishes one paper 500 times. You
should follow the second path; it's much easier. Begin with one good
paper, preferably published in a prestigious scientific journal. This
paper must have your name listed as first author. Your actual
contribution to the paper may have been small, even negligible, but
this will not matter in the long haul. This paper will be the template
for all future papers and future grant applications from your
laboratory. Because every scientific contribution opens up new
Page 72 of 355
questions related to the original work, use those questions as the basis
for all of your subsequent publications. Publish at least one paper
each year on same variation of the original paper. Soon, you will be
recognized as the world's leading authority in your field (your field
being your original article). When discussing your work, express
contempt for scientists who do not concentrate their energies on a
single topic. You will find that narrowly focusing on your own work,
staying oblivious to the external world of science, confers credibility.
If you follow this popular pathway, you will be rewarded with the
respected and comfortable life of an academic scientist.
There is a second strategy for self-plagiarism, that is somewhat

riskier, but not without merit. It is based on the simple truth that
stealing from yourself is not a crime. Basically, you take one of your
publications and re-publish the same paper in a new venue. It is
common practice to publish a paper in a Proceedings Symposium,
and then re-submit the same paper to a journal publication (82), (83),
(84), (85), (86), (87). Journal editors are well aware of this practice
and have clarified their opposition: "Authors publish a preliminary
manuscript as part of conference proceedings. Mistakenly believing
that conference publications do not count as "official" publications
(of note, several informatics conference proceedings, such as
MEDINFO, MIE, and the AMIA Fall Symposium, are indexed in
MEDLINE), the authors later submit the same work, with minimal
alteration or expansion, to a peer-reviewed journal for
publication" (88).
Publishers oppose re-publication, in part because they cannot claim

copyright to an article that has been published previously. The
submission guidelines for almost all journals contain language
indicating that previously published material cannot be submitted for
publication in the journal (88). This entanglement can be avoided. If
you, as the author, hold copyright to the original paper, or if the
original paper fell into the public domain (as happens with works by
federal employees), or if the publisher happened to own copyright to
both the original and the duplicate publication, then self-duplication
would not rise to the level of a criminal offense.
Page 73 of 355
In theory, a publisher could sue an author for the cost of the materials
involved in re-publishing a previously published article. This never
happens. Self-plagiarism occurs whenever authors copy and paste
some of their previously published text into review articles and book
chapters. Re-cycling publications as duplicate works in other
languages is also common. Bruce Schneier has recounted instances
where his works were pirated and re-published in other languages,
under the authorship of blatant plagiarists (89).
Multi-lingual self-plagiarism occurs when an author translates a

manuscript into several different languages, and submits it to multiple
journals, worldwide, that publish in the corresponding languages.
This practice violates the "one manuscript one journal" rule of
scientific publication. Authors want to attain the greatest possible
readership for their manuscripts. By publishing the same manuscript
in different languages, they expose their ideas to groups of scientists
who may not otherwise have access to their work. This is an example
of a victimless crime, because neither author, reader, nor editor are
hurt by the procedure. Still, it perverts the idea that journal
manuscripts report "new" findings. Self-plagiarized articles never
come with a warning label, "The information published in this article
was published five years ago, in another language, and may have
become obsolete in the interim."
In most instances, the stakes are small in scientific plagiarism. There

is no crime, if nobody complains.
1. People will not read your papers. Even if your paper is cited by
other papers, it is a safe bet that nobody has actually sat down and
read your paper from beginning to end. You can be certain that your
department chair, your close colleagues, even your co-authors, have
not read your research papers. If you value your marriage, never ask
your spouse to read your research papers.
2. Unlike just about every other competitive endeavor, being the first
person to achieve a new idea, discovery, process, or invention,
Page 74 of 355
seldom means that you will be credited with the breakthrough. The
more powerful laboratory, the more recognizable name, the splashier
publication will take precedence over mere chronology. It is often
more profitable to be the first person to commercialize another
person's idea than to be the idea's creator.
3. Scientists do not need to publish. Some of the most influential

scientists have made no scientific contributions, preferring to take
credit for the work of their colleagues and subordinates. You will find
these people running academic departments, occupying powerful
positions within scientific institutions, and sitting on peer review
committees.
4. Most of the scientific work attributed to you, will be the product of

someone else's toil. In any collaborative effort, you must insist, from
the very beginning, that your name must appear on any and all
publications that result from the collaboration. The magnitude of your
effort, compared to that of the other authors, must not be measured.
The point is that you are a professional, and you must be rewarded
for any professional contribution when the paper is published.
5. Every paper that you publish should be preceded by an abstract

presented at a scientific meeting. The abstract establishes the date
that the work was completed and adds to the number of publications
in your curriculum vitae. Abstracts are much easier to publish than
full-length journal articles. Abstracts provide an opportunity to
present your work to influential colleagues. More importantly,
abstracts provide an opportunity to present yourself to influential
colleagues.
6. Divide your work into LPUs (Least Publishable Units, also known
as MPU, Minimum Publishable Units). A journal manuscript must
convince the reviewers that the work is original, and that it advances
science. Just how much a journal article advances science is an
unmeasurable quantity, though everyone assumes it is almost always
very close to zero. Because advances typically require a collection of
small observations and studies, it is often possible to split a paper into
minipapers, each containing part of the total research product. When
you split a paper into three or four LPUs, you enhance the chance that
Page 75 of 355
one or more will be published, and you ultimately increase the

number of papers that you have published. Each LPU should include
citations to the other LPUs in the series, and to your abstracts.
7. After you have published several LPUs within a project, you can
combine your LPUs into a more extensive paper, submitted to a
prestigious journal. Do what you must to ensure that your name
appears as first author on the composite paper. With care, your can
mix and match your LPUs into several composite papers in several
different prestigious journals.
8. After you have published your abstracts, your LPUs, and your
composite paper, publish a review paper that highlights the
importance of your prior works. With luck, you can turn a mediocre
research effort into publication empire.
9. When choosing co-authors on your papers, include the names of

influential cronies. By doing so, you will increase the likelihood that
your manuscripts will be accepted, enhance the prestige of the
published product, and diffuse responsibility if the paper is
discredited.
10. Don't expect much from co-authors, most of whom will not read
the paper and will have only a vague idea of its contents.
11. When you prepare the bibliography for your paper, never cite the
papers written by your competitors. This is particularly important
when when your competitor has published the same conclusions, at
an earlier date. In all likelihood, your reviewer is unaware of your
competitor's publications. In the unlikely event that your competitor
is your reviewer, cut your losses and re-submit to another journal.
12. When you submit your manuscript, do not hesitate to list several
scientists who should not be invited as reviewers. This serves several
purposes. It eliminates the people most likely to reject your paper. It
makes the editor suspicious of your enemies; more likely to believe
anything negative about them. It implants the idea that your paper has
sufficient importance that others in your field will try to stop its
publication.
Page 76 of 355
13. Get to know editors of several different journals in your field. If

you feel that the editor dislikes you, do not even dream about sending
him a submission. It will be rejected, even when the reviews are
generally positive. If the editor likes you, your paper will be
accepted, unless the reviews are scathing. Give the editor a call
before you submit the paper, indicating the subject matter, and ask
the editor if he is interested in receiving articles such as yours, at this
time. The editor will be flattered that you value his scientific opinion
[you don't, really], and if he gives you the go-ahead, there is an
excellent chance that the paper will be accepted.
14. If you want to re-publish one of your earlier papers in a second

journal, use some common sense. Modify your title, and change a
few words in each paragraph. Most importantly, change your
conclusions [does not require any modification of your data]. Most
papers live in obscurity, never read by anyone, and serve only to pad
your Curriculum Vitae. It is exceedingly unlikely that anyone will
discover your deception. If you are caught (by an editor or a
reviewer) trying to republish one of your prior papers, insist that the
paper builds on your earlier work, adding new and important
conclusions. Though self-plagiarism angers editors, who have been
duped into publishing material that has appeared in print elsewhere, it
is a crime that has no punishment. If you stick to your guns and
proclaim your righteous innocence, all will end well for you.
15. Career-wise, it is much better to publish one paper 100 times than
to publish 100 different papers.
16. Behind every great scientist is an evil scientist, ready to take steal
his credit. You can be that evil scientist.
17. In the long run, your scientific contributions will have no real
impact. Don't dwell on this thought.
CHAPTER 4. EVIL EDITORS AND REVIEWERS
"Any fool can criticize, condemn and complain and most fools do."
-Benjamin Franklin
Page 77 of 355
"La critique est la vie de la science."
-Victor Cousin
By far, the most powerful way to destroy the self-esteem of any

creative person is by ignoring him. Basically, if no one listens to you,
reads your work, or even glances in your direction, your mark on
science will be small.
The second most powerful way of destroying a scientific career is

with scathing, unrestrained criticism. Basically, all science is
tentative and flawed. Any researcher can be ripped to shreds with a
few cutting remarks.
When it comes to putting the kibosh on the dreams and aspirations of

earnest, youthful scientists, journal editors are unequaled.
You read a fascinating journal article in the October issue of

Science Life. The authors have discovered that galactic acid,
secreted by tear ducts, increases the time that astronomers
can stare through their telescopes without blinking. You find
this article particularly interesting for two reasons; 1) in the
March issue of The Science of Our Lives, you reported that
galactic acid increased the time that birdwatchers could stare
through their binoculars without blinking, and 2) the authors
of the Science Life paper did not cite your work, that predated
their work by 7 months. You write a letter to the editor of
Science Life, indicating that yours was the earlier work, and
that you would like to have a letter published in the very next
issue of the journal, rectifying the oversight.
Three weeks later, you receive a letter from the editor's office
indicating that your letter has been received and is being reviewed by
an impartial referee. The letter indicates that you will be informed of
the editor's decision once it has been made.
Two months pass. You call the editor's office. His assistant indicates
that the editor is aware of your complaint, is working to reach a
decision, and that you will be notified when a decision is reached.
Page 78 of 355
A month later, hearing nothing, you call the editor's office again.
This time, you reach the editor. The editor indicates that your
complaint has been reviewed, and that the outside consultant had
determined that the authors of the Science Life paper are innocent of
plagiarism.
You inform the editor that you had not accused the other authors of
plagiarism. You simply had accused them of being the second, not the
first, laboratory to discover that galactic acid inhibits blinking. As
such, your paper should have been cited in their paper.
The editor indicates that because there was no plagiarism, there was
no scientific misconduct. If there was no scientific misconduct, there
is no obligation to publish a retraction.
You indicate that you are not requesting a retraction. You are
requesting that the editor publish a short statement indicating that
you were the first to discover the effect of galactic acid on blink-
avoidance.
The editor indicates that his journal does not embroil itself in
disputations over precedence. He says that such arguments need to
be settled among the authors.
You indicate that the problem is that the readers of Scientific Life
were informed, incorrectly, that the October article was the first to
observe the effects of galactic acid on blink-avoidance. You are
simply asking for the mistake to be corrected.
The editor indicates that he is pressed for time, and the conversation
ends.
Editors have their own biases and will summarily reject scientifically
sound papers, if it suits them. There really is nothing that a scientist
can do when an editor tells him that a flawless work, requiring years
of hard work, is simply unsuitable for publication in the journal (45).
Editors have a lot of self-serving rules that they expect authors to

obey. In a paper pompously titled, "On Exemplary Scientific Conduct
Page 79 of 355
Regarding Submission of Manuscripts to Biomedical Informatics

Journals," a group of editors vented some of their frustrations with
authors. Particularly vexing was a practice they call "journal
shopping," occurring when "Authors submit a manuscript to one
biomedical informatics journal, and, after peer review, it is not
accepted for publication, and a critique is provided. The authors do
not make any of the changes suggested by the previous review and
instead submit the unchanged manuscript immediately to a second
journal, without disclosing the existence or results of the previous
review by the first journal."
Authors do not publish guidelines telling editors how to edit; editors

should not publish guidelines telling authors how to write. If authors
were to list some of the more egregious practices of journal editors,
they might include the following points:
1. Accepting papers of highly questionable scientific merit when

those papers come from an influential laboratory, or when those
papers address a hot topic of great interest of their readers.
2. Failing to provide a timely review. Editors always blame the

reviewers, but the reviewers are selected by the editor. A craftsman
never blames his tools.
3. Not bothering to ask whether the reviewer or the authors have

conflicts of interest. Or, asking reviewers and authors if they have
conflicts of interest, but doing nothing to verify their response (90)
4. Relying on reviewers who routinely reject papers written by their

competitors.
5. Failing to determine the competency of reviewers.
6. Failing to have any quality assurance program for rendered

reviews. Editors should be able to show that that reviews have
consistency. Editors should follow the destiny of rejected papers. If
the journal's rejecta are published in competing journals, receiving
praise and peer citations, then something went wrong with the
original review process.
Page 80 of 355
7. Failing to provide reviewers with guidelines for a fair review.

When a reviewer flatly rejects a paper because it was prepared in a
small font, then perhaps the reviewer could use some instruction.
8. Failing to determine if the study protected research subjects from

harm.
9. Failing to determine if the paper was written by a ghost writer.
10. Failing to provide authors with the names of the peers who
reviewed their papers. Criminals are allowed to confront their
accusers; why don't scientists have the same rights.
11. Delaying publication of low-priority papers that have been

accepted.
12. Yielding to pressure from the publisher regarding the content of

the journal. For example, the marketing department may stop the
publication of an accepted paper containing conclusions detrimental
to the interests of advertisers (57).
Editors cannot seem to grasp the idea that scientists submit papers for
the purpose of getting the paper published. Scientists do not submit
papers for the purpose of learning the opinions of reviewers, or for
the opportunity to mollify their complaints. Authors will take the
course of action that will lead to publication. If an editor forwards
scathing reviews and requires the author to repeat experiments, gather
more data, provide more analysis, revise the results, pay homage to
their competitors, and generally grovel to the delight of anonymous
critics, the authors may not willingly comply. Editors who demand
that authors adjust their behavior to serve the interests of the journal
are likely to be disappointed.
Every author knows that editors routinely reject scientifically valid

manuscripts if they are deemed to be of limited interest to the readers.
Journals, like all publications, need to attract and maintain an active
readership. Most scientists have received, at some point in their
careers, the classic put-down for an otherwise adequate work of
science, "Your manuscript is not of sufficient scientific interest to be
Page 81 of 355
published at this time." In truth, the editors are almost always correct
when they deliver a "not of sufficient interest" notice. Most papers,
whether published or unpublished, do not advance science. The
problem is that we really have no method of distinguishing the
important papers from the unimportant papers. There are many
examples of Nobelists whose seminal work seemed uninteresting to
editors (91). If editors had the power to stop the authors of rejected
papers from submitting to another journal, scientific advancement
would come to a standstill.
From the author's point of view, the problem with rejection distills
down to time. After submitting a paper, an author can wait a year or
longer before he receives his rejection letter (92). During that time,
the author is prohibited from submitting his paper to any other
journals. The editor, at his whim, can delay publication of a
scientifically valid paper for reasons that are purely self-serving and
without benefit to the scientific community.
Editors have a bad record of ensuring that the results published in

their journals were not biased by financial interests (93), (94).
Authors seldom volunteer their conflicts of interest, and editors
seldom demand disclosures (95). You can never be sure whether the
authors of any scientific paper have a financial interest in the results.
Ensuring integrity is a time-consuming and thankless task. No editor
has ever earned a dollar for his journal by uncovering a conflict of
interest in a study, or a lapse in human subject protections. Basically,
editors are in the business of selling journals, not advancing science.
Though editors loathe to scrutinize, they love to criticize. The chief

vehicle for scientific criticism is the peer review process, and editors
never miss a chance to heap praise on the process. Here is what a
group of medical journal editors have said: "The peer-reviewed
literature constitutes the main archival source of knowledge in
biomedicine. Authors, editors, and publishers must respect
reasonable, common-sense ethical and legal imperatives in order to
maintain the integrity of the peer-reviewed literature as a vital and
important resource. Peer review is conducted by busy professional
colleagues who are experts in a given field and who are not
Page 82 of 355
compensated for their efforts" (88).
If these editors were asked to demonstrate the value of peer review,

with the same scientific rigor they demand from the authors of
journal articles, it is unlikely that their praises would be published.
Peer review has never been shown to have any merit (58), (96). Peer
review does not seem to improve the clarity of the papers published
in scientific journals, and peer review does not seem capable of
finding or reducing scientific fraud and human subject abuses. In a
recent test conducted by the British Medical Journal, eight errors
were deliberately inserted into a paper and sent to 420 potential
reviewers: 53% responded with a review, the median number of
errors spotted was two, no reviewer spotted more than five of the
eight errors, and 16% found none (97). We can say that peer review
greatly lengthens the interval between a paper's submission and its'
subsequent publication. Otherwise, peer review has no proven effect
on scientific advancement.
The silliest section of the editors' statement is that "Peer review is

conducted by busy professional colleagues". The reason that editors
refer to reviewers as "busy people," may stem from the excuses they
hear for tardy reviews. "It took me six months to review this paper
because I've been very busy." Or, perhaps, "No, I haven't reviewed
the paper. I've been very busy." Or, "Has a year gone by already? I
really think it is important for me to offer the authors some
instructive comments, and I want to make sure that I give the paper
all of the time it takes to do a helpful review. Can I have a two month
extension for this review."
How long does a reviewer work on a review that takes two years to
complete? About five hours; if you're working in the field it simply
does not take much longer than this to read and comment on a paper.
The procrastinator is not a "busy professional." He is simply a selfish
person who places a higher value on five hours of his own time than
on two years of the author's time. A procrastinating reviewer can
easily delay the publication date of a paper by a year, two years, or
even longer (92). Late reviews are almost always unfavorable
reviews. After you have submitted a manuscript, each month that
Page 83 of 355
passes while you wait for the reviewer's comments reduces the
likelihood that your reviews will be favorable.
If peer review were important, wouldn't you expect scientists to

receive some training in the area. Wouldn't you expect peer reviewers
to be held to a standard of conduct? It doesn't happen. When the
reviewer receives your manuscript, he knows that he can handle the
review exactly as he wishes. Most editors hide the identities of their
peer reviewers with the same zeal that journalists hide the identities
of their sources. A reviewer can kill the work of a competitor or a
colleague, and nobody will ever know the name of the assassin.
As the number of journals increases, and the number of submitted

papers increases, editors have an increasingly difficult time finding
reviewers. If an editor asks you to review a paper, always accept. A
review is your opportunity to hurt your competitors, and to stifle
innovative ideas that threaten the status quo. Always remember the
first rule of the journal reviewer: "Every manuscript can be justifiably
rejected." If you take your job seriously, you can find a flaw in any
research effort. In the event that one of the other reviewers supports
the paper, over your objections, don't be discouraged. A reviewer has
the power to delay the publication of any paper. If the editor instructs
you to return your review in two weeks, you can take six months,
without rebuke. The author will be required to submit new revision of
his manuscript, responding to your criticisms. If you nitpick each
successive revision of the manuscript, you can easily stretch the
review process to 18 months. By the time the author has successfully
responded to all of your criticisms, his innovative paper will be
stripped of new ideas and transformed into a non-controversial fluff
piece.
On rare occasion, you may be asked to review a truly excellent

research paper. You can delay its publication for about two years.
This gives you ample time to duplicate the experiment in your own
lab, and publish the results in an electronic journal that offers quick
publication. Don't worry about being caught stealing the author's
ideas. Editors defend the anonymity of reviewers. Why do editors
protect the anonymity for reviewers? The given reason for this
Page 84 of 355
practice is that a reviewer, fearing retribution, might be reluctant to

criticize a paper written by a powerful colleague.
As a reviewer, you are the defender of your chosen field of science. It

is your duty to reject any paper that challenges the integrity of your
field. Simon LeVay, in his book, When Science Goes Wrong,
recounts the story of fetal cell transplantation gone wrong (98). The
researcher injected tissue from two sixteen-week old human fetuses
into the striatum and the ventricles (of the brain) of a patient with
advanced Parkinson's disease. The operation was performed by an
American scientist, in China, where experiments using fetal tissue are
legal. Two years later, the patient died. An autopsy showed no
surviving fetal tissue in the striatum. However, the injected fetal
tissue had grown into a teratomatous neoplasm, composed of bone,
cartilage, skin and hair, filling the ventricles. The autopsy was
restricted to an examination of the head, but the findings of teratoma
in the ventricles seemed to be the logical cause of death. The
pathologist who performed the autopsy submitted her findings to the
New England Journal of Medicine, where her paper was rejected by a
reviewer who happened to be a supporter of fetal tissue
transplantation research. The manuscript was subsequently published
in a neurology journal (99).
When you read a journal article, remember the following:
1. You can't assume that the paper was written by the listed author.
The paper may have been written by a ghost writer paid by industry.
2. You can't assume that the co-authors contributed to the paper.

They may have been listed for political or economic reasons, without
contributing in any measure to the manuscript.
3. The listed authors may have undisclosed conflicts of interest, of a

financial nature.
4. In the case of clinical trials, the study may have violated the rights
of human subjects.
5. The conclusions may be based on falsified or fabricated data.
Page 85 of 355
6. You will never have access to the raw primary data upon which the
conclusions were based.
7. The Discussion section may misrepresent the data.
8. The Reference section may exclude important precedent work

published by the author's competitors.
9. The paper may have been accepted for publication because it

confirmed the biases held by the reviewers.
10. The research may have been submitted for publication several
years prior to the publication date and has no current scientific value.
11. The work described in the article may bear no relevance to the
intended area of research supported by the funding sources listed at
the end of the article.
12. The article may have appeared in another place and another time,
in another language, with a different title and conclusion.
13. You are probably the only person on the planet who has bothered
to read the published manuscript.
1. You must understand that journals exist to make money for the
journal publishers. Journals that cannot bring profit will be
discontinued. Editors work for the publishers, and their only job is to
choose articles that sustain the economic viability of the journal.
2. Do not kid yourself into thinking that editors try their best to
accommodate authors. Editors could care less about the authors.
3. Do not think that all valid scientific work will be welcomed by

editors. Editors prefer poor scientific contributions that draws the
readers, over good scientific works of limited interest to readers.
Editors routinely reject flawless scientific papers.
4. Do not worry about whether your submission provokes an ethical
Page 86 of 355
dilemma for the editor. Editors do not care enough about the ethical
issues related to journal publications to spend any serious time trying
to ensure compliance.
5. Editors can make your life miserable as follows: 1) delaying your

reviews, 2) sending your paper to toxic reviewers who will
undoubtedly find many reasons to render a rejection, 3) rejecting
your papers, even when the reviews are good, 4) ignoring your
attempts to learn the status of your submission, 4) accepting your
paper, but greatly delaying publication of the accepted paper, 5)
accepting your paper, but stopping publication when the marketing
department finds the paper to be critical of an important advertiser, 6)
accepting your paper but stopping publication when he realizes that
so much time passed in the review and publication process that the
subject and contents of your article are no longer current.
6. After receiving a rejection letter from an editor, never call the

editor to defend your paper. Editors routinely reject papers for
reasons other than those listed in the rejection letter. Arguing the
merits of your paper is a waste of time, and will almost certainly
inflame the editor's smoldering animosity.
7. When you are given a submitted paper to review, never think of

the task as a burden; think of it as a chance to get even. Don't worry
about retribution; the editor will keep your identity secret.
8. The first rule for reviewers is, "Every manuscript can be justifiably
rejected." Every manuscript has flaws, and it's your job, as a
reviewer, to find them.
9. Always take at least three months to review a manuscript. Never

turn in your review until the editor's office has sent you at least two
reminders. All of your reviews must include requests for major
revisions. If you do not find fault with the manuscript, the editor may
question why you needed so much time to complete your review.
10. As a reviewer, your criticisms need not be fair, relevant, or even

competent. Remember, the critic is not the one being judged.
CHAPTER 5. GRANTSMANSHIP
Page 87 of 355
"[A]ny new writing, from reporting to reviewing to intellectual

journalism, finds the easiest path to publication by seeking the
consensus and falling into the deep groove of what's already written
and held to be true."
-Paul Maliszewski (100)
Grantsmanship is the art of getting grants. Institutions hire new

faculty and research staff based on grantsmanship skills, not research
skills or teaching skills. The faculty member who brings in grants
will be hailed as a consummate researcher and teacher, even if he is
incompetent in both areas. A staff member may be a highly skilled
and innovative researcher or a dedicated and competent teacher;
nonetheless, he will be reviled as an incompetent researcher and
teacher if he cannot win grants. Grants are the currency of science.
Just as the pursuit of money is the root of all evil, the pursuit of
grants is the basic imperative of every evil scientist.
Universities, like corporations, exist to accumulate wealth and to

perpetuate their own existences. Open any University newsletter, and
you will see headlines listing the awards received by the various
departments and centers. The article will name the principle
investigator, the size of the individual's award (usually 5 to 40
million dollars for the most prestigious universities), and a few words
describing the general area of research. Newsletters focus on awards,
not science; it's much easier to count money than comprehend new
ideas.
It is ironic that the ascendancy of grantsmanship in universities

comes at a time when the scientific value of most grants has steeply
declined. The likelihood that any chosen NIH grant will advance the
field of medicine is extremely small. The leadership at NIH
understands this and has produced a an official definition of grant
success that omits the expectation for scientific advancement. The
official NIH definition for the grant success rate is "the percentage of
reviewed grant applications that receive funding" (101). Success at
NIH is determined by money spent (the award), not value received
(the product of the award).
Page 88 of 355
NIH receives between 40,000 and 50,000 grant applications each

year. When you consider that NIH is just one of the many U.S.
federal agencies that fund grant applications, and that science grants
are funded by governments and private agencies throughout the
world, you can see that grant applications represent a large industry.
The effort wasted on rejected grants has increased, along with the
number of grant applications. In the 1950s, grants were awarded to
about 70% of the people who applied for a grants; this dropped to
30% by about 1980 (102). In 2008, NIH the grant award rate was
21.80% (103).
Writing a good grant requires a lot of hard work and scientific talent.
An evil scientist avoids the task altogether. Grant writing is best left
to the professionals. Most departments have someone on hand who is
a good writer, who knows the rules of grant writing, and who cannot
write his own grants, no matter how hard he tries. Such honored
servants learn how to write a strong summary statement (the only part
of the grant that is carefully read by the reviewers), how to prepare
credible budgets, and how to lard an application with an impressive
group of co-investigators. Well-funded institutes, centers and
academic departments usually have a star writer who has prepared
many funded grant applications. The ghost grant-writer, collaborating
with your institution's grant administrator, and using template text
from successful grants, will provide you with a grant application you
can be proud to call your own.
If you can't weasel out of writing your grant, there are a few simple
lessons that you must learn. When you look at grants, you quickly
realize that the final product comes as the result of a small but frantic
intellectual effort. Keep in mind that NIH receives about 50,000 grant
applications each year. If grants were really hard to write, the number
of grant applications would be much smaller. Much of the grant
proposal is informational boilerplate; names of investigators,
institutional grant administrators, addresses, telephone numbers,
biographic data for the investigators and co-investigators. A large
portion of the grant will be cobbled together from parts of similar
grants written in your department. In many cases, the methods you
Page 89 of 355
will be using are the same methods that have been used by your co-
investigators and that were included in prior grants. Such methods
can be pasted into your grant. The background section, which usually
begins with some unnecessary discussion of the history and
magnitude of the problem addressed by the grant, can be used for all
your grant applications. This assumes that the problem you are
addressing will not be solved in your lifetime, a safe assumption in
most cases.
The most important part of the grant is the abstract, which conveys a
summary of the proposed work, and the rationale for doing the work.
The study section needs to know what you plan to do, why you want
to do it, and whether you can actually pull it off within your
institution, with the specified personnel, equipment, and techniques.
The typical grant reviewer gives your grant a perfunctory once-over,
looking for answers to the following simplistic questions:
1. Is the applicant a bona fide scientist?
2. Does the applicant have a history of completing the grant awards

that he has received?
3. Is the applicant known to the members of the study section?
4. Is the grant well written?
5. Does the grant address a real scientific problem that has not been
previously solved?
6. Is the scientific hypothesis of any interest to the funding agency?
7. Does the grant application make any scientific sense?
8. Is the grant budget realistic?
Grants with these basic assets cannot be further distinguished from

grants written by competitors. A Committee of Science and Public
Policy report concluded that if you were to switch the review group
for a set of grant applications, you would change the group of funded
investigators by 25-30% (104). Agencies would save a great deal of
Page 90 of 355
money if they pooled the adequately written grants, and awarded

funds by lottery. Deep down, everyone knows this.
Though writing grants is easy, scientists frequently commit three

avoidable errors:
1. Procrastination. The most common cause of procrastination is self-

doubt. You simply are not confident that you can complete the task.
You lack the emotional maturity to develop and complete a set of
steps that will lead to a finished product. You cope by
procrastinating. You wait until the last possible moment to write your
grant. Driven by panic, you feverishly produce a rather crude
product. Your grant is not funded. When the next grant deadline
comes, the same story unfolds. You are pathetic.
2. Thriftiness. It makes no sense to write a grant with a low-ball

budget. Grants are judged on their scientific merit, not on the size of
the proposed budget. Review committees cannot give a grant a low
score because the grant is large; their job is to determine whether the
funds requested are commensurate with the work proposed. If your
budget is too small for the work proposed, the review committee will
conclude that you don't know what you're doing.
3. Honesty. It makes no sense to write a grant proposal that faithfully

describes your intended research. The review committee will be
composed by your competitors, who will give your grant a low score,
and steal your ideas. Under these circumstances, honesty is the worst
policy. Most agencies publish the list of people who sit for the
various grant review committees. It's best to pander to the biases that
prevail in the committee. If your reviewers believe in global
warming, and that the oceans will rise 18 inches in the next decade,
then you must believe the same. Feel free to write ridiculous,
misleading proposals; reviewers will not object so long as your
hypothesis legitimizes their biases.
Once the grant is won, the next step is to work on the grant and fulfill
the promises made in the grant application. WRONG!!! After a grant
is obtained, the next step is to win another grant. Grants, and the
money they bring to the researcher and his institution, are all that
Page 91 of 355
matters. Grantees have two options:
Option 1: Palm off the the grant work on a post-doctoral worker or on

a grantless faculty member.
Gina Kolata wrote an investigative article for the New York Times,
titled, "Labs, A Scientist's Foreign Country (105)." For this article,
Kolata interviewed highly successful scientists, who agreed that
success requires you to leave the labwork to others. One of the
interviewed researchers indicated that he had not performed
experiments in years. Dr. Shirley Tilghman, now President of
Princeton University, admitted that, for some scientists, "the best
thing that ever happened to them was to get out of the lab." As a
successful scientist, your job is to bring money into your institution.
Leave the work to others, but remember to take the credit for
yourself.
Option 2: Use your grant to attain more grants, in quick succession;

never completing your goals.
If you tell a lie, and people believe you, and you profit immensely
from the lie, why would you ever want to stop? Among the most
prominent financiers are life-long liars who understood that the value
of an investment is buoyed by a belief system. With a little luck, you
can suspend the disbelief of your investors indefinitely. Ivar Kreuger,
once known as the "Match King", and credited as the inventor of
derivatives, created an enormous Ponzi scheme that lasted for years,
until the Great Depression spoiled his fun and brought his investors
to financial ruin. Hard lessons learned by Kreuger's investors were
soon forgotten. Another Ponzi schemer, Bernard Madoff, swindled
billions of dollars from investors over several decades. Until the
moment that the Ponzi scheme unraveled, Madoff was held in the
highest esteem by his investors and by his colleagues on Wall Street
and the Securities Exchange Commission. The wizards at Enron built
a shell-game into one of the largest financial empires in the world,
and enjoyed the adoration of biographers and colleagues, until the
illusion finally collapsed.
Once you've been awarded a grant, you're considered to be superior
Page 92 of 355
to every scientist who has not been awarded a grant. This will hold
true even if you never make any contribution to science. Use your
prestige as a grant-winner to attract additional grants. Your
colleagues will be glad to add your name as a co-investigator on their
grant applications; your name will provide vicarious legitimacy to
their application. When you apply for your next grant, the members
of your review committee will see you as an established leader in
your field, greatly improving your chances for additional funding.
Grantsmanship is a never-ending Ponzi scheme. One grant parlays
into many.
Ponzi schemes work well for academics, but they work best for small
businesses. Federal funding agencies must award a percentage of
their grants to small businesses, through the Small Business
Innovation Research Program. A small business is usually a
corporation, and holds all of the legal corporate advantages. One of
the most useful rights of corporations is the right of re-incarnation. A
corporation can simply kill itself on Monday and arise as a new
corporation on Tuesday, with a different name, but with the same
owners and employees. A small business can win a grant, spend the
appropriated funds without producing any useful product, and apply
for another grant, in the same scientific area, under a new legal
identity, and a fresh slate.
5.1 TRUE FUNDING MEANS NEVER HAVING TO SAY

YOU'RE SORRY
"He that increaseth knowledge, increaseth sorrow."
-Ecclesiastes 1:18
Artists must produce art, if they accept a commission. Writers must

produce books, if they accept advances from publishers. But
scientists need not produce science if they have grants. Why is this
so? Funding agencies hold the act of scientific discovery in such awe
and veneration, that they cannot sully the process by requiring funded
investigators to produce results on command! The same delusion is
preserved in academia. When applying for a staff position in a
university, your success in getting grants will be closely scrutinized.
Page 93 of 355
Yet nobody will ask you what you have actually accomplished with
your grant; such inquiries are considered crude and irrelevant.
Sometimes, after receiving grants for decades, and without any

substantive scientific results to show for it, your funder might
question your competence or your diligence. This is unlikely to
happen, because funding agencies don't seriously expect much to
come from any individual researcher. If you happen to have one of
those rare, earnest Program Directors, who actually cares how
taxpayer money is spent, you should be prepared to defend yourself.
Here are a few retorts, of proven value:
1. "Over the years, I have trained dozens of graduate students and

post-doctoral assistants."
The grad students and post-docs do the actual work of the grant.
There is no way to verify that the principle investigator contributed to
their training.
2. "I am currently a full professor and have won multiple awards."
This is basically a circular argument. Scientists attain tenure and earn

awards in return for acquiring funding.
3. "I have a grant, not a contract. Grants have no expected

deliverables."
Federal funding agencies have two general ways of funding scientific

programs: contracts and grants. A contract lists the work that must be
done by the contractor, and specifies a set of deliverables that the
contractor must produce by the time the contract is finished. A grant
is a gift. There are no deliverables. The funding agency can check to
see that the grantee is using his grant funds for his research, but few
grantees receive serious scrutiny. With very rare exceptions, a grant
will receive continuous funding until it reaches its full term of
expiration. This is true even in the event of death of the grantee; the
funds simply transfer to a co-investigator or to an appointed surrogate
researcher if no co-investigator is listed on the grant application.
4. "I completed the work described in the RFA that your agency
Page 94 of 355
provided me. What else do you want?"
An RFA (Request for Applications) is a public announcement for a

federal grant funding initiative. RFAs differ from investigator-
initiated grant applications. Investigator-initiated grant applications
provide a mechanism whereby a researcher can receive funding for
any project that interests him, provided he can convince a peer review
committee (the so-called study section) that the research is important
and feasible. In an RFA, the funding agency provides a specific
research objective, and contains a list of the kinds of activities that
are appropriate for the specified project. In general, RFAs are
answered by a large number of competing proposals, all promising to
adhere to the research objectives specified in the RFA.
After the RFA is awarded, it is common practice for funded

investigators to veer sharply from RFA guidelines. There are several
reasons for non-compliance. First, researchers think of themselves as
free spirits, a notion reinforced by the culture of academic freedom
fostered in most universities. Researchers are loathe to follow
research plans developed by bureaucrats who work for funding
agencies. Second, researchers like to follow tangential lines of
research, even when the research diverts them from their primary
mission. Third, and most important, researchers follow a modus
operandi. Regardless of the project, a researcher will always return to
the methods he mastered as a graduate student. Over time, the RFAs
project will morph into the principle investigator's narrow field of
study.
How do RFA recipients get away with ignoring the well-documented

goals specified in the RFA document? It's easy. The principle
investigator simply asserts that the RFA did not adequately specify
the project. It is impossible to specify, in advance, every aspect of a
research project. A crafty principle investigator will use the uncertain
nature of research to excuse any and all breaches from the RFA.
5.2 INVESTING IN SCIENCE
"Don't gamble; take all your savings and buy some good stock and
hold it till it goes up, then sell it. If it don't go up, don't buy it."
Page 95 of 355
-Will Rogers
Here's a nifty idea for funding agencies: fund the really important
research, and don't fund unimportant research. This simplistic
approach, analogous to the stock broker's advice to buy low and sell
high, never seems to work as hoped. Basically, when one powerful
individual is permitted to choose the winners and the losers, the
winners always seem to be the friends, allies, and loyal supporters of
the person in power.
A series of headlines appearing in Science magazine in 2003 and

2004 convey one example of a perennial theme.
-April 25, 2003: Canceling Grants, VA Research Chief Shakes the

System (106)
-July 4, 2003: VA Shaken by Plan to Cut Grants, Cultivate the

'Stars' (107)
-December 12, 2003: Defunded VA Grants Restored; Wray Returns

to Texas (108)
-April 2, 2004: IG Report Faults Handling of Veterans Affairs Funds

(109)
In 2003, the Chief of Research and Development for the VA over-

ruled the peer-review process, and de-funded 17 projects (106). She
was of the opinion that outcomes research, her own area of study,
was more worthy of funding than some of the basic science projects
slated for funding (107). Many scientists disagreed with Dr. Wray,
particularly the de-funded ones. Before too long, the de-funded grants
were restored, and Dr. Wray vacated her position at the VA (108).
The other shoe dropped in March, 2004, when the VA Inspector

General's office issued a report on allegations that "Dr. Wray misused
funds provided to VA by pharmaceutical companies; misused
Government travel funds; unfairly hired, promoted, and managed
staff; and did not act impartially or reasonably when approving and
disapproving Research and Development Office projects." On the
Page 96 of 355
particular complaint pertaining to her approach to grant funding: "We

further substantiated that Dr. Wray did not act reasonably when she
re-evaluated and re-scored 130 research proposals that had previously
earned fundable scores, less than a month before their effective
funding date, and disapproved 15 of them." (110).
Nobody can determine which ideas are important and which ideas are
not. When we look at the major advances in science and medicine
throughout history, almost all of them were ridiculed from the
moment of their conception. Picking future science winners is a
sucker's game.
The peer review system for funding is a nasty business; about 80% of
grant applications are denied funding. You might prefer to increase
your chances of success by bypassing the grants review process
entirely. Here are a few alternate roads to success:
1. NIH awards grants to applications that receive the highest scores in

open competition, but not always. The Institutes have some
discretionary money that can be applied to grants applications that
did not compete well (i.e., did not receive a fundable score during the
review process). These grants are called "exceptions," because they
circumvent normal review. Exception funds can be assigned to
research projects that received poor scores. In rare instances,
exception funds can go to an idea that was never developed into a
formal grant application. Exception funds invariably go to scientists
who can motivate an NIH program director or high-ranking official to
exercise influence on their behalf. Smart scientists cultivate allies at
NIH.
2. Higher than the exceptions process is the direct appeal to the head
on an NIH Institute. The office of an NIH director has a variety of
methods for moving funding to a favorite supplicant. An NIH
director can request his division chiefs host an NIH workshop to be
chaired by the supplicant. The workshop lends authority to the
supplicant and legitimacy to his area of interest; this builds
enthusiasm for supporting his research. The NIH director can ask
program directors to launch a new initiative along the lines of
research of the supplicant. The NIH director can arrange
Page 97 of 355
collaborative efforts between funded NIH researchers and the

supplicant, essentially piggy-backing the supplicant onto a funded
laboratory.
3. If you are a physician seeking grant support, you really don't need
to look any further than your own suite of examination rooms. Dying
patients and their families can often be persuaded to leave their
estates, in part or in whole, to further the research interests of their
beloved family doctor. The request often takes the following form:
Isn't (name of disease) a terrible disease? It (may be, is, was, could
be) too late to save (name here), but my lab is on the verge of a
breakthrough. We are very close to stopping this disease, so that
nobody else's (father, mother, son, daughter) needs to suffer like
(name here). The NIH only pays for big science these days. They'll
give millions of dollars to the big labs, but it is virtually impossible
for a small lab to get a few hundred thousand dollars for an
innovative project. You know better than anyone else how important
it is to cure (name of disease). Can you help with a donation?
4. Earmarks are the only sure-fire way way of getting grant funding,
while avoiding the risks that come from the peer-review process. An
earmark is a budget expense, inserted by a congressman, for a
designated recipient in his home state. In 2007, Congress spent $2.3
billion on earmark projects for universities and colleges (111). If
somebody on Capitol Hill likes you, you can get millions of funding
dollars for otherwise unfundable research projects (112).
In the past, science was done on-the-cheap. Today, science is big

business, and requires generous support. The absolute requirement
for funding has turned the culture of research upside-down. Prior to
1960, the purpose of funding was to achieve research. After 1960, the
purpose of research was to achieve funding. Because funding lies at
the heart of modern science, and funding comes primarily from large
federal agencies, today's scientist is essentially a welfare recipient.
Money goes from the state to the scientist; very little comes back in
the form of scientific advancement.
Does it need to be this way? Of course not. We could substitute a
Page 98 of 355
cash-on-delivery policy for grants. Here's how it would work. A

scientist submits a scientific proposal to a central repository. As
examples, the proposal might be for an insomnia cure, or for an
improved jet engine, or for the genetic sequence of an aardvark.
Funding agencies and private corporations review the grants, and
place a bid based on how much it would be worth to have the
proposal completed. In each example, you might imagine that certain
agencies or corporations might want to place a bid, while others
might find any given proposal irrelevant to their missions.
Once the bids are placed, the proposal is awarded to the highest
bidder. The scientist looks at the size of the bid. If it is too low, he
simply informs the winning bidder that he won't be doing the work,
and the bid is withdrawn. Otherwise, the highest bidder then puts the
money for the bid into into an escrow account. The money will be
given to the scientist when he delivers on the proposed research,
within an agreed interval of time.
At this point, the scientist has no money for his research. He needs to
secure a loan for the research, using the bid as a form of collateral, he
find one or more investors willing to stake his research, in return for a
negotiated portion of the money in the escrow account.
Basically, this method of research funding permits society to pay for

what it receives, at a price that it is willing to pay. It is similar to a
"completion bond" (113). Scientists who cannot deliver on their own
proposals will receive no money. Because bids are not tied to the cost
of the work, productive scientists will do very well.
1. Science progresses as follows: many different areas of inquiry are

funded. A small number of them may one day lead to an important
advancement. We cannot tell in advance which areas will lead to
advancement and which areas are a waste of time. Major
advancements often come from ignored areas that had never received
funding.
2. If you believe that the purpose of funding is to do research, you
Page 99 of 355
need to turn your thinking around. Evil scientists know that the
purpose of research is to get funding. Department heads and
university administrators understand that professors are hired for the
sole purpose of bringing grants and other forms of revenue into their
institutions.
3. Understand that there is no relationship between the a grant's merit

and its funding success.
4. As an academic scientist, you are only as good as your next grant;

focus your efforts on securing future funding.
5. Never write your own grant. Grant writing is best left to

professional ghost writers employed by your department.
6. Never work on your grant. Time spent on your current grant is

time stolen from securing the next grant. Research is something done
by technicians, graduate students, and post-doctoral fellows.
Successful scientists never step foot into their own laboratory.
7. Spend, spend, spend. The most successful scientists have the

largest grants. If you write your grant thinking that the study sections
will look favorably upon a low-budget project, you are sadly
mistaken. A small budget grant is the calling card of the loser. Don't
be afraid of asking for more money than you can responsibly spend.
8. When your grant has expired, abandon your work. The only people
who will be inconvenienced are the technicians, graduate stuents and
post-doctoral fellows who slaved over the project for the past half-
decade.
9. Take credit for all of the work that comes from your laboratory. If
you must list your subordinates as co-authors, be sure to stagger their
names on your papers. Your name will be the only name that appears
on every paper coming from your laboratory; and the only name that
is associated with the laboratory's work.
10. Commercialize your research. If you find yourself to be the

unintended inventor of a process, drug, or invention that can save
thousands of lives, don't make the mistake of giving it all away.
Page 100 of 355
11. Don't worry about scientific stagnation in your field. The public
will pay and pay forever, if they believe that a breakthrough is near.
You can hold society hostage for decades, if they really need a
solution to a scientific problem.
12. The truly powerful scientist becomes independent of grant

funding. Earmarks from government, grants from private
corporations, grants from charitable institutions, and money received
directly from wealthy donors can free you from the endless pursuit of
grants.
CHAPTER 6. REJECTION
"That it will ever come into general use, notwithstanding its value, is
extremely doubtful because its beneficial application requires much
time and gives a good bit of trouble, both to the patient and to the
practitioner because its hue and character are foreign and opposed to
all our habits and associations."
-The London Times, 1834, reviewing a new medical device, the

Stethoscope
The life of a scientist is full of rejection. Rejection is a judgment from

your peer community that your work has no merit and should not be
rewarded, or even acknowledged. It is an official indictment against
your work, and your self-image. Though some creative persons seem
to thrive on rejection, most whither.
Perhaps nobody has been as deeply ignored, during his short, obscure
lifetime, than Vincent Van Gogh (1853 - 1890) . In the last decade of
his short life, he produced over 2,000 paintings. He just kept getting
better and better at his craft, producing many of his most beloved
works in the last two years of his life. Though he had connections to
a successful art dealer (his brother Theo), his paintings had no
buyers. Rejected and depressed, he took his own life.
John Milton (1608 - 1674) received only 10 pounds, from his

publisher, for the manuscript and the copyright to Paradise Lost
(1667). Despite an examplary life, Milton died blind and
Page 101 of 355
impoverished. His epic poem would not achieve critical acclaim in

his own country until 30 years post-mortem. Perhaps Satanic forces
prevailed against Milton, much as they prevailed in Paradise Lost
(Figure 6-1).
Figure 6-1. Satan, drawn for a nineteenth century edition of Paradise

Lost, by Gustave Dore (1832 - 1883). Source: Wikipedia, public
domain.
Herman Melville (1819 - 1891) finished writing Moby Dick in 1851.

He considered it to be his greatest novel, but reviewers disagreed. His
publisher printed a small number of first edition books; most went
unsold. Melville's career delined after disappointing sales for Moby
Dick. Melville was forced to take a job as a customs inspector to
make ends meet. He died in almost total obscurity, leaving behind the
unpublished manuscript of his last work, Billy Budd. Today, Moby
Dick is considered one of America's greatest novels.
Emily Dickinson (1830-1886) wrote about 1,800 poems. Fewer than

a dozen poems made it to print during her lifetime; these were altered
by the publisher to suit the prevailing norms of poetic form, and were
ignored by all but a few close friends. Death did little to enhance her
reputation, until 1955, when a collection of her works were
published. Today, Emily Dickinson is one of the most beloved poets
of all time.
From the 1930s to 1960, publishers had little or no interest in Louis

Zukofsky (1904 – 1978); he wrote with virtually no audience. His
Page 102 of 355
book "Barely and Widely" sold only 26 copies two months after
release. Today, Zukofsky is considered to be one of the greatest poets
of the 20th century (114).
David Oshinsky wrote an essay on book rejections discovered in the

Alfred A. Knopf, Inc., archive (115). In 1950, Alfred A. Knopf Inc.
rejected "The Diary of a Young Girl," by Anne Frank. The publisher
found the work dull and "a dreary record of typical family bickering,
petty annoyances and adolescent emotions." After 15 other publishers
passed on the title, Doubleday published the book (over 30 million
copies sold). In the same essay, Oshinsky reported that Pearl Buck's
The Good Earth was rejected by Knopf (Americans are not interested
in China), as was George Orwell's Animal Farm, (animal stories don't
sell). Also rejected was Isaac Bashevis Singer (rich Jews again), and
Sylvia Plath (not enough talent).
Art and literature are subject to personal taste. Science is tethered to

objective reality. You would expect that scientific discoveries would
be greeted with immediate acceptance because legitimate scientific
assertions can be tested and verified. Such is not the case, and the
history of discovery is filled with sad stories of great works rejected.
A short chronology of scientific rejection follows (116):
480 B.C.E. Democritus (460 B.C.E. - 370 B.C.E.) invents atoms, a

theory supplanted by the much more popular "Earth, air, fire, and
water" school.
350 B.C. Aristotle (384 B.C.E. - 322 B.C.E.) recognizes that dolphins
are mammals. The rest of the world disagrees, classifying dolphins as
fish. After two thousand years of derisive laughter, the world
eventually agrees with Aristotle.
325 B.C.E. Pytheas (350 B.C.E. - 285 B.C.E.) sails from Greece to
Iceland. Pytheas watched the Atlantic tides (absent in the smaller
Mediterranean sea). When he returned from his remarkable voyage,
Pytheas described his voyages and his observations. Nobody believed
him.
240 B.C.E. Eratosthenes of Cyrene (276 B.C.E. - 195 B.C.E.)
Page 103 of 355
working in Alexandria, computes the size of earth correctly. At the

time, the preponderance of scientific opinion favored a flat earth,
supported by a giant (Atlas) or possibly a turtle.
134 B.C.E. Hipparchus (190 B.C.E. - 120 B.C.E.) observes a newly

appearing star (nova). The western world remains incredulous until
Tycho Brahe's observation 1500 years later.
1705 Edmond Halley (1656 - 1742), calculates that his comet would
return to the solar system in 1758. Nobody took him seriously, until
1758, when Halley's comet returned.
1747 James Lind (1716 - 1794) determines that citrus prevents

scurvy. It takes another 50 years and hundreds, perhaps thousands, of
deaths, before British navy listens.
1796 Edward Jenner (1749 - 1823), writes paper on smallpox

vaccination; rejected. Forced to self-publish research results (117).
1847 Ignaz Philipp Semmelweis (1818 - 1865) reduces rate of

puerperal fever by hand-washing. Hand washing was soon abandoned
by the hospital staff. Semmelweis eventually lost his sanity. To this
day, many physicians and healthcare professionals neglect to wash
their hands.
1884 Svante August Arrhenius (1859 - 1927) defends his PhD thesis
on ionic dissociation. His professors thought it was all wrong,
reluctantly passing him with the lowest possible qualifying grade. In
1903, the very same thesis earned Arrhenius the Nobel prize.
1869 One-armed civil war veteran John Wesley Powell (1834 - 1902)
is denied federal funding to explore the Grand Canyon; his privately
funded exploration is credited with many of the significant
discoveries of the Colorado basin.
1892 Georg Ferdinand Ludwig Phillip Cantor (1845 - 1918)

publishes the theory of transfinite numbers, to the immediate and
vociferous condemnation of the religious, philosophical, and
scientific communities. Mathematics, unlike the natural sciences,
yields to logic. In 1904, the Royal Society bestowed its highest honor
Page 104 of 355
on Cantor.
1987 Fred Cohen, who introduced the term, "computer virus" in a

1984 paper, and who was one of the first scientists to predict the
threat of computer viruses, asks the National Science Foundation for
a grant to study countermeasures. His grant was denied; not of
current interest (118).
Sometimes, the best works are found amongst the rejected efforts. In
mid-nineteenth century France, the Salon de Paris, the official art
exhibition sponsored by the Academie des Beaux-Arts, rejected
works by Monet, Manet, Pissarro, Cezanne, and many others whose
concept of art conflicted with prevailing sensibilities. Complaints
reached the ears of Napoleon III, who allowed rejected words to be
displayed in a Salon de Refuses (a gathering of the rejected people).
These exhibitions of rejected art are credited with the rise of
impressionism. Today, the term "salon des refuses" refers to any
exhibit of works that were rejected by a juried show.
Mathematicians have their equivalent of a Salon de Refuses. Today,

mathematicians can publish their rejected papers in Rejecta
Mathematica, available online at: http://math.rejecta.org/about-
rejecta-mathematica. Sometimes, great ideas are not rejected; they're
just ignored. Hundreds of years can pass while a deserving idea is
discovered, lost, re-discovered, lost again, and so on.
In 1668, the world was modernized, in many ways. We had the

fundamentals of cryptography (Viete, 1589), Pi calculated to 20
decimal places (Ludolf, 1596), logarithms (Napier, 1624), Fermat's
last theorem (1637), the fundamentals of probability (Pascal, 1654),
and the ability to diagnose cancers by pathologic examination
(Malpighi, 1659). Differential equations were understood (1662), and
the last details of integral calculus were being written, independently,
by Newton and Leibnitz. Despite all of these scientific advances, the
world believed that the life of very small organisms arose
spontaneously, from thin air, or possibly from inanimate particles of
dirt. Otherwise rational intellects were comfortable with magical
thinking, and believed that life could be explained by postulating
forces acting in a realm beyond human perception.
Page 105 of 355
Francesco Redi, in 1668, designed an experiment to test whether

maggots arose through spontaneous generation (Figure 6-2). He
incubated meat in flasks; some flasks covered to stop the entry of
flies, and others left uncovered, permitting flies to enter. After some
time passed, Redi examined the meat in both sets of flasks. Only the
meat from the open flasks contained maggots. Redi correctly
concluded that maggots do not generate spontaneously from dead
meat. We now know that maggots generate from tiny eggs laid by
flies.
Figure 6-2. Francesco Redi. Source: Garrison FH. History of

Redi's experiment had very little influence on the prevailing belief

systems. Seventy-two years later, John Turberville Needham
conducted his own meat-related test for spontaneous generation. He
heated mutton broth in a closed container, and examined the contents
a few days later. The container swarmed with micro-organisms,
proving, to the satisfaction of many, that micro-organisms arise by
spontaneous generation. In retrospect, we can assume that the broth
was not heated sufficiently to kill all of the organisms initially
present in the container, or that the container was not closed tightly.
For some time, though, Needham's experiment vanquished lingering
doubts regarding the validity of spontaneous generation.
In 1768, a full century after Redi's experiments, Lazzaro Spallanzani
Page 106 of 355
(1729 - 1799) repeated Needham's experiment, this time boiling the

broth for forty-five minutes. No organisms grew in the closed
container (Figure 6-3).
Figure 6-3. Lazzaro Spallanzani. Source: Wikipedia, public domain.
Spallanzani's experiment should have put the kibosh on spontaneous

generation, but it did not. Ninety-two years passed before the
controversy was revisited. In 1860, scientists knew enough about the
biology of life to infer that spontaneous generation was a needless
and absurd theory. At that time, Virchow, a highly influential
pathologist, argued against spontaneous generation, observing that
cells arise from other cells, through cell division. In 1860, Pasteur
showed that dust particles in air carried micro-organisms. If boiled
meat is exposed to purified air (without dust particles), bacterial
growth does not occur. Nearly two centuries were required to
convince the world that Redi's experiment, disproving spontaneous
generation, was valid.
Back in 1668, just as Redi was trying to convince his colleagues that
living organisms cannot generate from nothing, Richard Lower was
putting the finishing touches on his Tractatus De Corde: Item De
Motu Et Colore Sanguinis. Lower demonstrated experimentally that
venous blood pumped from the heart, into the lungs, is transformed
(from venous dark red, to arterial bright red) by aeration and returned
to the heart, where arterial blood is pumped to the peripheral
Page 107 of 355
circulation. This seems obvious today; barely worthy of explanation.

But it took 1600 years to solve the mystery of heart-lung circulation.
We need to be reminded that for about 1500 years, all medical

thought in Europe was dominated by one honored physician. Galen
(129 - 199 C.E.) was a Greek physician who lived in Rome, and
Pergamum (Turkey), and retired early to live a life of scholarship. He
wrote many books, including "On Prognosis," (177 C.E.), and
produced a total of about 3 million bon mots before he died (119).
For the subsequent 1500 years, his words were accepted on blind
faith by virtually all European physicians. To reject Galen was a type
of heresy, that almost always resulted in professional ostracism.
Galen, great as he was, labored under the somewhat limited scope of

second century science. Some of his most far-reaching thoughts fell
into the realm of superstition. For example, Galen believed that blood
was embued with natural spirts by the liver, and vital spirits by the
heart. Furthermore, Galen believed that blood moved through the
septum of the heart through invisible pores. The concept of a closed
circulation was unknown to Galen.
Every child who rides an escalator must wonder where the steps go
when they reach the top. The escalator steps seem to slink under the
floor, and drop off into a hidden chamber. Meanwhile, another
mysterious process creates new steps that emerge from the floor of
the elevator, and rise upwards. The idea of a continuous belt of stairs
seldom catches the imagination of very young children, who prefer
magical thinking over mundane observations. Basically, medieval
physicians accepted Galen's magic stairs version of blood circulation.
Blood was constantly replaced by the liver at a rate that equaled its
issuance through invisible pores in the heart. It was just fantastic.
Anatomists who gave any thought to Galen's theory of blood

circulation knew that Galen could not be correct. Still, to doubt Galen
was clearly unacceptable. In frustration, Henri de Mondeville, the
author of Cyrurgia (1312), an early textbook of surgery, wrote, "God
did not exhaust all His creative power in making Galen (119)."
Andreas Vesalius (1514 - 1564) published "De Fabrica Humani
Corporis," in 1543 (Figure 6-4).
Page 108 of 355
Figure 6-4. Andreas Vesalius, on left. Source: Garrison FH. History

of medicine. WB Saunders, Philadelphia, 1921.
Vesalius provided a detailed description of human anatomy that

corrected some of the misconceptions and superstitions left by Galen
(Figure 6-5). Vesalius' closest friends turned against him. Others in
his profession condemned, mocked, or ignored his work. Die-hard
Galen fans insisted that any discrepancies between Galen's second
century human anatomy, and Vesalius' sixteenth century observations
were due to naturally occurring modifications in the human
condition. Sylvius, Vesalius' teacher in Paris, grumbled, "Man had
changed but not for the better (119)." Vesalius departed Venice, and
died alone, impoverished, ridiculed by his colleagues, shipwrecked
on the Island of Zante (Zakynthos) (119).
Page 109 of 355
Figure 6-5. Vesalius' drawing of the base of the brain, demonstrating

a thorough understanding of brain anatomy, including the crossing of
the optic nerves, the origins and course of the spinal nerves, and the
relationship of the cerebellum to the brain stem. Source: Wikipedia,
public domain.
Ten years later, Michael Servetus (1511 - 1553) published Restitutio

Christianismi, in which he noted that the pulmonary vessels deliver
blood to the heart, after the blood has mixed with air in the lungs.
That same year, Servetus was burned at the stake (along with most of
the copies of his book) by Calvin for a poorly written sentence that
seemed heretical at the time (Figure 6-6).
Figure 6-6. Michael Servetus. Source: Wikipedia, public domain.
By 1628, the world was ready to take a second look at some of

Galen's opinions. In this year, William Harvey (1578 - 1657)
published De Motu Cordis, describing the circulation of blood from
Page 110 of 355
heart to lungs and back, and from the heart to the periphery and back.
This brings us to back to Richard Lower (1631 - 1691) (Figure 6-7).
In 1691, Lower published an explanation of the relationship between
the peripheral and pulmonary circulations, and described the
intrapulmonary aeration of venous blood. Lower's work was a
complete anatomic and physiologic synthesis that has withstood the
test of time.
Figure 6-7. Richard Lower. Source: Wikipedia, public domain.
The Italians credit Andrea Cesalpino (1524 - 1603), a professor of

medicine at Pisa, for discovering the closed heart-lung circulation
prior to Harvey. The point is moot. In 1242 C.E., the Arabic
polymath Ibn an-Nafis (1213 - 1288) described the heart-lung role in
circulation and aeration; four centuries before Cesalpino. At the time,
nobody in Europe cared to listen. The moral of the story is that new
ideas will be rejected if they contradict cherished beliefs.
As Galen dictated medieval medicine, so did Ptolemy dictate

medieval science. Claudius Ptolemaeus (90 - 168), known in English
as Ptolemy, was contemporary with Claudius Galenus (129 - 199),
known in English as Galen. According to Ptolemy, the earth sat in the
center of the universe, and the size of the universe has a radius equal
to 20,000 times the radius of the earth. Wrong or right, European
scientists held Ptolemy's judgment inviolate for nearly fifteen
centuries.
Page 111 of 355
Figure 6-7. Ptolemy, pointing away from the center of the universe.
Source: Wikipedia, public domain.
Reality is the thing that can kill you whether you believe in it or not.
For centuries, navies refused to believe that citrus can cure scurvy
(Vitamin C deficiency disease). Most animals can synthesize ascorbic
acid (Vitamin C), and do not require a dietary source of the vitamin.
Humans and guinea pigs must acquire the vitamin in their diets, or
they will die. Without Vitamin C, the body cannot properly
synthesize collagen, the fibrous protein that braces connective tissues
in animals. The first known large epidemic of Vitamin C deficiency
occurred in 1497, when Vasco da Gama sailed from Lisbon to
Calcutta. About three-fifths of his crew died. Prior to the age of
European sea explorations, voyages were shorter, or they involved
foraging for food along the way. The Europeans set larder on their
ocean-going ships with provisions for the full journey. Unfortunately,
their stored foods lacked sufficient Vitamin C, resulting in death by
scurvy, a particularly nasty condition marked by a general collapse of
the body's structural integrity, often ending with stroke due to
vascular hemorrhage.
In 1593, Sir Richard Hawkins demonstrated that scurvy could be

prevented and cured by eating oranges and lemons. If citrus fruits
were not to a sailor's liking, a type of salad cress was shown, in 1597,
to work just as well. It would seem that by 1597, one century after the
medical disaster aboard Vasco da Gama's ship, scurvy was eliminated
Page 112 of 355
as a threat to naval adventurers.
Not so. Soon after the cure for scurvy was found, it was abandoned.
Scurvy resumed its killing spree on the British navy. It was up to
James Lind to re-discover, in 1747, that citrus prevented and cured
scurvy. Lind's re-discovery was lost on some explorers. A century
later, in 1848, the ships Erebus and Terror, while navigating through
the Northwest Passage, became trapped in ice. Citrus was absent
from their provisions. The crew died of scurvy.
The basic theory of asepsis is simple; keep wounds clean, and avoid
contaminating anyone with infected materials from other persons,
and everyone stands to live a lot longer. The limitation of asepsis, as
a medical procedure, are three-fold: 1) humans are dirty; 2) humans
are lazy, and 3) nobody in human history has ever been paid to wash
his hands.
Asepsis is another idea whose time had come and gone and come and
gone. Hippocrates (460 - 377 BC) irrigated wounds with wine or
boiled water. Galen (130 - 200 A.D.) knew enough to boil his
surgical instruments. In 1266 A.D., Todorico Borgognoni taught
aseptic wound treatment.
In 1847, Ignaz Phillipp Semmelweis was working at the Vienna

General Hospital's maternity clinic, on a three year contract (Figure
6-8). Through much of human history, mothers commonly died of
infections arising immediately following childbirth. As many as forty
percent of mothers contracted and died from puerperal fever, also
known as childbed fever. The cause of these deaths would have been
obvious to Hippocrates, Galen or Borgognoni. Doctors scurried
between sick patients and healthy patients without washing their
hands. Semmelweis saw the problem, and contrived an experiment;
Doctors and medical students would wash their hands between
patient examinations. The staff doctors were skeptical, but they
agreed to humor Semmelweis, if only to prove him wrong. The death
rate from puerperal fever dropped precipitously. Unfortunately for
the women at Vienna General, staff doctors abandoned the hand
washing ritual when Semmelweis's contract expired. Hand washing
was an annoying diversion. All told, they preferred the filth and the
Page 113 of 355
high death toll to the incessant hygienic obligations. The patients

supported the staff. They didn't like to see doctors washing their
hands after touching them; it made them feel dirty.
Figure 6-8. Ignaz Phillipp Semmelweis, wedding diptych. Source:

Have you ever wondered why Jewish doctors are held in high esteem,
even among patients who are openly anti-semitic? Do Jews make the
best doctors? The answer may lie in the ancient Hebraic hand-
washing obligations. Observant Jews wash their hands often, and
thoroughly. Ritualistic hand-washing is a thorough procedure,
requiring clean water, and repeated hand immersions. It comes as no
surprise that a doctor who carefully washes his hands will save more
patients than a doctor whose hands carry infection from patient to
patient.
Today, nobody doubts the effectiveness of a clean environment for

patients, but hand washing is still a lot of work. Doctors, even in the
best hospitals, neglect washing their hands (120). For physicians, not
hand washing is the perfect crime. It can kill as easily as a bullet, but
no doctor has ever been punished for having dirty hands. As Dr.
Robert M. Wachter, an expert in patient safety has said, "I can lose
my hospital privileges if I fail to sign a dictated discharge summary
or operative note. But if I don't clean my hands for the next 10 years,
nothing will happen to me" (121). Every evil scientist understands
that doctors will not wash their hands for free. The same careless
disregard for cleanliness extends from their hands to their
examination equipment. In a New Jersey Hospital about one in three
stethoscopes was found to be contaminated with potentially lethal
MRSA (methicillin-resistant Staphylococcus aureus) (122). When
Page 114 of 355
cleanliness becomes a billable procedure, its scientific value will be

re-discovered, again.
Sudden Infant Death Syndrome (SIDS) is a disease known to every

parent. Typically, the baby is left to sleep. When the parents check in
on the baby, they find that it is dead. Moments of temporary sleep
apnea are common in babies and adults. In SIDS, the process of
breathing simply stops, and does not resume. Autopsies on SIDS
patients have never shown any consistent conditions in organs that
may have caused death. Many bright medical researchers have
devoted their careers to SIDS. The obvious suspects (respiratory
controls in the brain and lungs) were examined in hundreds of
studies, with little to show for the effort. These expensive but
fruitless research efforts were conducted in a time when an effective
method to prevent SIDS was known; and ignored.
As early as the 1940s, the observation was made that many victims of
SIDS were found in the prone position on pliant bedding (123).
Similar observations were made again and again, and by the 1970s,
people began to wonder whether babies could breathe adequately
under these conditions (124). New Zealanders are credited with
showing that the incidence of SIDS drops precipitously when infants
sleep in a supine position, on a firm mattress. Numerous population
studies have confirmed these observations. Currently, the "back-to-
sleep" campaign is a worldwide effort whose goal is to spread
awareness of a breakthrough in SIDS prevention, discovered more
than six decades ago.
Scientists will reject observations that challenge their belief systems.

No story better exemplifies this than the tale of seventeen centuries of
night-blindness experienced by European astronomers. Hipparchus
(190 B.C.E. - 120 B.C.E.) was an early Greek astronomer (Figure 6-
9). In 150 B.C.E., Hipparchus correctly calculated the distance from
the earth to the moon (250,000 miles). Some years later, in 134 B.C.
Hipparchus looked in the sky and saw a new star (a nova). He was
certain that the star was new because he had just finished mapping
the known heavens when the new star appeared.
Page 115 of 355
Figure 6-9. Hipparchus, the first to discover and record a new star
appearing in the sky. Source: Wikipedia, public domain.
The next European to see a new star in the sky was Tycho Brahe, in
1572. The curious thing about this dark interim is that nova occur
frequently. Several dozen nova, visible from earth with the naked
eye, occur each year (125). Moreover, in the year 1054, the Crab
Supernova was recorded by Chinese, Japanese, Persian/Arab and
Indian astronomers. The Europeans, who were literally in the dark
ages, missed the event.
Figure 6-9. The Crab Nebula, shown here in a NASA image, contains
the remnants of the 1054 supernova, carefully recorded for history by
every civilization in the Northern hemisphere, with the exception of
Europe. Source: Wikipedia, public domain NASA image.
The reason that no nova were observed in Europe, over a period of

seventeen centuries, is very simple. The Europeans believed in the
Page 116 of 355
fixed heavens. If you believe that the heavens are the same now as
they were when the universe was created, and will stay the same until
the universe ends, then you will not see new stars twinkling in the
night sky.
For many, the purpose of science is to confirm a set of

preconceptions. When something new comes along that contradicts a
previously held belief, it is ignored or rejected.
6.1 APPLAUDING BAD SCIENCE
"Intellectuals can tell themselves anything, sell themselves any bill of

goods, which is why they were so often patsies for the ruling classes
in nineteenth-century France and England, or twentieth-century
Russia and America."
-Lillian Hellman
It is often easier to believe a bad idea than a good idea. Bad ideas can
be carefully designed to provide people with something they want to
believe, unconstrained by reality.
Geocentric heavens - Aristarchus of Samos (310 B.C.E. - 230 B.C.E.)

correctly reasoned that the earth orbits the sun. Four centuries later,
Ptolemy (90 - 168) inserted the earth into the center of the universe.
Ptolemy's vision prevailed for about 1500 years. In 1543, Nicolaus
Copernicus (1473 - 1543), published De revolutionibus orbium
coelestium (On the Revolutions of the Celestial Spheres), proving
that Aristarchus was correct. Even so, renasissance cosmographers
continued to put earth in the center of things, as depicted in a 1568
chart by the Portuguese cosmographer Bartolomeu Velho (Figure 6-
10).
Page 117 of 355
Figure 6-10. The Ptolemaic Universe, by the Portuguese

cosmographer and cartographer Bartolomeu Velho, in 1568. Source:
Titius-Bode Law - In 1766, Johann Titius (1729 - 1796) found that

the distances of the planets from the sun, in astronomical units, were
determined by a simple formula: double the number of each planetary
orbit (after the first), add 4 to each number, and divide by 10. The
law predicted a missing planet between Mars and Jupiter. The
presence of asteroids in this location prompted speculation that the
missing planet had exploded in the distant past. Johann Bode
popularized Titius' work in his 1772 astronomy textbook. Alas,
discoveries of Neptune (in 1846, at a location predicted by Le
Verrier, not Titius), and Pluto (1930) violated the Law. Today, The
Titius-Bode Law (often incorrectly called Bode's Law, a sterling
example of Stigler's Law in action), is considered a vacuous exercise
in numerology, with no basis in theoretical or observational science.
Canals on Mars - Well into the twentieth century, scientists believed

that there were canals on the planet Mars. Optical lines criss-crossing
Mars were first observed by the Italian astronomer Giovanni Virginio
Schiaparelli (1835–1910), in 1877. The observations stirred the
imagination. Here was irrefutable evidence that a riparian civilization
thrived on an alien-created canal system. We now know that the
canals are an optical illusion, and do not represent any physical
structure, water-filled or otherwise (Figure 6-11).
Page 118 of 355
Figure 6-11. Schiaparelli's map of mars, showing canals. Source:

Status thymicolymphaticus - In the late nineteenth and early

twentieth centuries, doctors attributed childhood asthma and crib
death (now known as sudden infant death syndrome) to enlarged
thymus glands; they named the condition status thymicolymphaticus.
In the 1920s, doctors radiated enlarged thymus gland of children as a
preventive measure against crib death. It is estimated that about
20,000 - 30,000 people died from cancers produced by "therapeutic"
radiation for this and other real or imagined disorders (126). We now
know that status thymicolymphaticus is not a disease. Some children
are born with larger thymus glands than other children, but no disease
syndrome results from this anatomic disparity.
Stomach cancer produced by a worm - The 1926 Nobel prize for

medicine went to Johannes A.G. Fibiger, who discovered a cause of
cancer that that was eventually shown to be an artifact. According to
Fibiger, a larval parasite caused stomach cancer in rats. Years later,
scientists concluded that the tumors must have been caused by some
other factors. Humiliated by their mistake, the Nobel Assembly
waited four decades before they awarded the prize to another cancer
researcher.
Frontal lobotomies - The frontal lobotomy was invented by Dr.

Antonio de Egas Moniz in 1935 and popularized by Dr. Walter
Freeman. For the procedure, Dr. Freeman applied local anesthetic,
then inserted a gold-plated ice-pick just above the eyeball, and
shoved it into the brain. The Doctor gingerly scraped the ice-pick
through the frontal lobe, the presumed site of unrestrained emotions.
Apathy and mental impairment often followed the procedure, and this
was considered an improvement in most cases. Dr Freeman
performed over 3,500 procedures; his disciples, performed about
40,000 more. The procedure has since been largely discredited, but
not before Dr. Moniz received the 1945 Nobel prize in medicine,
honoring his dubious gift of frontal lobotomy.
Polywater - In the 1960s, soviet researcher Nikolai Fedyakin
Page 119 of 355
introduced polywater to the world; a polymerized form of water with

a higher boiling point, lower freezing point, and higher viscosity than
ordinary water. Other workers seemed able to repeat and extend
Fedyakin's early observations. After many years of wasted effort, the
scientific community finally conceded that polywater experiments
were unrepeatable and that polywater does not exist.
Phrenology - Phrenology is the pseudoscience that predicts

personality by inspecting the surface features of a person's skull.
Phrenology was invented by the German physician, Franz Joseph
Gall, in 1796, but was practiced well into the twentieth century.
Phrenologists believed that personality, the aggregate expression of
many different brain functions, could be predicted by measuring
protrusions of the skull overlying brain regions lifted by high levels
of activity or depressed by atrophy (Figure 6-12). Nineteenth and
twentieth century discoveries in brain science provided a theoretical
basis for phrenology by assigning specific cognitive functions to
specific anatomic locations of the brain. It was a nice idea, but
completely wrong.
Figure 6-12. Phrenologist's skull chart. Source: Wikipedia, public

domain.
Cold fusion - Stars are fueled by fusion. For decades, physicists have
been trying to develop a controlled fusion reactor that would provide
unlimited energy, from hydrogen; without much success. In 1989
Martin Fleischmann and Stanley Pons held a press conference to
Page 120 of 355
announce that they had produced fusion in a tabletop experiment

involving electrolysis of heavy water and a palladium electrode.
Fleischmann and Pons did not fully specify the theoretical basis for
their success, but physicists throughout the world were only too
happy to fill the void with theories of their own. Several laboratories
reported that the observations of Fleischmann and Pons were
repeatable! Meetings, seminars, and workshops were hastily
assembled and attended by the top minds in physics. Lectures were
delivered explaining how cold fusion worked. As time went by,
despite early declarations of success, other laboratories could not
achieve cold fusion. The theoretical works explaining cold fusion
have been discredited. The long, frustrating quest for free, unlimited
fusion energy continues.
6.2 PROGRESS? WHAT PROGRESS?
"The progress of man is based on disbelief of the commonly

accepted."
-J. Frank Dobie
Much of what we call modern science was actually discovered by a

few dozen Greek thinkers in a span of about 300 years. Most of the
important events in human history seemed to play out in a very short
time, in a very small country.
460 B.C.E. Hippocrates used boiled water when irrigating wounds

(first use of asepsis)
460 B.C.E. Zeno of Elea proposes his "Dichotomy" paradox;

basically, you need to traverse half a distance before you traverse a
whole distance, but there an an infinite number of half-distances in
any traversal, so how can you traverse any distance?
460 B.C.E. Pericles leads Athens into golden age.
440 B.C.E. Democritus invents "atoms."
429 B.C.E. Plague in Greece, also known as Plague of Athens.
Page 121 of 355
420 B.C.E. Hippocrates observes that each side of the brain controls
the opposite side of the body.
404 B.C.E. Athens capitulates to Sparta, ending Peloponnesian Wars.

Sparta wisely spared Athens; simply added it to Sparta's province.
399 B.C.E. Socrates is condemned to death for corrupting the minds

of Athenian youth (Figure 6-13).
380 B.C.E. Plato finishes The Republic.
350 B.C.E. Aristotle determines that earth must be round.
350 B.C.E. Aristotle classifies animals. His assignment of dolphins

with mammals was received with derision for about two millennia,
when he was belatedly proven correct.
337 B.C.E. Philip II of Macedon creates League of Corinth and

essentially becomes the commander of the all-Greek army, set to
attack the Persian empire. After Philip's assassination (in 336
B.C.E.), his son, Alexander, picked up the gauntlet.
331 B.C.E. Alexandria founded in Egypt (by Greece), grafting

Grecian culture (itself highly influenced by Egyptian culture) back
into Egypt.
331 B.C.E. Alexander captures Mesopotamia and Babylon.
326 B.C.E. Alexander captures the Punjab, and his long, exhausting
campaign for world domination stops at the River Hyphasis.
323 B.C.E. Alexander the Great (356 B.C.E. - 323 B.C.E.) dies.
320 B.C.E. Theophrastus classifies 500 plants (de Historia

Plantarum). He divided plants into two larg categories: flowering
(angiosperms) and non-flowering (gymnosperms) and recognized that
flowers were specialized leaves.
300 B.C.E. Euclid's Elements written in Alexandria. Becomes

geometry standard for over 2,000 years and counting.
Page 122 of 355
300 B.C.E. Pytheas sails from Greece to Iceland. Nobody believes

him.
300 B.C.E. Pytheas describes Atlantic tides (absent in

Mediterranean). Nobody believes him.
280 B.C.E. Aristarchus reasons that the sun is the center of the
universe.
260 B.C.E. Archimedes describes principles of levers.
260 B.C.E. Archimedes calculates Pi as 3.142.
240 B.C.E. Eratosthenes, working in Alexandria, computes size of

earth correctly.
150 B.C.E. Hipparchus calculates distance to moon correctly,

250,000 miles.
146 B.C.E. Corinth (Greece) plundered, essentially marking the end

of the free Greek city states and increased Roman influence in Greece
and Macedonia. Rome benefitted by the absorption of Greek
philosophers, physicians and scientists.
134 B.C.E. Hipparchus finds a newly appearing star (nova). The next
recorded nova in Europe was made by from Tycho Brahe, in 1572.
134 B.C.E. Hipparchus makes first star map (includes about 850 of
the 2500 stars visible to the naked eye).
Figure 6-13. Death of Socrates, by Jacques-Louis David, 1787.

Page 123 of 355
Our modern triumphs are puny compared to those of a few men,

several thousand years ago.
By 1960, industrial science reached the level that we see today. In

1960, we had home television (1947), transistors (1948), commercial
jets (1949), computers (Univac, 1951), nuclear bombs (fission ,
fusion in 1952), solar cells (1954), fission reactors (1954), satellites
orbiting the earth (Sputnik I, 1957), integrated circuits (1958),
photocopying (1958), probes on the moon (Lunik II, 1959), practical
business computers (1959), lasers (1960). When you watch a movie
circa 1960, and you look at streets and houses, and furniture, and
clothing, do you see any differences between then and now? Not
much. Nearly all the scientific advances that shaped the world today
were discovered prior to 1960.
These engineering and scientific advancements pale in comparison to

the advances in medicine that occurred by 1960. We had the basic
principles of metabolism, including the chemistry and functions of
vitamins; the activity of the hormone system (including the use of
insulin to treat diabetes and dietary methods to prevent goiter), the
methodology to develop antibiotics and to use them effectively to
treat syphilis, gonorrhea, and the most common bacterial diseases.
We had effective vaccines that protected us from deadly viruses, such
as smallpox. Sterile surgical technique was practiced, bringing a
precipitous drop in maternal post-partum deaths. We could provide
safe blood transfusions, using A,B,O compatibility testing (1900). X-
ray imaging had improved medical diagnosis. Civil engineers
prevented a wide range of common diseases using a clean water
supply and improved waste management. Safe methods to preserve
food, such as canning, refrigeration, and freezing saved countless
lives. In 1941, Papanicolaou introduced the smear technique to screen
for precancerous cervical lesions, resulting in a 70% drop in the death
rate from uterine cervical cancer in populations that implemented
screening. By 1947, we had overwhelming epidemiologic evidence
that cigarettes caused lung cancer.
When we entered 1950, Linus Pauling had essentially invented the

field of molecular genetics by demonstrating a single amino acid
Page 124 of 355
mutation accounting for the the defective gene responsible for sickle
cell anemia. In 1950 Chargoff discovered base complementarity in
DNA. Also, in 1950, Arthur Vineburg routed an internal mammary
artery, in place, to vascularize the heart. In 1951, fluoridation was
introduced, greatly reducing dental disease. Then came isoniazid, the
drug that virtually erased tuberculosis (1952). Also, in 1952, Harold
Hopkins designed the fibroscope, heralding fiberoptic endoscopy. In
1953, Watson and Crick showed that DNA was composed of a
double helix chain of complementary nucleotides encoding human
genes. John Gibbon performed the first open heart surgery using a
cardiopulmonary bypass machine (1953), and D.W. Gordon Murray
used arterial grafts to replace the left anterior descending coronary
artery (the coronary artery bypass graft). Oral contraceptives (birth
control pills) were invented in 1954. That same year, Salk developed
an effective killed vaccine for polio, followed just three years later
with Sabin's live polio vaccine. Thus, in the 1950s, the two most
dreadful scourges of developed countries, tuberculosis and polio,
were virtually eradicated.
Don't believe those reports announcing longer life expectancies for

Americans. The people who are living longer today are the people
who were born in the twentieth century and benefited directly from
the advances in medicine occurring prior to 1960. Nobody has any
way of knowing whether children born in the twenty-first century
will live longer lives than their twentieth century predecessors. But
their chances for long lives do not look very good. Here are some of
the medical reversals that have occurred since 1960.
1. The worldwide spread of AIDS, a virus-spread disease that could

have been eradicated with a few simple precautions, but was not.
2. The emergence of multiple drug-resistant tuberculosis. The root

cause of the rise of resistant TB is the incomplete treatment of
identified patients.
3. The emergence of multiple antibiotic resistant strains of

Staphylococcus aureus.
4. Global warming, loss of the ozone layer, and other consequences
Page 125 of 355
of atmospheric pollution.
5. Mass starvation.
6. Reduced access to potable water, affecting the vast majority of

humans, and resulting in epidemics of diarrheal diseases.
7. Planetary scale deforestation and desertification.
8. Monoculture of a few favored crops, and the elimination of

agricultural biodiversity.
9. Large scale emergence of invasive and destructive species of

plants and animals.
10. Increases in the total number of U.S. deaths from cancer.
11. The re-emergence of resistant insect and other vectors carrying

viral and parasitic diseases.
12. Astronomical costs of new medications for chronic diseases,

unaffordable to all but a small percentage of the world population.
13. The rising worldwide incidence of obesity and its sequelae.
14. The rapid geographic spread of outbreaks of new strains of

influenza and other evolving viruses, including HIV and hemorrhagic
fever viruses.
If the rate of scientific accomplishment is dependent upon the number

of scientists on the job, you would expect that progress would be
accelerating, not decelerating. According to the National Science
Foundation, 18,052 science and engineering doctoral degrees were
awarded in the U.S., in 1970. By 1997, that number had risen to
26,847, nearly a 50% increase in the annual production of the highest
level scientists (127). The growing work force of scientists failed to
advance science very much, but it was not for lack of funds. In 1953,
according to the National Science Foundation, the total U.S.
expenditures on research and development was $5.16 billion,
expressed in current dollar values. In 1998, that number has risen to
$227.173 billion, greater than a 40-fold increase in research spending
Page 126 of 355
(127).
Unproductive scientists always promise a breakthrough just around

the corner. What else would you expect them to say? Humans live in
hope, but funding agencies are expected to calculate the future based
on measurements of past performance. The U.S. Department of
Health and Human Services has published a sobering document,
entitled, "Innovation or Stagnation: Challenge and Opportunity on the
Critical Path to New Medical Products. (128) " The authors note that
fewer and fewer new medicines and medical devices are reaching the
Food and Drug Administration. In the past few years, only a handful
of important drugs have entered the market, and most are molecular
variations of previously available drugs (129). For example,
following Simvastatin, five new statins have been brought to market
(Mevacor, Lipitor, Pravachol, Lescol, and Crestor). Each new drug is
sold at high cost, while under patent, but does each new drug bring
innovation beyond that offered by Simvastatin, now sold as an
inexpensive generic? Significant advances in genomics, proteomics
and nanotechnology have not led to significant advances in the
treatment of diseases. Extrapolating from the level of scientific
progress in the past half century, there's not much reason to expect
great improvements in the next 50 years. The last quarter of the 20th
century has been described as the "era of Brownian motion in health
care" (130). Wurtman and Bettiker, in their review of medical
treatments, commented that, "Successes have been surprisingly
infrequent during the past three decades. Few effective treatments
have been discovered for the diseases that contribute most to
mortality and morbidity" (131).
Meanwhile, science has become irrelevant for many people (132). A

growing number of Americans (perhaps the majority), do not believe
in global warming, do not believe in evolution, and do not believe
that vaccines are safe and effective. A large number of people,
without much evidence to support their fears, believe that vaccines
cause autism, that water fluoridation is harmful, and that AIDS was
invented by government scientists as a genocidal agent to be used
against black populations. These days, scientists are met with
suspicion, if not outright hostility, by a large percentage of the world.
Page 127 of 355
Among the many shortcomings of modern science, cancer research

sits high on the list. Scientists tell us that they are making great
advances in the treatment of cancer. Anyone can see that this is not
so. The total U.S. age-adjusted cancer death rate today is about where
it was 60 years ago (133). Though deaths from some types of cancer
have dropped, these drops have been offset by the rise in other
cancers. Of the cancers that have dropped the most: stomach cancer
and cancer of the uterine cervix, improved mortality is due to a drop
in cancer incidence, not due to any progress in treating advanced
cancers. The reduced incidence of stomach cancer is generally
credited to refrigeration and improved methods of food preservation.
The drop in cervical cancer has been due to effective Pap smear
screening for precancerous lesions (small lesions that precede the
development of invasive cancer). The HPV vaccine will, in all
likelihood, prevent many additional cases of cervical cancer.
Cancer death rates that have increased since 1950 include:

esophageal cancer, liver cancer, pancreatic cancer, lung cancer,
melanoma, kidney cancer, brain cancer, non-Hodgkins lymphoma,
and multiple myeloma. The list includes some of the most common
types of cancer. If cancer research were effective, we would expect to
have ways of preventing the rise in incidence of these common
cancers.
With the exception of curing a few types of rare tumors, cancer

research has yielded none of the dramatic advances seen in the 1950s,
with diseases such as polio and tuberculosis.
Over the decades, clever cancer researchers have discovered a

successful strategy for attracting millions and millions of dollars of
research funding for diseases that they cannot cure. Each year, they
point to the number of people who will die from cancer, and they say,
that cancer is a terrible diseases, causing untold suffering, and killing
hundreds of thousands of Americans each year. Certainly, they argue,
research to cure this dreadful disease must be funded. They fail to
mention that the reason that hundreds of thousands of people die each
year from cancer is that the scientists who received money to cure
cancer failed to deliver the cure. Every year, the bulk of cancer
Page 128 of 355
funding is delivered to the very same institutions and laboratories that

failed to produce any reduction in the cancer death rate.
6.3 THE CONSEQUENCES OF REJECTION
"The purpose of life is to be defeated by greater and greater things."
-Rainer Maria Rilke
Scientists live in a pervasive culture of rejection. Recent and past

history provides ample proof that good science is not exempted from
the withering effects of rejection. It would also appear that scientific
advancement is stagnating, despite access to unprecedented funding
largesse and a huge workforce of highly trained scientists.
There are many factors that contribute to the slowdown in scientific

progress. Some claim that we have made most of the scientific
discoveries that will ever be made; that there's not much left to do.
Some might suggest that we have shifted into a new era of collective
intelligence (e.g., twitter, facebook, social networking via texting)
that transcends outmoded notions of scientific advancement.
Regardless, it is impossible to avoid the conviction that unrelenting,
spirit-crushing rejections take their toll on our societal effort to
advance science. Rejections follow a scientist throughout his/her
career: disappointing SAT scores, rejections to college of choice,
poor grades, rejections to graduate schools, scornful treatment in
graduate school, cold reception of research ideas, rejection of
manuscripts, lack of any peer response to published manuscripts (i.e.,
research papers that nobody bothers to read), grant rejections, tenure
rejections, and so on.
Many scientists cope by taking the path of least rejection throughout

their careers: non-innovative grant applications (grant reviewers tend
to approve applications that they can easily grasp, for work that can
be easily accomplished), blind devotion to existing paradigms, group
research projects, narrowly focused research (less likely to be
rejected by reviewers), delegation of risks (let somebody else get
rejected), demise of the single author research paper (dozens of co-
authors decrease rejection rate).
Page 129 of 355
1. Any scientific work can be justifiably rejected.
2. People only believe what suits them. If it is not in their perceived

interest to believe in global warming, evolution, the health benefits of
vegetarianism, the hazards of nuclear proliferation, the
irresponsibility of corporations, the dangers of aggressive or
distracted driving, the dwindling availability of oil, the value of
public health interventions, they will not believe any findings that
support these hypotheses. Don't waste your time trying to convince
people to believe something they do not want to believe.
3. People will not accept ideas they cannot grasp, unless they directly
benefit from the belief. For example, religions that promise an eternal
afterlife, in paradise, have more followers than religions that promise
a brief life filled with sorrow and persecution, followed by eternal
non-existence.
4. Join a famous laboratory. Scientists are highly xenophobic and will

ignore work from scientists they do not know. They will review your
grant applications with thinly disguised hostility, judging you instead
of your proposal ("This applicant has made no recognized
contributions to the field."). When you join a respected laboratory,
you work will be respected, regardless of its merits.
5. Don't try to discredit the research of powerful people in your field.

Your papers will be rejected. Your grant proposals will not be
funded. Your research will be never see the light of day.
6. Jump on the bandwagon; restrict your curiosity to well-funded

fields of research. Cancer is well-funded; diarrhea is not (though
more lives have been saved from diarrhea research than from cancer
research) (134).
7. Conduct tabloid-ready research. A diet pill is news. An improved

method for solid waste treatment is not news.
8. Work on sure things. Lots of well-funded projects have no serious
Page 130 of 355
hypothesis. The Human Genome Project (sequencing all of the DNA

in the human genome) had no hypothesis. DNA sequencing methods
were available to the scientists who launched the project. The effort
more closely resembled a long, expensive chore, rather than an
exciting scientific investigation.
9. Get backing from funders who are fully invested in the project.
When your funding organization wants your project to succeed, they
will do everything in their power to publicize your findings and
exaggerate the importance of your work.
10. Stop setting yourself up for a fall. Rejection comes when you
seek the approval of others in your field. Get someone else to do your
research, draft your papers, prepare your grant proposals, write the
chapters in your book. Rejections are easy to take when someone else
has done the work.
11. In science, failure is the norm; success is the exception. If you

want to be right more often than any of your colleagues, always
predict failure. If you want to be popular, always predict success.
12. The key to dealing with rejection is to stop caring. If you don't
care what other people think, rejection is just a minor nuisance.
13. Don't think of rejection as a bad thing. You can be quite certain
that, at any moment, somewhere on this planet, a great idea is being
ridiculed, and a great scientist has abandoned all hope of success.
This is nature's way of making room for evil scientists, who are
equipped to survive in a stupid and hostile environment.
CHAPTER 7. COMPLEXITY: THE DEVIL IS IN THE

DETAILS
"Any informatics problem can be solved by adding an extra layer of

abstraction."
-Anonymous, often referred as the golden rule of computer science
"There are 10 kinds of people...those who use binary annotation and

those who do not."
Page 131 of 355
-Anonymous
In the prior chapter, we discussed scientific progress, or, more

precisely, the lack thereof. Is it possible that in the past half century,
we have made no medical progress whatsoever? Well, maybe there
were a few bright moments. Here are just about all of the the major
breakthroughs in medicine occurring since 1960.
1. Zinc drastically reduces childhood deaths from diarrhea, a disease

that kills 1.6 million children under the age of five, every year (134).
2. Helicobacter pylori causes gastritis, gastric ulcers, and some

stomach cancers (135). A simple antibiotic treatment cures gastritis
and reduces the incidence of stomach cancers (136). This work
earned the two discoverers, Barry Marshall and Robin Warren, the
2005 Nobel prize
3. When babies sleep on their backs, instead of their stomachs, the

incidence of SIDS (sudden infant death syndrome, or crib death)
plummets (124).
4. Daily aspirin ingestion seems to reduce deaths from cardiovascular

disease and colon cancer (137).
All of the significant medical advances in the past few decades (and
there haven't been many) have been simple measures. All of the great
debacles in medicine have been complex. This is because scientific
methods have reached a level of complexity that nobody can
understand.
Gone are the days when a scientist could describe a simple, elegant
experiment that could be replicated by his peers. When several
laboratories perform the same experiment, using equivalent
resources, and producing similar results, it is a safe bet that the
research is valid (102).
Today, much of research is conducted in a complex, data-intensive

realm. Individual studies can cost millions of dollars, involve
hundreds of researchers, and produce terabytes of data. When
Page 132 of 355
experiments reach a high level of cost and complexity, repetition of

the same experiment, in a different laboratory, becomes impractical.
In the late 1990s, a variety of data-intensive methods were developed

for molecular biology, all of which required complex and
sophisticated algorithms to convert the raw data into measured
quantities. One such method is gene expression microarrays. In these
studies, RNA molecules in tissue samples are converted to DNA and
incubated against an array of pre-selected DNA samples. Identical
sequences will, under precise conditions, anneal to form double-
stranded molecules. The number of matches can be semi-quantitated,
and a profile of the relative abundance of every RNA species in the
original sample produced. RNA profiles in one specimen can be
compred with the profiles of other specimens. Using these
comparisons, medical researchers have tried to identify profiles (of
diseased tissues) that predict responsiveness to particular types of
treatment. In particular, researchers have tried use cancer tissue
profiles to predict the likelihood that a specific tumor will respond to
a specific type of treatment. Since the late 1990s, an enormous
number of studies have been funded to produce the tissue microarray
profiles for many different diseases, in many different clinical stages,
and to correlate these profiles with treatment response.
Because there are so many different variables in the selection of

patients, the selection of tissues, the preparation of tissues, the
selection of microarray reagents, the collection of data, the
conversion of data to a quantifiable measure, and the methods of
analyzing the data, it is impossible for different laboratories to
faithfully repeat microarray experiments. Michiels and co-workers
have shown that most microarray studies could not classify patients
better than chance (138). Still, the field of microarray profiling
continues, as it should, because every field has its obstacles.
Continued efforts may resolve seemingly intractable problems. Or the
field may collapse, a victim of its own complexity. Experience
suggests that it takes at a few decades to thoroughly discredit a well-
funded idea.
Artificial intelligence is the field that employs computers to make
Page 133 of 355
decisions that humans cannot. Computers can perform millions of

computations in a second, and can store and search huge quantities of
technical data. Computers have earned their place in every space
launch, surely computers will prove themselves indispensable to
physicians, faced with tough diagnostic problems. Despite decades of
funded efforts, artificial intelligence has made very little headway
among practicing physicians. In a 2002 review of a computerized
decision support system, the authors found that "The computerised
decision support system had no significant effect on consultation
rates, process of care measures (including prescribing), or any patient
reported outcomes for either condition. Levels of use of the software
were low (139)." Today, computers play an essential role in every
field of science, including medicine. Still, medicine is a subtle and
complex art, that cannot be reduced to a set of algorithms, no matter
how much funding is thrown at the task. Every attempt at modeling
the medical decision-making process has met with failure. Irrational
as it may seem, when it comes to making life-or-death decisions,
humans prefer to make their own mistakes.
In general, computers cannot perform tasks where the operational

rules are in constant flux. Here is a case in point. The U.S. Veterans
Administration Medical System operates about 175 hospitals. This is
an immense undertaking, but the work is accomplished fairly well,
using a rather simple algorithm. The VA hires a bunch of doctors,
nurses and healthcare workers, gives them a set salary, and houses
them in hospital buildings. When registered patients appear in their
clinics, the VA pays for the supplies necessary to treat the patients.
Each year, the Congress appropriates the funds to keep the VA going
the next year. One of the greatest benefits of the VA system is the
lack of billing. Patient visits, medical procedures, diagnostics,
pharmaceuticals, and other medical arcana are absorbed into the
general budget. If you were to compare the level of complexity of the
VA healthcare system with the level of complexity of 175 privately
operated hospitals, you would find the VA system to be a model of
simplicity.
Then one day, somebody asked, "Should the VA pay for medical
services rendered on veterans who have their own private insurers?"
Page 134 of 355
Having no affirmative answer, the VA undertook an effort to pry

reimbursements from the private insurers of veterans treated at VA
hospitals. Suddenly, billing and expense records became important to
the VA, an institution with no experience in fee-for-service care.
The VA planned a $472 million software system to track billing and

other financial transactions. The pilot site was the Bay Pines VA, in
Florida. After preliminary testing at Bay Pines, the system, known as
the Core Financial and Logistics System, or CoreFLS, would be
rolled out to all of the VA hospitals nationwide. Unfortunately, the
system could not be implemented at Bay Pines. Neither the software
nor the humans were up to the job. In 2005, the VA decided to pull
the plug on a $472-million system at because it did not work (140).
Four years later, in 2008, the Government Accounting Office

reviewed the billing performance on just 18 of the 175 or so VA
hospitals. It found that these 18 hospitals, in fiscal year 2007, failed
to collect about $1.4 billion that could have been paid by private
insurers. The report from the Government Accounting Office
concluded, "Since 2001 we have reported that continuing weaknesses
in VA billing processes and controls have impaired VA’s ability to
maximize the collections received from third-party insurers. (141)"
Why, after so many years, has the VA not succeeded in billing

private insurers for VA care delivered to privately insured veterans?
The reason can be distilled in one word: complexity. When the VA
tries to collect from third party payers, they must deal with insurers
across fifty states. Private insurers have their own policies, and their
own bureaucracies, that are constantly changing those policies. The
job of collecting the money was simply too complex to succeed.
Hospital information systems are among the most complex and most
expensive software systems. The cost of a hospital information
system for a large medical center can easily exceed $200 million. It is
widely assumed that hospital information systems have been of
enormous benefit to patients, but reports suggest that 75% of installed
systems are failures (142). Software crashes that bring hospitals to
their knees are not uncommon. A November, 2002 crash at Beth
Israel Deaconess Hospital in Boston disabled computer systems for
Page 135 of 355
four days (143). Common complaints include systems that never

attain full functionality, poor vendor support, restricted access to
system source code, and vendor bankruptcies (144).
If Hospital Information Systems worked well, why does the cost of

healthcare continue to rise? Has information technology eliminated
the fragmentation of medical care or reduced the complexities of
health payment plans? Evidence for the value of implementing
complex health information technology in community hospitals is
scant. Most of the credible reports on the benefits of Hospital
Information Systems come from large institutions that have
developed their own systems incrementally, over many years,
correcting mistakes as they occur, and assembling a a staff with
expertise in the system (145).
Much can be learned from documented technology disasters. A 2003

article in the British Medical Journal described a failed effort to
deploy a computerized integrated hospital information system in
Limpopo (Northern) Province of South Africa (142). This poor
province invested heavily to acquire the system. The article describes
what went wrong and provides a list of factors that led to the failure
of the system. There was an underestimation of the complexity the
undertaking and insufficient appreciation of the length of training
required by the hospital staff.
One of the most challenging features of many Hospital Information

Systems (HISs) is computerized physician order entry (CPOE). The
intent of CPOE is to eliminate the wasteful hand-written (often
illegible) doctor's orders that need to be transcribed by nurses,
pharmacists, and laboratory personnel before they're entered into the
HIS. Having the physicians directly enter their orders into the HIS
has been a long-awaited dream for many hospital administrators. In a
fascinating report, patient mortality was shown to increase after
implementation of CPOE. In this study, having CPOE was a strong,
independent predictor of patient death. Somehow, a computerized
service intended to enhance patient care had put patients at increased
risk (146).
High-tech medical solutions seldom achieve the desired effect when
Page 136 of 355
implemented by low-tech medical staff. Introducing complex

informatics services, such as CPOE, requires many hours of staff
training. There needs to be effective communication between the
clinical staff and the hospital IT staff and between the hospital IT
staff and the HIS vendor staff. Everyone involved must cooperate
until the implemented system is working smoothly. This is virtually
impossible. Hospital personnel know that a wide range of standard
practices (such as complex tests, tests using specialized imaging
equipment, procedures that require patient preparation or
transportation, timed-interval dosage administration, expert
consultations, interventions that require close attending staff
supervision) become very iffy on weekends, holidays, and after about
4:00 PM on weekdays. It is difficult to get shift workers to interface
seamlessly with a computer system that never sleeps.
When it comes to hiding in the safe shadow of complexity, nobody

does it better than software designers. They will take a problem, such
as computer-aided diagnosis, or computer-aided medical decision-
making, and produce a software application that purports to provide
an answer. We fool ourselves into thinking that the designers of
complex software systems must understand how the system works.
Computers allow us to design complex, interdependent, systems that
are unknowable and unpredictable.
Software failure is a sensitive indicator of the limits of complexity. It

is very easy to create software that works at a level of complexity
beyond anything found in physical systems. The weakest
programmers tend to fix bugs with layers of subroutines. Stronger
programmers will simplify the problem and re-write their code,
eliminating unnecessary subroutines. A 1995 report by the Standish
group showed that most software projects sponsored by large
companies are failures. Only 9% of such project are finished on time
and within budget, and many of the finished projects do not meet the
required performance specifications (147).
Each year, in the U.S., approximately 400 million radiologic

procedures are performed that expose patients to nuclear radiation
(148). In many cases, complex software helps to determine and
Page 137 of 355
control the location, spread, intensity and total amount of radiation

delivered to patients. Are mistakes made? You betcha. Probably the
most famous medical software disaster involved the Therac-25 (149).
Between 1985 and 1987, at least 6 patients received massive
overdoses of radiation due to a software error in a radiation therapy
device. A review of the incidents uncovered numerous errors in the
engineering and in procedures for detecting and correcting software
problems. Software errors in radiation devices did not stop with the
Therac-25. In 2005, a Florida hospital reported that 77 cancer patients
were overdosed with radiation due to a software error that went
undetected for a year (150). At Cedars-Sinai Hospital, in Los
Angeles, 260 patients were exposed to as much as eight times the
proper radiation from diagnostic CT scans. The errors were found
when patients complained that their hair was falling out (151).
Medical software errors are not rare. The FDA analyzed 3140
medical device recalls conducted between 1992 and 1998 reveals that
242 of them (7.7%) are attributable to software failures. Of those, 192
(or 79%) were caused by software changes made after the software's
initial production and distribution (152).
The National Reconnaissance Office is the U.S. agency that handles

spy satellites. In 1998, the agency offered a contract to build a new
generation of satellites. The contract went to Boeing, which had
never built the kind of satellite specified in the contract. According to
an investigative article written for the New York Times, the Boeing
engineers designed subsystems of such complexity that they could
not be built (153). Because the workforce was inexperienced in
assembling satellites, they included parts that could not work in
space. Most noteworthy was their use of tin parts, which deform in
space, sometimes leading to short circuits. Seven years later, the
project was killed, after running costs estimated as high as $18 billion
dollars. Experts reviewing the failed project indicated that it was
doomed from the start. Basically, the level of complexity of the
project exceeded Boeing's ability to fulfill the contract, and exceeded
the government's ability to initiate and supervise the contract (153).
There are some projects that seem to hover just outside human reach:
Page 138 of 355
sending men to mars, commercializing supersonic transport jets,

long-term stock market predictions, introduction of species to a
foreign ecological environment, tamper-proof computerized voting
machines, planned tactical warfare, etc. It is not as though the world
does not contain complex, and functional, objects. Jet planes,
supercomputers, skyscrapers, telecommunication satellites,
butterflies, and humans are just a few examples. These highly
complex objects all arose from less complex objects. Butterflies and
humans slowly evolved, over billions of years, from an early life
form. Jets and other complex machines were built by teams of
humans, working from a collective experience, adding improvements
incrementally, over decades. Good complexity takes time to develop.
The savvy evil scientist understands that incompetencies, blunders,

frauds, and assorted crimes can all be buried under scientific
complexity. If you are a bad scientist, and you cannot do anything
right, and you know that anything you try to do will produce
unrepeatable results, the safest strategy is to confine your efforts to a
complex realm of well-funded research.
1. Always strive for complexity. Stupid people confuse complexity

with cleverness, and you can make this work for you.
2. Involve yourself in complex projects. Complex projects receive the

most funding.
3. The more complex your data, the less likely it will be that anyone
can prove that the data is wrong.
4. When competing for a contract on a complex project, always

underbid your competitor. Knowing full well that the project will not
be completed, regardless of who is awarded the contract, the contract
committee will always opt for the lowest bidder.
5. Remember the "one miracle per grant" limit. Review committees

will not give you a contract if your grant has too many high hurdles
to surmount.
Page 139 of 355
6. Remember to have a scapegoat. When some major catastrophe

hits, someone, other than yourself, will absorb the blame.
7. Make certain that your staff writes detailed progress reports, on a

monthly basis. The contracting agents will not have the time,
patience, or intellect to read your reports. When the project goes sour,
and it will, you can point the finger to someone within the contracting
agency, indicating that you had provided them with all of the
necessary information to modify or abort the project.
8. When the money runs out on the contract, abandon any wacky
ideas about finishing the research at your own expense. Just walk
away from the project, and don't look back.
CHAPTER 8. SCIENTIFIC GLOBETROTTING
"90% of success is just showing up."
-Woody Allen
"I've never been an intellectual but I have this look."
-Woody Allen
"An army marches on its stomach"
-Attributed to both Napoleon and Frederick the Great
When you step into an elevator in any research institute, and you
chance to hear a conversation between two or more high-level
administrators or scientists, you will soon learn that every exchange
conveys the following five items:
1. An announcement of how busy you are.
2. The city/country/meeting that you recently attended.
3. What you ate while there.
4. You next port of call.
Page 140 of 355
5. What you will eat at the next port of call.
Today, professionals are constantly on-the-go. Physicians, who are

among the top paid professionals, have learned that patient care need
not interfere with an active travel itinerary. A lawsuit filed by federal
officials alleges fraudulent billings for radiation therapy in a
Melbourne, Florida cancer clinic between 2003 and 2008 (154).
According to federal officials, when 62 of the treatments were
provided, the treating physician was in Cancun, Mexico, and Seoul,
South Korea. When 144 of the treatments were provided, another
treating physician was in Hong Kong, Athens, Rome and Quito,
Ecuador. Medicare still labors under the old-fashioned notion that,
for complex cancer treatments, a physician should occupy the
continent as the patient he is treating; thus the lawsuit.
In the past, most inhabitants of earth stayed put, seldom venturing

more than a few miles from their birthplace. Even the wealthy and
powerful understood that you sent people to travel on your behalf;
you didn't go yourself. Henry the Navigator (1394 – 1460)
understood that travel is a vicarious pleasure (Figure 8-1). Henry
organized many Portuguese expeditions, and helped established
Portugal as a colonizing nation. Henry himself neither voyaged,
explored, nor navigated.
Figure 8-1. Henry the Navigator. Source: Wikipedia, public domain.
The Horticultural Society in London, at the turn of the nineteenth
Page 141 of 355
century, sent collectors to the four corners of the earth to find, and
send home, exotic plant species. David Douglas (1799 - 1834) was a
great Scottish botanist, with over 200 plants named after him,
including America's Douglas fir (Figure 8-2).
Figure 8-2. David Douglas. Source: Wikipedia, public domain.
Douglas, at age 23, was sent to the Northwestern region of North

America to see what he could find. By New Year's Day, 1826, at the
age of 26, Douglas was writing his own obituary, having recently
endured a series of weather calamities including hurricanes, torrential
rains, hail storms and accidents that contributed to a general
deterioration of his health, including difficulties with vision. His
benefactors in London had predicted that he would perish in
America. Despite the odds, he managed to return to England, in 1827,
where he freely dispensed advice regarding Britain's future role in the
Northwest region. Douglas wanted Britain to annex what is now
called Washington State. The British government ignored him, and it
was soon agreed that the proper place for Douglas was back in the
wilds of North America. A new set of near-death experiences befell
Douglas in California. During these adventures, he discovered gold,
fully seventeen years before the Gold Rush of 1849. Unfortunately,
nobody, was much interested in his findings. Douglas's health
continued to decline, along with his eyesight. In 1834, while
exploring Hawaii, he fell into a pit where a bull had been trapped. He
may have fallen in because his eyesight was poor; or he may have
been pushed. Regardless, the bull survived the encounter, but
Page 142 of 355
Douglas, age 35, did not. Douglas is remembered as one of the

greatest explorer-scientists in history (72).
Douglas was soon followed by Richard Spruce (1817 - 1893), who

embarked from Liverpool to explore the Amazon River, in 1849
(Figure 8-3).
Figure 8-3. Richard Spruce. Source: Wikipedia, public domain.
During his expeditions to South America, Spruce flirted with oblivion

on many occasions, narrowly avoiding death from yellow fever,
stinging ant invasions (tucandera), blood-sucking bats, hoards of
mosquitoes, extremes of weather, riots, revolutions, and wars.
Eventually, Spruce developed malaria. Over the years, he became one
of the world's greatest authorities on Bryophytes, discovering
hundreds of species of moss and liverworts. His last and greatest
achievement was his expedition, launched in 1859) to find and take a
collection of Cinchona plants (Red Bark tree) and seeds for
successful cultivation in India (155). At the time, South American
Cinchona was the only source for the only cure for one of the worst
diseases of mankind: malaria. Spruce's last expedition established a
cheap, world-wide supply of quinine and quinidine. The Cinchona
expedition took its toll on Spruce, turning him into an invalid by the
age of 43. This great scientist and savior of millions of people arrived
back in England, penniless. Some of his influential friends helped
Spruce to eventually secure a small government pension, on which he
Page 143 of 355
lived out his days, barely able to walk. He died at age 76. The spruce
tree was not named for Richard Spruce. His name is commemorated
by the moss, Sprucea (72).
Today, scientists will eagerly travel the globe to attend a meeting of

fellow scientists, but very few scientists make any kind of effort to
discover a new species of moss. Speak to any successful scientist and
ask him where he has been lately. He will rattle off a list of cities,
domestic and foreign, that would be the envy of any travel writer.
Scientists who do not travel are relegated to obscurity. Nobody will
know their name. Their work will not influence the work of other
scientists in their field.
Travel for modern scientists, in contrast to predecessors such as

Spruce and Douglas, is easy, pleasurable, and fully reimbursed. Most
scientists work in major metropolitan areas and have access to an
international airport. In the U.S., almost anyone can fly to Chicago (a
centrally located location that hosts many meetings and scientific
societies) in about two hours. London-based scientists can hop on a
non-stop flight from Heathrow to Las Vegas; air travel time, a
tolerable nine hours.
More than a few budding scientists are drawn into their fields by the
opportunity to attend lavish meetings, held in exotic locations. Young
scientists enjoy the opportunity to meet bright, attractive colleagues
in a socially exciting atmosphere, to network, and to enhance their
careers just by being there. Senior scientists enjoy the adulation and
the amenities, particularly fine wining and dining. Those with tight
per diem budgets will enjoy the meeting freebies.
10:00 A.M., Tuesday morning, Venetian Hotel, Las Vegas.

There is nothing quite like a scientific meeting in Las Vegas.
Things that are impossible anywhere else are likely to occur
here. Here, you have a chance to meet beautiful women who
were well beyond your pay grade anywhere else. You march
briskly through the casino aisles, barely glancing at the
human residua seated night and day at the gaming tables, and
you approach the vast meeting area that lies beyond. Another
set of tables awaits the scientists. These are filled with trinkets
Page 144 of 355
brought as gifts by the laboratory vendors. The treasures

consist of pens (retractable, gel-tipped, glow-in-the-dark, on-
a-rope), pocket flashlights, paperweights, miniature souvenirs
and keepsakes marked with a corporate logo (valuable
collectors' items), key rings, t-shirts, lanyards, coffee mugs,
thumb drives, nail clippers, business card holders, money
clips, umbrellas, mirrors. They're all for you and they're all
for free. Then come the foods: coffee, cookies, potato chips,
pretzels, chocolates. If you're a VIP, you won't need to collect
freebies by visiting the tables. The vendor organizers will
prepare a VIP basket filled with a selection of the best freebies
from all the vendors, plus special gifts selected just for you.
The personal services are a nice touch. Look for 3-minute
massages (to relieve the stress that comes with every meeting),
and caricatures (drawn by an artist or rendered by a
computer from a digital photograph). You can count on a door
prize and a grand raffle, so be sure to register early on the
first day. Consolation prizes will include golf clubs, and
answering machines. Luckier attendees will receive
computers, or free registration to next year's meeting. The top
prize is $5,000 in cash. Seduced by trinkets, by meeting's end
you will have fallen in love with every vendor in the room. Do
you worry that once you've accepted a vendor freebie, you can
no longer promote yourself as an impartial expert in your
field. Nonsense. What happens in Las Vegas stays in Las
Vegas.
What is the purpose of a scientific meeting? All meetings serve one

purpose; to produce wealth for the meeting sponsors and power for
the meeting organizers. If you have a big radiology meeting, or
surgery meeting, you can bet that the meeting was supported by
vendors of radiology equipment or surgery equipment. The vendors
will construct elaborate booths for the purpose of selling their wares.
The vendors, who are much better showmen than the scientists who
attend meetings, will set the general tone of the meeting, and will
greatly influence the meeting agenda. In many cases, vendor
representatives will make scientific presentations, often brazen
advertisements for their latest products.
Page 145 of 355
You own a software company. Years ago, you were an earnest

assistant professor at a major university, and you take pride in
your scientific credentials and the network of scientific
associates that you cultivated over the past decade. When one
of your former students (now the head of the Program
Committee) invites you to present a lecture on Middleware,
you jump at the chance. Your company exclusively produces
middleware, and there is nobody in the world who has more
ground-level experience with the subject than you. Here is
your chance to convince the scientific community to place
their trust in your middleware product, and yours alone. You
will come prepared with the slickest visuals that any of those
ivy tower pundits have ever seen. You have signed a disclosure
form that tells everyone that you are the President and owner
of a middleware company, so you needn't worry about anyone
complaining that they weren't warned. You will spend the hour
hyping the importance, value, and dependability of your
product. You will be very careful not to mention any of your
competitors. This is your hour, not theirs. They would do the
same, if they were asked to speak.
Here are the signs of a commercial agenda disguised as a scientific

presentation:
1. Only the speaker's product will be mentioned by name. The

speaker will only mention competitors in the context of the
deficiencies of their products.
2. The speaker will refute any criticism of their commercial product,

even when the criticism is fair. In many instances, they will try to
discredit or marginalize all critics.
3. The speaker will not discuss any technical difficulties that

members of the audience might have had with their product.
4. Open source or free products will be mocked ("Oh yes. I've heard
of the freeware you're referring to. You get what you pay for.").
5. The speaker will discuss issues related to product popularity, rather
Page 146 of 355
than product value ("We've had 100,000 visitors to our web site").
6. The speaker will plant friendly associates in the audience, who will
provide personal testimonials stressing the value of the product.
7. The speaker will often place a moderator or panel chair who will
divert discussion away from criticisms ("We'll be discussing this
general issue at this evening's round-table. So I'm asking you to defer
this question until then.")
8. The speaker will have professional quality graphics for his

presentation. The average scientist would not go to the trouble of
creating impressive graphics.
9. The speaker will be attractive and well-spoken; real scientists are

neither.
10. The speaker will be sincere. Real scientists seldom seem sincere
because they are constantly re-examining their own assumptions and
conclusions. Commercial speakers have learned to fake sincerity.
11. The speaker will use buzz words. Besides the hackney "synergy,
leverage, network, enterprise," look for terms that seem out of place
in a scientific venue: CIO, CFO, return on investment, workflow,
user profile, enterprise, product.
12. The speaker will not give credit to prior art. This would
jeopardize pending patents.
13. The speaker will be future-oriented, not past-oriented, even with

regard to their own product. This will avoid criticism from members
of the audience who had problems with earlier versions of their
product. Also, speakers are often people who are newly hired by the
company. They honestly don't know much about the history of the
product.
14. The speaker may be an academic. Companies will sometimes pay

a respected scientist to promote their product during a "science"
lecture. Read the meeting documents. There will be a page that lists
the conflicts of interest disclosed by the speakers. You will find that
Page 147 of 355
the speaker has been paid by a company that stands to profit from a
favorable presentation.
Why are commercial speakers, and scientists with commercial

conflicts of interest, allowed to speak at scientific meetings?
Disclosure forms are used as a sort of license to say anything at a
meeting, without consequence. The Disclosure form is a document
wherein a speaker lists his real or potential conflicts of interest that
might cause him to produce a less than objective presentation. As
originally conceived, the Disclosure form had benefit for the
attendees, not of the speaker. When a speaker publicly disclosed a
conflict, those attending his presentation would be able to detect self-
serving remarks and biases. The Disclosure was not intended to
relieve speakers from their basic obligations: to be objective, honest,
fair and unbiased. In practice, Disclosure forms are not scrutinized by
attendees. Speakers who have disclosed their conflicts of interest
always believe that their audience has been provided fair warning.
Once a speaker takes the podium, he knows that he has license to say
anything that suits his agenda; if he has signed the Disclosure form.
Meeting presentations are certainly the least reliable sources of

scientific information. Every word spoken at a meeting, whether
heard in a hallway or from a keynote speaker, is unsubstantiated. At a
meeting, you can lie all you like, without triggering an investigation
by the Office of Research Integrity. Scientists are expected to make
mistakes during oral presentation. Feel free to distort the truth or omit
a discussion of opposing ideas. Don't worry about being grilled
during the question periods that follow a presentation. You can
ignore tough questions by providing an answer to another, less
incriminating, question. Nobody really cares.
If meetings are simply exercises in brain-washing, shouldn't you be

spending more time reading scientific books? Don't be silly.
Successful scientists are way too busy to waste their valuable time
reading books. The very act of reading a scientific work alienates the
reader from the hordes of devoted non-readers who dominate every
scientific field.
You might argue that reading provides the knowledge and insight
Page 148 of 355
required for your scientific field. Reading permits you to think deeply
about scientific problems. Nikola Tesla, one of the world's greatest
scientists, once said "The mind is sharper and keener in seclusion and
uninterrupted solitude. No big laboratory is needed in which to think.
Originality thrives in seclusion free of outside influences beating
upon us to cripple the creative mind. Be alone, that is the secret of
invention; be alone, that is when ideas are born. That is why many of
the earthly miracles have had their genesis in humble surroundings."
Though Tesla was a great scientist, he was shunned by the scientific
establishment and died without friends or money. Nonetheless, we
can find a few examples of productive scientists and thinkers who led
circumscribed lives, with little or no travel.
Isaac Asimov (1920 - 1992), one of the most prolific science and
science fiction writers in history, with hundreds of books to his
credit, was a claustrophile (a lover of small spaces) and an avid
indoorsman (Figure 8-4). Asimov refused to fly. He lived a life of
ideas, without much action, and seldom traveled any great distances.
His productivity was enhanced by his immobility.
Figure 8-4. Isaac Asimov. Source: Wikipedia from a photograph

donated to the public domain by the New York World Telegram and
Sun.
Immanuel Kant (1721 - 1804) never left his country of birth, Prussia.
Page 149 of 355
He rarely ventured from Konigsberg, the town where he was born

and where he died (Figure 8-5). In 1781, he published Critique of
Pure Reason, one of the most widely read and influential books in
Western philosophy. From his Prussian home, Kant had an
unobstructed view of the boreal universe. Proceeding without the
assistance of observatory or telescope, Kant, in 1755, was the first
cosmologist to explain the origin of nebulae and solar systems from
the chaos of hot, elemental matter produced at the dawn of the
universe. His nebular hypothesis, as it came to be known, was
ignored until 1796, when Laplace made a similar suggestion. Kant
provided the first satisfactory description of the universe, reckoning
over time and space, without leaving his armchair. Kant correctly
deduced that the milky way galaxy was a flat disk, and that the dense
swath of stars, seen nightly from his window, was nothing less than
our own galaxy, viewed on edge.
Figure 8-5. Kant's tomb in Konigsberg (known today as Kaliningrad,

Russia), where he lived his entire life. Source: Wikipedia, public
domain.
Friedrich Wilhelm Nietzsche (1844 - 1900) spent his writing years in

ill-health (Figure 8-6). His life was spatially restricted and thus
conducive to mental creativity and prolific writing. He wrote highly
influential (perhaps too influential) books on religion, morality,
culture, and science.
Page 150 of 355
Figure 8-6. Nietzsche's moustache, left and center. Nietzsche, right.

If you are a genius, you might be able to achieve your evil goals
without the benefit of attending meetings. But you're not. The goal of
the evil scientist is to become better off than his peers (not to become
a better scientist than his peers). Commuting to airports, standing in
long lines for security checks, waiting for delayed flights, cramming
yourself into small airline seats, listening to inane banter from
adjacent seats; they are all worth the effort. The information that you
will need to get ahead in your career is the information provided at
meetings; not books and journals. The roster of meeting speakers tells
you who is important in your field. When you hear each speaker
making identical points, using almost the same words, you can be
sure that these are the dogmatic opinions that form the heart of your
discipline. You need to remember that a brilliant idea appearing in
one book, written by an author who is never invited to speak at
meetings, has no value.
The cost of meetings reflects their importance, but most organizations

will not divulge the cost of their meetings. In 2003, the American
Association for Cancer Research (AACR) was scheduled to have its
annual meeting in Toronto. Unfortunately, their meeting date
coincided with an outbreak of SARS virus; also in Toronto. The
meeting was canceled just days before it was scheduled to
commence, and the AACR indicated that their cost for cancellation
Page 151 of 355
was $7.5 million (156). One can only speculate that the expenses
involved in holding the meeting would have been millions of dollars
in excess of the cancellation costs. In addition to the costs for the
meeting organizers, there are the uncounted costs of thousands of
attendees traveling to Toronto, paying registration and housing fees,
food and living costs, and the costs of all of the vendors who
transport their wares to the meeting site, construct booths, and pay for
salespersons to man their on-site operations. The American
Association for Cancer Research sponsors many meetings throughout
the year. There are many thousands of scientific organizations that do
the same. Much of the money in science finds its way into meetings.
With few exceptions, scientific organizations do not support

themselves with the dues provided by their members. Virtually every
professional organization is supported by corporations, and the
largest source of corporation funding comes through corporate
sponsorships of meetings. With millions of dollars on the line, you
can predict that meetings are among the most tightly controlled
scientific forums in existence. It is of paramount importance to
assemble a roster of speakers whose interests coincide with the
interests of the vendors who subsidize the meeting. If you seek a
venue in which to voice an opinion that opposes the interests of the
meeting organizers and the meeting vendors, don't bother coming to
meetings.
1. Never miss an opportunity to attend a meeting. Remember,

meetings are called meetings because they allow you to meet people.
Potential employers will mindlessly trust you if you've met someone
that they have also met. This makes no sense, but it is true!
2. Remember that meetings are vehicles for mass indoctrination. A

powerful speaker can rally scientists to support his agenda, without
resorting to an open debate of opposing ideas.
3. Meetings may not teach you what you need to know, but they can
certainly teach you what you don't need to know. Scientific issues
related to your field of interest that are not covered at meetings, are
Page 152 of 355
intellectual cul-de-sacs.
4. Don't worry if meetings take you away from your responsibilities.

Real researchers delegate scientific research to underlings. No
scientists has ever been denied tenure because he attended too many
meetings.
5. No self-respecting evil scientists pays for meetings with his own

money. Institutions, funding agencies, and meeting sponsors all
understand that a meeting is like a party. You don't pay to attend a
wedding or a Bar Mitzvah. Why should you pay to attend a meeting?
If you can't get your institution, or industry, or somebody else to pay
for your meeting expenses, you don't deserve to attend the meeting!
6. They say that an army marches on its stomach. The same is true for
scientists attending a meeting. Never forget that regardless of the
scientific agenda, the meeting is all about food. The best meetings
provide the best food.
7. Cultivate your palate. Your next boss will almost certainly be an

oenophile. At every meeting, there is a social event where wine is
served. Listen to the urbane elders as they wax eloquent on the
inadequacies of the evening's wines. Their inane patter is the sound
of science, fermented and aged.
8. Be sure to attend the keynote speech at every meeting. Meeting

organizers assign the keynote speech to a time and place that does not
conflict with other meeting activities. Once you've attended the
keynote speech, you're free to waste the remainder of the meeting
gossiping in the hallways, drunk in a hotel room, or otherwise
indisposed. If anyone should ask, you can prove that you attended the
meeting by recapitulating some pearl of wisdom tossed by the
keynote speaker.
9. Do not waste your meeting time at the poster sessions. Posters are
presented by scientific losers. Most poster presenters sit forlornly in
front of their works, while disinterested throngs pass by, on their way
to collecting free gifts at the resplendent vendor kiosks. The poster
people naively believe that they can achieve a coveted status among
Page 153 of 355
their peers by presenting the results of their laboratory experiments.

How absurd.
10. The action at meetings occurs in the hallways. Short, hurried,

conversations occur all day and all night long, but the best time to
have a hallway conversation is during the refreshment breaks. When
gossiping in the hallways, feel free to say whatever pleases you,
unconstrained by accuracy or truth. These conversations are so short
and so distorted by noise and competing conversations, that your
assertions will never be seriously challenged.
11. Most lectures are not recorded, so you can claim anything you
like without much fear of contradiction. An exception occurs for
lectures that are taped for later review. Institutions must get
permission to tape your lecture for future use. Just refuse permission.
If asked why, indicate that your employer, as a matter of policy,
prohibits employees to make videotapes without pre-approval.
Nobody, in the history of science, has every gotten into trouble for
fudging, distorting, or fabricating information delivered in a lecture.
If challenged, you can always say there was a misunderstanding, or
that someone on your staff handed your the wrong data, you mispoke,
or any excuse that suits your purposes.
12. Stop reading journal articles. People attend meetings instead of

(not in addition to) journal reading. Journals are read by
disadvantaged scientists who do not have the wherewithal to attend
meetings.
13. Stop reading books. In the time that your pathetic colleagues take
to read a book, you could have traveled to Istanbul, eaten Shish
Kebob and Kazan Dibi sloshed down with Ayran, and returned to tell
the tale, at your next meeting.
CHAPTER 9. EVIL INTELLECTUAL PROPERTY
"Don't worry about people stealing your ideas. If your ideas are any
good, you'll have to ram them down people's throats."
-Howard Aiken (American computer engineer and mathematician

1900 - 1973)
Page 154 of 355
"Most people are other people. Their thoughts are someone else's
opinions, their lives a mimicry, their passions a quotation."
-Oscar Wilde
"What is mine is mine. What is yours is negotiable."
-Nikita Khruschev, who is credited with using it to describe the

American approach to arms control negotiations with the former
U.S.S.R.
Intellectual property is the "dark matter" of the scientific world. We

know that there's a lot of it, that it's everywhere, and that it has a
strong effect on our lives, but it's all quite invisible to our senses.
When we think of intellectual property, we usually think in terms of

patents (for inventions and processes) and copyright (for literature).
Patents are rights assigned to an inventor, for a specified interval, in
exchange for disclosing his invention to the public. Patents probably
came to us, like most great ideas, from the ancient Greeks. In 500
B.C.E., the Greek colony Sybarus (in Southern Italy), gave inventors
the exclusive rights to profit from their invention for a period of one
year. The length of a patent grew over the centuries. In 1449 King
Henry VI granted a 20-year patent to John Utynam, who brought
colored glass-works to England. The holder of a patent collects
royalties from those who use the patent. The term royalties carries the
idea that money that would ordinarily go to the king is assigned to the
patent holder.
The idea of copyright seems to descend from the settlement of sixth

century Irish dispute over copies of a book of psalms. King Diarmait
reasoned, "To every cow belongs her calf, therefore to every book
belongs its copy." Basically, copyright guarantees that a book's
creator owns the copies. In the United Kingdom, modern copyright
was enacted by the Statute of Anne (Copyright Act of 1709). Every
nation extends copyright protection to authors. Today, copyright
protection extends to the form and content of the text and images and
does not apply to particular ideas that might be expressed in the
copyrighted work. Copyright protection lasts much longer than patent
Page 155 of 355
protection. In the U.S., Copyright persists 70 years after the death of

author, unless the author is a corporation, in which case, copyright
extends 95 years from publication or 120 years from creation,
whichever expires first. As in the case of patents, royalties are paid to
the copyright holder, in lieu of the king.
Evil scientists have used and abused intellectual property protection.

A legal and popular method of bypassing the patent system is through
"trade secret." If nobody knows your secret, your exclusive use of a
property could be leveraged to your financial advantage. Nobody
understood the concept of trade secret better than the surgeon
William Chamberlen. Circa 1570 Chamberlen invented or acquired
the design of an improved delivery forceps (tongs with large curved
grasping handles that can be pressed together with a scissors action).
The forceps was highly profitable to William and to his heirs. His son
Peter became the attending physician to Queen Anne, the wife of
James I and to Queen Henrietta Maria, wife of Charles I. The forceps
kept the Chamberlen family in riches for over a century. A
descendant fell upon hard times and sold the secret of the forceps in
1720 to Dutch surgeons. The forceps monopoly was broken when
several of the new owners published the secret. A largely apathetic
world paid little notice until the highly influential William Smellie
published his description of the improved model of the forceps, in
1750 (Figure 9-1). Because an intellectual property was kept secret,
the world was deprived of a life-saving medical advancement for
approximately 180 years (117), (157).
Page 156 of 355
Figure 9-1. William Smellie. Source: Garrison FH. History of

Though depriving society of a medical advance is not a crime, few

holders of intellectual property resort to secrecy nowadays; they use
patents, copyrights, and courtrooms to protect their interests. The
modern patent is a property right (lasting 20 years) given by a
government to an inventor of a method, or invention, or a novel item.
Patent means "open," so named because the patent process opens the
invention to scrutiny. The U.S. Patent and Trademark Office
(USPTO) publishes detailed descriptions of every awarded patent,
and equivalent patent archives are available in other countries. The
right to patent is sometimes referred to as the right to sue patent
infringers. The idea is that patents are made public. Users of patented
inventions must pay the patent holder a royalty. In return for a
royalty, the patent holder refrains from taking legal action against the
user.
When a patent or a copyright has expired, the work falls into the
public domain and can be used freely. Many patent holders have been
ruined by poor timing. Patent holders need to recoup their investment
and earn all their profits within a twenty year window. When a
patented invention requires twenty years or more to develop a
market, the patent holder cannot profit from his work. Likewise,
patent holders may not profit if the practical implementation of their
invention requires a second technological advance, that comes twenty
years later.
A fine example of a patent issued before its time is the

Lamarr/Antheil patent for Frequency Hopping Spread Spectrum
(U.S. patent 2,292,387, 1942), issued to Hedy Lamarr and George
Antheil. Circa WWII, Hedy Lamarr was a glamorous actress, and
George Antheil was a Hollywood music composer. The two came up
with and idea for secretly passing messages by jumping a signal from
frequency to frequency, giving it the appearance of noise to enemy
interceptors. When the sender and the receiver change frequencies
simultaneously, the message can be retrieved. Their patent preceded
the technology required to implement the idea. Today, decades after
Page 157 of 355
the patent expired, spread spectrum radio uses the Lamarr/Antheil

technique. In a symbolic gesture, Wi-LAN, a telecommunications
firm, purchased the original patent as an historical document, for an
undisclosed amount. This was the only income that Hedy Lamarr and
George Antheil received from their patent.
In the U.S., the first patents were issued in 1790; three in total. By
1800, there were 41 patents issued. In 1900, there were 26,414
patents issued. In 2000, there were 159,255 patents issued, of which
157,494 were inventions, 17,413 were designs, and 548 were plants
(158). The reason that the rate of patent issuance has increased
through the centuries has less to do with the heady pace of scientific
progress and more to do with the profitability of holding intellectual
property.
The original intent of patents was to grant the inventor the exclusive
right to make, use, sell, or license his invention. Over the years, the
uses of a patent have expanded to include the following:
1. Patenting to suppress innovation. If you were in the oil business,

and an inventor developed a source of free, unlimited energy (e.g.,
solar power), you might be inclined to buy the patent for his solar
energy invention for the sole purpose of halting its implementation.
Likewise, if you held a patent on a gene or a drug, you could assert
your patent to squelch research or medical testing on your property,
for the duration of the patent (159).
In the case of healthcare, there are some limits on the use of patents
to suppress a scientific discovery. In 1999, Congress passed 35
U.S.C. 287 specifying conditions that would limit the damages
collected by patent holders from healthcare practitioners (160). If you
held the patent on a new way of tying a knot, and if a surgeon
required the use the patented knot as a ligature in a surgical
procedure, the patent would probably not be enforceable on the
surgeon, under 35 U.S.C. 287. For the moment, patent holders cannot
stop physicians from saving lives.
2. Patent farming. If you hold a patent for an algorithm or a

manufacturing process that could be used in other technologies, you
Page 158 of 355
might benefit by "seeding" your invention into the derivative

technology. When the new technology is released, you can "farm"
your patent by announcing that anyone using the new technology will
need to pay you royalties. For example, if a committee is creating a
new software standard, you might strive to become a member of the
committee. If you can insert your algorithm or subroutine into the
new standard, then your patent rights will extend to the final
standard. If the standard is mandatory, you can expect to collect
royalties from thousands or millions of unwilling users.
3. Patent spreading. Every patent contains a set of claims that specify

the intellectual components that are protected by the patent. For
example, a patent for a software application may claim each of the
algorithms or subroutines that are featured in the application, the
graphic user interface by which the application is accessed, and novel
features included in the application. An evil scientist will maximize
his list of claims, effectively magnifying his intellectual property.
4. Patent holding. A shrewd capitalist can buy patents that cover

fundamental processes that are necessary for a particular field.
Whereas a single patent may be vulnerable to challenge, a collection
of patents that insinuate their claims throughout a complex industry,
might be invincible. Patent holding companies (called patent trollers
by their detractors) strategically collect patents on devices and
processes that are vital to an industry. When the time is ripe, after a
new technology has become an indispensable component of business,
the patent holding companies will assert their portfolio.
5. Patent shifting. Sometimes, a patent holder may find himself in a

position where it would be unwise to assert his patent. Large
corporations and patent holding companies occasionally reach
agreements with their competitors to hold each other harmless from
patent infringements. These kinds of agreements can save companies
a vast amount of time and expense. In such cases, a corporation may
choose to sell various patents to a third party (an individual, a
corporation, or a holding company). The third party, unrestricted by a
non-litigation agreement, can prosecute the patent. This works best if
the patent is not owned directly by the company that sells the patent.
Page 159 of 355
For example, if a corporation sits on a committee that is developing a

new industry standard, it may need to sign an agreement promising
not to prosecute patents held by the corporation and implemented by
the standard. This kind of agreement is developed by standards
committees to discourage patent farming. The company can simply
sell the patent to a holding company. Sometime in the future, when
the standard becomes entrenched in an industry, the holding company
will assert the patent against all of the patent users. The corporation
that developed the patent would have made its profit up front, at the
time of the patent's sale to the holding company.
6. Remixing prior patents. You can re-mix prior art to make a new
device that you can patent for yourself. This provision in patent law
is particularly useful for software corporations; virtually all new
software is made by re-mixing old software. You must be careful,
though, to produce a re-mixed product that is not obvious to your
peers. In KSR v. Teleflex (April 30, 2007), the U.S. Supreme Court,
in a unanimous opinion, reversed a Court of Appeals decision, and
determined that a prior patent was unenforceable because it was
obvious (161). The opinion discussed, at length, the principles of
obviousness. In particular, the Supreme Court indicated that merely
putting together prior art to make a new device can only qualify for a
patent if the resulting device is unexpected by people working in the
field; hence, not obvious.
7. Patenting the uses of unpatented inventions. The wheel is an

unpatented invention. If you were to come up with a novel, useful,
and nob-obvious application of the wheel, you might be able to patent
your work. This means that when you use an invention that is not
covered by a patent, your use of the invention may still constitute a
patent infringement. Here is an example. DICOM (Digital Imaging
and Communications in Medicine) is a freely available, unpatented
standard for radiologic images. Currently, there is an effort to have
all medical specialties adopt DICOM as the exclusive format for all
medical images. Nonetheless, there there are specific circumstances
for which the DICOM standard cannot be used without infringing on
patented intellectual property. U.S. Patent 6725231, issued Apr 20,
Page 160 of 355
2004, to Jingkun Hu and Kwok Pun Lee and assigned to Koninklijke

Philips Electronics N.V., has the following claim.
"1. A method for mapping a DICOM specification into an XML

document, comprising: mapping each entry of a DICOM table of the
DICOM specification into a corresponding XML element of a
plurality of XML elements,outputting each XML element of the
plurality of XML elements to the XML document, in an output
format that conforms to at least one of: an XML document-type-
definition and an XML Schema."
In addition, the patent owners have been granted a similar patent by

the European Patent Office (EPO). Mapping image information from
a free specification, such as DICOM, into another free specification,
such as XML, is a common task for medical informaticians. Does this
activity constitute an infringement on an existing "use" patent? These
are the types of questions that keep patent lawyers busy.
8. Patenting life. What must it feel like to own a species of living

organisms? It must be like God would feel, if God had the the
Supreme Court on his side. In a 1980 5-4 ruling, the Supreme Court
upheld that a living organism could be patented. The case was
Diamond v. Chakrabarty and involved a dispute over a patent for a
genetically modified bacterium (162), (163).
After a patent on life is awarded, the consequences can be far-

reaching. For example, Monsanto developed and patented genetically
engineered corn that is resistant to Monsanto's Roundup weed killer.
Using Monsanto's corn seed, robust corn grows in fields that are
liberally treated with Roundup. This guarantees that farmers who buy
Roundup-resistant corn will also buy Roundup, at Monsanto's price.
When farmers buy Roundup-resistant corn, they agree not to collect
seed (from their corn crops) for replanting. This means that each
growing season, they must buy new seed from Monsanto, at
Monsanto's price (164). The use of genetically engineered seed is
rapidly spreading. As more and more farmers use Monsanto's seed,
the risk increases that genetically engineered seed will drift (from the
winds, or from passing seed transport trucks) onto the fields of
farmers who chose not to use genetically engineered corn. After
Page 161 of 355
genetically engineered corn invades a field, Monsanto can assert its

seed patent on the hapless farmer, even when the farmer had not
intended to use Monsanto's seed.
It is dangerous to rely on a single genetic variant of vital crop seed. A

newly emerging disease that targets the crop can decimate the world's
food supply. In the specific case of roundup-resistant corn, new
varieties of roundup-resistant weeds may emerge. In 2010, twenty-
two states were infested by multiple new species of roundup resistant
weeds, essentially nullifying any benefit from the genetically
engineered corn (165).
The Diamond v. Chakrabarty ruling extends "life" patents to genes

and sequences of DNA. Jensen and Murray reported in 2005 that
4,382 of 23,688 human genes in National Center for Biotechnology
Information had been patented (166). The two most highly patented
genes were BMP7, an osteogenic factor, and CDKN2A, a tumor
suppressor gene (166). These two genes are claimed in more than 20
patents.
9. Viral patenting involves asserting a patent on the manufacturer of

an assembled device, and asserting the same patent on the users of
the manufactured device. Viral patenting is risky for the patent
owner. In a precedential case, the U.S. Supreme Court unanimously
ruled that LG Electronic could not assert a patent against Intel (the
manufacturer that implemented a memory-technology patent owned
by LG Electronics) and on the computer makers that install Intel
chips in their computers (167). The patent power to collect royalties
was effectively exhausted by its first license (with Intel).
10. Royalty stacking. For a complex process, it may be possible to

assert different patents on various steps in a process. For example, a
medical test may involve processing cells using a patented
technology, using one or more patented reagents, performing a
patented analytic process, using a patented machine, and evaluating
the data with patented software. After all the royalties are stacked, the
totaled costs are transferred to the patient or to a third party payer
(168).
Page 162 of 355
11. Reaching through a patent. Savvy patent holders may issue

licenses that contain an insidious "reach-through" clause. The clause
may stipulate that license holders can use the patent under the
condition that any future technologies, that the license holder
develops with the licensed technology, will be assessed a royalty. The
clause allows the patent holder to reach through into the intellectual
property created by the license holder, and impose an additional
royalty.
If you were to take the time to visit the USPTO website, you would
soon learn that most patents are trivial, obvious, derivative, or
useless. True "Eureka" moments are rare. Those who file patents are
often motivated by fear ("If I don't patent this, somebody else will,
and I can't bear to think that I may be required to pay royalties for my
own invention."), opportunism ("Hmmm. I can't believe nobody has
patented this! I'd better do it before someone else does."), security
("My boss will not give me that raise unless I produce another patent
this year."), or greed ("I'll squeeze every penny out of my
competitors."). To receive a patent, an invention should be novel,
non-obvious, and useful, but the reviewers at the patent office cannot
always make that determination.
Software developers are among the angriest critics of the USPTO. In

recent years, the USPTO has awarded many software patents, a
practice that seems to counter the principle that "ideas" are not
patentable. Software developers argue that all software is built from
recycled algorithms whose original sources are lost to techno-history.
You cannot create a software application without using bits of code
that where developed by legions of software developers, over the past
half century. Today, software developers live in fear that a line of
their code or a brief algorithm they may have included in a complex
software application will infringe on one or more software patents.
The ever-present risk of patent infringement is a nightmare for
earnest software developers, and a dream come true for evil
scientists. If you can patent an algorithm or subroutine that every
developer uses, you stand to make a fortune.
Of course, nobody is obligated to patent his discoveries. On
Page 163 of 355
November 8, 1895 Wilhelm Roentgen performed the experiment that

marked the discovery of X-ray imaging (Figure 9-2). Six years later,
in 1901, Roentgen's effort was awarded with the Nobel prize.
Roentgen declined to seek patents or proprietary claims on his
discovery and even declined, unsuccessfully, the eponymous
appellative, "Roentgen ray." Such altruistic behavior is unsuitable for
evil scientists.
Figure 9-2. One of Roentgen's earliest x-rays, taken on January 23,

1896. Source: Wikipedia, public domain.
The government awards patents, but when someone infringes on your

patent, the government takes no action. Only the patent holder is
harmed, and only the patent holder can litigate against the infringing
party. For this reason, a patent is sometimes referred to as the right to
sue. Paradoxically, the typical patent holder is terribly frightened of
lawsuits and will do almost anything to avoid a court appearance.
Why?
Imagine that you hold a software patent, and you have identified a
person whose software contains some code that seems to infringe on
one or more of the claims contained in your patent. Your lawyer
sends this person a letter claiming infringement and demanding that
the person either stop using the patented property or begin paying an
Page 164 of 355
assigned royalty. This is the so-called "demand letter" that every

software programmer fears.
The alleged infringer, if smart, will seek remedy in a federal court,

arguing that your patent is invalid or unenforceable, or that he did not
infringe. He will ask for a declaratory judgment to stop you from
pursuing your patent demands.
The declaratory judgment is a preventive adjudication. Its purpose is

to clear the air, so that the defendant (the alleged infringer) need not
worry about your impending lawsuit (169). Your alleged infringer
will bring his case to a federal court venue where he lives (you will
need to travel to the location), giving him the home court advantage.
If he asks for a declaratory judgment based on non-infringement, you
will be required to pursue a counterclaim of infringement; an action
that you may not be prepared to pursue. In the case of software
patents, virtually every patent holder stands on very weak ground. All
software is derivative of someone else's work; hence, every software
patent is vulnerable to a declaratory judgment. You may have spent
millions of dollars developing your invention and seeking your
patent, but all of your investment could be lost through a declaratory
judgment.
Declaratory judgment cases must be triggered by a significant

controversy, usually a threat of litigation. Your demand letter,
indicating infringement and requiring compensation, is all that is
needed to trigger a claim for declaratory judgment. This means that,
if you have a vulnerable patent (and you probably do) you must not
send a demand letter that has the effect of a threat.
You may try having a salesman send the letter (not a lawyer). A letter
from a salesman is less likely to imply the threat of legal action than a
letter from retained counsel. In the letter, you might want to simply
identify the patent and indicate that it is available for licensing. It
may be wise not to suggest that infringement has occurred.
The purpose of a "demand" letter is to motivate the receiver to buy a

license, without triggering a declaratory judgment action. If the letter
is sufficiently bland and non-threatening, it may do the trick.
Page 165 of 355
Remember, though, that the receiver will likely interpret your letter
as a thinly veiled threat. When determining jurisdiction for a
declaratory judgment, courts look at all the relevant circumstances. If
you have a history of vigorously pursuing patent claims, or your have
a history of intimidating people with the implied threat of legal
action, a court may interpret any letter from you, no matter how
bland, as an intent to litigate.
1. Money distinguishes the professional from the amateur. Just as

prostitutes don't "give it away", neither should scientists.
2. A patent is often referred to as a right to sue. This is nonsense. The

last thing an evil scientist wants is to defend his patent in court. A
patent is better thought of as the right to intimidate.
3. A patent is expected to be new, non-obvious, and useful. Don't let

this discourage you. There are about 175,000 new patents issued each
year. If they were all new, non-obvious and useful, we'd be living in
utopia. Most patents do not meet any of these criteria.
CHAPTER 10. EVIL STANDARDS
"Standards have become so popular that everyone wants one of their

own."
-Anonymous
Standards provide an impenetrable, yet subtle, refuge for evil. Many

of the most accomplished evil scientists are totally ignorant of the
chaos and corruption that comes from the imposition of standards
upon the scientific community. When you create a new standard, you
are imposing a set of behaviors on the world. The purpose of this
chapter is to explain how to exploit the standards-making process for
your own benefit and to the detriment of your competitors.
Here are the basic elements of an evil standard:
1. Hard to understand. A well-written standard should be
Page 166 of 355
indecipherable to everyone except the members of the committee that

created the standard.
2. Unimplementable. We spend our lives being told to live up to one

set of standards or another. But we always fail, because successful
standards cannot be implemented. Consider the Ten Commandments.
It's hard to do a good day's work without breaking three or four of
these impractical behavior standards. For most of us, the Ten
Commandments could be renamed the Ten Recommendations or the
Ten Options.
3. Expensive. Believe it or not, standards are intellectual property.

They can be owned and licensed, with all manner of charges imposed
on the users. It's really the greatest scam you can imagine. First you
and your cronies invent a set of rules that work to your advantage and
to the disadvantage of everyone else; then you tell everyone that they
must conform to your standards; then you tell them that they must
pay you to use the standards.
4. Encumbered (both the standard itself and the uses of the standard).
People believe that standards are free. Not necessarily. Many
standards are developed by organizations that expect to make a profit
from their efforts. Such standards require the purchase of a license.
Once you've bought a license to use a standard, you don't get to use
the standard any way you choose. You must use the standard within
the limited conditions specified in the license. You may be able to
use the standard at your primary place of work, but not at your
satellite offices. Your information technology officer may use the
standard, but not your chief technician. You may be able to use the
standard for your CAT-scan reports, but you may be restricted from
using the standard for your MRI reports. It all depends on the
wording of the license. This provides the owner of the standards with
the greatest possible power over the people who must use the
standard.
5. Incompatible with all standards, including itself. Of course, you

don't want your standard to be compatible with any other standards.
You want to lock them into your standard. A good standard is issued
in successive versions, sometimes on an annual basis, with each new
Page 167 of 355
version incompatible with its predecessors.
6. Monopolistic. The best standard has no competitors. The best way

to get rid of your competitors is to convince the government that life
would be better if everyone followed one standard... yours. Again and
again, the U.S. government has been duped into backing a standard
that nobody really wants.
7. Coercive. Every standard organization strives to make life

miserable for the people who ignore the standard. If your standard is
sufficiently coercive, those who do not use the standard to will be
ineligible for government contracts, unable to interoperate with their
clients who use the standard, and generally squeezed out of business.
You might assume that standards are produced by the government.

This is simply not the case. The government, disinclined to create
new standards, expects industries and user communities to create
their own standards. Even NIST, the U.S. Government's National
Institute for Standards and Technology, is barred from making
standards. The U.S. government's hands-off approach towards
standards is specified in the National Technology Transfer and
Advancement Act of 1995 (NTTAA), Public Law 104-113 (170).
In most instances, NIST is reduced to providing scientific assistance

to SDOs (Standards Development Organizations). SDOs are
organizations composed of entities who benefit from standards. For
example, the tool and dye industry might benefit from a uniform
standard for cutting tools. A consortium of tool and die
manufacturers might form an SDO to develop an industry standard.
It all seems innocent, until you follow the money. Money is required
to assemble and charter the SDO, to pay for organizational meetings,
to transport participants to the meetings, to pay the salaries of the
SDO staff members, to market the standard, to launch a lobbying
campaign to legitimize the standard and to compel government
officials to enforce its use, to prepare licenses, and to collect license
fees. Lawyers must be retained to protect the value of the standard as
an intellectual property, and to litigate against unauthorized uses of
the standard. It can easily cost millions of dollars to develop and
Page 168 of 355
protect a standard that might be used by a small number of scientists

and ancillary industries.
Every standard has its financial benefactors, and those involved in

standards efforts learn that "he who pays the piper calls the tune."
Most standards are developed by committees compose in part by
representatives of the corporations that pay for the effort.
Consequently, most standards are written to support the commercial
interests of the benefactors.
How might a commercial interest benefit from a standards

development effort? Much can be learned from the legalistic
adventures of Rambus, a patent licensing organization (171). Rambus
served as a participant when the Joint Electron Device Engineering
Council (JEDEC), developed a new standard for dynamic random
access memory (DRAM) devices. JEDEC incorporated a technology
into the new standard that happened to be owned by Rambus. While
the standard was under development, Rambus did not disclose that its
intellectual property was inserted into the standard. After the user
community was locked into the new standard, Rambus asserted its
patent and imposed license fees on the users.
The Federal Trade Commission found that Rambus should have

disclosed its patented property to JEDEC before it was inserted into
the new standard. The U.S. Court of Appeals overturned the FTC,
concluding that JEDEC had failed to adequately clarify its disclosure
policies to the standard developers. Furthermore, JEDEC failed to
convince the Appeals Court that the standard would exclude Rambus'
technology if the disclosure had been provided. The Rambus cases is
considered one of the finest examples of patent farming (171).
Can SDOs develop certifiably patent-free standards through a

disclosure document? Probably not. A participating corporation can
simply shift its patented properties to a third party (e.g., a patent
holding company) when it learns that the technology will be inserted
into a standard. Profits to the corporation can come through a back
door arrangement through the holding company that returns a portion
of the holding company's licensing fees collected from each user of
the new standard. In practical terms, a disclosure form cannot force
Page 169 of 355
corporations to disclose what they do not know, do not own, and

cannot predict. Corporations can come forth, after a standard is
developed, with patents whose applicability to the standard was not
anticipated during the disclosure process. Furthermore, Corporations
can buy standard-critical intellectual property after a standard is
designed. Most importantly, corporations can develop and patent
novel, non-obvious and useful application for a standard, after it the
standard is developed.
An important incentive for working on a new standard comes from

learning potentially patentable uses of the standard. Corporations
commonly instruct their delegates to listen closely to their
counterparts from competing corporations, without actually
contributing to the new standard. The strategy is to let your
competitors work on the standard, while you sit on the sidelines,
looking for an opportunity to exploit their work. After each SDO
meeting, delegates are debriefed by their supervisors.
In some cases, a corporation may benefit if the standards effort is

delayed (arriving when it is too late to matter), debilitated (producing
a standard that is so weak that it has no impact on the industry),
discouraged (resulting in a standard that is immediately rejected), or
derailed (aborting the effort to make a new standard). In this case, a
corporation may go through the motions of backing the standard,
while instructing their committee delegates to interfere with
development efforts.
There are thousands of standards development organizations,

producing an endless assortment of standards. It stands to reason that
many of the newly developed standards are unnecessary and counter-
productive.
Some of the most numerous standards relate to digital data. For

example, there are dozens of standard formats for electronic images.
Some of the standards are proprietary, others are free and open
source, and some have fallen into the public domain. Virtually all
image formats are interconvertible. This means, that you do not need
to buy a license for a proprietary image standard. You can work with
images stored in a free image format. Those who prefer to use a
Page 170 of 355
licensed image standard can interoperate with you by converting your

images to their licensed standard, as needed. Though many people
feel the need for a single, mandatory standard for digital data, the
dirty truth is that a multitude of electronic data standards do not pose
a technical obstacle to the free exchange of information. If an
obstacle exists, it's one of perception; people mistakenly believe that
data can only be exchanged when stored in the same digital format.
When a standards organization manages to create a standard whose

usage is compulsory for an industry, the consequences can be
disastrous. A mandatory standard may impose license fees and
royalty fees on the user community. More importantly, three
scenarios may arise that have dire legal consequences.
First, the mandatory standard may limit competition by other

standards, thus inviting anti-trust actions against the organization that
produced the standard.
Secondly, and less obviously, the standard may impose burdens upon
users of the standard and upon non-users who conduct commerce
with users, and this might fall under RICO (the Racketeer Influenced
and Corrupt Organizations Act, encacted 1970) (172). Here is an
excerpt from RICO:
-"1951. Interference with commerce by threats or violence
-(a) Whoever in any way or degree obstructs, delays, or affects

commerce or the movement of any article or commodity in
commerce, by robbery or extortion or attempts or conspires so to do,
or commits or threatens physical violence to any person or property
in furtherance of a plan or purpose to do anything in violation of this
section shall be fined under this title or imprisoned not more than
twenty years, or both.
-(b) As used in this section-
-(1) The term "robbery" means the unlawful taking or obtaining of

personal property from the person or in the presence of another,
against his will, by means of actual or threatened force, or violence,
or fear of injury, immediate or future, to his person or property, or
Page 171 of 355
property in his custody or possession, or the person or property of a

relative or member of his family or of anyone in his company at the
time of the taking or obtaining.
-(2) The term "extortion" means the obtaining of property from

another, with his consent, induced by wrongful use of actual or
threatened force, violence, or fear, or under color of official right."
Though RICO was designed to provide prosecutorial power against

the mafia, its uses have been expanded since its enactment. When a
group conspires to interfere with commerce under color of official
right, this might fall under RICO. It is important for a standards
organization to avoid using their "official right" to extort money.
There is a third legal consequence of having a mandatory standard. A

standard may be technically flawed, resulting in loss to property, loss
of commerce, and injury or death to persons. If you tell people that
they must construct their machines or buildings or software, or
medications in a manner dictated by your standard, you had better be
certain that nothing bad happens as a result of conforming to the
standard.
10.1 WHAT THE STANDARDS DEVELOPMENT

ORGANIZATIONS NEVER DO
"Everything should be made as simple as possible, but not simpler."
-Albert Einstein
Every standards development organization complains that there is

nothing they can do to prevent their standard from becoming
encumbered by patents. Actually, SDOs have many opportunities to
protect their standards from encumbrances. Here are just a few
examples of the kinds of progressive measures that SDOs routinely
avoid:
1. Work with the USPTO (US Patent and Trademark Office) or the
EPO (European Patent Office) to block trivial or non-original patents
applied to your standard. The USPTO supports the Peer to Patent
project, which opens the patent examination process to public
Page 172 of 355
participation (http://www.peertopatent.org/).
2. Collect and publish a list of prior art for all the methods included
in your standard. This document would make it difficult for someone
to obtain a patent on technology contained in the standard.
3. Do your own careful patent search to ensure that your standard

does not include any previously patented methods.
4. Require your members to search their company's patents to ensure

that they have no patents within the standard. Clarify these
instructions and have each committee member organization provide a
binding document indicating that they hold no patented property
included in the standard, and that they never held patented property
that is included in the standard.
6. The patent searches conducted by companies that are members of

the standards committee should include any patents transferred to
patent holding companies.
7. Require members of the standards committee to sign agreements

(co-signed by authorized representatives of their companies) that no
company patents (held or transferred) or claims will apply to the
standard.
8. Whenever possible, use open source, or public domain methods

within your standards.
9. Whenever possible, use "escape" methods in the standard so that

users are not locked into a single method that implements the
standard.
10. Make optional standards, not required standards, so that the user
community is not locked into one implementation.
11. Make interoperable standards (that can port to-and-from related

standards).
12. Have open [to the public] committee meetings and publish the
minutes of your meetings
Page 173 of 355
13. Include a "user advocate" in the standards committee
14. Publish the documents related to the efforts you have made to
comply with items 1 through 13.
Luckily for evil scientists, standards are typically prepared by other

evil scientists. Every standard is made for mischief.
1. Standards are written by committees of powerful people who

represent large corporations. As a member of a standards committee,
it is your primary responsibility to advance the interests of your
corporation, not the interests of the users of the standard. Use your
position to design a standard that works against the interests of your
competitors.
2. Don't do any real work on the standard. Attend standards meetings

to protect the interests of your company, to gather information on
your competitors, and to to report back to your supervisor. That's all.
Let the other companies waste their time.
3. Make the standard a requirement for your user community. This

can be accomplished by lobbying the government and/or user
organizations. Though the U.S. government is reluctant to create new
standards, it has a long history of backing hard-to-implement,
ineffective, expensive, or unpopular standards. Enforcement of your
standard will require new government regulations (rules provided by
a Federal agency) or new laws (rules provided by Congress). Let your
lobbyists write the regulations and laws, and pass them to an
influential agency bureaucrat or congressman.
4. Encumber your standard with licensing fees. You might need to

wait until the user community is locked into your standard before you
release the hounds.
5. Surreptitiously plant your company's patented technology into the

new standard. When the standard becomes a legal requirement, you
can intimidate the users to pay royalties.
Page 174 of 355
6. Strive to produce a standard that is too complex for your

competitors, but not so complex that you cannot master its subtleties.
Doing so will solidify your position as your corporations authority on
all questions related to the standard. Remember that the more
confusing a standard, the less likely that your inserted patents will be
detected.
7. There is no limit to the number of encumbrances that can be placed

on a single standard. You can charge a license fee for the standard
itself; you can charge royalties for any and every piece of technology
that embeds the standard; and you can charge a royalty for novel uses
of the standard that are covered by a patent.
8. Research agencies and 501K charities will use their non-

commercial status to beg for exemption from your licensing fees.
Negotiate on a quid pro quo arrangement. If they can persuade their
members to purchase licenses for your standard, you can be
charitable.
9. Coerce your potential users. Tell holdouts that they will be

ineligible for government contracts, unable to interoperate with their
clients who use the standard, and generally squeezed out of business
if they do not adopt your standard.
10. Bad standards, such as yours, get worse over time. A poor
standard provides the opportunity to make a new version of the
standard. Your users will be forced to purchase licenses for the new
standard, at a price that you dictate.
CHAPTER 11. ABUSING POWER
"Comfort the afflicted and afflict the comfortable."
-Finley Peter Dunne
Power is influence over other people. Powerful people do not

contribute anything to society, directly. They coerce others to
contribute, and they take the credit. If you're lucky enough to have
power, you'd be a fool not to abuse it.
Page 175 of 355
Among the powerful scientists are department chiefs, deans, editors,

journal reviewers, grant reviewers, institutional review board
members. The title "Director" is often bestowed on administrators,
with no training in the sciences, who find themselves directing teams
of scientists. Basically, the powerful people in the world of science
are marginal scientists or non-scientists, who decide what working
scientists must and must not do.
Here are the basic duties of powerful scientists:
1. Influence peddling. Your influence will often have more value to

other people than it has for you directly. In such instances, other
people will be eager to pay you to exert your influence, in exchange
for money and other favors. Be careful not to break the eleventh
commandment - "Thou shall not get caught". Bribery cases have
resulted in billion dollar fines (173).
2. Influence influencing. Whether the vacancy is for a Chair of

Physics, or Chemistry, or Mathematics, or Medicine, the dynamic is
always the same: a group of department heads, often from other
institutions, with no affiliation, loyalty, or knowledge of the
particular needs of a department, will fill the vacancy with one of
their esteemed cronies. Why does this happen? University
administrators have a deep mistrust of their faculty. Their assumption
is that faculty, left to their own devices, will always choose a chair
who is loyal to the faculty. The administrators want a chair who will
be loyal to the administrators. This means that administrators will
solicit advice from department chairs outside their own institution.
3. Influence cycling. When powerful people change their jobs, the

power moves with them. For example, the life cycle of an attorney
may begin as staff lawyer for the EPA (Environmental Protection
Agency). Soon, he may be hired by the chemical industry, eager to
employ someone with in-depth knowledge of EPA regulations. Later,
he might be hired as a federal attorney, prosecuting industry moguls
who run afoul of EPA regulations. Next, he may be hired by industry,
to defend them in the same types of courtroom cases that he was
previously prosecuting. Later, he may be hired in a top leadership
Page 176 of 355
position within the Federal government, still in the environmental

field. Eventually, he may be hired on as chief counsel, head lobbyist,
board member, or officer working for a corporation or consortium.
The point is that powerful people bounce through the corridors of
power, working both sides of an adversarial conflict.
4. Intimidation is the power to make people do what you want them

to do, without asking. An intimidated faculty will know that your
name should be added as a co-author to every paper they write. At the
end of every departmental lecture, the staff will know that you
reserve the right to ask the first question. In any discussion, when
your interjection interrupts a colleague's remarks, in mid-utterance,
he will awkwardly halt, while you will smoothly continue. The
simplest application of intimidation involves sparing yourself from
unwanted interpersonal interactions. Ideally, the people around you
will not engage you in conversation without your invitation.
5. Neglecting others. True power means never having to say you're

sorry. The powerful person is expected to neglect others. The general
principle is that powerful people are more important than powerless
people; their time is more important, their thoughts are more
important, and their sense of importance is more important. They
expect others to hang on their every word, while they are expected to
disregard your deepest concerns. The best and most effective method
to neglect others is to ignore them entirely. If you send an email to an
important person, do not expect the favor of a reply.
6. Cronyism. In science, if you have friends, you will always be

forgiven, no matter what sins you may have committed. If you have
no friends, you will never be forgiven, whether you're sinful or
righteous. Everything you do, no matter how innocent, will be
ignored, or will be treated with great suspicion. The social pact
wherein friends do favors for other friends, is called cronyism.
Powerful scientists are in the best position to help their friends, to the
detriment of strangers.
Here is an example of how cronyism might work. Two senior

investigators, from different institutions, frequently give lectures to
similar audiences. Whenever either one talks, he exaggerates the
Page 177 of 355
contributions of the other. Ersatz boastfulness is highly effective.

Audiences ignore self-promotion, but they will believe anyone who
confers adulation on a competitor in the same field. Only by
attending lectures by both speakers will anyone discover their cynical
strategy to inflate each other's merit.
6. Judging. Rejection is the cornerstone of science. As a person of

power, it is your job to do the rejecting. Always reject the work of
strangers and enemies. If you do your job right, the rejected
individual will search within himself for the cause of his failure.
When it comes to your friends, remember the words of Arnold

Bennett (1867 - 1931), who said, "It is well, when judging a friend, to
remember that he is judging you with the same godlike and superior
impartiality." Approve the follies and foibles, misdeeds and mistakes
of your friends. They will do the same for you.
7. Exercising authority. Herman Kahn (1922 - 1983) said, "Authority

is not power; that's coercion. Authority is not knowledge; that's
persuasion, or seduction. Authority is simply that the author has the
right to make a statement and to be heard." Your authority has value
to those whose authority is tapped out. New York Times reporter
Natasha Singer recounts how the Pharmaceutical company, Wyeth,
paid a research company, DesignWrite, to write papers favorable to
their hormone replacement therapies. Once written, DesignWrite
solicited Professors to allow their names to appear as the authors. The
papers, which appeared in respected clinical journals, failed to
disclose DesignWrite's or Wyeth's role in the final publication (174),
(175).
8. Hiring and Firing. Only the meek and powerless anguish over
decisions related to hiring and firing. For the powerful, there is only
one rule to remember: hire your friends, and fire your enemies.
10. Distributing largess. Because you occupy a position of influence

over others, you will find yourself courted by subordinates. You
decide who gets a bonus, and who does not. You decide whether a
graduate student finishes in 4, 5, 6, or 7 years; or never. You can
create sinecure positions for your friends.
Page 178 of 355
12. Raising money. Power does not grow on trees. It costs money,
most of which will be spent on your salary, your bonus, and your
perks. Raising money usually consists of forcing your staff to acquire
large grants; cutting a large slice of the university's budget for your
department; buttering up investors and donors in the typical
locations: the golf course, the boardroom and the bedroom.
13. Building and protecting the pecking order. In academic circles,

the pecking order is maintained by the person with the most to gain
from its persistence; the department chair. Those with the least to
gain from the pecking order are the graduate students, medical
students, post-doctoral fellows, and experienced technicians. These
unfortunates get pecked by everyone, but they don't get to any
pecking of their own.
14. Power politics. Power, like marriage, is a game of give and take.
If you want others to do your bidding, sometimes you must do the
bidding of your powerful allies. New York Times reporters Gardiner
Harris and David M. Halbfinger reported a tale of power sharing at
the FDA (176). ReGen Biologics, Inc., developed a patch for injured
knees. Reviewing scientists at the FDA repeatedly and unanimously
determined that the ReGen patch was unsafe and had a high failure
rate. Four congressmen from the Garden State, where ReGen is
located, challenged the FDA's scientific panels; a challenge that came
hard on the heels of significant campaign contributions provided by
ReGen to said congressmen (176). The FDA director,apparently
conferred greater credibility on the honorable New Jersey
Congressmen than he credited to his own science panelists. The
ReGen patch was approved for sale (176).
11.1 THE DEPARTMENT CHIEF
Of course I believe in luck. How otherwise to explain the success of

some people you detest?"
-Jean Cocteau,
Department chiefs are hired by their institution's administration, and

not by their own department. The administration expects department
Page 179 of 355
heads to work for the administrators, and to side with the

administration in conflicts between departments and institution.
Therefore, department chiefs have no reason to work within their
departments, or to extend loyalty to faculty and staff within their
departments.
Most of the academic rank and file have no idea what the department
chief does for a living. Most department chiefs prefer it this way.
Here are the responsibilities of department chiefs:
1. Bring money into the department, usually accomplished by

fighting with the other department chiefs for a piece of the
university's budget.
2. Hire staff who will bring money into the department.
3. Fire staff who are not bringing money into the department.
4. Distribute perks and bonus money to staff members who have

faithfully served the department chief.
5. Keep an eye on compliance issues (usually related to how money

is spent).
6. Balance the departmental budget (always delegated to the

department's business manager).
7. Occasionally spearhead new projects that bring additional money

to the department.
8. Participate in institutional committees.
9. Travel a lot.
Who hires the department chief? In academic institutions, department

chiefs are seldom selected by the departmental faculty. Though the
professors in a department are in the best position to know the best,
brightest and most productive professionals in their field, these
qualities are not major factors in the selection process. Because the
salary of the department chief is paid by the institution, the leadership
within the institution selects department chiefs.
Page 180 of 355
If the institution is wealthy and powerful, the administration will

usually not choose a department chief recommended by the outgoing
chairman. When an outgoing chairman leaves to take over
chairmanship at another institution, they often take with them some
of the best faculty. The transformation of a trusted general to a
heinous traitor takes occurs with lightning speed. When the current
chairman leaves to begin retirement, there is usually a sense that the
departure was long overdue. In either case, the advice of the exiting
chairman is no longer required.
Evil administrators always draw department chiefs from outside the

department. When an in-house faculty member has all of the qualities
of a good department chief, they are likely to be tainted by peer
loyalties. A good chairman will be loyal to the leadership of the
institution and will not extend his loyalties to the department's
faculty. As a department chief, he will be asked to fire, demote, or
marginalize his former colleagues.
If the institution chooses a department chief in-house, it is always a

sign of weakness. It means that the institution is ineffectual, hated,
unknown, or cheap. Nobody outside the institute will want the job.
During the selection process, institutional leadership will go to

extreme lengths to shield outside candidates from exposure to the
department faculty.
You want to be a Department Chief. You are interviewed for

the job in the evening, over dinner, by the search committee.
After dinner you are given a tour of the lab. There's only a
skeleton staff, and you aren't introduced to any of the workers.
The next day, you are interviewed by the top administration at
the hospital. You don't meet the day staff. Six months later,
you are offered the position. Six months after that, you have
moved your family to their new home. You know some of the
department staff member by reputation. You don't consider
anyone your friend. You introduce yourself to them, as their
new boss. Each staff member voices some perfunctory
complaint about their lack of resources. Some indicate their
Page 181 of 355
distaste for the furtive way in which you were hired. They all
seem hostile. At the end of the day, you write a litter, tendering
your resignation. Three months later, you are back at your old
job.
1. All self-respecting scientists seek power. If you do not scratch and

claw your way to the top, your colleagues will assume that you lack
self-esteem. They will eat you up and spit you out.
2. As a person of great power, you must understand that excrement

always flows downhill. This means that the cleanest scientist is the
one on top of the dung hill.
3. Every scientist loves to criticize. As a powerful person, you will be

invited to criticize other scientists. When you criticize, you must
leave the impression that your are superior to the person who is the
object of your criticism, even when you are totally ignorant of the
matter being criticized. Never accept criticism from subordinates.
Criticism moves from top to bottom, never the other direction.
4. Loyalty can be bought. Use bonuses to reward your allies and to

punish your enemies.
5. Use your position to expropriate the ideas of your subordinates.

Stealing someone else's ideas is a time-honored privilege of powerful
people.
6. Relax. Most of the atrocities committed by powerful people are

accomplished with passive-aggressive inaction. Whenever it suits
you, simply neglect to return urgent phone calls; do not even bother
to read emails; papers that require your signature can sit in the in box
indefinitely; pass unavoidable problems to your least competent
assistant; travel to a meeting whenever a messy problem erupts in
your institution. Problems are solved by the people who are most
adversely affected. After someone else has solved your problems for
you, be sure to take full credit for the solution.
7. Delegate all work. The most effective way to accomplish this is
Page 182 of 355
through the pecking order. Each person delegates their work to their
direct subordinate. Only the lowest person in line does any work.
CHAPTER 12. GOVERNMENTS AND EVIL SCIENCE
"Science is 10% intellectual and 90% psychological."
-Anonymous
Evil is concentrated in governments and other institutions of power.

Wars, crusades, genocidal massacres, mass starvations, blitzkriegs,
firebombings, nuclear devastation, mass rapes and murders, ritualistic
human sacrifices, and holy crusades, inquisitions, are all the products
of respected, and trusted institutions.
Face it, governments can get away with behavior that would be
considered reprehensible if committed by individuals. We see, again
and again, that when it comes to the government, a good lie is
preferable to a bad truth. When the U.S. government tested atomic
bombs in the Nevada Proving Grounds, north of Las Vegas, the
activity was gleefully welcomed by the locals. Tom Zoellner, in his
book, "Uranium: War, Energy and the Rock that Shaped the World"
recounts that nuclear tests were felt on the Las Vegas strip, where
roulette balls and dice were jostled by the blasts. Herds of Utah sheep
sickened and died. Sores appeared under their wool. The Atomic
Energy Commission blamed livestock deaths on malnutrition and
cold weather. The public bought the lie. At the time, the tests were
widely supported by the people who were directly and adversely
affected. The testing sights brought federal jobs, and scientific
prestige to the American West. Politicians who urged a testing ban
were sharply criticized by the public. Zoellner quotes the Las Vegas
Review-Journal, "We in Clark County who are closest to the shots
aren't even batting an eye" (177). In the ensuing decades, the number
of cancer deaths in the region were high. The National Cancer
Institute has estimated that between 11,300 to 212,000 cases of
thyroid cancer alone may have resulted from 90 atmospheric tests
conducted over the Nevada Proving Ground (178). In 1990, the U.S.
passed the Radiation Exposure Act to provide some some
compensation to cancer victims who had lived in downwind regions.
Page 183 of 355
Everyone likes a good lie, if it benefits them. On August 18, 1993,

The New York Times exposed a fascinating tale of cold war
disinformation, entitled "Lies and Rigged 'Star Wars' Test Fooled the
Kremlin, and Congress (179)." The story begins during the early
1980s, soon after President Ronald Reagan launched the Strategic
Defense Initiative, popularly known as the Star Wars project.
Military scientists were instructed to deploy orbiting space satellites,
armed with powerful lasers. These satellites would detect launched
missiles aimed at the United States, and would fire powerful laser
beams, destroying the missiles in flight, before they reached their
target.
When the Star Wars project was announced, civilian physicists

scoffed at the idea. Experts said that the technology needed for the
project was far beyond our capabilities. Nonetheless, the project was
funded. Three early tests of the system were complete failures. A
fourth test was planned. If this test failed, Congress would almost
certainly cut funding for the project.
The fourth test was a stunning success. Shooting down a missile,

from a satellite, using a laser blast, is equivalent to pulverizing a
bullet, in mid-flight, with another bullet, when the first bullet is shot,
without warning, from any location, and aimed in any direction.
Congress was highly impressed.
Despite the dramatic success of the fourth Star Wars test, the project
never produced any practical results. Star Wars funding was
continued throughout the 1980s, but eventually, the space-based
defense strategy fizzled out; replaced with a modest earth-bound anti-
missile launchers, such as those deployed against Scud missiles in the
1991 Gulf War. These launchers are impressive, when everything
goes right and the enemy missile is destroyed in mid-flight. But it's
very difficult to strike incoming missiles, and the launchers don't
always work as advertised. There are many possible defenses against
anti-missile launchers. When an enemy launches a barrage of dummy
missiles (with no warheads), with a few armed missiles mixed into
the fray, it's very difficult to know which to target.
Page 184 of 355
What went wrong? Why had the Star Wars project failed, after such a
miraculous beginning? The fourth, decisive test of the Star Wars
project was a fake, plain and simple. According to one of the military
scientists interviewed for the New York Times article, "We rigged
the test. We put a beacon with a certain frequency on the target
vehicle. On the interceptor, we had a receiver." The launched missile
colluded in its own destruction, something that rarely happens in
warfare. The continued funding for the Star Wars initiative was
predicated on a hoax.
When news of the deception was revealed, in 1993, there were no

public outcries. Nobody in the Pentagon was punished. Pentagon
officials freely admitted the subterfuge. If there was any reaction, it
was congratulatory. Though Congress and U.S. citizens were
deceived, and the deception was sustained over the ensuing years of
the Reagan administration, and billions of dollars were wasted on a
senseless project, neither the Congress nor the public were outraged.
Why not?
Circa 1989, the Soviet empire collapsed. The Pentagon attributes the
collapse of the Soviet empire to economic exhaustion. According to
the Pentagon, it was Soviet policy to pump billions of dollars into a
military system that matched, project-by-project, the U.S. military
system. According to the Pentagon, the faked Star Wars test was a
clever ruse aimed at the Kremlin, not Congress (179). The Kremlin, it
seems, was suckered into investing money in their own impossible
Star Wars initiative. The Soviet's unsustainable military spending
spree, we are told, eventually led to the demise of the Soviet
communist state.
I have discussed this story with a number of scientists. None of my

colleagues have expressed any outrage. Everything seemed to turn
out well. The deception was a justifiable cold war strategy. Or was it?
Actually, there are some serious flaws in the Pentagon's story. First,
if the Kremlin scientists were fooled by the faked Star Wars test, and
if this led to unsustainable military spending, you might expect that
there would be a lot of retired Soviet military scientists to confirm the
assertion. Former Soviet scientists, military experts, and politicians
Page 185 of 355
blame the fall of Soviet Communism on a wide variety of complex

issues, all unrelated to Star Wars. We should not lose sight of the fact
that the test was a fraud, committed by military intelligence, the same
group who later told us that the fraud was part of a successful cold
war operation. Why would we believe the same people who lied to us
in the past?
Let's give the Pentagon the benefit of the doubt. Let's assume that the
fourth (faked) Star Wars test convinced the Soviet scientists that the
U.S. was close to developing a space-based weapon capable of
destroying Soviet nuclear missiles, before they reached their target.
This would mean that the U.S. would soon be capable of launching
their missiles at the Soviet Union, whenever they pleased, without the
threat of mutual nuclear annihilation. Essentially, the Soviets would
have no defense against nuclear attack. In this case, wouldn't the
Soviets be strongly motivated to launch an all-out preemptive nuclear
strike against the U.S., before the Star Wars initiative could be
deployed? If the Kremlin truly believed that the U.S. Star Wars test
was successful, wouldn't this precipitate a nuclear holocaust?
As an evil scientist, I think of the faked Star Wars test as a lie that
resulted in the career advancement of everyone involved in the lie
(project scientists and military planners). The hoax fooled Congress
and bilked the American taxpayers out of billions of dollars. The Star
Wars Project could have led to the end of the world, if the Kremlin
had been as gullible as the U.S. Congress.
A simple explanation for the Star Wars ruse is that the military enjoys
working on huge, complex projects, and the scientists involved in
these projects will go to extremes to defend their own interests. We
see that kind of thing happening all the time. One of the longest-
running endeavors involves the V-22 Osprey, affectionately renamed
"The Grand Ole Osprey." In the history of engineering, there have
been many attempts at dual-purposed devices: automobiles that can
sprout wings and fly, boats that come ashore and covert to
automobiles, washing machines that also dry clothes, houses on
wheels that can be towed, behind a car. All of these devices exist, but
they have not replaced single-purposed devices. It's very difficult to
Page 186 of 355
engineer a reliable and inexpensive composite device when each

component is complex.
Circa 1980, the Pentagon decided it needed a hybrid aircraft that

could take-off and land like a helicopter, but fly like a plane. Thus
began the long, expensive and disappointing sago of the V-22
Osprey. After more than a quarter century in the making, and $16
billion dollars spent, the U.S. government has not created a safe and
dependable aircraft. Through the years, multiple crashes of the
Osprey have resulted in 30 deaths. One might think that somewhere
during 22 years of troubled development, someone might have put a
halt to the program. Actually, there is little incentive to stop a multi-
billion dollar funding project. Nobody wants the gravy train to come
to a halt.
In January, 2001, the New York times reported that a Marine

Lieutenant-Colonel had been fired for falsifying Osprey records and
for ordering the members of his squadron to do the same (180). "We
need to lie or manipulate the data, or however you wanna call it," he
said (181). The lies were intended to win new funding, but a
squadron member caught the orders on tape.
All is not lost for the Osprey. Mike Lieberman, a military affairs aide
on the House Armed Services Committee, was quoted by a Wired
article as saying, "My God, we've thrown so much money at it, we
have to get something out of it. (181)" Yes, the Grand Ole Osprey has
grown too big to fail.
12.1 GOVERNMENT COVER-UPS
"There is no trick to being a humorist when you have the whole

government working for you."
-Will Rogers
When people eagerly consume official government lies, it hardly

seems worth the effort to cover-up the facts. Still, you can argue that
it's easier to hide the truth than to invent a lie.
One of the most outrageous medical cover-ups occurred in April,
Page 187 of 355
1979 in an area 850 miles east of Moscow, in a building designated

compound 19, now the acknowledged site of cold war biologics
research. Simon LeVay, in When Science Goes Wrong, describes an
incident when anthrax was accidentally disseminated through the air
ducts of compound 19, and into the immediate environs. Spores
settled in the lungs of the unfortunate inhabitants of Sverlovsk (182).
During the ensuing six-week period, about 76 people became ill, and
at least 66 people died.
The U.S. State Department made public their suspicions that the
anthrax outbreak was the result of a germ warfare experiment gone
awry. The Soviet Union was a signator of a multinational agreement
banning the development and deployment of biological and toxic
weapons. If the accusation were true, the Soviet Union would have
been in breach of the treaty.
Russian authorities acknowledged the anthrax outbreak, but insisted

that it was animal-born, originating in farm animals and spreading to
humans via the ingestion of black market meat. This explanation
raised certain suspicions, because the anthrax illness was pulmonic
(involving the lungs, as would occur if spores were inhaled).
Symptoms did not involve the skin (as would occur if infected
animals were handled) or the gastrointestinal tract (as would occur if
infected meat were eaten). The date of occurrence did not fit an
animal outbreak. April in Sverlovsk is cold, and animals are not put
to pasture (where the anthrax lives) until the Russian spring.
Moreover, the victims did not cluster within families. If the epidemic
arose from infected meat, we would expect victims to cluster as
infected households.
There followed a decade or more of erudite scientific discussions,

accusing and defending the Soviet authorities of causing the
outbreak. In general, those who had a vested interest in exonerating
the Russians argued on the side of innocence. The anti-Soviets,
particularly the CIA, were inclined to argue on the side of guilt.
After the fall of the Soviet Union, forthcoming detailed accounts

clarified that the outbreak resulted from a containment breach in the
germ warfare facility; a crucial filter was removed and not replaced.
Page 188 of 355
Boris Yeltsin eventually ordered compensation for the victimized

families; compensation that never came.
12.2 GOVERNMENT AGAINST THE PEOPLE
"Be thankful we're not getting all the government we're paying for."
-Will Rogers
Nobody is really surprised when government-sponsored research fails

to meet its goals. Far more sinister is the use of government research
for the purpose of killing its own citizens. On June 12, 1998, the
[Baltimore] Sun reported on a South African government-funded
laboratory that developed ingenious methods to eliminate opposition
(from its own citizenry) and to reduce its black population (183). In
the early 1980s, according to the article, the Roodeplaat Research
Laboratories produced more than 500 items "ranging from chocolates
laced with botulism to cigarettes with anthrax and whiskey with
weedkiller." According to testimony, an anti-apartheid sympathizer
was killed, in 1984, with a simulated snake-bite. A black dissident
was killed with a paroxane-soaked shirt. According to testimony from
scientists who had worked at the laboratory, the biggest project was
the infertility project; designed to reduce the fertility of black
citizens, while sparing white citizens.
When questioned, scientists from the lab indicated that they worked
under the threat of assassination. If they refused to work, they would
be killed. Certainly, the threat of assassination is a strong motivator,
but you must stop and think that a laboratory staffed entirely of
scientists working under the threat of death might not function at
peak efficiency. Wouldn't the workers, about 2:00 each day, say to
themselves, "Well, I've worked enough to avoid being assassinated
tonight. I think I can knock off for the day." You would think that
when staffing a government laboratory whose purpose is to invent
weapons for use against its own citizens, one might be somewhat
selective. During the job interview, openly evil scientists would have
a hiring advantage over scientists who profess goodness.
12.3 THE POWER OF BUREAUCRATS
Page 189 of 355
"The brain is a wonderful organ; it starts working the moment you

get up in the morning, and does not stop until you get to the office."
-Robert Frost
Sometimes, if you procrastinate long enough and well enough,

somebody else will do your work for you. If you're really lucky, you
can submit the work as your own, and take all the credit.
Government bureaucrats, if you didn't already know, wield enormous

power. They can make your life miserable just by "misplacing" a
form or a letter. When it comes to bureaucracies, no country has a
longer history than China. Confucious (551 B.C.E. - 479 B.C.E.)
admired the Chinese bureaucracy so much that he transformed it into
a religion. Though the Imperial bureaucracy ended in 1905,
Communism eventually restored the status quo. Today, in China,
everyone has a file, containing their academic records, locked in a
bureaucrat's cabinet. If your file shows an unblemished history of
high achievement, you can expect to get a very good job. A history of
failures and low achievement will work against you. If your file is
lost, you vanish. In 2009, The New York Times reported the sad
story of a promising student whose file mysteriously disappeared,
along with his academic standing (184). Accusations were raised that
officials stole the files, removed identifiers, and sold the files to
underachievers who could afford to pay a bribe to acquire an
exemplary academic record (184).
Whereas many powerful scientists actively exercise their influence,

the bureaucrat, like the Aikido warrior, practices a passive
philosophy. Much can be accomplished by not doing. For example,
suppose the rich inner life of a powerful bureaucrat is interrupted by a
work request. The following steps must be observed:
1. Work requests received without a clear chain of evidence, linking

you to the request, should be immediately destroyed, regardless of
who submitted the request. If anyone ever asks, just say that you
never got the request. Requests should be tracked through the system,
recording the persons and times involved in for each step in handling
Page 190 of 355
the request. It's the system's fault if they pass you an untracked
request. By destroying un-tracked requests, you're actually improving
service, by punishing those who would bypass the system.
2. Work requests received from an unimportant person, even with a

clear path to you, can be ignored. If anyone asks why nothing has
been done, indicate that you are prioritizing your work.
3. Work requests received from an important person should be done

slowly. If you return the work quickly, they'll expect a fast turn-
around in the future.
1. Sometimes, a scientist, in the course of his research, discovers that

his project cannot possibly succeed. The evil scientist is obligated to
keep the funding coming, in the face of demonstrated failure. Military
research projects provide many examples of failed projects that are
kept on artificial life support, sometimes for decades, with billions of
dollars wasted.
2. Not infrequently, governments will promote some completely

nonsensical device, process, standard, or idea. You know it cannot
succeed. Nonetheless, so long as it has the government's
endorsement, you stand to make some profit by playing along.
3. The Federal workforce is composed primarily of low-grade

bureaucrats who have no particular party loyalty. However, the
highest ranking government bureaucrats hold presidential
appointments. Heads of agencies will tend to make decisions that
reflect the philosophy and the culture of the administration that hired
them. If you want to get ahead in a federal agency, you should
carefully watch to see which way the wind is blowing on Capitol
Hill.
CHAPTER 13. CORPORATIONS AND EVIL SCIENCE
"This is a government of the people, by the people and for the people
no longer. It is a government of corporations, by corporations, and for
corporations."
Page 191 of 355
-Rutherford B. Hayes, U.S. President 1877 - 1881
A corporation is a legal construction that exists separately from the

people who created it. Corporations exist to make money and to
survive. Corporate activities that do not create wealth and do not
extend the life of the corporation are always dysfunctional and can
trigger a legal action against the agents of the corporation (e.g., the
CEO and Board of Directors).
Corporations have rights and protections much like those of humans,

under the legal doctrine of "corporate personhood." In addition,
corporations have certain defining rights (not granted to private
citizens), and rights attained through the application of wealth and
power (not available to private citizens). Here are a few examples:
1. Limited liability. If a corporation fails, shareholders only lose their

investment. They are not liable to pay the debts held by the
corporation.
2. Tax advantages. Some large corporations may pay little or no tax.
3. Immortality. There is no natural life-span that limits a corporation.

Companies can live forever, as long as they continue to create wealth.
A corporation may be too big to be allowed to fail; the government
will provide artificial life support at taxpayer expense. There are no
humans who are too important to die.
4. Power. Corporations can afford to hire teams of lobbyists, public

relations managers, and lawyers to promote or defend their interests.
5. Political influence. In 2010, the Supreme Court affirmed the first

amendment right of corporations to contribute as much as they please
to promote the election of a favored office-holder (185). Eventually,
all three three branches of U.S. government will be owned by
corporations.
6. Unrestricted conflicts of interest. Corporations can hire employees

directly from government agencies, thus providing corporations with
inside knowledge of regulatory plans and tactics. In addition,
Page 192 of 355
government organizations can, and do, hire their leadership from the
corporations that they regulate, thus inculcating friendships and
loyalties with the same corporations that government must regulate.
7. Right to sue humans. Corporations can bring legal actions against

citizens.
8. Right to "take". Corporations can take property from citizens when

the government asserts eminent domain (Kelo v New London, 2005
(186)).
The kinds of profit made by large corporations are enormous, and the
fines they pay for their indiscretions are proportionately large. For
example, Siemens AG, was found guilty of bribing foreign officials,
to obtain contracts (173), (187). This kind of corruption, is
considered by some corporate executives to be standard operating
procedure, and just another cost of doing global business (187). If so,
why would a corporation try so very hard to bury their bribery
payments in their books? In the Siemens case, Siemens pleaded
guilty to criminal violations of the books and records laws (173).
More than $1.6 billion in fines and penalties was levied against
Siemens (173).
The Johns-Manville corporation was an early adapter of asbestos, a

mineral fiber with extraordinary fire and heat resistance, used for a
wide variety of industrial and domestic purposes. Unfortunately for
Johns-Manville, asbestos causes mesothelioma, a malignant cancer
that rarely arises in the absence of asbestos exposure. Asbestos also
causes an incapacitating lung disease (asbestosis) that often leads to
death. Claims against the company led to chapter 11 bankruptcy. A
Trust was created to deal specifically with tort claims. As of March
31, 2007 the Trust had received 782,349 claims and had made total
claim payments of approximately $3.4 billion (188).
These settlements pale in comparison to the fees paid by the tobacco

companies, which total in the hundreds of billions of dollars. Still,
cigarette advertisements continue, much as they did in the past (189).
13.1 ERBITUX AND THE BRAVE NEW WORLD OF GENE
Page 193 of 355
TARGETED THERAPY
"People who enjoy eating sausage and obey the law should not watch
either being made"
-Otto von Bismarck
Erbitux is an anti-cancer drug developed by ImClone Systems, Inc.

On March 1, 2006, the FDA approved Erbitux for use in squamous
carcinoma of the head and neck. In the first nine months of 2007,
sales totaled about $1 billion (190). This all sounds well and good,
but the apparently happy ending for ImClone follows a long and
turbulent history.
On December 28, 2001, the FDA informed ImClone that it would not
receive fast track approval for its anti-cancer drug, Erbitux (191).
On December 27, 2001, one day before the FDA's action, Zvi Fuks,
chairman of the department of radiation oncology at Memorial Sloan-
Kettering Cancer Center, sold over $5 million worth of ImClone
stock. In 2005, Zvi Fuks was charged with securities fraud and
conspiracy to commit securities fraud. In the criminal complaint,
Fuks was accused of acting on an insider tip-off, passed by ImClone's
then CEO, Samuel Waksal (192), (193), (194). On June 10, 2003
Samuel Waksal was sentenced to 87 months in prison and ordered to
pay $3 million in fines for tax evasion and insider trading (195).
ImClone insider trading was not the exclusive domain of scientists;
etiquette guru Martha Stewart also indulged. Stewart was charged
with securities fraud and obstruction of justice, and served a five
month prison term, starting in 2004.
The House Energy and Commerce Committee investigated the

ImClone application for FDA approval. The Committee invited
testimony from Dr. Raymond Weiss, a medical oncologist from
Georgetown University. After reviewing ImClone's data, Weiss
found that nearly 27% (37 out of 139) of the trial patients did not
meet criteria for inclusion in the trial. Furthermore, 15 of the 37
unqualified patients were entered into the trial through waivers, a
forbidden practice, according to Weiss.
Page 194 of 355
In 2007, ImClone was scheduled to appear in court to battle a patent

infringement lawsuit brought by MIT, and a biopharmaceutical firm,
Repligen. One day before the scheduled court date, ImClone paid
MIT and Repligen $65 million to settle the case (196).
Ambitious scientific ventures can be very messy. Like sausages and

legislation, if you like science, you should never watch it being made.
13.2 IT PAYS TO ADVERTISE
"Without the people who go to far, we wouldn't go far enough."
-Michael Kinsley
You are an overweight middle aged man, who leads a

sedentary life. You have dangerously high blood levels
cholesterol and triglycerides. Your doctor has put you on a
strict diet, with instructions for daily exercise, and has
prescribed simvastatin, a low-cost, generic statin, to control
your dyslipidemia.
While watching TV, you see a commercial, featuring Dr. Robert

Jarvik, inventor of the Jarvik artificial heart, talking about the
benefits of Lipitor. The scene shifts from a close-up view of Dr.
Jarvik, to a panoramic view of a man who looks like Dr. Jarvik,
rowing a canoe. In the space of a short commercial, you make the
following assumptions.
1. You assume that Dr. Jarvik was the inventor of the Jarvik heart.
2. You assume that artificial hearts, like artificial hips, and artificial
breasts, are a practical alternative to natural hearts.
3. You assume that Dr. Jarvik was making a public service

announcement, not a crass advertisement. Dr. Jarvik was paid in
excess of $1 million dollars for his spot in the commercial.
4. You assume that Dr. Jarvik is a practicing physician.
5. You assume that Dr. Jarvik has expertise in the pharmacologic
Page 195 of 355
field relevant to lipitor (dyslipidemias and their treatment).
6. You assume that Dr. Jarvik had some professional experience with
Lipitor.
7. You assume that Dr. Jarvik rowed the canoe.
8. You tell your doctor to switch your cholesterol-lowering

medication from the cheap generic drug (simvastatin) to the high-
priced patented drug, Lipitor. If he asks why, you tell him that Dr.
Jarvik recommended Lipitor.
Your assumptions about the Lipitor ad were inaccurate (197). Let's

review:
1. Dr. Jarvik was not the inventor of the Jarvik heart; at least, not the
sole inventor. Remember Stigler's Law of Eponymy, "Credit always
goes to the wrong person." The father of the Jarvik artificial heart
was Kolff, who never commercialized his name. A large team of
scientists developed the Jarvik heart. Kolff brought Jarvik into the
project.
2. Artificial hearts are not practical alternatives to natural hearts.

Though originally designed as a permanent replacement for failing
hearts, a succession of artificial hearts, including the Jarvik, failed to
do the job. Today, artificial hearts are bridge devices; they keep
patients alive from the time that their natural hearts fail until the the
time that they receive a transplant heart. It's more accurate to think of
these devices as types of cardiopulmonary bypass machines, and not
as artificial hearts.
3. Though the commercial had the appearance of a public service

announcement produced by a kindly, concerned cardiologist, it was,
in fact, a carefully choreographed advertisement produced by a large
pharmaceutical corporation with the single goal of increasing Lipitor
sales. Dr. Jarvik was paid in excess of $1 million dollars for
participating in the project.
4. Dr. Jarvik received an M.D., but never pursued the post-doctoral

ordeals that that qualify practicing physicians: internship, residence,
Page 196 of 355
fellowship. Nor did he pass any medical specialty Boards that certify
competence in a particular area of patient care.
5. Dr. Jarvik has no professional expertise or experience in the

dysplipidemias, or their treatment.
6. Dr. Jarvik is not a cardiologist, and has never prescribed Lipitor.
7. An actor, who looked like Dr. Jarvik from a distance, rowed the
canoe.
The Jarvik commercial was caught up in a congressional

investigation into false and misleading advertising by the
pharmaceutical industry; the ads were pulled (197).
Did Dr. Jarvik commit any crime? No. Did the pharmaceutical
company commit any crime? No. How are Lipitor sales doing?
Lipitor is the number one selling statin drug. Global annual sales of
Lipitor exceed $13 billion.
The Lipitor story has a moral. Corporations exist for the purpose of
making money. When a corporation advertises, the purpose of the
advertisement is to promote a product, and not to provide an accurate
representation of reality.
13.3 SCIENTIFIC ORGANIZATIONS ARE INSTRUMENTS

OF LARGE CORPORATIONS
"The strongest man is he who stands alone in the world."
-Henrik Ibsen.
Do you belong to a scientific organization? If so, have you read your

organization's charter? Every charter lists the purpose of the
organization, and this usually involves the advancement of a field of
science through the efforts of the membership. The charter is always
a distortion of reality, because most organizations exist to serve the
interests of their sponsors. It's a matter of economics. Organizations
attract members by holding lavish conferences that attract many
influential leaders. Big conferences cost a lot of money; much more
Page 197 of 355
money than the membership provides through dues and registration

fees. Consequently, conferences turn to corporations to make up the
difference (and then some). He who pays the piper calls the tune. The
culture of the organization, the scientific direction of meetings, and
the type of people accepted into leadership positions in scientific
organizations are all determined by the sponsoring corporations.
Every successful scientific organization has the following attributes:
1. Sponsors. The sponsors are often corporations, but they can

include any type of entity with power and money (e.g., government
agencies).
2. Authority in its scientific field. This can be obtained through a

large membership, or through the participation of powerful figures.
3. Numerous lavish, well-attended, meetings.
4. Intellectual property. For example, The American Chemical

Society owns Chemical Abstract Services, the American Medical
Association owns the CPT (Current Procedural Terminology) that
hospitals use to assign billing codes patient care transactions, the
IEEE (Institute of Electrical and Electronics Engineers) owns the
IEEE Standards Association. Many professional organizations own
and publish successful journals.
5. Official status. Powerful organizations often serve the government

in an official capacity. For example the National Academy of
Sciences was signed into being by President Abraham Lincoln, and is
mandated to provide advice to the Federal government.
6. Lobbying activities. Many professional organizations maintain

offices or headquarters in Washington, D.C., so they can effectively
promote their interests to Congress.
7. Cultural monopoly. A successful corporation sets the mindset of

the field it represents. People who think and operate outside the
culture are typically fringe players, with no influence.
8. Credentialing. Powerful professional organizations can sometimes
Page 198 of 355
determine who gets to be credentialed as a professional. For example,

the College of American Pathologists offers credentialing services for
laboratories and laboratory testing services. The Society of Actuaries
administers the actuarial exams.
9. Wealth. Large organizations have lots of money.
9. Non-profit status. Yes, you can be rich as Croesus and still have a
non-profit status.
1. Corporations have more legal rights and more legal power than
individual citizens. Evil scientists should not mess with corporations.
2. Without corporate money, organizations die. Corporate sponsors

pay for the lavish meetings, high speaker fees, abundant meals and
refreshments, travel perks, lobbyists, publications, and administrative
expenses of every successful professional organization. Evil
professional organizations will exert their influence for the benefit of
the sponsoring corporations.
3. The difference between an irresponsible corporation and an

responsible corporation is the focus. Irresponsible corporations focus
on their successes; what makes them money. You can't argue with
success! Responsible corporations focus on their mistakes: what can
be done to avoid errors and improve their corporate productivity.
Nobody wants to live under the never-ending burden of self-
improvement.
CHAPTER 14. UNIVERSITIES AND EVIL SCIENCE
"A professor is someone who talks in someone else's sleep."
-Anonymous
Though Universities promote themselves as egalitarian institutions,

where admission and advancement are based on academic merit, this
is hardly accurate. Universities, like Corporations, exist for the
purpose of achieving wealth and perpetual life. The goal of every
Page 199 of 355
university operation, including admissions, is directed toward

enhancing the wealth and health of the university.
The Madey v Duke lawsuit settled any lingering doubts as to the self-
serving motives of academic institutions. John Madey was a lab
director who was fired from his position at Duke University. Madey
owned patents preceding his job at Duke. Duke used those patents
without paying royalties, prompting Madey's suit against the
university. Duke asserted the traditional academic "experimental use"
protection. Duke also asserted that the patents had been developed for
the government. Because, Duke argued, the patent was used to fulfill
their work under a government contract, the government's own
exemption from patent costs should extend to Duke.
The District Court upheld Duke's positions, but the Federal Court
reversed the District court decision in favor of Madey (198). Though
Duke's work was done under a government contract, the Federal
Court held that the activities in question advanced the interests of the
University, and were not done for the Federal Government and were
not motivated by non-commercial scientific curiosity. In its reversal
decision, the Federal Court affirmed the obvious truth that academic
centers have the same goals as corporations; the accumulation of
wealth and power and the perpetuation of their own existence.
The commercial interests of universities was further demonstrated in

Greenberg v. Miami Children's Hospital. The Greenbergs and about
150 other families provided funds, tissues, and a range of services in
support of Dr. Reuben Matalon's efforts to find the gene responsible
for Canavan disease. He succeeded, and promptly patented the gene,
for his employer, Miami Children's Hospital (U.S. patent 5,679,635,
October 21, 1997). The Miami Children's Hospital charged a royalty
fee for the test. The families, thinking that their donations of time,
materials and money had supported an altruistic effort, were shocked
that Miami Children's Hospital was trying to profit from the the
misfortune of those with Canavan's disease; hence the lawsuit. Miami
Children's Hospital essentially won the settlement, and was permitted
to continue to charge royalties for the use of their diagnostic test
(199). However, the settlement provided that scientists could use the
Page 200 of 355
gene, without paying royalties, for research purposes only. Once

again, we learn that researchers and institutions are inspired by the
universal motivator: money.
Universities, like other corporations, lobby for influence and money.

In his book, "So damn much money: The triumph of lobbying and the
corrosion of American government" (Knopf, 2009), Robert Kaiser
discusses a successful lobbying effort conducted by Tufts University,
in 1976. Jean Mayer, world-famous nutritionist and President of
Tufts, wanted a nutrition center on the Tufts campus. He sought the
services of the lobbying firm, Cassidy and Associates. Gerald
Cassidy was an avid reader of the Congressional Record. He learned
that a law had been passed authorizing a national nutrition center.
After a talk with Tip O'Neill, Congressman from Massachusetts,
newly elected Speaker of the House, and personal friend of Jean
Mayer, Congress appropriated $27 million, for the center known
today as the Jean Mayer USDA Human Nutrition Research Center on
Aging.
In a story reported in the New York Times, the School of Ostopathic

Medicine at the University of Medicine and Dentistry of New Jersey
hired a powerful state legislator. There followed a dramatic increase
in legislated funds funneled to the university (200). Apparently, the
legislator was hired to lobby himself!
Every university president knows that the right word, from the right
lobbyist, at the right time, to the right politician, can bring millions of
dollars.
14.1 ACADEMIC FREEDOM IS THE FREEDOM TO LIE TO

YOUR STUDENTS
"Wise men may not be learned; learned men may not be wise."
-Chinese proverb
If you are a student, you only know what you're told by your
instructors. If your opinions on a subject differ from those of the
instructor, you will learn, when you fail the final examination, that
your opinions have no value. Consequently, students accept whatever
Page 201 of 355
nonsense a professor professes to be true.
When a professor has a conflict of interest that influences the content

of his lectures, the results could be very detrimental for students. At
Harvard, students were lectured by a professor who strongly
promoted the benefits of a cholesterol lowering drug. The same
professor, when confronted by a student who asked about adverse
side effects of the drug, was answered with a comment that seemed to
belittle the student. The students later learned that the same professor
was a paid consultant for ten pharmaceutical companies, including
five companies that manufactured cholesterol lowering drugs (41).
In the case of Harvard Medical School, about 1,600 faculty have

disclosed that they, or their close family members, have financial
arrangements with businesses tied to their teaching, research, or
clinical care responsibilities (41). The former dean of Harvard
Medical School served on the board of Baxter International, a
medical products company that supplemented his dean's salary with
up to $197,000 per year (41).
The corporate takeover of academia has the flavor of cheesy science

fiction plot:
1. Non-human corporations invade the minds of faculty (with money)

and take control of their thoughts;
2. Faculty enlist legions of students using slogans and speeches

prepared by the supreme commander of the corporate forces;
3. A student uprising against the faculty is suppressed, using a

diabolical super-weapon, academic freedom, that selectively destroys
students.
4. The student body capitulates, and obeys the commands of the

faculty.
5. Students, the subjects of non-human corporate mind-control,

graduate to become the next generation of faculty.
What is the difference between science fiction and real life? It costs
Page 202 of 355
$8 to send your child to a science fiction movie; it costs $266,000 to

send your child to four years at Harvard Medical School.
How can the faculty receive money from pharmaceutical companies

and promote the interests of these companies in their lectures to
students? Isn't this a flagrant conflict of interest? Of course, but there
is a loophole that protects the faculty, and the loophole is called
academic freedom. Academic freedom permits professors to make
assertions that are unpopular. Academic freedom also provides
faculty with the right to operate openly, as the shill of corporate
interests. This means that academic faculty can openly promote the
positions of their corporate sponsors, even when those positions have
no scientific merit. The most important feature of academic freedom
is that it belongs to the faculty, not the students. Students, you see,
are the victims of academic freedoms exercised their instructors.
When students attempt to use the same freedoms enjoyed by their

professors, the consequences can be dire. The Christian Science
monitor reported the unusual fate of Petr Taborsky, who worked on a
corporate-sponsored science project as a University of South Florida
(USF) student (201). According to Mr. Taborsky, he developed a new
way of purifying waste water while participating in the project. The
USF took an interest in the research, claiming ownership of the
process. A judge agreed, forbidding Mr. Taborsky to use the research
data. Mr. Taborsky had other ideas, and proceeded to successfully
patent the process. When he refused to sign the patents over to the
university, he was sent to prison, where he served on a chain gang.
Universities are ruthless, greedy entities no different from
corporations. If anyone doubts this, just ask Petr Taborsky.
It's easy to exploit students. A popular tactic is to divvy up their

responsibilities on a research project, keeping each participant
ignorant of the others' work, and taking credit for the total product.
Here is an example of how the process might unfold:
1. A graduate student isolates a class of related chemical compounds,

obtained from an herb. The herb is touted, by traditional Chinese
healers, to have anti-cancer activity. The related chemical compounds
Page 203 of 355
have some inhibitory effect on a cellular pathway known to be

activated by an oncogene.
2. Another graduate student, in the same lab, develops methods to

isolate, purify, and chemically characterize the different active
compounds.
3. Another graduate student, in the same lab, demonstrates that these

compounds inhibit the proliferation of several different cancer cell
lines.
4. The laboratory chief (a full professor in the University, and a paid

consultant for 15 different pharmaceutical companies) contacts the
University's Technology Transfer Office. Plans are laid to patent the
class of compound as an anti-cancer treatment, based entirely on cell
line studies, with no actual anti-cancer trials in any animals or in
humans. Under the University's technology transfer policies, the
patent will be assigned to the University. The laboratory chief will
receive 25% of any patent royalties and licensing fees received by the
University. The graduate students who had key roles in the discovery,
will receive nothing; neither will the traditional Chinese healers.
Though universities and faculty make a big show of academic

freedom, most faculty will gladly sign away their freedom to
corporations; if the price is right. Thirty-five percent of agreements
signed between industry and academic researchers allow the sponsor
to delete information from publications; 53% allow sponsors to delay
publications (202). Basically, what a professor says, and when he
says it, can be determined by his industry sponsor.
14.2 THE FERTILE GROUND EXCUSE
"For what vice, pray, has ever lacked its defender?"
-Seneca (about 2000 years ago)
Just as academic faculties enjoy protections under the guise of

academic freedom, university administrators seek refuge under the
"fertile ground" principle (203). Basically, "fertile ground" depicts
universities as nurturing environments in which students develop into
Page 204 of 355
national assets. Extending the analogy, the best fertile ground is

covered by manure and compost.
Fertile ground distinguishes the ivy leagues from the on-line

universities and the community colleges. It promotes the idea that if
you haven't been immersed in the cultural milieu provided by a
prestigious college, you haven't been adequately educated. With
fertile ground under your feet, you can let education lie fallow for a
few generations. Providing a strong curriculum, with qualified
teachers, and stringent criteria for grading becomes less important
than establishing a diverse student body, famous faculty, and
influential administrators. Successful football and basketball teams
contribute to the fertile ground of a university. Generous athletic
scholarships for non-scholars is par for the course, along with
obscenely high salaries for coaches.
In a fertile ground university, academic faculty are not required to

teach, if they bring prestige or money into the university. The
University of Medicine and Dentistry of New Jersey was forced to
fire cardiologists when a newspaper investigation uncovered that the
staff members did no actual work for the University. The
cardiologists were given academic titles and were paid as much as
$150,000; but their only university-related activity involved referring
patients to the University Hospital (204). Federal law forbids
payments for referrals, but federal law does not forbid the
appointment of academic faculty who do little or no work. The issue
was eventually settled in court. The U.S. Attorney's Office got a $1.4
million settlement with one of the cardiologists, for taking a salary
from the UMDNH while improperly referring cardiac patients (205).
In an investigative article written for The Washingtonian, Harry Jaffe

recounted the imperial lifestyle and lavish expenses incurred by a
former president of American University (206). Eventually, his
personal expenses, charged to American University, upset the wrong
people; the details of his lifestyle were leaked to the public. American
University's problems multiplied when federal prosecutors began to
serve subpoenas for financial records. The high-maintenance
president departed, but not without providing a glimpse of the strange
Page 205 of 355
fruit grown from the fertile ground of academia.
1. Universities have the same aspirations as corporations: the

acquisition of wealth, and the perpetuation of existence.
2. Universities don't want to advance science, they want to cash in on

science.
3. Academic freedom is the right of university faculty to abridge the

academic rights of students.
4. Universities can lobby for whatever they please: money, scientific

legitimacy, grants, contracts, privileged treatment. Universities can
hire public relations firms, advertising agencies, and lobbyists that
promote a particular scientific opinion. They can create bogus think
tanks that issue technical reports that promote their own views. Truth
is determined by the loudest university.
CHAPTER 15. ETHICS, AND THE AVOIDANCE OF SAME
"Science doesn't work because we're all nice. Newton may have been
an ass, but the theory of gravity still works."
-Gavin A. Schmidt, NASA climatologist (207).
In the realm of human subjects research, the ultimate bastion of ethics

resides in the IRBs (Institutional Review Boards). In the U.S., an IRB
is a committee formed by institutions that receive federal funding for
human subject research. IRBs operate in accordance with a regulation
known as the Common Rule (208). Other countries have their own
versions of IRBs. Their mission is to protect human research subjects
from harm. Investigators who conduct human subject research must
submit their research proposals to an IRB; research cannot proceed
without IRB approval.
The bulk of the members of an IRB are drawn from staff within the
institution. Individual IRB members come with their own biases,
their own perceptions of human subject risks, and their own personal
Page 206 of 355
and professional agendas. IRBs are the natural enemy of

investigators, who see the IRB as an existential threat. Here are some
problems that researchers might have with their IRBs:
1. IRBs may not like certain research fields, finding them inherently
harmful to patients, essentially stopping the career of faculty who
work in the field.
2. IRBs may dislike particular researchers. Death by nitpicking is the

standard punishment reserved for unpopular investigators.
3. In an effort to protect the sovereignty of the IRB, the Common

Rule provides no mechanism wherein investigators can demand
accountability for bad IRB decisions. Any IRB can hound any
investigator to distraction, without needing to justify their actions to a
higher authority.
4. IRBs have notoriously poor communication with investigators.

Final judgments are issued without explaining to the investigator
what he must do to submit a proposal that would be acceptable to the
IRB.
5. IRBs often have nobody on the committee who can competently

read the proposal. IRBs seldom try to maintain the pretense of
scientific competence, taking the position that their job is to assess
risks to patients, not judge the research on its scientific merits. This
skirts the issue that if they do not understand the science, they cannot
estimate the resulting risks. When in doubt about research risks, IRBs
tend to err on the side of "no".
6. IRBs don't have a very good record regarding consistency; handing

down a rejection a trial that has the same research risks as another
trial that was previously accepted by the same IRB. IRB committee
turnover contributes to the problem, but the overall lack of firm
principles of operation probably accounts for the bulk of inconsistent
judgments.
7. There is wide variability in the way that different IRBs operate. A

project that is approved at one IRB can be summarily rejected by a
different IRB. Some of these inter-institutional differences may be
Page 207 of 355
due to the many ways that the Common Rule regulation is

interpreted.
8. IRBs have a tendency to be overly protective of human research

subjects. Whereas the Common Rule is designed to protect research
subjects from harm, many IRBs protect research subjects from any
perceived annoyance or inequity, no matter how trivial or unlikely. In
many cases, such protections, if enforced, would abrogate the
scientific value of proposals.
9. Principle 19 of the World Medical Association's Helsinki

Declaration (209) states the following: "Medical research is only
justified if there is a reasonable likelihood that the populations in
which the research is carried out stand to benefit from the results of
the research." The ugly truth is that there is never a reasonable
likelihood that anyone, other than the researchers themselves, will
benefit from the results of the research. Consider the field of cancer
research. Despite hundreds of thousands of experimental studies, we
don't have a cure for cancer, but we have produced thousands of
smug, well-funded scientists. Knowing this, it would be fair to say
that every future cancer study will have the same likelihood of
success as all of the past experiments; that's a number pretty close to
zero. If human subject research required a likely benefit for the
subjects, all clinical research would come to a grinding halt.
10. IRB decisions have finality. Investigators cannot appeal decisions

rendered by the IRB. The only solution for a rejected proposal is to
come back to the same IRB with a new proposal.
In the U.S., the Office of Human Research Protections (OHRP)

registers and regulates IRBs. You might think, that with all the angst
generated by IRB decisions, the OHRP might focus its attention on
the decision-making process. Not so. The OHRP is not in the habit of
faulting IRBs for bad decisions. Like any government office, the
OHRP is all about processes (not results) (210), (211). IRBs must
ensure the OHRP that approved protocols are legitimate (the
applicant did not misrepresent the study presented to the IRB), that
researchers are not conflicted by financial or other interests that
might lead them to harm patients, that the actual trial conforms to the
Page 208 of 355
submitted protocol (no bait and switch), that adverse events are
reported, and that these activities are documented and organized (so
they can be found), dated accurately, and saved. The job of an IRB is
to develop and deploy a well-documented process for approving and
following protocols. That's all.
You might think that institutions could assemble and operate a

smoothly functioning IRB. It seldom happens. Here are just some of
the many rituals followed by institutions that run IRBs: providing no
guidance to the members of the IRB; placing lazy and unqualified
staff into IRB positions, as a sort of administrative punishment;
bullying IRB members into approving or disapproving protocols for
reasons unrelated to human subject protection; placing staff into IRB
positions who have known conflicts of interest stemming from
financial arrangements with drug companies; performing no quality
assurance over the general activities of the IRB, to ensure that the
IRB is adequately fulfilling its responsibilities.
Despite their limited functions, IRBs manage to make life miserable

for many of the most ambitious and innovative researchers. What can
evil scientists do to protect themselves from the people who are
trying to protect human research subjects? Keith-Spiegel and
Koocher have written a fascinating report, describing some of the
tactics used by investigators (212). Because the Common Rule only
covers research, investigators will disguise their data-collection as
non-research activities. Non-research activities might include
teaching, or quality assurance, or clinical documentation. If a data set
collected under a non-research pretense looks promising, the
investigator can submit an IRB proposal to use the data in a research
publication. Keith-Spiegel and Koocher discuss the plight of
researchers delayed by the infrequency of IRB meetings. The IRB
can take many months to review a research application; during which
time, researchers are expected to wait. Not surprisingly, some
researchers will forge ahead, seizing the initiative and braving the
consequences (212). Other investigators, burnt by past encounters
with IRBs, omit or gloss over information that might provoke the
IRB to reject their protocols (212).
Page 209 of 355
Institutions are often clueless on matters relating to the execution of

approved protocols. Those who actually conduct clinical trials often
have little or no research training. In a recent article entitled, "Should
the NCI worry about community research?", Alan C. Milstein, an
attorney, in reference to protocol oversight, was quoted as saying, "I
have deposed researchers in these situations where the answers are
just startling, to the point where I have asked them 'did you read the
protocol?' And the answer is no. (213)"
15.1 CONSENT AND UNCONSENT
We are just "a volume of diseases bound together."
-John Donne
Human subject protection usually begins with consent. Patients who

are put at any risk in an experimental study must be provided with the
right to just say no. To this end, researchers must provide prospective
human subjects with a consent form that states the purpose of the
study, the risks involved, and that discloses any information that
might reasonably affect the participant's decision to participate (such
as financial conflicts of interest among the researchers). The consent
form must be understandable to laymen, must be revocable (subjects
can change their mind and withdraw from the study), must not
contain exculpatory language (no waivers of responsibility for the
researchers), must not promise any benefit to the participants, and
must not be coercive.
The non-coercive rule is subject to wide degree of moral latitude. In

the operating room, your surgeon holds your vital organs, knife at-
the-ready; your life or your death in his hands. When this man hands
you a consent form and asks you to sign it, are you likely to say no?
Veteran doctors know that any amount of patient resistance to any

type of consent form can be overcome with the proper application of
psychologic pressure. When the consent form needs to be signed by
the close relatives, or by a guardian, use a guilt-soaked admonition:
"If you don't sign this, you're sentencing your (father, mother, sister,
Page 210 of 355
brother, son, daughter) to death, and you will have to live with the
consequences of that decision."
If things don't work out exactly as hoped, and the patient dies, the
doctor may ask the next-of-kin for permission to perform an autopsy.
In this case, indirection is key. The best strategy is to join the
relatives in a defensive action against phantom bureaucrats. First, ask
"Have the administrators informed you of your rights to have your
(father, mother, sister, brother, son, daughter) autopsied?" The
relatives will answer in the negative. Then say, "I don't know what
their game is, but let me tell you that whenever a patient dies in this
hospital, the relatives have the right to request an autopsy that will be
done at no cost to them; the hospital will pay for it. Don't let the
hospital bureaucrats take that last right away from you and your
(father, mother, sister, brother, son, daughter)." This always works.
In the military, consent is not always required. The personal choices

available to soldiers are always limited. If military command decides
to vaccinate soldiers against perceived biological threats, the soldiers
must submit to vaccination. Apparently, soldiers can be ordered to
take PB pills (pyridostigmine bromide, to counter nerve gas), and
anthrax shots (214), (215).
Informed consent for children is a tricky subject. Children really can't

reach an informed decision relating to a medical procedure. A parent
or guardian needs to decide for them. When it comes to consent for
participation in a research project, parents seldom choose to put their
children at any risk, even when the risk is small. Consequently, it is
nearly impossible recruit children into clinical trials. As a result, few
new medicines have been tested on children; hence, few new
medicines have been shown to have a demonstrated benefit on
children. The FDA, frustrated by the lack of clinical trial data on
children, enacted a requirement, in 1998, that drug makers test new
products on the pediatric population. In 2002, the U.S. District Court
ruled that the FDA lacked the authority to impose a pediatric testing
requirement (216).
Though consent is usually considered an obvious ethical necessity, it

has a number of moral vulnerabilities that every evil scientist must
Page 211 of 355
learn.
1. Consent is a revenue source for researchers. When consent must be

obtained on thousands of patients, the consenting costs can actually
exceed the costs of conducting the trial. You need to consider that the
consent must be explained to the subject, by a professional staff
member. The consent form can be quite long, and the time for
acquiring consent can be lengthy. After consent is obtained, it must
not be lost. In most cases, the consent information must be entered
into a database (another cost). Patients have the right to reverse
consent at any time during the clinical trial. The trialists need to have
a way of flagging cases for which consent was withdrawn; not an
easy task. The tasks related to the consent process cost money,
without materially contributing to the research output. Because
funding institutions must support consenting efforts, you can ask for
and receive obscenely large grants when consenting is required.
2. Consent is itself a confidentiality risk. The moment you ask for

consent, you're creating a new security risk, because the consent form
spells out the procedure and the patient. The consent form must be
stored, and retrieved as needed. Copies of the consent form will
usually need to be attached to the patient's medical record, and other
documents needed for the duration of the patient's care and during the
trial follow-up period. As more and more people have access to
copies of the confidential consent forms, the risk of a confidentiality
breach increases. In many trials, the physical risks to the patient are
minimal (e.g., obtaining a swab of the oral mucosa, drawing one
extra vial of blood during a routine phlebotomy procedure). In
minimal risk trials, confidentiality risks associated with the
acquisition of consent may represent the greatest threat to the patient.
3. Consent diverts attention from a wide range of nefarious activities.

There is a limit to the number of problems anyone can worry about. If
half of your research effort is devoted to obtaining, storing, flagging,
and retrieving consent forms, you're less likely to pay attention to
other aspects of the project. More importantly, an IRB (Institutional
Review Board) that approves a consent process will have less time to
supervise your methods of treating patients, recording intended and
Page 212 of 355
unintended consequences of the treatment, and analyzing the

resulting data.
4. Consented research data can be used for unconsented purposes.

Once you've gotten permission to do a study, the results of the study
can be used for purposes unrelated to the original project. Here's how
it's done: when you have collected all the data for your consented
research, remove the patient identifiers (names, addresses, social
security numbers, and any other identifying information) from the
trial records. This yields a de-identified database. Government
regulations pertaining to human subject research and the uses of
medical records do not apply to de-identified data (217), (208). Use
the de-identified data for any purpose, commercial or non-
commercial, that suits your fancy. You can combine your data with
other data that you collected, or with data held by other collaborators,
including pharmaceutical companies. The project for which the
consent was obtained can be implemented as a ruse, the sole purpose
of which is to support research that patients would not dream of
consenting, otherwise.
Is it ethical to ask consent for a research effort that you never

intended to pursue? Maybe not. But it may be what you need.
15.2 CONFLICTS OF INTEREST
"The movies are the only business where you can go out front and
applaud yourself."
-Will Rogers
Most people simply do not understand the meaning of conflict of

interest, often confusing the term with payola, or bribery, or some
intentionally deceitful action designed to further one's own interests.
A conflict of interest is simply the condition where a person is put in
a position where his decisions may be influenced by factors other
than the usual and expected factors that motivate a person. Here is a
good example of a conflict of interest. A physician's son is sick. The
doctor decides to diagnose his child himself, without sending the
child to the pediatrician. Normally, a physician who encounters a sick
Page 213 of 355
child has one driving interest: to render a correct diagnosis, even

when that diagnosis is terrible news for the child and the parents. A
father's primary interest is his child's welfare. The father-physician
wants, more than anything else, for his child to have a benign illness.
The father-physician has a conflict of interest, because the motivation
to render a diagnosis may conflict with the motivation to have a
healthy child. A conflict of interest is not necessarily a dishonest
action; it is merely a situation where a person's motivations are
muddled.
How pervasive are conflicts of interest in the science literature?

Stelfox and colleagues reviewed papers that supported the somewhat
controversial issue of drug safety of calcium channel blockers. They
found that 23 out of 24 authors who defended the safety of calcium
channel blockers had financial ties to the pharmaceutical companies
that manufactured these drugs (218). Of 70 articles reviewed for the
study, only two of the articles disclosed potential conflicts of interest
(218). Studies that have looked specifically at the issue of financial
disclosures by authors of research articles have shown that voluntary
disclosures of conflicts are rarely reported (95). Most academic
institutions have no conflict of interest policy for staff receiving
commercial support (219).
Conflicts of interest accompany exercises in power, and are most

likely to occur among top-level scientists. Here is an example. A
university professor is a consultant for a pharmaceutical company. He
relationship with the pharmaceutical company extends over several
decades, during which time he has collected a considerable amount of
stock in the company. He conducts clinical trials testing drugs that
the pharmaceutical company has developed. Clearly, he has a conflict
of interest. He wants the drug trial to succeed for a variety of reasons
that are unrelated to scientific curiosity. If the trial succeeds, his stock
will increase in value. If the trial fails, his stock will plummet in
value. He has every reason to distort or misinterpret the findings of
the trial to favor the pharmaceutical company. He has every reason to
minimize, fail to report, and fail to treat adverse reactions from the
drugs.
Page 214 of 355
Jesse Gelsinger was a 17 year old who volunteered in a clinical trial

conducted in 1999, that resulted in his death. The trial was led by
James M. Wilson at the University of Pennsylvania. Accusations of
misconduct resulted in an investigation, and in 2005 the U.S. Justice
Department settled a civil case against Wilson and his major
collaborators and with the University of Pennsylvania. As part of the
settlement, Wilson was required to write an article on "lessons
learned. (220)" In 2009, a decade after Jesse Gelsinger's death, an
article appeared in the journal Genetics and Metabolism, written by
James M. Wilson, and entitled "Lessons learned from the gene
therapy trial for ornithine transcarbamylase deficiency. (221)" In the
article, the author reflects on the professional motivations of
academic scientists, such as himself. In this case, Wilson was a
founder of a biotechnology company focused on gene therapy, while
he led clinical trials of gene therapeutics. Furthermore, he owned
stock in Genovo, another gene therapy company. Success in Jesse
Gelsinger's trial may have bolstered the value of stocks held in the
gene therapy sector. Wilson wrote, "I learned it is very hard to
convincingly uncouple drivers for academic success from the
incentives derived from potential financial gain. (221)" Indeed.
Situations arise when an entire group of scientists are equally

conflicted. For example, most scientists have membership in several
different scientific agencies. The steering committee for one
organization is usually populated by the same scientists who hold
office in other organizations. Issues will arise that relate to the way
that one organization interacts with the other organizations in the
same field. Decisions are made to co-sponsor events, to send mailings
to members of the other organizations, to recruit new members from
the ranks of the other organizations, or to purchase services and
goods from other organizations. In each case, the committee
members have conflicts of interest. Which organization will their
influence serve? Nobody knows, and nobody seems to care. The
occurrence of conflicts among the officers in scientific organizations
is so pervasive that it cannot be stopped. In most instances, these
kinds of conflicts are simply ignored.
Page 215 of 355
Sometimes, conflicts of interest rise to the level of criminal action.

For example, a former head of the FDA, Lester M. Crawford, owned
stock in companies that his agency regulated. Two months after his
approval, by the U.S. Senate, as FDA Commissioner, Crawford found
himself pleading guilty to a conflict of interest charge. He received a
sentence of three years supervised probation and a fine (222).
15.3 BETRAYING CONFIDENTIALITY
"Everything is funny as long as it is happening to Somebody Else."
-Will Rogers, Illiterate Digest (1924)
Confidentiality is the process by which you tell someone a secret

about yourself, trusting that they will never divulge that secret to
anyone else. There are a lot of entrusted secrets in scientific research.
For many scientists, keeping secrets is often a condition of
employment. In the broad field of biomedical research, virtually
every piece of data collected on a human being is considered a
confidential secret. You might think that with all their experience
handling secrets, scientists would get pretty good at it. Not really.
Here are just a few examples to the contrary.
On May 3, 2006, a laptop computer was stolen from a Veterans

Affairs data analyst. On the computer and its external drive were the
names, dates of birth and Social Security numbers of 26.5 million
soldiers and and veterans. By the end of June, the laptop was
recovered, by the FBI. There was no evidence that the data had ever
been accessed. In the interim, the 26.5 million potential victims of
identity theft suffered sufficient emotional distress to launch a class
action suit against the VA. Three years later, the VA agreed to pay a
lump sum of $20 million dollars to the plaintiffs (223).
The episode brings to mind a flood of questions:
1. Is it customary for VA employees to take confidential information

home with them? Apparently, government staff just can't help it. The
problem extends to the top agent in the top security agency in the
U.S. While he was the CIA Director, John Deutch breached his own
Page 216 of 355
security protocols by bringing sensitive CIA information to an

unclassified computer at his home (224).
2. Is confidential information typically bundled into a neat, no-

nonsense file, with all of the information pertaining to the many
millions of individuals, organized for an easy one-click download?
Apparently, all the high-tech jargon thrown around concerning
encryption algorithms and security protocols just never trickles down
to the front-line staff.
3. Is there any way of really knowing when a confidential file has

been stolen? The thing about electronic data is that it can be copied,
perfectly, and in secret. A database with millions of records can be
downloaded in a few moments, without the victim knowing that the
theft has occurred.
Perhaps you are thinking that the VA laptop fiasco was an aberration.
Certainly, breaches of confidentiality would not occur in databases
that are collected on the condition of confidentiality, such as the U.S.
census. During World War II, 120,000 U.S. residents of Japanese
ancestry were collected and sent to internment camps, for the
duration of the war. Rounding up 120,000 people is not an easy task.
It helps to know where everyone lives. The 1940 U.S. census had
data on the race, nationality and addresses of everyone living in the
U.S. In a paper written by William Seltzer, a statistician and
demographer at Fordham University, and Margo Anderson, a history
professor at the University of Wisconsin at Milwaukee, the authors
report that the U.S. census bureau collaborated with the War
Department on the internment effort (225). According to the authors,
the census bureau identified, for the War Department, concentrations
of Japanese-Americans in areas as small as city blocks; thus
facilitating the roundup (225). Of course, World War II was a time of
national emergency. Strange things happen during wartime, and it is
difficult, in retrospect, to assign fault. The point here is that things
change, and promises of confidentiality made with the very deepest
sincerity may someday be withdrawn.
Perhaps there is something to be learned from the ingenuity of failed

dotcom companies. In an article written for CNET news, Greg
Page 217 of 355
Sandoval describes the privacy work-arounds practiced by a few

failed dot-com companies whose databases contained customer data
including names, phone numbers and credit card numbers. Customer
data is collected under the assumption of privacy, and confidentiality
is protected by dotcom entities. When the dotcom entity ceases to
exist, so might the protection. Customer databases may convey to the
company that buys the failed entity; and the new owners may use the
data as they see fit (226). How does this relate to research? Hospitals
are bought and sold; hospitals go bankrupt. The patient data collected
by a hospital conveys to the new owner. The new owner may acquire
several multiple hospitals, and all of the medical records held by
every acquisition will be available to the new owner. Patients
sometimes conceal medical information by seeking treatment in
different hospitals and medical offices. A patient who goes to
hospital A for his colon resection and hospital B for his psychiatric
appointments, may not be eager for doctors in hospital A to have
access to the same records held in hospital B (or vice versa). The
owner of hospital A and B will certainly combine the records.
Despite what you may hear, a person's medical data has minimal
intrinsic data for anyone, including the patient. Doctors routinely
order tests and never bother to review the results. They imagine that
if any of the tests produced an abnormal result, somebody from the
lab would call them. Though it could be argued that insurers might
take interest in your incurable disease, nobody really wants to hear
about your hemorrhoids, your constipation, or your acne.
15.4 EVIL PATIENTS
"Only the paranoid survive"
-Andrew S. Grove, former Intel CEO
You have just pissed into a cup. You pass the cup, along with
the requisition form, to a medical student, who will submit the
specimen to clinical pathology. On the following day, your
doctor will have the results of a complete urinalysis; part of a
routine medical check-up. The medical student looks at your
paperwork and pauses a moment. She turns to you and asks if
Page 218 of 355
you would like to participate in a medical study. You decline.

She tells you that there is an ongoing study for men, aged 40
to 70 (your age range) that measures small quantities of
prostate-associated proteins in urine. You decline again. She
mentions that you will not be bothered in any way by the
study. They can use the same urine sample that you just
submitted for your annual check-up. You decline. She informs
you that the results of the study may lead to a way to treat
early prostate neoplasia, before it has a chance of becoming
malignant. You decline again. She mentions that this treatment
may be available to you within your lifetime. You thank her for
the good news and decline again. She wishes you a good day.
You proceed with your life.
Patients can be just as selfish as scientists. Many scientific

experiments pose no hazard whatsoever to the patients involved.
Often, the scientist wants to use a piece of tissue that was removed in
the course of some procedure. Excess tissues removed at surgery are
usually sampled by a pathologist. The pathologist saves the small
tissue sample and discards the remainder. The excess tissue can
sometimes be used in research projects. Hospitals usually request
patients to sign a form allowing such tissues to be used for research
purposes. Well over 90% of patients sign the form, happy to
participate in medical research when there is no risk involved.
A subset of patients will refuse to cooperate, under any circumstance.

Rarely, the objection will be based on religious grounds. For
example, some native American tribes believe that bodies should be
kept intact. Tissues removed at surgery are collected, saved for the
duration of the patient's life. When the patient dies, his body is buried
along with the all the pieces removed during life.
In some cases, patients object without any rational reason. Some will
insist that their tissues must have some monetary value to the
scientists. Rather than give their tissues away, they want to negotiate
a contract for a piece of any profits that might result from the
experiment. This tactic never works. The scientists will simply obtain
their tissues from the next patient.
Page 219 of 355
Even when assured that a lucrative contract is simply not in the

offing, and that their excess tissues will be discarded if not used for
research, some patients will refuse to sign a release for the tissues. In
this case, refusing to donate excess tissues is a matter of selfishness,
not greed. These patients do not like to give anything of theirs to
another person. They would rather have the tissue incinerated.
The Helsinki declaration of the World Medical Association (WMA)

insists that participants share the benefits that come from clinical
trials: "The WMA hereby reaffirms its position that it is necessary
during the study planning process to identify post-trial access by
study participants to prophylactic, diagnostic and therapeutic
procedures identified as beneficial in the study or access to other
appropriate care. Post-trial access arrangements or other care must be
described in the study protocol so the ethical review committee may
consider such arrangements during its review (209)." This being the
case, shouldn't those who refuse to participate be denied benefits?
Every consent form should have a paragraph that reads, "I refuse to
participate in this research project. I understand that I will not be
permitted to use the medicines, and treatments that may become
available as a consequence of this research. Further, I understand that
my name will be included on a list of people who cannot receive
medication or treatments developed from this research project."
Justice happens whenever a person gets what they've asked for, and
then they are required to live with the consequences.
15.5 HARMING ANIMALS
"Boys throw rocks at the frogs in jest. But the frogs die in earnest."
-attributed to Pliny the elder (23 - 79 A.D.)
Mankind's casual cruelty and selfishness are apparent in the manner

in which we treat other living species. The number of animals
sacrificed in the name of scientific progress is small compared to the
number of animals destroyed in the insatiable food industry. At least
a quarter of all animals used to produce food are not eaten. Meat
becomes spoiled, or discarded as excess, or passed over because the
Page 220 of 355
gastronomic result was disappointing. The remaining three quarters

of animal-based food is unnecessary: humans can survive quite nicely
on a varied and balanced vegetarian diet (ask just about anyone in
India).
Here is the typical way of rationalizing a carnivorous lifestyle. "I love

to eat meat. The quality of my life would be greatly reduced if I could
not eat meat. The survival of all animals species on earth depends on
the death of other animal species. Animals must die for humans to
live. That is simply the way things are. The greatest religions of the
world acknowledge this simple fact. It would be an insult to God,
who provided animals for mankind to kill and eat, if I did not not
enjoy a good steak."
For most of us, the argument is won in the first five words, "I love to
eat meat." As humans, we relentlessly pursue our pleasures. The
well-being and ultimate destiny of farm animals has never held much
sway on the human psyche. Mind you, we do not eat every part of the
farm animal. Today's finicky eater is only interested in muscle meat.
The organs (livers, kidneys, intestines) are considered inedible by
humans.
Ironically, we now have the technology to produce muscle meat

without killing animals. We could take a small, harmless biopsy of a
cow's flank, and grow muscle cells in tissue culture dishes. A single
progenitor cell, cultured in flasks, could yield megatons of meat. The
technology is well-established, but has never been developed for
large-scale production. Scientists can do a lot of things that society,
quite literally, will not stomach. Still, the option of a carnivorous diet
without animal slaughter is out there.
The animals that are not used for food are likely to be used for
consumer product development. Industry tortures and kills millions
of animals each year to test the toxicity of cosmetics, shampoo,
conditioners, and thousands of household products. Just about every
new product intended for human use will be tested in animals. The
animals sacrified for medical progress are a small fraction of the
animals killed each year to test new, improved products that we do
not really need.
Page 221 of 355
The argument for the use of animals in medical research boils down
to, "my species is better than yours." You have heard it often,
delivered loudly, and with indignation. "If I have a choice between
saving a child dying from cancer, and killing a bunch of rats, you'd
better believe that I'll kill those rats."
About 10 million young children die each year, worldwide. Death of

young children in developing countries is rare, and nearly all of the
10 million deaths occur in impoverished or embattled countries.
Deaths are caused by malnutrition and a host of diseases that could be
prevented or treated, if the world seriously cared. Laboratory rodents
are not responsible for the dying children; it seems absurd to require
rats to pay the ultimate price for society's emotional lethargy.
When you argue that humans are fundamentally different from rats,
and these differences lead you to value the life of humans over the
life of rats, you might stop and think about how these differences
may influence our ability to extrapolate laboratory observations from
rats to humans. In fact, the differences between rats and humans are a
major impediment to using rats in cardiovascular research, cancer
research, human behavior, and research into the most important
human infections (malaria, sleeping disease, Chagas disease, parasitic
diseases due to worms, HIV, and so on). Many of the research
breakthroughs found in rodent and other animal models cannot be
translated to humans.
How much of the money, time, and effort spent on animal models of
human disease has been wasted? It is impossible to say. Certainly,
there have been medical breakthroughs that have been attained with
animal models. I often wonder where we would be if rodent models
were abandoned, and medical research were confined to in vitro
studies (using biological reagents without using animals), studies on
the so-called lower organisms (e.g., insects, plants, fish), and
naturalistic studies (observing and developing therapies for diseases
found naturally in animals, without re-creating the diseases in
laboratories).
Is there any difference between the modern practice of sacrificing
Page 222 of 355
animals for research, and the ancient practice of sacrificing animals

to please pagan gods? In both cases, the animals are killed, so that the
gods will not inflict their diseases on the humans. Perhaps, today, the
profit margin is bigger. Laboratory animals are provided by a large,
successful industry that employs many people. Despite the objections
of animal rights organizations, the laboratory animal industry enjoys
broad support from the public. Scientists who use laboratory animals
in their research will tell you that medical progress will end if animal
experimentation is impeded. It is a safe bet that animal
experimentation will continue unabated so long as we have a steady
supply of incurable diseases. As an evil scientist, you will learn to
think of animals as Petri dishes that poop.
1. For every ethical problem that arises over the course of your
career, there will be an unethical solution.
2. IRB members view themselves as judges, not inspectors. Once the

IRB approves a research protocol or clinical trial, they almost never
check to see if the human protection provisions are followed.
Basically, you can conduct your research as you please, once the IRB
approval is obtained.
3. Ambiguity is the lifeblood of ethical misconduct, and should be

inserted into clinical trials ad libitum. A lengthy, expensive, and
medically intensive trial that benefits a few patients, while providing
no benefit to the majority, will often attain IRB approval when you
show that no patients would benefit in the absence of your
experiment.
4. An easy way to get an IRB approval is to submit a protocol that is

virtually identical to some other protocol that has already been
approved by the IRB. The practice of minimizing innovation to
maximize IRB approval does little to advance scientific progress, but
it will do wonders for your career.
5. Risk is an inescapable condition of the universe. At times, you will

need to put others at risk. The best way is to do this is to conduct
Page 223 of 355
your research in a country far far away. Many of the restrictions in

the U.S., such as stem cell research, research on human embryos, the
use of placebos, informed consent requirements, and the inclusion of
children and mentally ill patients in clinical trials, are routinely
tolerated in poor and corruptible countries (44).
6. If you are an IRB member, do not confine your deliberations to

your mandated duty; protecting human subjects from research harm.
You should see yourself as the ultimate protector of your institution's
integrity. Feel free to expand the scope of your review to include any
minor aberration that detracts from the highest levels of professional
conduct. This will undoubtedly result in the rejection of every
protocol that comes to your desk; except, of course, your own.
7. Never mistake a clinical trial for a serious, factual, evaluation of

reality. Clinical trials are experiments, and have the same limitations
found in any experiment: poor quality of the measurements, cover-
ups of errors, data fabrication, data misinterpretation, data censorship,
and so forth. Just like any experiment, the results of clinical trials
need to be repeated before they achieve credibility. Ultimately, the
results of clinical trials need to be re-affirmed by clinical experience
gained in multiple institutions and in large populations.
8. Evil scientists need not behave unethically, in all circumstances.

Ethics is about how we treat others; the best way to meet your goals
as an evil scientist is to treat others well, and make a few friends in
the process. Alexander Dumas said it best: "Rogues are always
preferable to fools, for rogues sometimes take a rest."
CHAPTER 16. CLINICAL TRIALS ON TRIAL
"Wir Haben die Luge notig...um zu leben." (We need lies...in order to
live.)
-Friedrich Wilhelm Nietzsche
Scientists have a long history of inflicting pain, suffering, and death

on people. James Syme, a surgeon who performed mastectomies in
Edinburgh, Scotland, in the 1830s, decades before the
implementation of surgical anesthesia, left the following notes (227):
Page 224 of 355
"Allie stepped up on a seat, and laid herself on the table... arranged

herself, gave a rapid look at James [her husband], shut her eyes... and
took my hand. That operation was at once begun; it was necessarily
slow; and chloroform - one of God's best gifts to his suffering
children - was then unknown. The surgeon did his work. The pale
face showed its pain, but was still and silent... It is over: she is
dressed, steps gently and decently down from the table, looks for
James, then, turning to the surgeon and the students, she curtsies -
and in a low, clear voice, begs their pardons if she has behaved ill.
The student - all of us - wept like children; the surgeon wrapped her
up carefully, and resting on James and me, Allie went to her room."
Surgeons accused of mutilating cancer patients are quick to reply that

the tumor, left untreated, would produce far more mutilation, with far
more pain, than the patient's surgery. Still, history teaches us that
scientists and physicians have an enormous capacity to tolerate the
pain and suffering of others.
The clinical trial is a relatively new innovation. Prior to the mid-

twentieth century, standards of clinical care were developed by trial
and error. A doctor would try a new technique or medication and
watch his patient to see if the consequent physiologic effect was
salutary. If so, he might try it on a few more patients. After a
sufficient number of successes, he might report his treatment in a
medical journal. If enough doctors found the treatments to work
equally well for their own patients, it would enter common practice.
To this day, most of what we call clinical practice was based on this
kind of semi-scientific method. Here are a few examples:
1. 1796 - Edward Jenner successfully vaccinates 8 year old James

Phipps with unproven smallpox vaccine (prepared from cowpox).
2. 1881 - Louis Pasteur successfully vaccinates Joseph Meister with

unproven rabies vaccine.
3. 1900 - Jesse Lazear demonstrates (on himself) that yellow fever is

transmitted by mosquito bite. Lazear dies from successful
inoculation.
Page 225 of 355
4. 1985 - Marshall infects himself with H. pylori, thus developing

gastritis and demonstrating the bacterial origin of gastric ulcers.
Some of the early clinical trials were so poorly conceived that they
serve as purely cautionary tales, with no other scientific value.
Notable is the egregious Tuskegee Syphilis Study, conducted by the
U.S. Public Health Service (PHS) between 1932 and 1972. This study
observed the natural course of late stage syphilis in 399 black men.
The men were poor Alabama sharecroppers who were never told that
they had syphilis. Their doctors had no intention of curing them. The
data for the experiment was to be collected from autopsies. Some of
the ravages of untreated late stage syphilis include heart disease,
paralysis, blindness, insanity, and death (228). The project was the
longest nontherapeutic human experiment ever conducted.
In 1963, in a study at Memorial Sloan-Kettering Cancer Center,

cancer cells were injected into hundreds of chronically ill patients
(229). The investigator was curious to see who could, and who could
not, reject an injected bolus of tumor cells. He found that cancer
patients, and patients with chronic illnesses developed tumor nodules
at the sites of injection. These nodules grew for a few weeks, then
regressed. Regression occurred fastest in healthy volunteers. His
experiment was performed without benefit of informed consent
(229). What happened to the investigator? He went on to become the
President of the Association for Cancer Research.
By the late twentieth century, there was a push to design scientifically

rigorous clinical trials. Here are the defining steps of an idealized
randomized prospective double-blinded study:
1. The trial is designed by a team of physicians, biomedical scientists,

and statisticians, who have no self-serving interest, financial or
otherwise, in any particular outcome of the trial.
2. The trial is designed to be free of biases and to have sufficient

power to determine the efficacy of the treatment.
3. Candidates for trials are selected from a diverse population,

without preference for race or socio-economic status.
Page 226 of 355
4. Candidates for voluntary trials are not promised a cure or any

direct personal benefit for their participation.
5. Candidates for trials are informed of the risks associated with the
trial, and sign an informed consent document indicating that they
wish to enter the trial and that they understand the risks.
6. Trial participants are randomly assigned into treatment groups and

control groups.
7. Neither the patient nor the people treating the patient know who
receives any particular treatment.
8. The treatment of patients begins with the trial and the trial persists
for a predetermined length of time that permits the evaluation of the
effects of treatment and the outcome after treatment.
9. The data from the trial is collected and analyzed by statisticians

who have no involvement in the trial.
10. The sponsors of the study do not impose their own interpretation
on the statistical analysis of the trial; nor do they prohibit, censor, or
delay the publication of the trial results.
11. All results of clinical trials are published, even when the
conclusions conflict with the interests of the study's sponsor.
12. The raw data from the clinical trial is de-identified, to remove
links to patients, and placed in a repository, for public review.
In practice, one or more of these steps will be subverted or omitted.

For example, Gross and Co-workers reviewed 100 industry-
sponsored trials published in prestigious medical journals (the Annals
of Internal Medicine, BMJ, JAMA, Lancet, and the New England
Journal of Medicine) (94). The Uniform Requirements for Authors
recommends that manuscripts specify the type and degree of
involvement by the sponsoring agency. Only eight of the 100
industry sponsored studies complied. According to the authors of the
study, for the eight complying studies, terms used to describe the role
Page 227 of 355
of the sponsor included: "preliminary evaluation," and "coordinating

data collection and statistical analysis (94)." Richard Smith, writing
for the BMJ, described the experience of an editor for the Annals of
Internal Medicine, who was faced with authors who refused to tone
down their conclusions, despite repeated editorial requests to do so.
When the editor asked why they would not make the requested
changes, they indicated that they were doing what their sponsor had
requested (93).
Testing a new drug can take many years. In the realm of cancer trials,
the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial
(PLCO, NIH/NCI trial NO1 CN25512) serves as an example. The
PLCO is a randomized controlled cancer trial. Between 1992, when
the trial opened, and 2001, when enrollment ended, 155,000 women
and men between the ages of 55 and 74 joined PLCO. Screening of
participants and the collection of follow-up data will end around
2016. The purpose of the study is to determine if screening will
reduce mortality from these cancers (230).
The Framingham Heart Study began in July 1948 and will be

completed in September 2008. This 60 year study investigates factors
that may influence the development of cardiovascular disease humans
(231).
Khufu built the Great Pyramid at Giza, (2589 - 2566 BC) with the
assistance of an estimated 100,000 laborers. The Great Pyramid is
still standing and is visible to astronauts orbiting the globe. Khufu
managed to complete construction of the Great Pyramid in just 23
years (nearly 40 years faster than the Framingham study).
Clinical trials are experiments, and unexpected events may occur.

Simon LeVay recounts a clinical trial that went terribly wrong (98).
The drug, TGN1412 is a monocolonal antibody developed by a
biotechnology company. The biotechnology company provided
TGN1412 to a drug-testing company, for the purposes of conducting
trials in humans. After preliminary safety tests in laboratory animals,
a safe dose was selected for humans.
Eight paid healthy volunteers were assembled. These subjects would
Page 228 of 355
be the first humans to receive the test drug, under any conditions. In a
single session, six of the volunteers were infused with TGN1412, and
two volunteers were infused with a placebo. In about an hour, all six
of the subjects developed cytokine storm, a life-threatening condition
in which an immune-response precipitates shock, and a wide range of
extreme system-wide responses, including shock, and multi-organ
failure. Prompt treatment saved all their lives. Two of the six had
prolonged hospital courses. The incident occurred in 2006, and the
six patients must now deal with long-term medical consequences of
the event.
When a new drug is administered in humans, for the very first time (a
so-called first-in-man trial), you never know what to expect. That
being the case, why were all of the subject treated at the same time?
Furthermore, why were all of the volunteers given the same dosage of
the drug? Wouldn't it make sense to start with a very small dose,
carefully observing the patient over a day or more, and then
proceeding to a somewhat higher dose on the next patient. Another
aspect of the trial that eventually came to light involved the speed of
infusion of the drug. Would it not have been prudent to infuse the
drug slowly, so that the infusion could have been stopped if there
were any measured rapid effects?
An expert panel was assembled, to review the incident and to make

recommendations. Among their conclusions, "New agents in first-in-
man trials should be administered sequentially to subjects with an
appropriate period of observation between dosing of individual
subjects. (232)"
Clinical trials are a big business. In the U.S. alone, about $20 billion
dollars is paid to clinical trial providers (2008 study) (233).
Considering all the clinical trials that have occurred over the decades,
wouldn't you think that drug testing companies would know that, in a
first-in-man trial, you might want to observe the effects of the drug
on the first volunteer, before delivering the drug to the full study
population?
Ellen Roche, was a 24 year-old healthy volunteer who died from lung
failure on June 2, 2001, several weeks after participating in a Johns
Page 229 of 355
Hopkins University asthma study (37). Investigation of the incident

revealed that she had been administered Hexamethonium, a drug
which was not approved by the FDA, and for which there was some
evidence that it could be harmful to humans. The informed consent
sheet that Ms. Roche signed did not indicate that she would be
exposed to a drug of uncertain safety (37). The FDA criticized Johns
Hopkins University for conducting a human subjects experiment
using an unlicensed drug, without receiving FDA approval; for
failing to report an unanticipated adverse reaction that had occurred
in the experiment prior to Ms. Roche's participation; and failing to
inform participants that hexamethonium was experimental (234).
16.1 BIASES IN SURVIVAL DATA
"Deep doubts, deep wisdom; small doubts, little wisdom."
-Chinese proverb
A Clinical trial can make or break a corporation; why would anyone

want to leave the outcome to chance? By introducing bias or, better
yet, allowing a pre-existing bias to persist, you can produce any
clinical outcome that suits your agenda. Here are just a sampling of
biases that evil scientists can use in their clinical trials.
Accrual bias - Accrual is the process by which patients are

enrolled in a clinical trial. According to the U.S. National
Cancer Institute, less than 5% of adults diagnosed with cancer
each year will opt for treatment through a clinical trial (235).
Features that distinguish the small fraction of people who
enroll themselves in a clinical trial from the overwhelming
majority who do not, produce a trial population that is
different from the general population.
Co-morbidity bias - Survival is the length of time that patients live

following a diagnosis of cancer. Whether a patient dies of cancer or
heart disease or motor vehicle accident is immaterial. People with
life-shortening co-morbid conditions at the time of their cancer
diagnosis will have a shortened survival time on this basis alone.
People who are in good health when they are diagnosed with cancer,
Page 230 of 355
will tend to liver longer than people with co-morbid conditions.

Depending on the design of the clinical trial, co-morbid conditions
can bias the survival results.
Confounder bias - Confounders are unanticipated or ignored factors

that alter an outcome measurement. It is impossible to design clinical
trials that account for all confounder influences because confounders
are typically unanticipated. Confounders are the statistical
byproducts of the "Law of unanticipated consequences," which
simply asserts that there will always be unanticipated consequences.
Here's an example: Statins are widely used drugs that reduce the
blood levels of cholesterol and various other blood lipids. To the best
of my knowledge, nobody expected that the use of statins would have
any effect on the incidence or mortality of cancer. In a recent study
involving nearly a half-million male patients conducted between 1998
and 2004, statin use exceeding six months was linked to a significant
lung cancer risk reduction, of 55%. Participants who took a statin
longer than four years had a 77% reduction in lung cancer risk
(236). If we held a cancer trial for a non-statin chemotherapeutic
agent, and we did not take into account whether any of the trial
participants were receiving statins, this might create a confounder
bias for the trial.
Demographic bias - A variant of population bias. In most clinical

trials in the U.S., patients are assigned broad demographic groups
(European, Asian, etc.). Treatment response rates that may differ in
unaccounted subgroups within a broad group. For example, there
may be widely varying biological responses patterns among Asians,
depending on their land of origin (e.g., Manchuria, Korea, Thailand,
Malaysia). See Population bias.
Diagnosis bias - Diagnosis bias occurs when the patients in a repeat-

trial group have a disease or lesion that is different from the disease
or lesion affecting the first group. This distorts the survival outcome
after treatment. For example, if patients were accrued into a study
based on erroneous diagnoses rendered by an incompetent
pathologist, a group of patients with breast cancer might become
diluted with patients who have benign breast disease. More
Page 231 of 355
commonly, treatment groups are tainted when a new subset of

patients is added to the original group, through enhanced detection
and diagnosis of a biologically distinctive variant of disease. For
example, over the past few decades, there has been a many-fold
increase in the detection and diagnosis of ductal carcinoma in situ
(DCIS) of breast, due in large part to mammographic screenings
(237). DCIS has a very good prognosis. Only a small percentage of
patients with DCIS progress to invasive ductal carcinoma. If a breast
cancer clinical trial group included an increased proportion of
patients with DCIS, improved survival can be achieved, without an
improvement in the therapeutic protocol. The remedy for diagnosis
bias is to subdivide your study groups carefully. This remedy has its
own problems. If the first study did not carefully separate patients by
their prognostic subtypes, there's nothing much you can do to
compare the first study to later studies. Also, if you break groups by
their tumor subtypes, will each group contain a sufficient number of
patients to produce statistically useful results?
Eligibility bias - Every trial is designed with strict eligibility

requirements. When these criteria are applied to some subjects and
waived for other subjects, you get eligibility bias. Judith Randal
reported for the Journal of the National Cancer Institute, that a trial
for the drug Erbitux was populated, in no small part, by people who
did not meet the eligibility criteria for the trial (191). Twenty-seven
percent of the participants were ineligible for the trial, for one
reason or another. The trialists simply waived eligibility
requirements for some participants.
Income bias - In clinical trials, groupings are usually based on stage

of disease and age. Seldom do clinical trials stratify patients by
income. Nonetheless, socioeconomic status greatly influences cancer
survival (238). Groups that contain many economically
disadvantaged patients are likely to have a shorter survival than
groups whose members are financially well-off.
Lead-time bias - In medicine, an increase in survival is measured as

an increase in the interval between diagnosis and death. Suppose a
test is introduced that provides early diagnoses (i.e. diagnoses at a
Page 232 of 355
younger patient age). This test will yield an improved survival, even
though the age at which the patient dies is unchanged. The reason is
that survival is measured as the interim between diagnosis and death,
not as the prolongation of life after diagnosis. Much of the touted
advantages of early diagnosis are the direct result of lead-time bias.
Marketing bias - The purpose of drug marketing is to create the need

for a drug that you otherwise would not know you needed. Marketing
works; that's why the money spent on drug marketing dwarfs the
costs of research and development (129).
Medical record bias - Trialists draw information related to the

diagnosis, treatment, and outcome of patients by reviewing medical
records. The quality of medical research often depends on the quality
of medical records. When medical records are incomplete, incorrect,
illegible, or otherwise uninterpretable, the results for an otherwise
well-planned clinical trial can be disastrous. What do researchers do
when they find that their medical records are inadequate? Often, they
resort to re-abstraction, a time-consuming, expensive and
occasionally futile undertaking. Re-abstraction involves revisiting
charts, visiting outpatient clinics and the private offices of medical
doctors, re-interviewing patients and families, and a host of
extraordinary efforts aimed at restoring credibility to clinical trial
data. If a subset of patients has better maintained records than
another subset, a bias can be introduced to the trial.
Meaningless bias - Sometimes findings have no relevance to any

population other than your study set. This is particularly evident in
genetic association studies, which are usually done on families, not
large populations. Until you can show that the family you are
studying shares disease traits found in a wide population, your work
has no generalizable significance (239).
Measurement bias - The accuracy of response measurements may be

poor. For example, some of the newest anti-cancer drugs have low
toxicity for cancer cells. Current and future drugs may act by
decreasing the growth rate of a tumor, or reducing the likelihood that
the tumor will metastasize. These effects may fail to shrink or
eradicate a tumor, but they may increase the length and quality of
Page 233 of 355
post-diagnosis survival. In these cases, the measurements of tumor

response and patient survival should be modified to provide useful
information related to the value of the treatment, without producing
an unjustified expectation of cure.
Negative study bias - When a clinical trial produces negative results

(fails to show improved survival), there may be little enthusiasm to
publish the work. Sponsors of negative studies may be disinclined to
rally the cancer research community and the public around their
failures. Dickerson and Rennie have written, "The fact that some trial
results are never published would not be a problem, except that there
is good evidence that the results from unpublished trials are
systematically different from those of published trials" (240). When
statisticians analyze the results from many different published
manuscripts (meta-analysis), their work is biased by the pervasive
absence of negative studies. In the field of medicine, negative study
bias results in a false sense that every kind of treatment yields
positive results (241).
Population bias - For many different reasons, some populations

accrue more easily into clinical trials than other populations. It is
notoriously difficult to include children and pregnant women in
clinical trials. Insurers can refuse to cover the costs of medications
for pregnant women and children if there is no evidence indicating
that the drugs are safe and effective in these groups. See
Demographic bias.
Prayer-based bias - In the world of alternate medicine, many people

believe the total amount of prayer directed toward a patient will
determine the clinical outcome of a disease. The following anecdote
has been passed among clinical trialists, but it is impossible to verify
its historical accuracy. The story goes that the Institute for
Alternative Medicine at NIH funded a study to determine whether
directed prayer improved recovery. Two groups were formed, the
control group (nobody prayed for them) and the prayed-for group.
The subjects didn't know which group they were in. A reporter
requested an interview with the trial's principle investigator, but NIH
refused to cooperate, thinking that the press would ridicule the
Page 234 of 355
experiment. The reporter managed to get his interview, after

threatening to sabotage the whole trial by praying for the trial
patients, without authorization.
Second trial bias - After a therapeutic trial, clinicians can determine

the type of patients who are most likely to benefit from an
intervention. For example, a trial of bone marrow transplantation for
patients with metastatic carcinoma may find that patients over the
age of 55 responded poorly to transplantation. Older individuals with
transplants may be more prone to die from their treatment than from
their cancer. On the second trial for the same protocol, the clinicians
wisely exclude older patients. The second trial shows markedly
improved survival, compared with the first trial. The improvement
was achieved simply through better selection of subjects, without any
improvement in the treatment protocol.
Sponsor bias - Are the results of clinical studies skewed in favor of

the corporate sponsors of the trials? In a fascinating meta-analysis,
Yank and coworkers wanted to know whether the results of clinical
trials conducted with financial ties to a drug company, were biased
towards favorable results (242). They reviewed the literature on
clinical trials for anti-hypertensive agents, and found that ties to a
drug company did not bias the results. However, the found that
financial ties to a drug company are associated with favorable
conclusions. This suggests that regardless of the results of a trial, the
conclusions published by the investigators were more likely to be
favorable, if the trial were financed by a drug company. This should
not be surprising. Two scientists can look at the same results and
draw entirely different conclusions. It happens every day. How could
investigators, financed by a drug company, not be influenced by their
benefactors?
Stage bias - Stage bias uses a diagnostic or screening tool to shift the
proportion of people in a particular stage of disease, to produce a
false impression of clinical improvement. For example, if we
introduce a screening device that detects people who are infected
with mild Alzheimer's dementia and misses people with severe
dementia, then the prognosis of Alzheimer's in the general population
Page 235 of 355
will improve, because there will in an influx of mild cases in the

diagnosed population. The diagnostic tool would be credited with
increasing the prognosis of Alzheimer's diseases, though it
contributed nothing to treatment or outcome.
Stage treatment bias - This involves finding a treatment that is

effective for a small subset of people with a disease, that is falsely
interpreted as an intervention that is effective for everyone with the
disease. An example is the use of prostatectomy to treat prostate
cancer. Prostatectomy is a procedure that is credited with a high
cure rate, but it is only performed on patients with tumor confined to
the prostate. For patients with prostate cancer that has metastasized
to lymph nodes in the region of the prostate or to distant organs,
prostatectomy is contra-indicated. Why is this? If the cancer has
spread beyond the prostate, removing the prostate will not benefit the
patient. An apt analogy is closing the barn doors after the horses
have fled the farm. Of the cases of prostate cancer confined to the
prostate, we know that most cases are indolent, and do not benefit
from treatment. Autopsy studies have found that by age 80 to 90
years, 70% to 90% of men have prostate cancer that was undetected
during life (243), (244). This indicates that prostate cancer is a very
common disease that kills only a small proportion of affected
individuals. Because prostatectomy is only performed on men whose
prostate cancer is believed to be confined to the prostate, the group
cure rate is high.
Statistical method bias - Strange as it may seem, a statistician can

look at a set of data, apply different statistical methods to the data,
and arrive at any of several different conclusions. Often, conclusions
based on different statistical measures, on different data sets, are
contradictory. In this case, articles with opposite conclusions appear
in the medical literature, permitting scientists to selectively cite those
papers that support their own agendas (245).
All these biases are important tools for the evil scientist. Of the
sources of bias listed, stage bias is the most subtle. It is also the most
important bias introduced by the most modern cancer trials, which
are often aimed at developing stage-specific treatments for groups of
Page 236 of 355
patients with common cancers.
Suppose every patient with X type of cancer is staged into one of two
groups (I and II). The stage I group has no evidence of distant
metastases at the time of diagnosis and has a 40% chance of 5-year
survival under the standard treatment protocol. Patients are put into
the Stage II group if they have distant metastases at the time of
diagnosis. Their chance of having a 5-year survival under the
standard treatment is 2%.
Professor Rads, at the University of Goodcare, has recently

developed a very sensitive imaging device that can detect small
metastases that would be undetectable by less sophisticated devices.
In the next clinical trial for treatment of cancer X, Professor Rads
tests each trial candidate with his new device. He finds that about half
of the patients who would otherwise be assigned to Stage I (no
metastases) are found to have metastases with his sensitive machine.
With this information, these erstwhile Stage I patients are re-assigned
into Stage II.
A clinical trial is conducted with the standard treatment. The Stage I

group is now much smaller than the Stage II group. When the trial is
complete, we find that the 5-year survival for the Stage I group is
now 80% (up from 40%). The 5-year survival for the Stage II group
is now 2% (the same as before).
The newspaper headline following the trial is: "New imaging

discovery yields 100% improvement in survival for Stage I Cancer
X"
Actually, the clinical trial, as described, yielded no improved survival

for any patients. All it accomplished was to correctly re-assign some
of the Stage I patients into the low-survival Stage II group. The
apparent improvement in survival in Stage I cancer patients was
simply the result of more accurate staging of patients in the low-risk
category of disease.
What does this mean? Was the clinical trial a fraud? Did it
accomplish nothing at all? No, accurate staging of patients with
Page 237 of 355
cancer is an absolutely crucial step in the development of new,

effective anti-cancer regimens. It is impossible to assess the effects of
a new chemotherapeutic agent on a group with heterogeneous
disease. The detrimental effects of a new drug on Stage I cancer
patients might be lost in a study where the Stage I group is mixed
with patients with Stage II cancers. Evil scientists understand this and
use it to their own advantage.
John P.A. Ioannidis is the chair of the Clinical and Molecular

Epidemiology Unit at the University of Ioannina School of Medicine
and Biomedical Research Institute in Greece. In a provocative article
entitled, "Why most published research findings are false," he points
some common misinterpretations that pose as clinical facts (246).
These include: post hoc subgroup selection and analyses (i.e., cherry-
picking a subgroup that qualifies for statistical significance);
changing clinical group inclusion or exclusion criteria and disease
definitions after the trial has concluded; selective or purposefully
distorted reporting of results; data dredging (sifting through study
data, searching for outlier groups); for multi-center studies, reporting
the significant findings from some of the centers and ignoring
negative results from other centers (246), (247).
Dr. Ioannidis has suggested several prevalent research conditions that

produce invalid research findings (246):
1. Small studies are less likely to produce true research findings than
large studies.
2. Small effects are less likely to be true than larger effects.
3. Research findings are more likely to be true in confirmatory

studies (such as phase III trials that confirm observations made in a
phase II trial) than in hypothesis-generating studies.
4. The greater the flexibility in design, definition, and measured

outcome, the less likely that the research findings will be true.
5. The greater the financial and other interests in a study, the less
likely that the results will be true.
Page 238 of 355
6. The hotter the scientific field, the less likely that the results will be
true.
It is best to think of prospective randomized clinical trials as

experiments that have all the vulnerabilities inherent in any scientific
study. They can be poorly designed, misinterpreted, invalid for
under-represented patient subpopulations, unrepeatable, and falsified.
The best validation of clinical trials, diagnostic tests, screening tests,

and any treatment intervention are made by continuous clinical
correlations with patient outcomes in medical centers wherein many
different types of patients (male, female, different nationalities,
different ages, concurrent diseases, multiple medications) are
managed. Survival data need to be validated by post-trial
epidemiologic data. The data that are being interpreted must be made
available to the public, and the conclusions should be scrutinized and
debated. As luck would have it, it is neither easy nor lucrative to do
these kinds of large-scale clinical reality tests. Consequently, evil
scientists can continue making outrageous conclusions from biased
clinical trials, without much fear of discovery.
1. The effective dose of almost any drug is a somewhat arbitrary

quantity, because individuals will respond differently to any chosen
dose or dose regimen. If you want a new drug to appear more
effective than an older drug, design your clinical trial so that the new
drug is administered at a high dosage, while the old drug is
administered at a low, ineffective dose. The new drug will almost
always produce a better response, even when it is an inferior agent.
2. For safety trials, you can make your new drug seem much safer
than the old drug by administering the new drug at a low (sub-toxic)
dose and the old drug at a high dose (above the common therapeutic
range).
3. When you market your drug, have your salespeople quote clinical
trials that support your drug's effectiveness. Trials that show that your
drug is ineffective or unsafe are best ignored.
Page 239 of 355
4. Because clinical trials are complex, long, expensive, and have

strong economic consequences for its sponsors and investigators, an
evil scientist has many opportunities to manipulate the outcome to
suit his agenda.
5. Most clinical trials go unpublished. Selectively publish those

clinical trials that promote the safety and effectiveness of your drug.
Have someone on your staff write the results. Pay any academic
authority in the field, to allow his name to appear as the author on the
published product. Don't worry about interference by the author's
institution. Most academic institutions have no policy on conflicts of
interest between faculty and industry (219).
6. Not all clinical trials are equal. Some clinical trials are performed
on small groups of patients, without informed consent, by clinicians
or other personnel who have very little knowledge of how to design,
analyze, or report clinical trial data, and who have a financial stake in
the trial outcome. If you have performed an invalid clinical trial, a
diligent search will produce a journal that will publish your study.
Submit your study results to a journal that neglects to include a
financial disclosure statement, or a clinical trial registration number,
or proof of IRB (Institutional Review Board) human studies approval.
The number of journals that slide over these details is large (95).
7. Biases are present in every clinical trial. For best results, introduce
at least three biases into your own trials.
8. Effectiveness lies in the eyes of the beholder. A two week increase

in survival may mean very little to you, but it may be worth $100,000
to the family of a cancer patient. Never hesitate to promote the
effectiveness of a marginal drug.
9. So long as you do not fabricate your data, nobody can accuse you
of scientific misconduct.
CHAPTER 17. SCIENTIFIC DISASTERS
"God did not make us perfect, so to compensate, he made us blind to

our faults."
Page 240 of 355
-Anonymous
It is normal to fail. Within the course of your career, you will have
many setbacks.
As an evil scientist, you will be contributing to many horrible

mistakes during your career. Some of these mistakes will destroy the
lives of innocent people. As examples, engineers design buildings
and bridges that collapse; physicians prescribe medications that kill;
chemists brew compounds that wipe out exposed populations;
microbiologists release virulent organisms; nuclear scientists may
bring an end to human life on this planet. If you play your cards right,
you will never be held responsible for any of these mistakes.
The hard part about producing a fission bomb involves procuring

highly enriched uranium. Most raw uranium ore consists of more
than 99% non-fissile U-238. The fissile isotope of uranium is U-235;
extracting U-235 from the ore requires large machines, enormous
power, and advanced scientific resources and talent. A few powerful
governments can produce enriched uranium. Terrorists cannot. After
a football-sized chunk of enriched uranium is procured, the task of
making a working fission bomb is relatively easy; within the
capabilities of terrorist organizations. Consequently, the thrust of
nuclear security measures are focused on guarding the supplies of
enriched uranium.
Tom Zoellner recounts an interesting story. In 1951, in Dalhart,

Texas, three boys found a rock, near railroad tracks, that was far
heavier than its size would suggest. Another, similar rock, was found
in a nearby junkyard. The rocks were enriched uranium. The two
rocks, slapped together, could have destroyed the town (177). How
those rocks came to their resting places in Dalhart is a story that the
authorities have not explained to the public (177)
In his book Uranium: War, Energy, and the Rock that Shaped the
World, Zoellner provides several additional examples of U.S. nuclear
"materials uncaccounted for" (official acronym, MUF) (177). Is it
absurd to suppose that MUFs are exclusively a U.S. problem. Russia,
Page 241 of 355
India, Pakistan, and every nation that stores nuclear materials for
energy or for defense, is likely to have MUFs.
The world was shocked twice by nuclear reactor disasters: first at

Three-Mile Island (1979), followed by Chernobyl (1986). In both
these cases, events occurring in large nuclear facilities led to a partial
core meltdown (Three Mile Island) and an explosion (Chernobyl). An
incident that has escaped public attention occurred on January 3,
1961, in a remote U.S. testing station 40 miles west of Idaho Falls,
Idaho. Simon LeVay recounts the story of a fatal accident that
occurred when a technician lifted a cadmium metal control rod about
10 inches too far, triggering an uncontrolled chain reaction (98). The
story behind this obscure nuclear accident began soon after World
War II, when the United States embarked on a plan to build small,
transportable, and low-power nuclear reactors. One such reactor was
Stationary Low-Power Reactor Unit 1, which was operated by three-
man shifts. Cadmium rods inserted between enriched uranium plates
controlled the reaction. The higher the rods are lifted (from the fuel),
the greater the energy released. If the rods are lifted too high, a
nuclear chain reaction occurs, and a large amount of energy and
radiation is released, in a single, horrible moment. Nobody knows
why the rod was lifted above a critical height. But it happened, and
three men died. The clean-up was hazardous and expensive. In those
early days of nuclear power, one man, and one cadmium rod, pulled a
few inches too high, were all that were necessary to cause a
catastrophic nuclear accident (98).
What is the maximal amount of damage that can be credited to a

single person? On December 3, 1984, methyl isocyanate (MIC), a
highly toxic gas, escaped from the Union Carbide chemical plant in
Bhopal, India, quickly killing thousands of people, and injuring many
others. Accurate numbers for deaths and injuries are not known, but
the consensus seems to be about 15,000 deaths (including the number
of people who died at the time of the accident and the weeks
thereafter), and about 200,000 injuries.
Union Carbide blamed the disaster on a single worker. Here is what

happened at Bhopal (182). A worker was cleaning one of the pipes,
Page 242 of 355
with water. Water from the cleaning operation flowed into an MIC
tank, causing an explosion. Escape vents released hot MIC gases into
the atmosphere. About 40 tons of toxin descended as a hot cloud on
the population around Bhopal. Many people died on the spot. Some
families had a chance to flee. Parents with gasping children had to
decide quickly which child could be carried to safety and which child
would be left behind. Many survivors have endured decades of
suffering from lung, liver, kidney, and immune system ailments. The
rate of birth defects is high in the Bhopal population (248). The
Bhopal disaster is considered to be the worst industrial accident in
history.
After the event, Union Carbide lawyers blamed the disaster on one
individual; the worker who was cleaning the pipe. According to
Union Carbide, because the disaster was the work of a saboteur,
Union Carbide could not be held responsible.
Let's say, for the sake of argument, that a lone saboteur caused the
Bhopal disaster, What would this saboteur need to know in order to
pull off his deadly scheme.
First, he would need to know, that he alone would be selected to

wash out some clogged pipes that happened to connect with the MIC
tank. He would need to know that the valves separating the pipes
from the MIC tank were leaky. He would need to know that the
cleaning operation would not be inspected by an experienced shift
supervisor (a position that was eliminated to save money) who would
have probably inserted a safety disk to compensate for the leaky
valve. He would need to know that the refrigeration unit for the MIC
tank was not working, and that the MIC was not stored at a
sufficiently low temperature to ensure the stability of the MIC/water
mixture. He would need to know that the procedure for logging the
temperature in the MIC tank had been halted, thus preventing other
workers from noticing the rising tank temperatures. He would need to
know that the first tell-tale reaction odors would reach co-workers
during tea break, and that crucial human responses would be delayed
until after tea was served. He would need to know that the flare
tower, intended to safely burn off released gases, was inadequate for
Page 243 of 355
the job. He would need to know that the MIC would be vented from a
high stack (105 feet), above the reach of the water jets intended as a
safety curtain. He would need to know that the warning siren would
not sound until two hours after the gas release (after most of the
damage was done). He would need to know that emergency measures
to protect the population would not be taken. Rather than quickly
evacuating the population, plant spokesmen at first denied that an
accident had occurred. Rather than advising people that injuries could
be reduced by applying a wet towel on the face and shutting the eyes,
spokesmen reassured the public that MIC was not particularly
harmful (182).
Here we are, twenty-five years later. What is the news from Bhopal?
The former CEO of Union Carbide was issued an arrest warrant by

the Indian government, which has not been served because the Indian
government is officially unaware of his whereabouts. The former
CEO is said to be residing comfortably and openly in the Hamptons
(249).
The Bhopal site has not been cleaned up. Dow Chemical has since
acquired Union Carbide and accepts no responsibility for the clean-
up. Dow asserts that a 2001 payment of $470 million to the Indian
government has resolved the issue. The Indian environment minister,
when visiting the Bhopal site, lifted a clot of dirt and proclaimed,
"See, I am alive," certifying that the area is now safe. Nonetheless,
each month, an estimated 10-30 people die from the contaminated
groundwater and residual toxic waste (250).
Radiological contrast agents are dense liquids used by radiologists.

Some contrast agents are injected intravenously, some are swallowed.
When the contrast agent travels to an organ, the contours of
surrounding tissues can be visualized with an x-ray photograph. In
the 1930s through the 1950s, it was common to use thorotrast, a
colloidal suspension of radioactive thorium dioxide, as a radiological
contrast agent (251). After administration, the agent was absorbed
into the liver's Kupffer cells (specialized cells that absorb and store
particulate matter). The Kupffer cells, loaded with thorotrast, emitted
alpha particles, bombarding neighboring liver cells. Emission
Page 244 of 355
continues at a time-exponentially decreasing rate over the lifetime of

the patient. In retrospect, you would expect that people taking
thorotrast as a radiologic contrast agent might develop liver cancers
and chronic liver damage. Just so. In fact, the tumors caused by
exposure to radiological thortrast are hepatocellular carcinoma (a
relatively common tumor), and two types of rare liver cancers:
cholangiocarcinoma, and hepatic angiosarcoma.
When a carcinogen increases the incidence of a common tumor, it

can be very difficult to prove that any particular agent can be held
responsible for the increase. When you have an increase in the
incidence of a rare tumor, the situation changes. You can say, "This
tumor is very rare. Suddenly, we see a large number of cases
occurring exclusively in people who were exposed to a chemical that
was first synthesized and administered two decades ago. These
tumors must have been caused by this agent." Hepatic angiosarcoma
was the rare, sentinel tumor that warned scientists that thorotrast was
causing cancers. Today, iodinated contrast agents have replaced
thorotrast, and the incidence of liver angiosarcomas has plummeted.
Thorotrast came into general use in the early 1930s and stayed in use
until the early 1950s. It is estimated that two to ten million patients
worldwide were exposed to thorotrast. The increased numbers of
deaths from liver cancers and cirrhosis are unknown.
In May and June of 1981, an outbreak of severe pneumonia occurred

in Madrid, Spain, and the surrounding regions. The epidemic affected
about 17,000 persons; with 246 deaths. Many of the people who
survived pneumonia eventually developed a constellation of
neuromuscular symptoms including diffuse myalgia (muscle pain),
muscle atrophy, weight loss, weakness, sensory loss, hyporeflexia,
and assorted additional abnormalities (252). It is impossible to predict
the reduction in length-of-life among the current survivors.
The cause of the epidemic was bad cooking oil, contaminated by

rapeseed oil that had been denatured by the addition of 2% aniline.
The oil was intended for industrial use, but a distributor had illegally
marketed the oil for human consumption. Though the aniline was
removed from the oil prior to distribution, analysis of the marketed
Page 245 of 355
product showed that it contained a variable mixture of rapeseed oil,

other seed oils, liquefied pork fat, and small quantities of aniline and
fatty acid anilides (252).
1. If you are a lazy, disloyal, self-centered bastard, you need to put

somebody who is industrious, loyal and altruistic into key positions
of responsibility. Take all the credit you like, but never take on a
mission-critical task that you cannot delegate to a competent person.
Otherwise, all of your schemes and machinations will lead to your
own destruction.
2. Success comes from within, while failure often seems to come

from external forces. When your manuscript is rejected, it is because
the reviewer failed to see the value of your work. When your grant is
unfunded, it is because the study section, composed of your fierce
competitors, colluded to deny you a high score. Academic rejections,
passed over promotions, snubs from coworkers, and all manner of
professional disappointments can be interpreted as the failings of
other people. Nobody can succeed in science if they do not have a
misguided faith in themselves and a seething contempt for others.
The worst mistake any scientist can make is to care about what other
scientists think. If you follow the advice from this book, other
scientists will think what you want them to think.
3. Remember to get paid. Failed projects are opportunities for

windfall profits. For example, if your contract secures the payment of
a specified amount of money, payable at the end of the project, you
stand to gain if the project is terminated early. If you plan for failure,
you are guaranteed success.
CHAPTER 18. BELIEF AND DISBELIEF
"There is a cult of ignorance in the United States, and there always

has been. The strain of anti-intellectualism has been a constant thread
winding its way through our political and cultural life, nurtured by
the false notion that democracy means that "my ignorance is just as
good as your knowledge."
Page 246 of 355
-Isaac Asimov
"A lot of people mistake a short memory for a clear conscience."
-Doug Larson
"An idea that is not dangerous is unworthy of being called an idea at

all."
-Oscar Wilde
"Morality, spirituality, the meaning of life - science doesn't handle

those issues well at all. But that's cool. We have art and religion for
that stuff."
-Thomas Hayden (253)
Religion is about belief, and science is about disbelief. When

someone makes an assertion, and you believe that assertion, as a
matter of faith, without any real proof, then you're being religious.
When you say you won't believe the assertion until it's proven to be
true, then you're being scientific. There is a clear distinction between
religion and science, but both sides have attempted to blend the two
together. The scientific rationalization for religion usually begins
with a simple observation: "Things exist in the universe." Then
follows a piece of logic: "If things exist, they must have been
created." Then the coup de grace: "If there is a creation, then there
must be a creator."
The logic seems unassailable. The counter-argument uses the same

logic: "If there is a creator, then the creator exists." This is followed
with: "If the creator exists, the creator must have been created." Then
the coup de grace: "Therefore, every creator has a higher creator, and
there is no ultimate creator."
Perhaps the most cynical scientific rationale for the belief in God
came from the mathematician and physicist, Blaise Pascal (1623 -
1662), whose personal epiphany was was based on game theory.
Pascal reasoned that if you believe in God, and if God exists, you've
Page 247 of 355
won. If you believe in God, and God does not exist, then you haven't
really lost anything. Therefore, it's best to believe in God.
Humans have a natural tendency toward wishful thinking (i.e.,

pretending something is true because you want it to be true). Adept
evil scientists routinely use this human weakness to blur the
distinction between religion and science. The basic strategy involves
convincing scientists to accept a single assertion that they want to
believe, without proof. From there, you can build the assertion into a
complex religion composed of contingent ideas. The original
assertion is usually something that people have a strong vested
interest in believing (e.g., everlasting life, the avoidance of eternal
damnation, eligibility for success on earth, angels and ancestral
guides, etc.). Sometimes belief is grounded in real-life experiences or
conveyed observations that have not been tested (e.g., thirteen is an
unlucky number, madness occurs when the moon is full, disease
strikes when you miss Sunday sermon, etc). The most entrenched
beliefs are those that confer credibility on primitive or atavistic fears
(e.g., change is bad, foreigners and outsiders are bad), or that cannot
be otherwise explained (e.g., UFOs, ghosts, miracles). Once you
believe the original assertion, you're not likely to deeply examine
anything that follows.
There has always been a tension between established religions and

the scientific community. Galileo (1564 - 1642) offered irrefutable
evidence that the earth orbited the sun (Figure 18-1). Galileo
subsequently retracted his scientific findings, after being threatened
with torture by Papal messengers.
Page 248 of 355
Figure 18-1. Galileo Galilee, portrait in crayon by Leoni.
Sometimes religion is swayed by science. The Roman Catholic

Church officially acknowledged in 1950 that the theory of evolution
was not in conflict with Christian doctrine (Pope Pius XII, Humani
Generis). In 1996 Pope John Paul II, in an address to the Pontifical
Academy of Sciences, said,
"Today, almost half a century after the publication of the

encyclical [Humani Generis], new knowledge has led to the
recognition of the theory of evolution as more than a
hypothesis. It is indeed remarkable that this theory has been
progressively accepted by researchers, following a series of
discoveries in various fields of knowledge. The convergence,
neither sought nor fabricated, of the results of work that was
conducted independently is in itself a significant argument in
favor of this theory."
It is easy to find examples of science sullied by belief systems posing

as established truth. One of my favorites is the etiology of gastric
ulcers. For many decades, medical students were taught that stomach
ulcers resulted from a character flaw. Certain people "internalized"
their anger, by secreting huge quantities of stomach acid, which ate
away at the normal mucosal lining, producing ulcers. This theory
reinforced physician's innate tendency to blame the patient for the
illness ("You've brought this ulcer on yourself with your stressful
Page 249 of 355
lifestyle"). The patient is also at fault for the lack of a cure ("I can't
help you if you ignore my advice to vacation in Hawaii for the
summer"). A vindictive approach to healing relieves the physician
from pursuing any serious research into the cause and cure of the
disease. For many years, the treatment for gastric ulcers targeted the
patient's turpitude: tranquilizers, psychotherapy, change of job,
relocation to a less stressful environment, etc. With this approach,
symptoms sometimes abated (as they would with no treatment
altogether).
Scientists justified the "anger" theory of gastric ulcers on the

misbegotten idea that an infectious agent could not possibly live in
the acidic environment of the stomach. If an infectious agent could
not be the cause of ulcers, then the patient himself must be the cause.
Gastritis and gastric ulcers arose from the overproduction of acid,
causing the stomach to "eat itself"; the excess of acid having a
psychogenic origin. Nonsense.
In 1983, Robin Warren and Barry Marshall described what they

called "unidentified curved bacilli" in patients with gastritis, by direct
visualization under a microscope. These structures later proved to be
Helicobacter pylori. Marshall experimented on himself, by ingesting
gastric juice from a "dyspeptic" man. About ten days later, he
developed gastritis, suggesting that an agent in stomach contents
from patients with gastritis, could transmit the disease to other
people.
Marshall, at the time of their discovery, submitted an abstract of his

work. He was "flatly rejected" by the Australian Gastroenterological
Association (135). Undaunted, he persevered, and showed that the
most common cause of gastritis in humans is a transmissible agent,
Helicobacter pylori, that lives in the stomach. In retrospect, we know
that medical scientists labored in profound self-inflicted ignorance of
the gastric microorganisms that had been visualized as early as 1875
(136). In 2005, the Nobel prize for medicine was awarded to Robin
Warren and Barry Marshall. Helicobacter pylori infections are easily
treated with antibiotics.
Buried within our language are the remnants of long-abandoned
Page 250 of 355
belief systems. We use the word "quintessential" to signify the

perfect form of existence. The word derives from a long-abandoned
theory that life is composed of four essential elements (earth, wind,
rain, fire), plus a fifth, heavenly element (the quint essence) found in
latent form in earthly objects. The names of diseases remind us of
formerly cherished superstitions. Malaria means "bad air" (in
Medieval Italian), reflecting the old belief that the disease was caused
by vapors emanating from marshes and swamps. Though malaria was
treated successfully with quinine, through most of the 19th century,
the pathogenesis of the disease was unknown until 1898, when Sir
Ronald Ross correctly blamed mosquitoes (an insect that thrives in
marshes and swamps). We now know that malaria is caused by a
protoctist organism (phylum Apicomplexa, genus Plasmodium), and
transmitted by the Anopheles mosquito. We stubbornly flaunt our
former ignorance by preserving the misnomer, malaria.
Scientists, like laypersons, base their scientific beliefs on dubious

sources. Mihaly Csikszentihalyi, in his book, The Evolving Self: A
Psychology for the Third Millennium, asked this question (254):
"If you made a list of all the things you know for certain under four
headings:
(1) those things that you know from direct experience,
(2) those that logically follow from self-evident truths,
(3) those that you believe because you were told,
(4) those you "just know" because of an intuitive gut-level feeling,
which one of the headings would have the longest list?"
Because humans have a short life-span (compared with millennia of

documented scientific inquiry), and limited intelligence (basically,
creativity is rare and comes in spurts), and the corpus of published
scientific knowledge is large (nobody understands all of important
contributions within any field of science), most scientists have a
belief system based on wisdom received from authorities (i.e. what
Page 251 of 355
they were told). Very few scientists ever stop to ask themselves,
"How do I know what I think I know?"
You can take any scientist and ask him to explain the principles of his
field, pressing deeper and deeper into fundamental phenomena, and
you will soon leave the realm of experimental evidence and enter the
realm of blind faith. Once you grasp this truth, you can understand
that all scientists are pretenders; they will believe anything, without
proof, if they have faith that somebody else has established the truth
of the statement.
It's a funny thing that atheism creates a blank slate upon which evil
scientists can build pseudo-scientific belief systems. Shortly after the
1916 overthrow of the Russian Csar, a biologist named Trofim
Lysenko (1898 to 1976) rose to fame in the new Soviet empire.
Lysenko believed that plants and animals could adapt to changing
conditions in their environment and pass their physiologic adaptation
to their offspring. By exposing wheat to cold temperatures, it would
adapt and become cold-tolerant. Future generations of wheat would
be cold-tolerant, and further adaptations would result in more
extreme cold-tolerance in later generations. Lysenko's theories were
embraced by Soviet officials, who mistrusted traditional, European
science. After producing a successful crop in the 1920s, Lysenko
received Stalin's embrace and was appointed was the U.S.S.R.'s
Director of Biology. Lysenkoism rose to the level of official
scientific doctrine, dominating Soviet biology from the 1920s to the
early 1960s. During this time, Soviet farmers failed to replicate the
high crop yields reported earlier by Lysenko. Soviet skeptics of
Lysenkoism were politically censured; meanwhile, Western science
made great progress in biology, unraveling the mystery of DNA, and
firmly establishing molecular genetics. After many years of
disappointing harvests, and following the amazing improvements in
crop productivity accomplished by Western plant geneticists, the
Soviets finally abandoned Lysenkoism. In 1964, an official
committee of Soviet scientists reviewed Lysenko's experimental data
and pronounced him a fraud.
The failure of Soviet biology was an example of how the impulse to
Page 252 of 355
believe, without the benefit of scientific proof, is a fundamental

human property, that exists in atheists as well as religious zealots.
The problem that the Soviets faced was that reality exists
independently of personal belief systems; simply believing one way
or another will not alter the truth. Still, it is not hard to find examples
where belief and hope prevail over scientific skepticism: genetic
engineering (manipulating the genome to eliminate common
diseases), immune stimulation (improving the immune system to
conquer cancer and infectious diseases), the cancer genome anatomy
project, artificial intelligence, manned interplanetary space missions,
and human-manufactured nuclear fusion as a practical energy source.
All of these projects offer great hope for the future, but none of them
have yielded a reality that matches their earliest promises.
Major scientific advances come like a bolt out of the blue; not from
planned initiatives. We cannot know which scientific initiatives will
work, and which will fail. But we certainly can pretend that we do.
As an evil scientist, you must learn to use belief systems to promote
any idea, without benefit of facts or supporting evidence.
Scientists could learn a lot from religious leaders, who have created
an evidence-independent belief system. Often, the most effective way
of dealing with the truth is to avoid it altogether. Here are a few
options open to scientists.
1. Destroy the truth. Ignorance is bliss.
2. Delay the truth. Journal editors demand that authors not reveal
articles until publication date. For accepted papers, publication dates
often fall one to two years following the original article submission.
This essentially imposes a one to two year quarantine on scientific
discoveries.
3. Change the truth. Some truths are inconvenient and are best
exchanged for a self-serving lie. For example, the Office of Research
Integrity (ORI) investigated a physician and principle investigator
working under an NCI-supported Gynecologic Oncology Group
(GOG). The ORI found that the investigator had "engaged in
scientific misconduct by soliciting a pathologist to falsify the
Page 253 of 355
originally correct tissue-type on the pathology report (omentum) as

being another type (ovary) and submitting the falsified report to the
GOG group member at the University of Iowa, in order to justify
enrollment of a patient in GOG clinical protocol 182 (255)".
4. Ignore the truth. People can lead perfectly happy lives, in abject
ignorance of the truth; many prefer it this way.
5. Withold truth. In a 2006 article, Vogeli and co-workers measured

data witholding practices in the sciences. They surveyed over one
thousand doctoral and post-doctoral trainees, trying to determine the
success rate when they asked scientists to supply them with research
data or materials that had been described in published research.
Twenty three percent reported they had requested, and been been
denied, access to the primary information, data, or materials (256).
Federal agencies hide data vital to the public interest if releasing the
information would antagonize members of congress; as done for
Transportation Department data that indicated the safety risks of
driving while talking on the cellphone (257).
6. Appeal to authority. Few among us have the time, energy,

intelligence, or inclination to understand complex scientific issues.
Scientists will defer to an authority if it relieves them from the task of
mastering a new idea.
7. Sell yourself. If you create a relationship of trust, everyone will

believe your message. Personal appearance is important; nice suit,
polished shoes, and styled hair are more persuasive than a logical
argument.
8. Pray for revelation. For many, great truths are revealed through an
epiphany, a much more efficient method for scientific progress than
the soul-numbing process of conducting experiments.
9. Appeal to dogma. You can usually avoid data if you have a set of
all-encompassing beliefs that provide answers for every imaginable
question.
These truth-avoidance methods are standard tools of scientists. If

used properly, belief-based assertions will always carry more sway
Page 254 of 355
than calculations, logical inferences, and experimental results, all of

which tend to confuse or bore your peers.
Book burnings are a time-honored tradition enjoyed the world over

by religious zealots. Some of the greatest books in history have been
burned to a crisp. The first recorded, but least successful, book
burning in history occurred around 612 B.C. and involved the library
of Ashurbanipal (668 - 627 B.C.), king of the neo-Assyrian empire.
Among the texts contained in the library was the Gilgamesh epic,
written in about 2500 B.C. Marauders set fire to the palace and the
library, with limited effect. Many many of the greatest works were
written on cuneiform tablets. The fire baked the clay tablets,
preserving them to the present day. It is interesting that Sumerian
tablets written more than four thousand years in the past, can be read
today, while many mid-twentieth century books, printed on high-acid
paper, are already lost. Likewise, many digital works produced in the
past decade, and stored on outmoded media (digital tape, floppy
disks, zip drives, micro-fiche) or forgotten data formats, will never be
accessible.
The Library of Alexandria was the most famous library of the ancient
world. As a repository of truth and knowledge, it was a popular
target. At least four major assaults punctuated the library's incendiary
past: Julius Caesar in the Alexandrian War (48 B.C.), Aurelian's
Palmyrine campaign (273 A.D.), the decree of Theophilus (391 A.D.)
and the Muslim conquest (642 A.D.). We do not know the number of
books held in the Library, but when the Alexandria library was
sacked, the books provided sufficient fuel to heat the Roman baths
for six months.
Book burning never goes out of style. As recently as 1993, during the
siege of Sarajevo, the National Library was enthusiastically burned to
the ground. Thousands of irreplaceable books were destroyed in the
literary equivalent of genocide.
Book burning has been modernized for the computer age. Modern
hospitals use complex, powerful information systems to collect
terabytes of patient-related data each year. After a length of time
varying from two years to ten years, old data is routinely purged. As
Page 255 of 355
years go by, and old information systems are replaced by newer

systems, the legacy data in the old systems is routinely lost. It would
be prohibitively expensive, some say, to transform the legacy data
into a format that would be compatible with the new system. Nobody
knows the value of old data, until they make an effort to use the data.
There is very little justification for purging old hospital records. The
costs of electronic data storage are miniscule compared with the costs
of buying a new information system. The reason that hospitals purge
their old clinical data is the same as the reason why libraries are
burned. Hospital legacy data may contain incriminating information,
or it may contain information that would cause staff to challenge the
wisdom of past and present hospital policies.
Book burning is just one of many techniques for limiting access to

important information. One of the most heavy-handed techniques is
to limit the number of people who can read or otherwise interpret
literature. In the middle ages, books were written in Latin; a language
spoken by none and understood by few. This worked quite well in
Europe for about 1,000 years. The re-production of mechanically
printed books, rendered in common languages, heralded the demise
of the Dark Ages, and the beginning of the renaissance. Still, a
university education would remain available to none but a privileged
few. Women, of course, were excluded. The practice of depriving
women of an education has persisted throughout world history, to this
day.
You might think that modern scientists would want to disseminate

their work to the widest possible audience. This is seldom the case. In
March 2005, the NIH announced a startling new policy; the public
would henceforth have access to the results of NIH-funded research.
In recent years, members of the public had expressed concern that
they were paying well in excess of $20 billion dollars each year to for
NIH-funded research projects, yet they were being systematically
deprived of the research results. It seems that when scientists publish
their research results in journals, they transfer copyright on their
manuscripts to the publishers of the journal. In essence, the journal
publishers receive the rights to virtually all taxpayer-funded research,
merely by agreeing to publish the manuscripts containing the
Page 256 of 355
summarized final results. Taxpayers wishing to read research

manuscripts (paid for with taxpayer dollars), must pay journal
publishers for the privilege.
The 2005 policy issued by NIH asked principle investigators to

voluntarily deposit a copy of their published manuscripts in a
government repository (PubMed Central), that would be made freely
and openly available to the public. Investigator compliance with the
new policy was dismal, about 2.3% (258). Non-compliance was
attributed to a variety of intractable obstacles, such as technical
difficulties, labor and expenses of compliance, and prior contractual
obligations to publishers. The real reason for non-compliance was a
potent combination of laziness and selfishness on the part of
researchers. After a three year interval of near total non-compliance,
the NIH Director modified the policy. Effective 2008, compliance
would henceforth be mandatory (259). Since then, the
aforementioned obstacles have magically vanished, and compliance
has soared.
What is a manuscript? A scientist asserts his findings, then asserts his

conclusions, then publishes them in a manuscript. Typical journal
articles are about five pages in length. The primary data (from the
scientist's laboratory notebook) is likely to consist of reams of
numbers and assorted information that could never fit into the final
manuscript. Scientists are expected to summarize their findings in a
table that holds average values for selected types of data. When you
read a journal article, you are implicitly asked to suspend your natural
disbelief; accepting as a matter of good faith that the author has
honestly rendered his data into an objective summary.
Is it reasonable to accept the assertions in a manuscript without

having access to the primary data upon which the assertions were
based? Ask any UFO abductee. Today, there are thousands of people
who claim that they were abducted by UFOs. Many of these people
have undergone psychologic testing, and the results would suggest
that UFO abductees are pretty much normal people, with no
underlying pathology that would lead them to lie. Most people who
claim to be abductees receive no monetary or social benefit from
Page 257 of 355
their experiences. Nonetheless, most of us refuse to believe in alien

abduction. Despite the many stories told, by some very sincere
people, there is no evidence offered that supports their assertions: no
flying saucers, no little green men, no alien artifacts, no implanted
probes, nothing to directly support abduction claims. Eyewitness
testimony is not credible without the existence of evidence.
Somehow, the evidence requirement seems to be lifted for scientists.

Few scientists feel the need to provide the evidence (the primary
data) that supports their claims. This should come as no surprise. If
scientific claims really required evidentiary proof, we would have
very few scientific "discoveries".
Pierre do Fermat (1601 - 1665) is a case in point. He is known as one

of the greatest mathematicians of all time, yet he seldom provided his
colleagues with complete manuscripts. For the most part, he simply
declared his discoveries in letters to other French mathematicians.
Fermat's last theorem, an unproven assertion, stymied
mathematicians for over three centuries. Modern scientists, lack
Fermat's gravitas, and have no more credibility than the garden
variety alen abductee.
The Internet and electronic publishing permit scientists to post

complete data sets, regardless of their size, as supplemental files that
accompany their manuscripts. The raw data upon which manuscripts
base their assertions are often produced by complex instruments,
collected by dozens of different laboratories, or extracted from public
databases. There is no reason why this evidentiary data cannot be
made available to the public (260), (261). This almost never happens.
As it turns out, scientists apply lower standards to their fellow
scientists than they apply to alien abductees. There are two self-
serving reasons why this is so: vindication and self-preservation.
When your manuscript promotes an idea that benefits your
colleagues, your assertions will be accepted with enthusiasm and
without criticism. Nothing passes scientific muster easier than a
manuscript that vindicates everyone's biases. Furthermore, if you
were actually required to provide the evidence for your assertions, so
might your colleagues. Scientists will not set professional standards
Page 258 of 355
that are inconvenient.
One day, you will be giving a lecture, and some smart alec will ask
you why you have not provided the primary data that supports your
assertions. As an evil scientist, you will need a glib excuse. Here are
a few:
1. To preserve confidentiality. The data is confidential and it would

be unethical for me to release this data to the public.
2. To avoid confusing the scientifically-challenged masses.

Commenting on the wisdom of making clinical trial data to the
public, a director for the Center for Drug Evaluation and Research at
the FDA was quoted as saying, "I would be very concerned about
wholesale posting of thousands of clinical trials leading to mass
confusion" (262).
3. To protect the integrity of your findings. Competitors may

purposely misinterpret my data.
4. To maximize your productivity. Preparing the data in a format that

can be distributed to the public (e.g., the internet) requires time,
effort, expertise and money. My time would be better spent on
research activities.
5. For the betterment of your field of science. I want to control the

direction of research in my field, and my control would be lost if
everyone in the field had access to my data. Always remember,
science is like a compass and must always point in the right direction.
6. To avoid acrimony and to foster trust. It is disrespectful to insist on

having the primary data.
7. To comply with legal obligations. My data is integral to another

manuscript that is in press. If I distributed the data, it would violate
the publisher's ban on pre-publication release of research data.
8. To conform with standard practice. Nobody else provides their

data, why should I?
Page 259 of 355
9. The data does not belong to the author. The data belongs to my
university; it's not mine to give.
10. As a courtesy to your co-authors. The decision isn't mine alone;

my colleagues wouldn't like it.
11. The data is in a proprietary format. I would like to release the

data, but we used a proprietary standard for formatting the
information, and files prepared in this manner cannot be shared
without violating our license.
12. To avoid a technical fiasco. The data is spread over many

different laboratories in many different formats, and I have no
practical way to collect all that data into a single document.
13. To stay current. The data in the field is constantly being refined,
and it would be confusing to provide old data set that does not reflect
the newest advances coming from our laboratory.
14. To wait until the data is finalized. Nothing is ever final in science,
so this excuse is applicable for eternity.
15. To avoid distractions. If everyone had access to the data, we

would be deluged with requests from would-be collaborators. My
laboratory does not not have the funding to handle that kind of
situation.
All of these points avoid the basic problem that if the primary data
cannot be reviewed, then acceptance of the conclusions offered in the
manuscript becomes a matter of personal belief, not science. Nobody
knows what horrors the future may hold. One day, scientists will be
required to turn their laboratory notes over to governmental agencies
or to the public. Today, scientific data collected through a federal
grant, and used for the purpose of determining a public action, policy,
or regulation, is subject to a Freedom of Information Act (FOIA)
request (i.e., citizens can force you to provide your primary data).
As an evil scientist, you must take action to protect yourself from

these assaults on your freedom. Collect as little data as possible.
Page 260 of 355
Don't bother to annotate your data with specifiers that can tie your
numbers to a specific date, experiment, or technician. Don't conduct
quality assurance activities. If you must perform calibrations and
quality control measurements, destroy your records as soon as
feasible.
All scientists are salesman; and salesmen understand that the product
they are selling is themselves. If the customer trusts the salesman,
they will buy the set of encyclopedias, the broom, the shoes, the
mascara, and anything that the salesman offers. If your colleagues
trust you, you can sell them any scientific idea that suits your agenda.
How do you get colleagues to invest their trust in you, an evil
scientist?
1. Trust them. If a person feels that you trust and respect them, they
will trust and respect you.
2. Behave like them. This includes taking an interest in the same

things that interest them. If a colleague's office contains pictures of
his family, be sure to ask about that person's family. Indicate that you
are a family man as well. If you have no family at the moment, talk
about your youth and your relationship to your parents. If you hate
your parents, lie.
3. Look like them. People are uncomfortable in the presence of other

people who are dressed differently from them. If you don't know how
a person will be dressed, always err on the side of dressing up (not
dressing down). Formal attire is a sign of respect.
3. Understand their beliefs, and incorporate those beliefs into your

pitch. The number of white, Christian scientists and engineers shrinks
every year. Many scientists are agnostics or atheists, or follow a non-
Christian religion. If you don't know the religious convictions of your
colleagues, just follow their cue. The same applies to their prejudices.
An evil scientist is a moral chameleon.
If you adopt a particular religion, you are entitled to use your

religious beliefs to enrich and inform your scientific work. Nobody
has the right to tell you otherwise. You will find that people will be
Page 261 of 355
eager to believe any scientific assertion that lends credence to their

preferred religious doctrines.
Here are a few ways to use religious beliefs to your advantage:
1. If you say that an assertion falls within the realm of science and
religion, non-religious scientists will not have the right to challenge
this assertion. This argument has worked for the proponents of
intelligent design. Religious scientists insist that intelligent design
has just as much legitimacy, as an area of scientific study, as does
evolution.
2. If a detractor insists that your work lacks scientific evidence,

remind him that scientists cannot measure or understand every force
in the universe. Evidence can exist in a form that we cannot see and
measure, but which we can infer, based on our beliefs. Remind your
detractors that some scientific truths cannot be verified within the
limitations of current scientific beliefs.
3. If someone scolds you for mixing science with religion, scold them
right back, for pursuing science without the aid of religion.
Scientists pretend to hold a monopoly on truth, but we all know that

most scientific beliefs can be easily destroyed. Invoking the slogan,
"Further study is necessary," will bring any scientific theory to its
knees. The call for "further study" has been used many times in the
past to put a halt to social justice and to halt science-based social
initiatives. Here are a few examples:
1. Genocides. "The evidence you provide to support your accusation

of genocide is extraordinarily complex. Further study is required".
2. Global warming. "Can we really be certain that the warming we

see is not a short-term aberration? How do we know that Mother
Nature will not rectify the problem, without human intervention?
Further study is required."
3. Past ecological disasters. "The Easter Islanders didn't leave any

documents explaining why their population declined. Further study is
required."
Page 262 of 355
4. Species extinctions. "Species extinction is a natural process. There

is no way to be certain that any particular species was lost due to
human intervention. Further study is required."
5. Impending natural catastrophes. "You cannot be absolutely certain

when an eruption will occur, and evacuations cause economic and
social upheaval. Further study is required."
6. Ill effects of lucrative vices. "In moderation, alcohol is a healthful

drug and some people can drive responsibly with blood alcohol levels
that might impair others. We should factor in the positive social and
economic aspects of alcohol consumption before we reach any rash
conclusions about the ill effects of alcohol. Further study is required."
7. Predicted exhaustion of natural resources. "Humans are

resourceful. How can you be certain that we will not find additional
oil preserves in the future? Further study is required."
8. The theory of evolution. "Let's not get carried away with

Darwinian evolution until we explore alternate theories, such as
Intelligent Design. Further study is required."
Because all science needs further study, all science can be dismissed
as unproven. The U.S. government has codified the refutation of
scientific opinion with the Data Quality Act of 2001, a short and
cynical document that virtually guarantees that no legislation will be
based on scientific achievement. The Act was passed as part of the
FY 2001 Consolidated Appropriations Act (Pub. L. No. 106-554.
codified at 44 U.S.C. # 3516, note.) The Act requires Federal
Agencies to base their decisions on high quality data and to permit
the public to challenge and correct inaccurate data. The drawback to
this legislation, is that science is a messy process, and data may not
always attain a very high quality. It may require decades before the
data in a new area of study achieves the level of quality that critics
will accept. The easiest way to bring scientific progress to a grinding
halt is to insist on data quality. Special interest groups have invoked
the Act to reject published, peer-reviewed studies appearing in
prominent journals, claiming that such publications may not reach the
Page 263 of 355
standard of data quality required for government work (263), (264).

Always remember that if the opposite of "Pro," is "Con," then the
opposite of "Progress," is "Congress."
Evil scientists are pretty much insulated from the negative

repercussions of the Data Quality Act, which applies almost
exclusively to those scientists stupid enough to base their conclusions
on experimental data. If you play your cards right, you can live a
luxurious life in a data free zone, sustained entirely by hype.
Large research projects depend on public and private contributors.

Those contributors require scientists to paint an impossibly bright and
hopeful image for every project. Consequently, the scientists who
work on a scientific initiative will never say anything that imperils
the initiative. Never! The human genome project is a case in point
(265). The project began in 1990 as a multi-institutional effort to
sequence the three billion base-pairs of the human genome. Why
bother? Early claims stressed that the human genome sequence would
be the basis for understanding the genetic causes of human disease
(266). Once we understood the genetic basis of diseases, prevention
and treatment would follow. As the project moved forward, the
federal effort was duplicated and surpassed by a private initiative.
After about ten years, the federal and the private efforts mutually
announced that the human genome had been sequenced (more or
less). With the successful sequencing of the human genome, the
world entered the so-called post-genome era, wherein scientists
would review and analyze the collected genome. The project is
considered, by everyone involved, one of the greatest advances in the
history of mankind. In retrospect, considering the success of the
private effort, it hardly seems that the government-sponsored effort
was necessary.
The project has a few dirty secrets. Common diseases have a

multitude of genetic components; each genetic component may be
caused by variations in multiple different genes; and each variant
gene may have multiple different genetic changes. The
aforementioned sentence can be re-stated without jargon: common
diseases have many different underlying genetic alterations, and that
Page 264 of 355
is exactly why common diseases occur commonly. For common

diseases, such as schizophrenia, bipolar disorder, and type 2 diabetes,
we find very little evidence that there are specific genetic traits
present in the majority of cases. Dr. Goldstein, a population geneticist
has said that, "we have cracked open the human genome and can look
at the entire complement of common genetic variants, and what do
we find? Almost nothing. That is absolutely beyond belief" (265). A
cynic might conclude that the Human Genome Project was one of the
greatest examples of scientific hype in the history of mankind.
Pharmacogenomics, sometimes referred to as personalized genetic

medicine, is an over-hyped scientific field that draws heavily from
the human genome project. Soon after the human genome had been
sequenced, there was enormous enthusiasm for individualizing
medical treatment based on an analysis of each person's genome.
In a 1999 article entitled, "New era of personalized medicine

targeting drugs for each unique genetic profile," two Wall Street
Journal reporters described a $45 million dollar effort launched by a
consortium of 10 of the world's largest drug companies intended to
"identify several hundred thousand chemical signposts" (267). The
drug companies would use the gene data to create drugs specifically
targeted to each person’s unique genetic profile (267). A rich
scientific literature emerged at the turn of the millennium, heralding
the new age in gene-based medicines. A decade later, medicine hasn't
changed very much. Most drugs are dispensed in the traditional range
of 20 to 200 milligram doses. Trial and error is still the most effective
way of finding the right drug for any individual. Without genetic
analysis, physicians and their patients somehow settle on a drug and a
dosage that works for the individual.
What went wrong? Before you can get much benefit from
pharmacogenomics, you need to collect phenotypic data (treatment,
outcome, clinical, historical, physical) on millions of patients, catalog
the genetic alterations that can account for diseases and drug
responses in millions of subjects, and integrate the phenotypic data
with the genetic data. Simply acquiring genetic data will not suffice.
This project is well beyond the capability of modern science. No
Page 265 of 355
team of scientists and healthcare workers can do the job, no matter

how much money is at stake.
Gene therapy is another over-hyped ideas that captured the twentieth

century imagination. If there are genetic causes of diseases, should
we not try to cure those diseases by correcting the gene defect? James
Le Fanu, in The Rise and Fall of Modern Medicine, wrote that in
1995, after spending hundreds of millions of dollars in gene therapy
research, NIH reluctantly concluded that the approach was useless
(268). By the turn of the millennium, most of the funding for gene
therapy had dried up. Nearly fifteen years later, in 2009, the field has
made some progress. Gene therapy has successfully corrected several
cases of Leber’s congenital amaurosis (blindness), a rare congenital
disease (269). There is every indication that continued work in gene
therapy will lead to the correction of some diseases caused by single-
gene mutations. But there is little hope that gene therapy will
transform us into anything close to genetically perfect beings.
Nanotechnology, the science of small mechanical devices, has

inspired some of the very best science fiction. Star Trek's Borgs
could not live without their nanotechnology. The same Borg
technology has inspired (invaded?) the minds of the NIH leadership.
An NIH funding announcement, issued in 2007, clarifies the future
role of nanotechnology in medical research: "Nanotechnology and
nanoscience have the capacity to drive a new wave of medical
innovation through the engineering of bioactive nanoscale structures,
processes and systems based on the advancement of our
understanding of biology at the nanoscale (270)" NIH, along with the
Borg, might be correct in their assessment of the importance of
nanotechnology in human medicine. Or they may be wrong. Either
way, the time for hype is now.
Today, the most hyped area of scientific investigation is stem cell

research. Who can say that stem cell research is any more important
than any other area of active research? Experience tells us that most
of the important advances in medical science have come out of left
field, without the early support or recognition by large federal
institutions or funding agencies. What makes an institution or agency
Page 266 of 355
lavish publicity and funds on one area of research and ignore some
other areas? Hype is the answer. How many areas of research were
underfunded in the last two decades of the twentieth century, in
deference to a well-hyped idea whose time had not yet come?
A disease advocacy group successfully lobbies to funnel large

sums of money to their pet disease. Over the years, well-
funded laboratories make incremental advances toward a
cure. The advocates applaud every small advance. The
number of small advances is used as an argument that a cure
is certain to come very soon. From their funded research, a
sensitive screening tool is developed. Though there is no cure
for the disease, individuals with early, non-clinical disease,
can now be selected from a healthy population. Soon, a drug
is developed that extends the life expectancy, of people who
have the disease, by twelve days. Advocates consider this drug
a major breakthrough. A high level of funding provides
researchers with an incentive to pursue their research over the
next five decades. Finally, a cure for the disease is discovered.
A Nobel prize in medicine is awarded. The advocates, who
persevered over more than a half-century, collecting billions
of dollars for their project, are jubilant. You wonder to
yourself, whether the money might have been better spent on
some other disease, that could have been cured with less
money, in less time, for the benefit of more people.
One day, you will attend a lecture on a scientific topic, and the
speaker will smile throughout the talk, and he will tell you that every
idea and hypothesis in the field is exciting, every experiment is
successful, and every scientist in the field is brilliant. When this
happens, you must know that this is not science; it is advertising.
The life of young scientists is occupied by endless hours of cheap,

unappreciated labor, self-doubt and the feeling that they have put
their trust into the hands of villains (older scientists). The lives of
older scientists are dominated by a maniacal quest to justify their
languishing careers and to obtain the approval of their peers. Hype
allows you to achieve prestige, wealth, fame, and power, for marginal
Page 267 of 355
scientific contributions.
Have you read any of the reviews attached to books on Amazon.com?

Anyone can write a review for any book. Reviewers can supply their
names, but others simply identify themselves as "reader," and the city
where they live. Amazon keeps the names of the reviewers
confidential. Sometimes mistakes happen. The Associated Press, on
Saturday, February 14, 2004, reported that the identity of reviewers
had been unintentionally revealed on the Amazon.com's Canadian
website. As the names of reviewers came to light, it became obvious
that some authors had posted glowing reviews of their own work.
Was anyone surprised?
Here are some clues that you are being hyped:
1. The speaker's cause is virtuous and without negative consequences.

The speaker has made great personal sacrifices to advance the cause.
The speaker stands to gain nothing.
2. The speaker professes to see events that will unfold in the future.
3. Time is of the essence. Speed will be rewarded with success while

any delay will prove disastrous.
4. The opponents of the speaker's cause are small, narrow-minded

individuals and represent a minority opinion.
5. The speaker humbly admits that he had admired you and your
work for many years (typically, in silence).
In 2009, researchers found a 47 million year old fossil that may

represent an early primate bone. This kind of finding has some
interest to paleontologists, but its value as a popular interest item is
limited. Nonetheless, the discoverers parlayed their finding into a
media event involving: a ceremony at the American Museum of
Natural History, a film detailing their study, a book release, an
exclusive deal with ABC news, and a web site (271). When
interviewed, Jorn H. Hurum told the New York Times, "Any pop
band is doing the same thing (271)."
Page 268 of 355
For nearly two centuries, physicians held fast to a code that

prohibited self-advertisement. The American Medical Association's
Code of Ethics, of 1847, was adapted from Thomas Percival's
"Medical Ethics; or a Code of Institutes and Precepts adapted to the
Professional Conduct of Physicians and Surgeons (1803)". The 1847
Code of Ethics, Chapter II, Article I, Section 3, describes the practice
of physician advertising as "derogatory to the dignity of the
profession." This self-imposed humility came to a crashing end in
1975, when the U.S. Federal Trade Commission decided that the
prohibition against self-advertisement was "restraint of trade," in
effect elevating physician self-advertisement to the status of a
statutory right (272). Today, as an exercise in civic responsibility,
physicians brazenly advertise on television, radio, newspapers, the
Internet, and many any other media outlets. When a television
commercial features a dozen physicians from a large practice,
administering to their patients, while a disembodied voice assures
viewers that they will receive the best of care from this dedicated
team of professionals, it's easy to buy into the illusion.
18.1 MATHEMATICS IS NEITHER SCIENCE NOR

RELIGION
"Biologists think they are Biochemists,
Biochemists think they are Physical Chemists,
Physical Chemists think they are Physicists,
Physicists think they are God,
And God thinks he is a Mathematician."
-Anonymous
"Mathematics is the part of science you could continue to do if you

woke up tomorrow and discovered the universe was gone."
-Dave Rusin
"Only two things are infinite, the universe and human stupidity, and
Page 269 of 355
I'm not sure about the former."
-Albert Einstein
The most dangerous question a scientist can ask is, "How do we

know what we think we know?" Among all branches of science,
mathematicians are the only one who take the concept of "proof"
seriously. Theoretical mathematicians are obsessed with the ideas of
"assumption", "proof" and "provability." As such, mathematics
occupies a realm that is beyond belief and disbelief (i.e., beyond
religion and science). God may alter the rules of chemistry and
physics, but He/She cannot change the rules of mathematics. In 1824,
Abel (1802 - 1829) proved that it is impossible to find solutions to
quintic equations; impossible for Abel, and impossible for God. God
observes the rules of proof and provability that are written by human
mathematicians.
With the exception of mathematics, which enjoys an existence

unfettered by the space-time continuum, the residuum of science is
very much a human enterprise, not fundamentally different from
football or tap-dancing. As mathematicians have come to care more
and more about truth, the other scientific disciplines seem to care less
and less. Medical professors openly confess that half of what they
teach is simply wrong, but they cannot determine which half is wrong
and which half is right. Evil scientists should work within the real
world, avoiding higher mathematics like the plague.
1. In science, belief is a choice. You might as well believe in those

assertions that advance your career.
2. Nobody has the right to make you believe anything, even when it's
true. Just say, "I have listened to everything you have said, and I have
reviewed all of the evidence that you have provided, and, frankly, I
am just not convinced." Always remember that your ignorance is just
as valid as your critic's knowledge.
3. Scientists are hired for their ability to see into the future. It is not
unusual for an interviewer to ask a job candidate for their prediction
Page 270 of 355
of where they see the department, five years hence. Never hesitate to
take a stupid (but beloved) project and predict its great success in the
future.
4. Nobody has ever proven anything in the natural sciences. To create

an impasse, just insist on having proof. In particular, when you need
to stop progressive legislation that threatens your agenda, invoke the
Data Quality Act (that's why the Act was created).
5. Your data is your data. Hide, hoard, or suppress your data

whenever it suits your agenda.
6. When asserting your authority, don't get involved with facts or

logic. Simply indicate that you are the authority on the subject, and
the opposition lacks authority. People will appreciate this simple and
forthright approach to the problem. Remember that everyone will
yield to authority when the authority promotes an opinion that
furthers their own selfish pursuits.
7. By asserting authority, you render an act of kindness on all those

involved in the decision-making process. Through a simple act of
trust (in you), everyone is relieved from the intellectual burden of
analyzing data and judging opposing arguments.
8. Declare that intelligent design is a scientific ideology on par with

evolution. Insist that the purpose of science is to confirm the
fundamental beliefs of your funding religion (whatever those beliefs
may be). When your colleagues suggest that your beliefs are
nonsensical, reply that they are being close-minded, anti-scientific,
and godless.
9. Self-promotion is a time-honored pursuit among evil scientists.
10. It is a terrible thing to cheapen your reputation; make sure you

charge top dollar. Understand that your clients believe that the best
professional will charge the most money for his services.
11. When you're wrong, and you know it, insist that "Further study is
needed."
Page 271 of 355
12. Understand that science is politics, and successful scientists are

politicians. Any set of data can be interpreted to support any political
agenda.
13. If you want to be an evil scientist, stay away from mathematics as

a career.
CHAPTER 19. SEX AND GENDER
"Nobody really cares if you're miserable, so you might as well be

happy."
-Cynthia Nelms
You are a 35 year old male pathologist, married. There are

three parts to your job: service, research and teaching. The
service you perform is to render accurate diagnoses on human
tissue specimens (biopsies, blood samples, cytologic
preparations, etc.) that are delivered to the pathology
department. The research you perform involves trying to
understand the causes, mechanisms, diagnostic methods and
treatments for human diseases. Your teaching responsibilities
may include performing a few lectures to medical students and
allied health scientists.
Most of your teaching involves supervising the residents

(pathologists-in-training) who rotate through your department. The
pathology residents have all graduated from a school of medicine.
Each holds a medical degree, but they must devote more years
(typically 5 years) in specialized training before they can sit for the
pathology board examination and become someone who can
independently practice pathology.
Pathology residents tend to be in their late twenties or early thirties,

though you sometimes encounter a resident who is in his fifties. On
this particular day, as you walk in the long, long hallway that leads
to the pathology department, you find yourself gazing at the rear end
of the woman just ahead of you. She is a new pathology resident. She
walks in tandem with two other residents, but they fade into
Page 272 of 355
invisibility. You find yourself automatically adjusting your speed to

match that of this alluring new resident. You keep a safe distance
(one car length) behind her. The swaying, up and down, back and
forth, of her shapely ass captivates your attention. Through an act of
will, you lift your eyes a bit to survey her torso and her lovely red
hair. For a brief moment, you are happy.
Suddenly, she twists here head and spins her body a bit to look in
your direction. She smiles and your eyes meet. You smile back. Once
she has received your smile, she turns back and continues walking
forward with her friends, as though nothing had happened. "Did she
know that I was staring at her ass?", you wonder.
Later that day, you sit in your office, peering at a glass slide through
your microscope. On the glass slide is a thinly sliced tissue section of
a tumor that a surgeon had removed from his patient the prior day.
The surgeon will be expecting your rendered diagnosis later that
afternoon. You are relaxed, doing a service that your were trained to
do and that you do well.
A resident enters your office. You look up, and see, for the first time,
the front of the female resident. She comes closer, extending her
hand, as she tells you her name. You do not get up (a pathologist at
his microscope is not expected to rise when greeting colleagues). You
shake her hand. Without invitation, she sits on the chair adjacent to
your desk. She has somehow taken charge of the encounter.
She talks briefly about herself, her medical school, the service
rotations that she has had, and she asks questions about the current
service: on-call requirements, reporting time in the morning, frozen
section responsibilities. You reply to each of her questions with a
smile. You try your best to be witty, and she laughs lightly. To add
emphasize to her remarks, she reaches over, from time to time, to
touch your knee. You do nothing to dissuade this familiarity.
Suddenly a third year female resident walks into your office. The new
resident calmly keeps here hand clasped on your thigh, just above the
knee. Now, both of the residents are looking at you. You shift your
position, extricating your knee. Somehow, the awkward moment
passes and both residents leave your office to resume your duty.
Page 273 of 355
A horrible, sinking feeling overwhelms you. You lost something that

you valued; respect.
Every workplace is charged with sex. Office romances are never

announced, but you know when it happens. Sometimes it is overt,
with coworkers having affairs and cheating on their spouses.
It is winter here in Chicago. Two coworkers who seem very

friendly at work are both traveling to the same scientific
meeting, in New Zealand. They book their flights themselves,
not through the department secretaries. They fly on on the
same plane, on adjacent seats. A colleague who attended the
same meeting says that he would see them together in the hotel
and at restaurants in the evening, but that he saw neither of
them in the conference rooms. Your colleague returns from
New Zealand pale and a bit haggard after his long trip. Your
two coworkers return relaxed, happy, and tan.
Sex can be stormy. What begins as sexual favoritism can end

abruptly.
A young, beautiful junior scientist has joined your department.

Within three months, she is asked to co-author the fifth edition
of a major textbook authored by a senior male professor in the
department. Three months after that, she is abruptly dismissed
from the staff. You hear that she has found a good job at
another university, far away. Her name never appears as a co-
author on the book.
Most workplace sexuality is subtle. An insecure man flirts with every

woman in an office. He has no intention of cheating on his wife. He
seeks affirmation that he is desirable. Women do the same. The most
prevalent form of office sexuality is favoritism: the object of your
desire can do no wrong.
You are a woman attending a staff meeting. An object of your

sexual desire presents his scientific research to the group. You
see a major flaw in his approach to a problem, but you keep
quiet. The group decides to follow a plan that will certainly
Page 274 of 355
waste everyone's time. Afterwards, you congratulate him on

his presentation.
People think, incorrectly, that marriage somehow corrects the

inequities that result from office sex. Not so.
You are the male head of the physics department. Your wife is
an assistant professor, who is coming up for tenure. If she
does not receive tenure, she will be forced to look for a
position in another university. Physics positions are few, and
she might need to leave the state for work. Because of your
obvious conflict of interest, you have recused yourself from
participating in your wife's tenure committee. Your wife has
submitted a paper to a prestigious journal for publication.
After waiting months for review, the paper was rejected, She
has no other publications in any major journal, and this will
not bode well for her. You have friends who are members of
the National Academy of Sciences. One of them can sponsor
her paper in the Proceedings. As for the tenure committee, you
notice that one of the committee members has requested a
sabbatical. You set a date to discuss his request; the day
following your wife's tenure review.
19.1 WHERE THE BOYS ARE
"The American male doesn't mature until he has exhausted all other
possibilities."
-Wilfrid Sheed
If you read the history of any field of science, you may notice the
paucity of female participants. For the greatest part of human history,
women have been steered away from the sciences. This is true for
virtually every culture on the planet. There are theories offered as
explanation. You've heard most of them. In keeping with the theme
of this book, consider this question: "Are women sufficiently self-
absorbed, power-hungry, and generally evil to be good scientists?"
Maybe not. Boys are brought up to be self-centered, and ambitious. A
boy learns to take what he wants from weaker boys. Wars are a
Page 275 of 355
natural extension of learned boyhood behavior.
Look at prisons. They're filled with men. Hardly any women at all.
Most of the men in prison are relatively young; covering the
intellectual peak years for scientists. During their long, stumbling
course toward maturity, males are basically sociopathic, committing
most of the violent crimes that plague society, and achieving most of
the scientific breakthroughs that benefit society. Basically, science is
just another anti-social activity of young men; miraculously twisted
into the service of humankind. Women account for a minority of the
scientists, for the same reason that they account for the minority of
prison inmates; they're not evil.
1. In the long run, the workplace is the wrong place for sex.
2. For men, being evil comes naturally. Women may need to work at
it.
CHAPTER 20. GREED
"If you're an engineer, you don't want to outlaw the great technology
you've been working on. If you're a marketing person, you don't want
to outlaw the thing you've been trying to sell. If you're a C.E.O., you
don't want to outlaw the thing that's been making a lot of money."
-Bob Lucky, an executive director at Bell Labs, who developed car

cell phones, knowing that on-road conversations distracted focus
away from the task of driving (273).
"The haves have not what all the have-nots have since much of
having is the need to have."
-Samuel Hazo, in his poem, "The Necessary Brevity of Pleasures"
I have never met a high-paid professional who thought that his salary
was too high. Never. But if a highly-paid professional truly earned
the salary they received, the World Trade Center Towers would be
standing, Wall Street would not have collapsed in 2008, the mortgage
Page 276 of 355
crisis would have been averted, Enron would still be in business,

cancer would be eliminated as a common disease, we would need
many fewer physicians, and our planet would not be slowly roasting,
like a slab of meat on a rotisserie. Every day, we pay some
individuals large salaries, so that they can do a very bad job. Why is
this?
Jeffrey Kluger, in his book, Simplexity: Why Simple Things Become

Complex (and How Complex Things Can Be Made Simple), uses a
visual tool to answer this question (274). Imagine a U-shaped tube.
At the two top ends of the tube are the highly complex jobs. The low-
complexity jobs fall into the bend. The salary curve follows the U,
with the lowest paid jobs at the top-left point in the U, the medium
salaries in the bottom bend, and the top salaries at the top-right point.
The lowest paid jobs (top-left) are highly complex. They may involve
mastering a large inventory, knowing what multiple co-workers are
doing at any given moment, satisfying the real or imagined needs of a
fussy and diverse public, and so on. These jobs are found in Wal-
Mart stores, Burger King restaurants, airports, etc. The highest-paid
jobs, on the other end of the U, are also complex. They may involve
sticking an endoscope down another person's esophagus, watching a
screen with hundreds of stock prices, or writing wills. In the middle
are the jobs of low complexity, where workers do a few well-defined
tasks and meet an acceptable level of competence.
The people at one end of the "U" will earn 100 times or more than the
salary of the people at the opposite end; while the level of complexity
is the same at both ends. Those at the high-paying end are the
professionals. They have gone through a filtering process that serves
to reduce their numbers, without actually improving the final product.
Life, as everyone knows, is unfair.
The most highly paid of the scientific professionals are physicians.

How much are they really worth, and in what regard should they be
held?
The earliest physician known by name was I-em-hetep, who practiced

medicine about 4500 B.C. in Egypt. He was worshiped as a demi-god
at least up to the time of Mycerinus (about 2500 B.C.) (119). Not to
Page 277 of 355
be outdone, the Greeks had their own god of medicine, Aesculapius.

Legend has it that Aesculapius was born while his mother was being
consumed by fire on a funeral pyre. At the last possible moment, he
was cut out from her womb, and given his name, Aesculapius, which
means "to cut open." Today, most physicians have less eventful births
than Aesculapius, and shorter legacies than I-em-hetep, but they feel
a deep sense of entitlement just the same.
In the Book of Ecclesiasticus, written about 180 B.C. by Jesus Ben

(Son of) Sirach, we receive the following advice (119):
"Honour a physician according to thy need of him with the honours

due unto him:
For verily the Lord hath created him.
For from the Most High cometh healing:
And from the King he shall receive a gift.
The skill of the physician shall lift up his head:
And in the sight of great men he shall be admired."
Obviously, the ancients held their physicians in high esteem, and this
may have been based, on large part, on the ambiguaty between the
healing arts and the priestly arts. If the doctor's power comes through
prayer, and if the physician knows how to channel divine
interventions to his patients, his adulation would be well-deserved.
Nowadays, the power of physicians to heal comes from thousands of
scientific discoveries and technical contributions that were made
without his input. Basically, if you can get accepted into medical
school, the practice of medicine is included in the tuition.
Physicians typically endure about eight years of post-undergraduate

training. Though the length of physician training is long, it is no
longer than that of many scientists. Graduate studies in the sciences
(the period between undergraduate graduation and the time when the
Ph.D. is received) can easily extend 6 years or more. Following
graduation, Ph.D. scientists can expect to serve in a low-paying post-
Page 278 of 355
doctoral position for three years or more. Much of the effort

constitutes a long filtering process whose primary purpose is to
reduce the number of trained specialists, and hence raise incomes for
the fully-filtered residue (remember the "U" tube principle).
If you've been to a doctor's office recently, odds are that you were
seen by a Physician's Assistant (PA), not an M.D. Physicians
Assistants are professionals whose medical education was delivered
in a two-year bolus. This short spin around the hospital qualified
them to take care of you and your family. In all likelihood, you will
find that your PA surpasses your doctor in terms of professional
demeanor, level of expertise, quality of care, and personal hygiene.
The next time you drive by an obscenely large mansion, and your
passenger confides that the owner is a physician, you might want to
run through the following set of questions pertaining to the mansion's
owner:
1. Did the doctor have anything to do with developing the

medications or the technical instruments, or the treatment protocols
that he uses in his practice?
Answer: Of course not.
2. Did the doctor prove that the medicines he prescribes are effective?
Answer. Of course not; that's done for him by the pharmaceutical

industry and regulated, in the U.S., by the FDA
3. Does the doctor have any role in lowering the incidence of disease
in the population?
Answer. Not much. Public health authorities, epidemiologists,

nutritionists, exercise trainers, civil engineers, and a large cast of
non-physician characters have had the greatest influence on lowering
the incidence of disease, primarily by instituting preventive measures.
On average, people who drink clean water, have well-balanced diets,
abstain from smoking and excessive alcohol consumption, maintain
an optimal weight, exercise regularly, reduce their exposure to
pollutants and toxins, and lead a risk-averse life, require fewer
Page 279 of 355
medical services than people who do the opposite. Every doctor

knows that the majority of doctor visits are precipitated by life-style
indiscretions. If the American public behaved sensibly, the medical
workforce would shrivel into a tiny ball. Physician salaries and
healthcare costs would plummet. Basically, the delivery of medicine
is sustained by the stupidity of the receivers. It is simply not in the
interest of the medical profession to change the status quo.
4. Does the doctor have any role in increasing the incidence of

disease in the population?
Answer. Yes. The Institute of Medicine has estimated that medical

errors cause up to 98,000 deaths occur each year, in the U.S. (11). In
addition, the rising death rate from antibiotic-resistant organisms
(previously known as antibiotic-sensitive organisms) are due, in
greatest measure, from poor prescription practices, by physicians.
5. Does the doctor promote the diagnosis and treatment of conditions

that do not benefit from or require treatment?
Answer. American physicians get paid for performing diagnostic

procedures and for treating patients. The more tests and treatments
they perform, the more they get paid. Tests and procedures work best
on healthy patients, because healthy patients are less likely to suffer
adverse consequences from tests and procedures than the people who
really help. Consequently, physicians are motivated to provide
services to those who need them least. Increasing the number of
physicians with access to expensive tests and procedures will produce
a greater volume of unnecessary treatments. To counter the rising
number of unnecessary, expensive, and potentially harmful tests, a
number of laws and regulations have been enacted or proposed. For
physicians, the two most oppressive laws are the Anti-Kickback
Statute and the Stark Law (275).
6. Does the doctor charge fair and reasonable fees?
Answer. How many impoverished doctors do you know? Doctors

charge what the market bears.
7. Does the doctor wash his hands?
Page 280 of 355
Answer. Not often enough (120).
8. Does the doctor treat all his patients with the same level of care?
Answer. Some patients pay thousands of dollars for so-called

concierge practice, where patients pay for preferential attention and
quick service (276). Isn't this a violation of the Hippocratic Oath?
Don't physicians swear to treat all patients as equals. Actually, no.
The Hippocratic Oath seems to have omitted any such ethical
obstacle. But the AMA (American Medical Association) indicates
that it is the doctor's responsibility to provide timely attention to the
needs of his patients. Specifically, the AMA Code of Medical Ethics
states the following (277):
"(3) The patient has the right to courtesy, respect, dignity,

responsiveness, and timely attention to his or her needs."
Because timely and responsive care is a fundamental patient right, it

seems somewhat odd that physicians would provide it only to those
who are willing to pay extra.
From the doctor's point of view, the concierge system is a win-win

situation. In one strategic move, they have eliminated from their
practice the socio-economically disadvantaged patients, who often
present with complex, serious medical problems; and they gain a
healthier, wealthier patient population willing to pay for the
semblance of preferential treatment.
Who are the patients that physicians give preferential treatment? We

don't need to speculate; doctors are eager to tell us. In a New York
times article, reporter Natasha Singer focused on a California
dermatologist who maintained two waiting rooms: one for sick
patients, and one for patients seeking beauty treatments (278). The
waiting room for sick patients is adequate, while the waiting room for
people seeking botox and other enhancements is luxurious, with soft
music and flowers. Phone calls from sick patients go directly to voice
mail. Phone calls from patients seeking beauty treatments go to a
phone answered by a staff member. The treatment rooms for diseased
patients lack the aesthetic touches found in the treatment rooms
Page 281 of 355
reserved for the would-be beautiful patients. Singer found that some
offices hire special receptionists for patients seeking cosmetic work,
and offer these patients quicker appointments than the patients with
actual diseases.
Beauty treatments are usually not covered by medical insurance

policies, and the costs of cosmetic treatments are not controlled by
payers, such as Medicare. For beauty treatments, doctors will charge
whatever the market bears. It's much less profitable to treat a disease
than to provide a cosmetic procedure.
20.1 CASHING IN ON CANCER
"To be blunt about it, there's no money in prevention, and once

you've got cancer you'll pay anything to try to stay alive."
-Peter Montague (279)
In 1883, Oliver Wendell Holmes wrote, "There is nothing men will

not do, there is nothing they have not done to recover their health and
save their lives. They have submitted to be half-drowned in water,
and half-choked with gases, to be buried up to their chins in earth, to
be seared with hot irons like galley-slaves, to be crimped with knives
like codfish, to have needles thrust into their flesh, and bonfires
kindled on their skin, to swallow all sorts of abominations, and to pay
for all this, as if to be singed and scalded were a costly privilege, as if
blisters were a blessing and leeches a luxury" (280). Know one
knows this better than the corporations that sell drugs for the
treatment of cancer. Of all the diseases inflicted upon humanity,
cancer has proven itself the most lucrative. Here's why:
1. Cancer is common. One in two men; one in three women will

contract cancer during their lifetime.
2. Cancer is scary. Everyone is afraid of cancer, and the public

continues to lavish money on the National Cancer Institute, despite
decades of imperceptible progress.
3. Cancer is chronic. Cancer doesn't kill in a day or a week or a

month. Most cancer patients will languish for years of treatment
Page 282 of 355
(281).
4. Cancer is expensive, and insurers are obligated to foot the bill for
high-priced treatments.
5. There is no cancer cure on on the horizon. Drug companies don't

need to worry that someone will come up with an effective, cheap
cancer cure that will eliminate their source of income.
The leaders in the fight against cancer have never been limited to
saints. One of the earliest and most successful cancer crusaders was
Adolf Hitler. His liberal use of vivisection notwithstanding, Hitler
launched an innovative campaign against smoking, and led a
remarkably progressive screening program for cervical cancer (282),
(283).
Today's pharmaceutical industry cynically embraces cancer research,

knowing full well that desperate patients will grasp any cancer
treatment that lengthens their life, even for a few weeks, and at any
expense, so long as a third party foots the bill (284). Erlotinib, sold as
Tarceva by Genentech, OSI Pharmaceuticlas and Roche
Pharmaceuticals, was approved by the FDA for treatment of
pancreatic cancer. It costs about $3,500 per month, and will improve
survival by an average of 12 days (284) (285). This 12-day miracle
has been embraced by the community of oncologists. The chief
executive of OSI Pharmaceuticals, projected that annual sales of
Tarceva could reach $2 billion by 2011 (286).
Bevacizumab (developed and sold by Genentech as Avastin) is one of

the most popular cancer drugs in the world, bringing in about $6
billion in global sales, in 2009 (287). It can easily cost $50,000 to
$100,000 per year of use. Avastin does not seem to be much of a
wonder drug. Recent trials have shown that Avastin does not extend
the life of men with advanced stage prostate cancer (287). Ditto for
gastric cancer (287). In responsive cancers, studies indicate that it
extends life by up to four months (288). Why is Avastin popular? A
well-marketed drug that promises hope for to desperate patients, will
sell, no matter the price.
Page 283 of 355
At any moment, drug companies are running more than 800 clinical
trials for cancer drugs (284). They know that if they can develop a
drug that improves cancer survival, even for just a few weeks, they
can recoup their investments. Big pharma sinks about a billion dollars
into each new drug that come to market. Their exclusive right to
market the new drug lasts, at most, twenty years from the patent
filing date. In view of these circumstances, consumers expect
pharmaceutical companies to charge a lot for each dose of a newly
developed cancer drug. Conversely, consumers expect cheap prices
for generic and ancient nostrums, that are easy to manufacture in bulk
quantities and for which no research investment was made. No such
luck.
Matulane (sold as Procarbazine), is a drug closely related to mustard

gas, and was approved for the effective treatment of Hodgkin
lymphoma, way back in 1969. Cheap to synthesize, it sold for a
paltry 66 cents per pill until 2005, when the price jumped to $56 per
pill, an overnight 8,400% increase (289). How could this happen?
Easy. The price of drugs is not regulated by the FDA or any other
federal agency. In the U.S., if you happen to have a monopoly on
sales, you can charge whatever the market will bear.
Today, decades after the War on Cancer was launched (1971) the
cancer death rate is about the same as it was in the mid-nineteenth
century. The pharmaceutical industry has not produced many new
cancer drugs. The public is paying exorbitant rates for a few new
therapies, most of which have only minimally effectiveness. Who is
to blame? Many would blame the FDA, clearly the least likely culprit
in this sordid business. Guards are now posted at the FDA's public
cancer advisory meetings, to protect the FDA staff and its invited
committee members (290).
We are no closer to a cure for the common, advanced cancers than we

were fifty years ago. The number of people with cancer is increasing
and will likely triple over the next few decades. The medical-
industrial complex is counting on cancer to be a dependable revenue
source for the near future.
Page 284 of 355
20.2 OFF-LABEL PHYSICIANS
"Every American is just a diagnosis away from poverty."
-Anonymous
Physicians do not discover effective treatments, but they certainly

know what works for their patients; not! Physicians can be as clueless
as their patients when it comes to effective therapies. Though the
public is told that physicians are trained as medical scientists, nothing
could be further from the truth. Their training in statistics, clinical
trial design, outcomes research methods, medical toxicology, is
rudimentary, at best. Very few physicians have the expertise or
interest in evaluating new treatment protocols. Every drug salesman
knows that physicians will believe what they are told, if you exercise
the proper incentives.
Pfizer offered doctors $250 or more, per visit, for arranged

"mentorships" (291). For fees received, doctors are mentored by the
drug company representatives on the uses of their drugs, in real-life
patient encounters. Would a physician prescribe a medication solely
on the say-so of a drug company representative? Of course they
would; why else would the drug company pay for their time?
According to Peter Lurie, former deputy medical director of Public

Citizen, a Washington-based public interest group, "Most doctors
don't keep track of FDA-approved uses of drugs," and "The great
majority of doctors have no idea; they don't even understand the
distinction between on- and off-labeling" (291).
It's bad enough that doctors rely on drug reps to learn new treatments,
but the plot moves from stupid to criminal when the drug
representative pushes off-label uses for drugs. Here is the problem.
When the FDA approves a drug, the approval is restricted to one or
several particular uses. Specifically, the FDA considers those uses
that were tested in the clinical studies that pharmaceutical company
submit to the FDA. All drug uses other than the uses approved by the
FDA are considered off-label uses. In many cases, off-label drug uses
have not been been shown, in clinical trials, to be safe or effective. It
Page 285 of 355
is illegal for drug companies to market drugs for off-label uses.
Doctors, unlike drug manufacturers, are not regulated by the FDA. In

the U.S., physicians can legally prescribe drugs for off-label uses;
and they do. In a 2006 study, it was found that "about 21% of all
estimated uses for commonly prescribed medications were off-label,
and that 15% of all estimated uses lacked scientific evidence of
therapeutic efficacy" (292).
In 2004, Pfizer paid 430 million dollars in fines for illegally

marketing Neurontin for off-label uses (293). Prosecutors in the case
said Warner-Lambert [acquired by Pfizer] paid doctors to listen to
pitches for unapproved uses of Neurontin. One doctor was paid
nearly $308,000 to promote Neurontin at conferences (294).
Undeterred by Neurontin fines, in September, 2009, Pfizer

Pharmaceuticals pleaded guilty to a U.S. criminal charge related to its
promotion of Bextra. The drug company agreed to pay $2.3 billion to
settle charges that it promoted Bextra and Zyvox directly to doctors
for a variety of unapproved, or off-label uses and dosages (293).
Pfizer is not the only over-zealous drug manufacturer. Eli Lilly and
Company paid $1.42 billion to settle claims related to the adverse
effects produced by marketed, off-label uses of Zyprexa (295), (296),
(297). Zyprexa is approved for use in some cases of schizophrenia
and bipolar disorder. It is not approved for use in dementia. The drug
carries an FDA waring that it increases the risk of death in older
patients with dementia (295). Nonetheless, Eli Lilly urged their
salespeople to market the drug for dementia (295).
Though it is illegal for drug companies to persuade doctors to

practice off-label medicine, there are few restrictions on marketing
efforts for on-label uses. Big pharma pays doctors millions of dollars
to prescribe their high-cost medicines. The New York Times has
reported a six-doctor practice in the Pacific northwest area, that was
paid 2.7 million dollars by Amgen for prescribing $9 million worth of
their drugs (298). The payments were totally legal.
A Harvard psychiatrist received $1.6 million from a pharmaceutical
Page 286 of 355
company but did not report much of the income to Harvard

University. The payments were legal. The psychiatrist got into some
trouble only because he failed to report the income to his employer,
Harvard (299).
A survey of physicians has shown most payments received by

doctors, for collaborations with pharmaceutical companies and with
the medical devices industry, are deemed appropriate by doctors
(300).
20.3 GHOST WRITERS
"Behind every able man, there are always other able men."
-Chinese proverb
"Every writer I know has trouble writing."
-Joseph Heller
You have been working in your field for decades, attending

meetings, holding press conferences, providing expert witness,
and giving commentary to journalists. You have become a
brand name in your field. Football players, basketaball stars,
bicyclists, swimmers, all manage to bring in tons of
endorsement money based solely on their celebrity. Is it fair
that you cannot make a dime based on your sterling
reputation? Nobody has approached you to endorse a tennis
shoe or a breakfast cereal, but some day a pharmaceutical
corporation will ask you to endorse their latest anti-anxiety
drug or diet pill. When that day comes, you will not miss the
chance to cash in.
Of course, the best way of authoring anything is to take credit for

another person's work. In the past, wealthy people were well-
accustomed to paying others to for every conceivable service. In
Europe, the wealthy could pay to have a seat in Parliament. In early
America, the wealthy would pay to have someone serve in the army
in their place. Throughout the scientific community, wealthy students
would pay to have someone else write their theses and their scientific
Page 287 of 355
papers. People who wrote books and articles for money, without
appearing as a named author, were called ghost writers. Today, the
lucrative field of ghost writing has been turned on its head. Scientists
are paid, very handsomely, to have teams of corporate writers publish
journal articles with the scientist listed as the sole author.
Corporations have found that a journal article favorable to their
product, and credited to an influential and respected author, has
enormous value to the company.
In August, 2009, Natasha Singer reported, for the New York Times,
on ghost writing in the Pharmaceutical industry (174). Wyeth
pharmaceuticals helped produce 26 scientific articles between 1998
and 2005, that emphasized the beneficial effects of hormone
replacement therapy (174). In a proposal prepared for Wyeth by a
firm that wrote many of the articles, the goal of the publication's
initiative was to "increase physician awareness on the multitude of
benefits that hormone replacement therapy provides" and "diminish
the negative perceptions associated with estrogens and cancer" (175).
In a process likened to medical ventriloquism, the American physican
community willingly believed that hormone replacement therapies
had a protective effect on the heart (175).
Wyeth's sales of hormone drugs Premarin and Prempro were about

$2 billion in 2001 (174). Sales subsequently dropped after a large,
NIH-sponsored clinical trial showed that combination hormonal
therapies increased the risk of breast cancer, heart attacks, dementia
and pulmonary emboli (175).
Here is how drug company ghost writing generally works. The

pharmaceutical company chooses a set of scientific points that it
would like to emphasize. A company that specializes in medical
communications is generally contracted to write a series of articles
suitable to the pharmaceutical company. After the articles are
prepared to the satisfaction of the pharmaceutical company, respected
authorities in the relevant field are approached and asked if they will
permit the papers to be published listing them as authors, in exchange
for a consultation fee. The paper is published. The journal editor and
the journal subscribers are unaware of the arrangement. Readers
Page 288 of 355
falsely assume that the article was written by the listed author,
without influence by the pharmaceutical industry. Pharmaceutical
companies have the right to help authors write papers that highlight
the benefits of their products. Likewise, pharmaceutical companies
are under no obligation to emphasize, in scientific papers, the risks
associated with their products; nobody is held to such a standard.
Scientists have the right to accept consultation fees from
pharmaceutical companies, and they have the right to publish
scientific papers. Everybody wins.
When the New York Times article broke, scant attention was paid to
the role of journal editors in the tangled story (174). Why weren't the
editors aware that the articles were ghost-written? What had
happened to the vaunted peer review system? Why had the articles
not raised suspicions among the eagle-eyed peer reviewers? Isn't it
the job of the editor and the peer reviewers to ensure discussion of
both sides of controversial scientific topics? Why was the journal-
based review system unable to detect that the articles were ghost-
written by an industry-paid company commissioned to promote the
beneficial effects of hormone replacement therapies?
Ghost-writing is rampant in the scientific community. In a review of

809 scientific papers, by Flanagin and coworkers, 93 articles (11%)
had evidence of ghost authors (60). In a Washington Post article, a
nuclear energy consultant admitted that he was paid to write pro-
industry editorials and farm them to colleagues, who allowed
themselves to be listed as authors (301). This method of
dissemination provides the illusion of many minds, but analysis of
the text usually demonstrates the same key phrases in every editorial,
pointing to a single, ghostly author (301).
A 1997 paper published in the Journal of Occupational and

Environmental Medicine claimed no link between drinking
chromium-polluted water and cancer incidence. At the time that the
paper was written, a public utility was being sued for allegedly
exposing California residents to chromium pollution. The editors
eventually learned that ghost writers hired by the public utility had
contributed to the article that seemed to provide exculpatory
Page 289 of 355
scientific evidence for the utility company (302). The paper was
retracted by the journal, nearly a decade after the fact (303).
Sometimes, when industry ghost-writes a document, there are too

many people willing to take the credit for the same work. Lobbyists
working for Genentech ghost-wrote nearly identical position
statements for over a dozen members of Congress. The Congressmen
published the statements, as their own, in the Congressional Record.
Any citizen with the time and inclination would see that the same
text, with only minimal deviation, appeared repeatedly. In all, over 40
members of Congress used, as their own, points written by lobbyists
who were paid by Genentech (304). It's a pleasure to see the
American political system at work.
The services of ghost writers are many. Grant applications, review

articles, clinical trial summaries, legislation, committee reports,
consensus guidelines, industry standards, position statements, and all
manner of documents traditionally produced by groups of scientists,
can be prepared by a single ghost writer, serving a corporate agenda.
Whenever you read a scientific report, never assume that the persons
listed as authors had much input in the finished product. So long as
there is power and money, there will be ghost writers.
1. If you work in a large corporation, university, or government

organization, you may one day be in a situation wherein billions of
dollars can be gained or lost, based on your decisions. Keep cool.
Remember that your personal wealth is determined by your control
over the money; not on the competence of your decisions.
2. Patients who hold their lives dearly should not object to paying
dearly to prolong their lives.
3. Remember that hope carries a big price tag. So long as the patient
believes that a new cancer drug has a small chance of prolonging life,
even for a few weeks or months, they will pay anything for the
treatment.
4. With cancer, everyone gets a bite at the apple. Pharmaceutical
Page 290 of 355
companies, hospitals, medical associations, device makers, research

agencies, and numerous other auxiliary services profit from cancer. If
cancer were eradicated, all these industries would suffer. No
compassionate person would want that to happen.
5. Drug manufacturers can fund innovative medical research. If the

research happens to provide evidence for an off-label drug use, so
much the better.
6. The FDA can tell you what you can market, but it cannot tell
doctors what they prescribe. The most profitable returns on a drug
often come from off-label uses (uses that were not approved by the
FDA). For example, of the $2.27 billion Pfizer collected on sales of
Neurontin, in 2002, $2.12 billion came from off-label use (291).
Never forget that the most profitable niche in the multi-billion
pharmacy industry comes from prescriptions that have no proven
medical benefit.
7. Remember that scientific journals can provide effective

propaganda for drug marketing. The most valuable journal articles
are those in which your drug has been shown to have benefit for
clinical situations other than those approved for use by the FDA (so-
called off-label uses).
8. Though it is illegal to market off-label drugs, the penalties have

been trivial compared to the profits. Though Pfizer paid $2.3 billion
in fines and penalties for marketing off-label uses of Bextra and other
drugs, the revenues on those same drugs, for the years 2001 to 2008,
were $16.8 billion. The $2.75 billion paid by Pfizer for off-label
penalties since 2004 represents about one percent of the company's
earnings of $245 billion over the years 2004 - 2008 (291). Crime
does pay.
9. Remember, you have a fiduciary obligation to the patient, not to

the patient's family. Sometimes, a patient's family will weigh the
dubious benefits of vigorously treating a terminal patient against the
deprivations that the family will face when it tries to pay for your
services. Don't let them put their needs ahead of your own.
Page 291 of 355
CHAPTER 21. THE FUTURE OF EVIL SCIENTISTS
"We are here and it is now. The way I see it is, after that, everything
tends towards guesswork."
-Terry Pratchett, Small Gods (1992)
"Hell is where everyone is doing his own thing. Paradise is where

everyone is doing God's thing."
-Thomas Howard
"I don't try to describe the future. I try to prevent it."
-Ray Bradbury
"Never make predictions, especially about the future."
-Casey Stengel (sometimes attributed to Yogi Berra or to Sam

Goldwyn
Everyone knows that winning is better than losing. By extension,

most people believe that winners are better than losers. Consider the
lottery. The person who wins a $50 million lottery had no influence
over the lottery results. Anyone grounded in reality understands that
the winner of the lottery is determined by chance. Nonetheless, the
winner of a lottery becomes a celebrity, appearing on multiple news
spots, in interviews, in human feature stories, and so on. People want
to know how he chose his lucky number. Interviewers ask how he
plans to spend his money, a question that would be considered taboo
under any other circumstance. People admire this person. Why? For
religious people, God works through elements of nature that are not
controlled by the exercise of free will. If humans cannot control the
outcome of the lottery through an act of free will, then the outcome of
the lottery must be determined by God. For the non-religious lottery
enthusiasts, chance is the instrument of fate. The lottery winner is
fated to win, just as the lottery loser is fated to lose.
It is your job, as an evil scientist, to be a winner in the eyes of people

who are too stupid to distinguish fate from chance. This usually
Page 292 of 355
means modifying circumstances so that chance favors you (i.e., fixing

the bet). You can start to put the odds in your favor by eliminating
the common causes of failure:
1. Caring about what other people think
2. Not accepting credit for other people's work and talent.
3. Breaking the eleventh commandment (XI. Thou shall not get

caught).
4. Not blaming others for your mistakes.
5. Not being there. Woody Allen has told us that showing up is 90%
of success.
6. Wasting time developing your talent and imagination when you

have neither.
7. Cultivating the wrong friends.
8. Acquiring the wrong enemies.
9. Allowing personal feelings and interpersonal obligations to

interfere with your selfish goals.
10. Not accounting for the perversity of nature. The ancient Greeks
had a saying, "Man plans. The gods laugh."
If you indulge in scientific sentimentality (i.e., the belief that science

is the pursuit of truth), you will join the legions of pathetic losers,
who were incapable of advancing their ideas in a competitive
environment. Here are a few:
Johannes Kepler (1571 - 1630) - Kepler was a great scientist, and

astronomer. He wrote the laws of planetary motion, and he developed
fundamental principles that would come to underly the invention of
calculus. He made important contributions to optics and geometry.
Though Kepler was very supportive of the universe, the universe did
not support Kepler very well. Living in a time when mathematicians
were not highly valued, he could barely support his family. Kepler
Page 293 of 355
endured a lifetime of uninterrupted poverty. He died in relative

anonymity, but he is recognized today as one of the greatest scientists
of all time.
Nikolai Ivanovich Lobachevsky (1792 - 1856) - Lobachewsky

invented non-Euclidean geometry (sometimes called Lobachevskian
geometry). Though a full professor at Kazan University, in Russia,
who filled the roles of teacher and administrator, he was dismissed.
His health deteriorated, and he became unable to walk, and nearly
blind. He died in poverty, in 1856.
Nikola Tesla (1856 - 1943) - Special attention must be paid to Nikola

Tesla; no man has done more for the world and received so little in
return. Tesla was one of the greatest inventors and visionaries of the
nineteenth and twentieth centuries, best known for his invention of
AC (alternating current) power systems and methods for transmitting
power over long distances. His enthusiastic support for AC current
caused a huge rift with his early benefactor, Thomas A. Edison, who
steadfastly supported DC power systems. Tesla tried to convince
Edison, to no avail, that large power resources could not be
transmitted over long distances by direct current; only AC could do
the job.
Though Guglielmo Marconi (1874 - 1937) assembled a working

radio, his accomplishment required more than a dozen patented
discoveries of Tesla. Nonetheless, Marconi alone won the Nobel
prize, in 1909, for inventing the radio. Perhaps Tesla's most
significant uncredited accomplishment resulted from his
experimentation with x-rays, in 1887. He used x-rays to photograph
the bones of his hands, several years prior to Roentgen's famous
experiment. Many of his findings in the field of x-ray technology and
x-ray photography were lost in a lab fire, in 1895. That same year,
Roentgen got the credit for x-ray imaging. In 1901, Roentgen was
awarded the first Nobel prize in physics. For Tesla, the twentieth
century was a time for continued intellectual productivity, rewarded
by increasing isolation and social ostracism. His ideas were too
strange for most people, including his peers, to grasp. If you've ever
stayed at the Hotel New Yorker, caddy-corner to Penn Station, in
Page 294 of 355
New York City, you've been at the same hotel where Tesla lived out
the last years of his life.
Edwin Howard Armstrong (1890 - 1954) - Armstrong invented FM

radio and the superheterodyne receiver (used by all modern radios).
His life and career was plagued by a prolonged patent litigation that
eventually reached the Supreme Court. In addition, RCA lobbied the
FCC for regulations that would curtail the rising dominance of FM
radios. Endless court battles, combined with his single-handed battle
against the corporate broadcasting giants, led Armstrong into poverty.
In 1954, he committed suicide by jumping out of his apartment
window, 30 floors above the streets of Manhattan. After his death, his
family pursued his legal fight, and eventually won. Though
Armstrong never benefited from his contributions to society, his heirs
did.
These stories should convince you, beyond any reasonable doubt, that
life is best spent as an evil scientist. Once you have your life planned
out (evil, followed by even more evil, followed eventually by death),
what comes next? Death. Don't be alarmed, as Dave Lister said, in
Red Dwarf, Series I, "Lots of people have died and gone on to do
really really well."
Of course, when you die, you will go to hell. This is a consequence of

the "evil" part of being an evil scientist. Evil scientists should not be
dissuaded from pursuing their dreams just because of some irrational
and unfounded fears of eternal agony. The purpose of this section is
to explain what hell will be like for evil scientists and how it offers an
enjoyable after-lifestyle filled with colleagues, a sense of community,
and familiar surroundings.
The whole idea behind hell is that you get what you deserve; for
eternity. If you've been an evil scientist all your life, following all of
the suggestions offered in this book, and avoiding the temptations to
be weak, ineffectual, unpopular, and poor, you can expect to be
rewarded with the same standard of existence that you had when you
were alive.
First off, your hell will be exclusively populated by other evil
Page 295 of 355
scientists. You will be re-united with all of your colleagues who

passed away while you were alive. Everyone else (people who were
not evil scientists) go someplace else when they die, and you won't be
seeing any of them. This means that your hell will be the exclusive
preserve of your peers, the people who understand you and accept
you for who you really are.
As for the physical aspects of hell, they will be much as you

remember your life. You will live is a realm somewhat reminiscent of
downtown Detroit. There will be huge apartment buildings (to house
all of the dead evil scientists), dingy laboratories, and hotels with
enormous lobbies. The purpose of the hotels is to accommodate all of
the conferences, workshops, seminars, conventions, congresses, task
forces, review courses, brainstorming sessions, and other designated
group meetings that will occupy most of your infinite time.
In life, you loved meetings. They were the places where you
developed alliances, garnered undeserved credit for the
accomplishments of others, and generally outmaneuvered your
competition. In hell, every day will bring a new meeting. As in life,
you will see the same people attending every meeting. You will hear
the same lectures from the same speakers that you heard when you
were alive. You will roam the same hallways, making contacts,
handing out business cards, and discussing restaurants, wine, and the
good things that bond evil scientists.
Publishing will be much the same in after-life as it was during life. In

either case, the process of publication is endless. The key difference
is that in the after-life, authors are required to read all of the papers
on which they are listed as an author. For those scientists who are
accustomed to taking credit as a co-author without actually
contributing to the publication, this requirement can be agonizing.
Many evil scientists helped to develop unsafe, obscenely expensive,

and ineffective drugs during their earthly careers. Nobody is perfect.
Nonetheless, these scientists are conscripted into a complex and
distasteful ritual. First, they are obliged to contract the disease they
purported to cure. Then they must pay the full listed price for the
drug that they developed. They are then required to endure any of the
Page 296 of 355
side effects of the drug. Then they are expected to endure eternity
with the disease that was not cured by their ineffective treatment.
All the sinful pleasures are available ad libitum in hell. Because the
likelihood of having a loving relationship with any of your hellish co-
habitants is just about zero, you might as well indulge yourself with
the most superficial aspects of human involvement: gratuitous sex,
food as a form of pleasure, and intoxicating chemicals that enhance
your enjoyment of post-existence. These are basically the same sins
you enjoyed during your lifetime. If you were deprived of these perks
during life, here's your chance to rectify the situation, for eternity.
1. Never do any work. Work is what other people do for you.
2. Travel. Travel. Travel. The key to advancement in science is

through attendance at meetings, developing alliances, and building
your reputation as an available speaker.
3. Remember that the purpose of research is to get grants (not the

other way around). Never pass up the opportunity to be listed as a
principle investigator on a grant, even when you cannot possibly
contribute to the work. When the grant money ends, quickly abandon
any work that that may have been accomplished.
4. Attack anyone who disagrees with you, even when you know that
they are correct and you are wrong. Attacks should always be
indirect; nobody should know that you are the attacker. Undermine
your opponent's scientific credibility, authority, honesty, and
grooming. Keep good documentation of the past indiscretions of your
associates. A well-planned, surprise attack on a co-worker, or even a
superior, has the best chance for success.
5. Confine your work to scientific fields of low "reproducibility". If

the different laboratories in a field cannot reproduce each other's
work, then you can publish almost anything without fear of being
exposed (think microarray) (305) (306).
6. Hire cheaters. All cheating is high-risk behavior. When there is
Page 297 of 355
cheating that needs to be done, you'll need a professional.
7. Don't feel guilty about cheating innocent people. Remember, you

cannot cheat an honest man.
8. Promote all your failures as though they were successes.
9. Hire staff to sing the praises of your efforts. People will believe
you if they hear your words repeated by other people. Before long,
the voices of your retractors will be lost in cacophony of praise.
10. Always take the easy way out. If a project becomes difficult,
palm it off on a colleague, and settle for co-authorship. If the project
is successful, take credit for the work, as though it was your own.
11. You have now learned all the tricks that evil scientists use. You
can bet that your colleagues will try to use these tricks against you.
Watch your back!
CHAPTER 22. FINAL EXAM
Do you have the aptitude to be a successful evil scientist? Take a few

minutes to answer these twelve simple questions, and learn
something about yourself.
1. As a high school student, did your love of learning light your path
to higher education, or were you climbing the dark, crowded stairway
leading to college entrance?
2. As a college student, did you choose to major in one of the

sciences simply because you happened to ace the "Intro" course?
3. Have you ever made a scientific presentation in which you

neglected to mention any of the drawbacks of your approach, the
ambiguities in data interpretation, or the many obstacles that would
render your work unrepeatable?
4. When someone in the audience points out the drawbacks of your

approach, the ambiguities in your data interpretation, or the many
obstacles that would render your work unrepeatable, does that person
instantly become your mortal enemy?
Page 298 of 355
5. Have you ever discovered an error in a paper that you authored or

co-authored, and then neglected to inform the journal editor of the
mistake?
6. Have you ever recommended one of your close colleagues to be a

speaker for a scientific conference, bypassing serious scientists who
contributed much more to the field than your colleague has, but who
happened to be strangers to you?
7. Have you ever criticized the work of another scientist even though
you had never actually studied their published papers and could not
fully understand what they have done?
8. Have you ever spoken with admiration about a scientist whose

papers you never actually studied, and whose works you never quite
understood, simply because everyone else seemed to like him?
9. Have you ever made a scientific presentation in which you

neglected to cite scientists whose views disagreed with yours? Have
you ever declined to give credit to the competing laboratory that
reached the same scientific conclusion, months before you?
10. Have you ever reviewed a paper and taken four months or more
to return your review, instead of the two week turn-around period that
you promised the editor?
11. Have you ever chosen to attend a scientific meeting based on its
exotic location, or the alluring social amenities, or for any reason
other than the scientific value of the meeting?
12. When you appear on a paper as one co-author from among many
other co-authors, do you later count the paper as one that you have
published or that you have authored when you know that your
contribution was minimal, at best?
If you answered "yes" to all twelve questions, then you are a person
of the very highest moral flexibility.
If you answered "yes" to between 1 and 11 of these questions, then
Page 299 of 355
you are a person capable of doing good and evil. Don't make the
wrong choice.
If you answered "no" to all twelve questions, you must be lying.

Nobody is that virtuous. Congratulations, you are now an evil
scientist.
CHAPTER 23. GLOSSARY
11th commandment - "Thou shall not get caught."
404 moment - The moment when you realize that you have lost an
important document. Origin found in the internet error message, "404
- document not found".
Academic freedom - The principles of academic freedom were

specified by the Supreme Court as the freedom for a university and
its faculty to determine: who may teach, what may be taught, how it
should be taught, and who may be admitted to study. Though the
Supreme Court has limited a few outrageous admission practices, the
basic principle holds that academic freedoms are legally protected
from outside influences. The people who are adversely effected by
the exercise of academic freedoms are, of course, the students.
Students, or their parents, pay a handsome fee for their educations,
but they have no say over who is appointed to the faculty, what is
taught, and the manner in which lessons are delivered. Using their
academic freedoms, faculty can ram any nonsense down the throats
of students, and the students will be required to regurgitate the same
nonsense when they take their exams. Students have no control over
the admissions process. When a university chooses to offer
preferential admissions to the offspring of rich alums, the non-legacy
students will complain, but nobody will listen. Basically, academic
freedom is the freedom of academia to deny academic freedom to
their students.
Acades vulgaris - Scientific term for student. From the Genus Acades
(L. academic) and the species specific name, vulgaris (L. common).
Abandonware - Software developed with someone else's money

(most often money from the U.S. taxpayer) and abandoned when the
Page 300 of 355
funding expires (307).
Accrual - The gradual collection of items. In clinical trials, accrual

refers to the enlistment of patients into a study. Accrual is to an evil
scientist what jury selection is to an evil lawyer. It is an important
opportunity to advance your own agenda at the expense of truth or
justice.
Advertisement - A commercial strategy that seduces people to

believe your unproven assertions.
Agnostication - The process of not knowing. In medicine,

agnostication is used whenever a patient asks, "How long have I got,
Doc?"
Anonymization - The process whereby everything that might link a

specific person to a piece of data is destroyed. When data is
anonymized, it is rendered harmless to the individual. Furthermore,
the individual can not claim ownership to anonymized data. Under
HIPAA and the Common Rule, the two regulations that control the
uses of confidential medical data, anonymized data can be used
freely, for any purposes, without acquiring patient consent (217),
(208). The tricky part about anonymization is that it can be done
wrong (you think you have anonymized the data, but you haven't),
and it cannot be reversed (once the data is anonymized, you can
never re-identify the patient). The inability to re-identify anonymized
data is the feature that distinguishes anonymization from de-
identification (which allows re-identification under specified
circumstances). Institutional Review Boards need to determine
whether researchers who claim to have anonymized their data, have
actually done so. Institutional Review Boards seldom have
competence in this area, exposing a weakness to be exploited by
clever evil scientists. See De-identification.
Anticipatory plagiarism - "Anticipatory plagiarism occurs when

someone steals your original idea and publishes it 100 years before
you were born," Robert Merton.
Apologize - "To lay the foundation for a future offence." - Ambrose
Page 301 of 355
Bierce
Arrogance - An evil scientist is an arrogant scientist. Arrogance is

sometimes confused with a sense of superiority, but there is a
difference. If I say, "I am a better scientists than you are," that is an
expression of superiority. If I say, "I am a better scientist than you
will ever be," that is an expression of arrogance. In the latter, there is
the smug assumption that the universe is designed to reward you and
thwart your competitors, despite the most heroic exertions on their
part.
Authority - Herman Kahn (1922 - 1983) said, "Authority is not

power; that's coercion. Authority is not knowledge; that's persuasion,
or seduction. Authority is simply that the author has the right to make
a statement and to be heard."
Bayh-Dole Act (The Patent and Trademark Amendments of 1980,

P.L. 96-517) - Adopted in 1980, the U.S. Bayh-Dole legislation gave
universities, small businesses and non-profits commercial control of
inventions, processes and other intellectual property developed under
federal grants (i.e., with taxpayer dollars). Investigators and
institutions may seek intellectual property protection (e.g., copyright
or patent), and these rights extend to both inventions and data data. In
1983 President Reagan extended the Bayh-Dole Act to cover large
companies. The down-side of the Bayh-Dole act is that grantees who
would have formerly opted to donate their grant-supported inventions
to the public domain, may now prefer to sequester their inventions
while they seek profits through commercial ventures. After Bayh-
Dole, some institutions have adopted policies that prohibit faculty
and staff from releasing software and data to the public, so as not to
jeopardize potential profits.
Belief system - A generic catch-all that includes religions,

philosophies, and cults whose existences are not based on any reality-
based proof. A true believer, knowing this, would insist that his
beliefs transcend observable reality.
Best - "The best is the enemy of the good," Voltaire.
Page 302 of 355
Bigot - "One who is obstinately and zealously attached to an opinion

that you do not entertain," Ambrose Bierce.
Body-snatcher - "A robber of grave-worms. One who supplies the

young physicians with that with which the old physicians have
supplied the undertaker." - Ambrose Bierce
Bore - "A person who talks when you wish him to listen," Ambrose
Bierce.
Busy - The universal excuse for not getting busy. When a scientist
says he is busy, it really means that he will not make himself
available to help you. Most scientists have a lot of leisure time; that's
one of the perks of being a scientist. The rare scientist who is
perpetually busy is usually someone with poor time-management
skills.
Cause of death errors - Cause of death data comes from death

certificates (308). Death certificate data have many deficiencies
(309), (310). The most common error occurs when a mode of death is
listed as the cause of death. For example, cardiac arrest is not a cause
of death, though it appears as the cause of death on many death
certificates. There is not much value in a death certificate for a man
who died with end-stage cancer when the listed cause of death is
"cardiac arrest." An international survey has shown very little
consistency in the way that death data are collected (311). Most death
certificates are completed without the benefit of an autopsy. At best,
death certificates express a clinician's reasonable judgment at the
time of a patient's death.
Cherry-picking bias - Selecting experimental parameters that are

most likely to promote your own scientific agenda, or biases. In
medical science, the most common cherry-picking activity occurs
during patient selection. By choosing the right patients, you can often
guarantee that your protocol will produce the results that you want.
Purists complain that cherry-picking is unscientific, and produces
results that are misleading and unreproducible in a general patient
population. Evil scientists understand that cherry-picking is no
Page 303 of 355
different that the legal practice of voir dire during jury selection. If
lawyers are allowed to cherry-pick a jury, why can't scientists cherry
pick their patients?
Citation - Among scholars, a citation is a credit given to a previously

published work from within a later work. A citation comes in the
form of a pointer to the author, title, and source of the prior work, as
a footnote or as a numbered item in a reference section. If you use an
original finding, method, or comment from a previously published
work, without citing the work, you are engaging in plagiarism. The
number of times that a work is cited in the literature is a rough
indicator of the importance of the work.
Co-author - Short for co-opting author. A person whose name has

been included on the list of persons responsible for a scientific
literary work (manuscript, chapter, or book), without making any
substantial contribution to the final product. In most cases, the list of
co-authors is chosen to achieve some political or social agenda. Co-
authorship is, in many cases, tacitly understood to be a reciprocating
process ("I'll list you as a co-author on my paper if you'll list me.").
There is no upper limit to the number of co-authors that may be listed
on a paper. Some manuscripts have over 100 co-authors. Obviously,
in these cases, the majority of the co-authors could not have seriously
contributed to the paper.
Committee - A group of people with nothing better to do. An adept

bureaucrat can form a committee that will function in a totally
predictable manner, if he chooses committee members whose
prejudices, allegiances, and work customs are known. In modern
times, service on committees has essentially replaced scientific
productivity as the sign of a credible scientist. Many famous
scientists have built their reputations exclusively on committee work.
Common Rule - The Common Rule (Title 45 Code of Federal

Regulations, Part 46, Protection of Human Subjects) is the U.S.
federal regulation that describes how scientists and institutions must
protect their human research subjects (208).
Competing Interest - See Conflict of Interest.
Page 304 of 355
Compilation - How do you tell the difference between a book (which

tells a story) and a compilation (a bunch of informative essays
published as an ensemble)? In a book, you cannot change the order of
the chapters without destroying the product. In a compilation, you
can devise a new ordering the chapters and still have an equivalent
(or maybe even an improved) product.
Confidant (alternate, Confidante) - "One entrusted by A with the

secrets of B, confided by him to C." - Ambrose Bierce
Confidentiality - Keeping safe an entrusted secret concerning another

person.
Conniver - One who permits a dishonest act to proceed without

interference.
Consensus - Scientific consensus is the illusion that truth is achieved

when everyone agrees.
Conservation of Energy, Law of - Evil scientists need to conserve

their energy; let others do the work. Sir Winston Churchill distilled
the Law of Conservation of Energy into basic elements; "Never stand
up when you can sit down, and never sit down when you can lie
down."
Contract - Had Van Gogh been a house painter, he would have had
steady employment. Just about everyone needs their house painted, at
one time or another. Nobody really needs an original piece of art
hanging on their wall. The relationship between house painting and
art is analogous to the relationship between contracts and grants. A
contract is a legal agreement to acquire a service or a deliverable item
for a specified remuneration. The funding agency specifies what it
wants, and the contractor delivers the item. In a grant, the researcher
tells the government what mysteries he would like to pursue, and the
funding agency provides him with the necessary money.
Corporation - A corporation is a legal entity that conducts business,

whose purpose is to sustain itself, to grow, and to profit. As a legal
entity, it has many of the same rights held by humans. Corporations
Page 305 of 355
can own and sell property; they can hold patents and copyrights; they
have rights of free speech under the first amendment, and they can
use those rights to mock their political enemies; they can sue people
and other corporations; they have the right to enter into contracts and
advertise their products. Most importantly, corporations can lobby
congress. Under the law, corporations must be motivated by profit.
When you combine an existential mandate for greed, with the power
to influence congress, you can understand why corporations are
usually much more successful than people. Remember the maxim:
laws don't protect citizens from ruthless corporations; laws protect
ruthless corporations from citizens.
Cronyism - Favoritism towards friends. Crass people think of

cronyism as a safe way to discriminate against everyone in the world
who is not your friend. Evil scientists think of cronyism as a sort of
power cooperative. Cronyism permits individuals to contribute some
of their power to a general pool of power (i.e., the sum of all evils).
Members of the cooperative can dip into the pool, as needed. See
Nepotism.
Data cooking - Discarding experimental data that does not fit your
hypothesis.
Data quality act - Data quality act The Data Quality Act was passed
as part of the FY 2001 Consolidated Appropriations Act (Pub. L. No.
106-554. codified at 44 U.S.C. # 3516, note.) The Act requires
Federal Agencies to base their decisions on high quality data and to
permit the public to challenge and correct inaccurate data. The
drawback to this legislation, is that science is a messy process, and
data may not always attain a very high quality. It may require
decades before the data in a new area of study achieves the level of
quality that critics will accept. The easiest way to bring scientific
progress to a grinding halt is to insist on data quality.
De-identification - Similar to anonymization, but with an escape

clause that permits data to be re-identified (linked to the unique
person who is the subject of the data) under specified circumstances.
Disclosure - A disclosure is a form, signed by a conference speaker,
Page 306 of 355
that lists commercial relationships and other potential sources of bias,

of the speaker. Many speakers believe, erroneously, that a disclosure
allows them to promote their commercial interests during their
lecture. They believe that anyone attending the lecture has access to
the disclosure and has been properly warned that the lecture will
contain a commercial message. This is simply not the case. The
disclosure does not relieve speakers from any of the customary
restraints and responsibilities imposed on speakers. The disclosure
exists for the benefit the attendees and for the protection of the
hosting organization. It informs attendees that the speaker has a
potential conflict of interest.
Dishonesty - A special type, class, or subset of honesty (the "dis"

kind).
Do-good doctors - You've seen them; they are the physicians who
work tirelessly in free clinics, who provide pro bono services to the
poor, and who travel to third world countries to provide basic health
services. These are the doctors who join Doctors without Borders and
other humanitarian organizations. Do-good doctors are weak people,
of low self-esteem, who have succumbed to primitive compassionate
instincts that normal doctors sublimate early in their careers. As an
evil doctor, you understand that if every doctor provided free
services, the entire medical-industrial complex would collapse.
Dogma - What we believe when we don't have evidence. Scientists

like to think of themselves as rational beings, but most of science is
riddled with dogma. Nobody has the time to verify every scientific
assertion, and every scientist settles for believing those things that are
believed by the majority of his peers. When the majority of scientists
buy into an idea, it becomes accepted dogma (until it's replaced by
yet another dogmatic belief). Once you grasp this basic flaw in the
fabric of knowledge, you can use it to your advantage.
Economy of truth - If truth is as precious as people say, it makes

sense to be economical with it. Use the truth sparingly, and only in
situations where hyperbole, understatements, omissions, or
distortions will not suffice.
Page 307 of 355
Effective treatment - A therapeutic regimen that has been shown to

be better than nothing at all, under restricted circumstances, and for a
defined patient population, in at least one study.
Egotist - "A person of low taste, more interested in himself than in

me." - Ambrose Bierce
Ethics - Distinguishing right and wrong, and then doing whatever you
want. Ethics is easy once you understand whatever serves your
interests is right, for you.
Expert - Someone who knows the limits of a field. Though experts

often oppose one another on issues of theory and practice within their
fields, they will often agree about the boundaries of their field. Only
an expert can say, with confidence, what cannot be achieved through
the application of a set of skills common to the practitioners of a
field. A powerful expert can essentially destroy a new and exciting
area of research, simply by insisting that it has no chance for success.
Expert witness - The term "expert witness" is usually an oxymoron,

because in almost every case, the expert did not witness anything.
More often than not, an expert witness is someone who draws a
conclusion from some piece of evidence, or who comments on the
scientific merit of the conclusions drawn from the evidence.
Felon - "A person of greater enterprise than discretion, who in

embracing an opportunity has formed an unfortunate attachment." -
Ambrose Bierce
Fertile ground - Academic centers liken themselves to fertile ground

for students and faculty. The fertile ground simile permits universities
to justify a wide range of activities that have nothing to do with
education.
FOIA - The U.S. Freedom of Information Act (FOIA, pronounced

Foy-a and rhymes with LaToya), enacted in 1966, gives U.S. citizens
access to data produced by the federal government (i.e., the right to
know what the government knows). In the U.S., some states have
FOIA laws similar to the federal FOIA. The Southern Illinoisan, a
Page 308 of 355
newspaper, requested state health department documents relating to

the incidence of neuroblastoma from 1985 to 1997. The state health
department denied the request, arguing that although the documents
were stripped of identifying information, it may be possible for a
malevolent person to discover the identifies of the patients using
demographic and other information contained in the records. The
Illinois court ruled against the state health department, ruling the foia
rights of medical researchers outweigh the privacy concerns of the
health department (312).
FOIAable - (Pronounced foyable). Retrievable under FOIA
Freedom of Information Act. See FOIA.
Fudging data - Changing values in data, usually for the purpose of

furthering a particular self-serving result. See Cooking data.
Funding rates - Each year, NIH receives about 50,000 new grant
applications. The number, 70,000 is sometimes used. But this higher
number includes grants that are amended and re-submitted in the
same year, and grants that are bounced back to the applicant without
review. The lower number more accurately reflects the actual number
of reviewed individual grants. Of these 50,000 grants, about 20% are
funded. This means that 80% of grant applications were a huge waste
of time and money.
Genetic colonialization - The practice of institutions (generally

Western institutions), sending scientists into underdeveloped
countries, extracting samples of various indigenous species (usually
crop species), and patenting the samples for themselves. Synonyms:
"business disguised as science," "gene prospecting", "genetic
colonization" and "trinket exchange" program (313).
Godwin's law - "As a Usenet discussion grows longer, the probability

of a comparison involving Nazis or Hitler approaches one." A
somewhat outdated Internet term (nobody uses Usenet anymore),
signifying that multi-party Internet discussions will eventually
deteriorate into an exchange of insults.
Graduate students - If you envision a department hierarchy as a totem
Page 309 of 355
pole, with the department chair sitting atop the pole, then you must
understand that the graduate student is located about 5 feet
underground, squeezed between the stump of the pole, and the cold
earth beneath. Graduate study begins after the undergraduate degree
is conferred, and extends to 4,5,6,7, or even 8 years. There is little or
no incentive for departments to shorten the length of training,
because graduate students are the cheapest labor force in the world.
Grant - A grant is a gift from a funding agency. Unlike a contract,

which is payment for a deliverable product, there is no specified
"deliverable" for a grant. For many grantees, the purpose of a grant is
to fund the preparation of the next successful grant application.
Greater than total recall - The ability to recall events that never
actually occurred or data that never existed. Strange as it may seem,
"greater than total recall" is a much more common talent than "total
recall."
Half-truth - Same as a whole lie.
Highly published scientist - A scientist who has published more

papers than he has read. Highly published scientists are seldom aware
of the contents of their own papers. If you try to engage a highly
published scientist in a conversation related to one of his
publications, he will immediately steer you to speak to one of his
post-doctoral fellows.
HIPAA - HIPAA is the 1996 Health Insurance Portability and

Accountability Act. As the result of that act, the HHS (Health and
Human Services) has issued 45 CFR Parts 160 through 164, the Final
Rule of the Health Insurance Reform: Standards for Privacy of
Individually Identifiable Health Information (217). Although the
HHS Final Rule is actually separate from HIPAA, common parlance
refers to the Final Rule as "HIPAA". In the United States, illness is
something that many people feel the need to hide. In particular, U.S.
citizens want to hide their medical histories from health insurance
companies and employers. HIPAA makes it a crime for health care
professionals to violate the privacy of their patients. Nonetheless,
U.S. insurers hire teams of investigators who use a variety of legal
Page 310 of 355
methods to find pre-existing conditions that can disqualify people

from obtaining insurance or that can disqualify reimbursement claims
from covered patients. A large percentage of U.S. Health Care
investment is devoted to denying coverage to sick citizens.
Human subject - As defined in the Common Rule, a human subject is

a living person who takes part in a research project. Deceased persons
are not human subjects (as defined under the Common Rule) and are
not protected under the regulation. Research on medical records is a
type of human subject research protected by the Common Rule.
Immutability and mutability - An immutable message can never be

altered, without revealing that an alteration has been made. Almost
no information is immutable. People can go back into electronic
records and change electronic messages, often with nobody the wiser.
This applies to confidential medical records, legal records, and more.
George Orwell deftly developed the concept of newspaper mutability
in his masterpiece, 1984, wherein news was altered retrospectively to
suit the agenda of a totalitarian state.
Indirect costs - When an investigator receives grant money from a

federal agency, the investigator's institution receives money as well.
The money that the institution receives is intended to support the
structural and infrastructural environment that the investigator cannot
provide for herself. The research building, the utilities, libraries, and
the costs of keeping services current are examples of indirect costs.
Indirect costs can equal or exceed the costs of the actual funded
research. Institutions benefit from grants awarded to their faculty,
primarily through these indirect costs.
Informed Consent (for Human subject research) - Subjects who are

put at any risk in an experimental study must be provided with the
right to just say no. To this end, researchers must provide prospective
human subjects with a consent form that informs the subject of the
purpose and risks of the study, and discloses any information that
might reasonably affect the participant's decision to participate (such
as financial conflicts of interest among the researchers). The
informed consent must be understandable to laymen, must be
revocable (subjects can change their mind and withdraw from the
Page 311 of 355
study), must not contain exculpatory language (i.e., no waivers of

responsibility for the researchers), must not promise any benefit for
participation, and must not be coercive.
Institutional Review Board - A committee formed in institutions

where human subject research is conducted, that ensures that the
institution complies with regulations that protect humans subjects
from harm. In the U.S., the two federal regulations that are of greatest
interest to Institutional Review Boards (IRBs) are the Common Rule
and HIPAA (217), (208).
International reputation - Albert Einstein has an international

reputation. You do not.
Iron Law of Oligarchies - Developed by Robert Michels (1876 -

1936). The office-holders in an organization work to increase the
wealth, power, and longevity of the organization, rather than pursuing
the mission of the organization.
Iron Law of Disciplines - Attributed to Ludwik Fleck (1896 - 1961).

Scientific disciplines become increasingly conservative over time.
Journal article - The following warnings apply to every scientific

manuscript you will ever read: 1) the paper may have been written by
a ghost writer, with the listed authors as shills, prostituting their
reputations for a consultation fee, 2) the listed authors may have
undisclosed conflicts of interest, of a financial nature, 3) in the case
of clinical trials, the study may have violated the rights of human
subjects, 4) the conclusions may be based on falsified or fabricated
data, 5) you will never have access to the raw primary data upon
which the conclusions were based, 6) the discussion section is a
subtle misrepresentation of the conclusions, designed to promote the
selfish agenda of the primary author, 7) the references omit important
precedent works published by competitors, and all relevant valid
works whose conclusions oppose the conclusions promoted in the
article, 8) the paper was accepted for publication only because it
confirmed the biases held by the reviewers, 9) the research was
probably submitted one to two years prior to the publication date and
currently has negligible value, 10) the article may have appeared in
Page 312 of 355
another place and another time, in another language, with a different

title and conclusion, 11) you are the only person on the planet who
has bothered to read the published manuscript.
Laputa - From Jonathan Swift's Gulliver's Travels, Laputa is a flying

island. The island is populated by over-educated theorists, who spend
their lives in deep thought (314). A Laputan field of science is one in
which new discoveries never yield any practical benefit. The
scientists in the field are constantly startling one another, with
observations and measurements of no apparent utility. Examples of
Laputan efforts might include: alchemy, the design of perpetual
motion machines, automobiles built as hovercrafts, jet back-packs
that fly individuals from place to place, computers that predict
sociological events such as wars and insurgencies, the strategic
defense initiative. The jury is still out on some of the big, well-funded
research projects of today, some of which have persisted for decades
without much benefit to society: the human genome project, the
cancer genome anatomy project, personalized pharmacogenomics,
medical nanotechnology, artificial intelligence, gene therapy for
common diseases, manned space missions including the space shuttle
project, and human-manufactured nuclear fusion as a practical energy
source.
License - A license is an agreement from a lawgiver or a copyright

holder or a patent holder or an owner indicating that the restrictions
that apply to everyone else (by virtue of a law, copyright, patent or
right of ownership) will not apply to you. For example, if you have a
license to use a patented process, that means that the normal rights of
the patent holder will be suspended for you, in the manner specified
in the license.
Menuese - Rhymes with Gouda Cheese. Menuese is the international

language of science. If you can't read and speak fluent Menuese, your
scientific career is ruined. Usage: "Menuese" is used in the following
verse, "The Doctor ignores you when you wheeze; he's planning
lunch in Menuese."
Merton's Hypothesis - "All scientific discoveries are in principle

multiples." That is, discoveries come from multiple contributors (65).
Page 313 of 355
MIA (Missing In Action) - A scientist is missing in action when he is

present at work, for the purposes of collecting his salary, but nobody
knows his whereabouts. If you call the office of an MIA scientist, the
receptionist will inform you that he "has stepped out," or "has not
been seen in the office", but nobody knows where he is. When
pressed, they might volunteer that he "is somewhere," hoping that
this information will suffice. In all cases, you will be invited to leave
a message on his answering machine, send him an email, or, if you
insist, leave a message with the receptionist. They will not volunteer
to arrange an appointment with the MIA, because they do not know
that you are appointment-worthy. In my experience, most scientists,
particularly academics, are MIA more often than not. Where are
academics when they are MIA? More than likely, they are at home,
transporting children to scheduled events, shopping, indulging in a
discrete sexual interlude, intoxicated, looking for another job,
receiving medical services, engaging in private consulting, fulfilling
the obligations of a second full-time job, or just sitting in their office
and refusing to accept calls. The beauty about being MIA is that you
collect your salary, without actually earning your salary.
Middleware - "Middleware is the intersection of the stuff that

network engineers don't want to do with the stuff that applications
developers don't want to do," Kenneth J. Klingenstein.
Moral flexibility - The ability to find a moral justification for an

action, no matter how unethical.
Moral relativity - The idea that an immoral act is venial (forgivable

after some limited punishment) if it is less immoral that some other
immoral act.
Multi-author paper - A single journal article may have dozens or even

hundreds of assigned authors. One of the most cherished absurdities
in science is the notion that a journal article can be written by
multiple authors.
Multi-tasking - The ability to do several things at once. What is

commonly called multi-tasking is a euphemism for flightiness: the
Page 314 of 355
inefficient habit of hopping around from one unfinished task to

another, without much to show for the effort. The multi-tasking
mystique has several advantages for powerful scientists: it provides
the illusion of productivity, and it allows the powerful scientist to
abandon tasks that require sustained, intensive, and uninterrupted
effort.
Nepotism - Nepotism is the blood-borne form of cronyism.
New idea - An old idea that you are hearing for the first time.
Obviousness in patents - For a device to be patented, it should be

new, useful and non-obvious. In KSR v. Teleflex (April 30, 2007),
the U.S. Supreme Court, in a unanimous opinion, reversed a Court of
Appeals decision, and determined that a prior patent was
unenforceable because it was obvious (161). The opinion discussed,
at length, the principles of obviousness. In particular, the Supreme
Court indicated that merely putting together prior art to make a new
device can only qualify for a patent if the resulting device is
unexpected by people working in the field; hence, not obvious. The
decision may have raised the bar for patents, particularly patents that
are built on prior art (e.g., all software and most software standards).
Off-label use - In 1962, Congress required that drug manufacturers

produce scientific evidence that a marketed drug is both safe and
effective for a specific use. When a drug company receives FDA
approval, the approval is restricted to the specific use demonstrated in
an FDA-approved clinical trial. All other uses of the drug (for
populations and conditions not included in the clinical study, or for
doses not deemed safe in the study) are not covered by FDA approval
and cannot be marketed by the drug company. Off-label use occurs
when the approved drug or device is used for a purpose other than the
purpose approved by the FDA. The FDA controls drug companies,
not doctors. Physicians are permitted to use drugs and devices for off-
label uses, if they wish.
One field one book rule - The evil scientist does not waste time
reading books in his field. At most, the number of books that an evil
scientist will read is "1". Every field has a so-called bible, so named
Page 315 of 355
because it is contains contradictory, incredible, and merciless

doctrine, often written by a committee, and altered by succeeding
generations of scientists who are angry about being left out of the
first edition. If you refuse to read more than one book, then you must
read your field's "bible."
Orphan drug - A drug needed by a small number of people. In the

past, drug companies were reluctant to manufacture drugs for rare
diseases. The small population with the disease cannot produce an
adequate return on investment for the manufacturer. Nowadays, drug
companies produce orphan drugs charging up to thousands of times
the manufacturing costs. Th idea is that third party payers (such as
health insurers) will pay any fee for a medically required drug, so
long as no competitors offer the same drug at a lower price.
Ownership - Ownership is a mercantile concept that bestows an entity

with the right to sell. If you own a horse, that means that you alone
have the right to sell the horse. If you own a tissue sample, that
means that you have the right to sell the tissue sample. A long-
honored tradition has prohibited the sale (hence ownership) of human
tissue. This tradition was broken by a recent court ruling that
assigned ownership of a collection of human tissues to Washington
University (315)
Panglossian - Blind optimism, after Pangloss, the optimist in Candide

(1759), by Voltaire (1694 - 1778).
Parker, Janet (1938 - 1978) - The last person on earth known to die
from smallpox (98). In 1978, Janet Parker was a 40 year old
photographer who lived in Birmingham, England. She worked on the
floor above Henry Bedson's smallpox research laboratory. Virus
particles escaped from Bedson's laboratory and infected Ms. Parker.
After learning of Parker's infection, Bedson committed suicide (98).
Patent farming - Planting (usually, surreptitiously) patented

intellectual property within someone else's intellectual property. The
patent farmer reaps his crop by surprising users of the
aforementioned intellectual property with notice that their activities
rely on a patented process or device owned by the patent farmer. An
Page 316 of 355
example occurs when patented methods are included within technical

standards. Hidden patents within standards can be asserted against
anyone who implements the standard (316).
Patent holding company - Private entities that buy many patents, thus
building portfolios of patents to assert intellectual property rights in
strategically chosen business sectors.
Use patents - Even when intellectual property has been made freely
available, the uses of the property may still be patented. This means
that when you use an idea, device, or process that is not covered by a
patent, you still need to determine whether your use of the patent may
constitute a patent infringement.
Peer review - A venerable tradition, in which clueless editors,

funding agencies, and awards panels ask scientists to spend their time
and energy reviewing the grants and manuscripts written by their
fiercest competitors. Not surprisingly, peer review provides reviewers
with the risk-free opportunity to ravage their enemies and steal their
ideas. Peer review has never been shown to serve a useful purpose;
yet we persist (67).
Pharma - Slang for pharmaceutical industry. Used in conjunction

with, and following, "big."
Ph.D. M.D. - A person who is qualified to be incompetent in two

fields. If you're lucky enough to have these both degrees, you can
parlay them into a lifetime of leisure. Basically, you can use your
research activities to cover poor clinical acumen ("Sorry, I was busy
in the lab"), and your clinical activities to cover poor research
("Sorry, I was in the clinic"). Because researchers seldom speak to
clinicians, your colleagues on either side of your job will be unaware
that you actually spend your afternoons in salacious trysts, with their
wives.
Pilfer - Scientists don't steal from other scientists; they pilfer.

Pilfering is a time-honored way of taking some scientific
advancement produced by another scientist and using it to advance
your own research agenda. One of the most successful acts of
Page 317 of 355
pilferage occurred when James Watson and Francis Crick got hold of
Rosalind Franklin's X-ray photographs of DNA (without her
permission). Watson and Crick have acknowledge that the photos
were of critical importance in their work, which culminated in their
discovery of the double-helical structure of DNA. Watson and Crick
received the Nobel price. Rosalind Franklin received their gratitude.
Though pilferers sometimes receive criticism from their peers, they
never get into any serious trouble, because pilfering is not a crime. If
you are ever accused of pilfery, the best defense comes from Isaac
Newton, who famously said, "If I have seen further it is only by
standing on the shoulders of giants." In other words, great science is
accomplished by peering over the shoulders of your colleagues.
Plagiarism - Taking credit, through a literary device, for another

person's intellectual contribution. Plagiarism is often confused with
intellectual piracy. If I take an idea, developed in a book that you
published, and I include it in my book, as though it were my original
idea, without citing your book as the source of the idea, that would be
plagiarism. Publication piracy is the copy-theft of a literary work. If I
take your book, re-publish it, sell copies of the re-published work,
and keep all the money paid to buy the re-published book, that's
piracy. As books go, scientific works have negligible value, and are
seldom pirated. Ideas are the currency of scientists, and plagiarism is
rampant.
Predicting the future - The thing about predicting the future is that
you need to start with a good understanding of the present. Nobody
really understands what is happening in the here and now. So it is
very unlikely that anyone can see the future.
Privacy - The right not to be bothered. Often confused with

confidentiality, the right to keep a secret. See Confidentiality.
Proprietary Standard - A Standard that belongs to some entity and

that cannot be used freely (i.e., without obligation, or restriction).
Prostitution - Currently the world's oldest profession, but at the time

when it was invented, it was the world's youngest profession.
Page 318 of 355
Publication dishonesty - Falsifying or fabricating data, lying about

the original source of the data (e.g., plariarism), adding co-authors
who did not contribute to the paper or whose contributions were
marginal, failing to cite the proper precedent papers, and listing as
co-authors persons who did not read and approve the final version of
the paper. In the case of journal articles, duplicate publications are
usually considered a form of publication dishonesty, because the
appearance of the publication implies originality.
Re-abstraction bias - Gaps in records often require re-abstraction

from other sources, and this may produce a final data set wherein the
re-abstracted records are quite different from the records that did not
require re-abstraction.
Record bias - Records can be inaccurate, incomplete or otherwise

flawed. If you base your conclusion on false records, it's unlikely that
your conclusions will have much value.
Reproducibility - Reproducibility was the former test for scientific

legitimacy. If an experimental result could not be reproduced in
another lab, then the original work was discredited (317). Today,
reproducibility cannot be used to discredit bogus research. Many of
the studies done today are way to expensive to repeat; or the data
produced by the experiment is so immense (gigabytes) that there is
no reasonable expectation of reproduction; or the information upon
which the assertions are based is confidential, and must be accepted
as a matter of untestable faith. Because research is no longer held to
the standard of reproducibility, it is a safe bet that scientists will seize
upon this new opportunity for risk-free scientific misconduct.
Retro-noting - The time-bending ability to post-date notes. It is one of

the most valuable tools available to physicians. A doctor who hasn't
seen his hospitalized patient in a month can make a short visit to the
ward, pull the patient's medical chart, and insert short notes, for each
day that the patient was in the ward, indicating something such as,
"Patient visited 8:20 a.m., no change in status, vital signs stable,
continue current treatment plan." Retro-noting permits lazy
physicians to comply with time-crucial standards of care, and to bill
Page 319 of 355
for "visits" that never occurred.
RICO - RICO is the Racketeer Influenced and Corrupt Organizations

Act, U.S. Code Title 18, Part 1, Chapter 96. RICO was designed as a
legal tool against the Mafia and other institutions of organized crime.
Since its passage, in 1970, the scope of RICO has been expanded. In
particular, RICO has provisions that may apply to professional
organizations that use their powers to obstruct the commercial
activities of people working outside the organization.
Royalty - The idea of royalties traces back to the rights of the crown
to claim a percentage of the proceeds from mines operating in the
royal domain. Today, royalties refer to payments made to an author
or a patent holder for the sale or performance of his or her intellectual
property.
Royalty packing - A requirement placed on a product developer to

include multiple patented technologies within the product.
Sometimes, the requirement to use multiple technologies is a
condition specified within the license for one of the necessary
technologies. Sometimes a government agency or a professional
society requires multiple technologies to be included in a product, to
conform with a standard. It goes without saying that a clever owner
of intellectual property may try his best to pack one or more of his
patented holdings into a product, even when it is not a valid and
necessary component of the device. Royalty packing increases the
cost of the product, and is closely related to royalty stacking. See
Royalty stacking.
Royalty stacking - Occurs when a product aggregates multiple

patented technologies within the final product. The greatest number
of aggregate patents occurs in manifold inventions, that involve
multiple parts and subcomponents, each containing multiple patented
properties. The practice of royalty stacking vastly increases the cost
of using the product.
Scapegoat - An animal or human (usually a graduate student or

technician) to which all sins can be transferred, after which the
scapegoat is conveniently sacrificed to the gods. Every laboratory
Page 320 of 355
should be equipped with one or more of these indispensable tools.
Selfishness - A biological imperative. Evolution's "survival of the

fittest," is just nature's way of telling you to look out for number one.
Semmelweis reflex - Dismissing the value of a novel scientific idea,

without the benefit of thought. Occurs whenever a new idea is
proposed or demonstrated by a non-authority (usually a young
person, or a person who has worked in a different scientific discipline
than yours). Named for Semmelweis, who proved that the number of
patient deaths could be drastically reduced if the maternity room
doctors washed their hands between patients; but the doctors decided
they would rather not.
Stealing - The crime known as "stealing" is a lay term that cannot be

applied to scientists. Scientists "pilfer"; they do not "steal", and
pilfery is not a crime and is not a form of scientific misconduct. See
Pilfer.
Stigler's Law of Eponymy - "No scientific discovery is named after

its original discoverer." (65)
Striving - To struggle or to work with great effort and sacrifice to

achieve a goal. The well-heeled scientist does not strive. Remember,
your goal as an evil scientists is not to be better than your colleagues;
your goal is to be better off than your colleagues.
Synonym - "A synonym is a word you use when you can't spell the
other one," Baltasar Gracian.
Type errors - Even statisticians will admit that the fundamental

concepts of their field are based on untenable assumptions about the
nature of reality. When you try to draw conclusions by sampling
populations, you're bound to produce scurrilous results. Rather than
correcting the fundamental errors in their field, statisticians have
simply classified them into four types:
Type 1 error. Rejecting the null hypothesis when the null hypothesis
is correct (i.e., seeing an effect when there was none).
Page 321 of 355
Type 2 error. Accepting the null hypotheses when the null hypothesis
is false. (i.e. seeing no effect when there was one).
Type 3 error. Rejecting the null hypothesis correctly, but for the
wrong reason, leading to an erroneous interpretation of the data in
favor of an incorrect affirmative statement.
Type 4 error. Erroneous conclusion based on performing the wrong

statistical test.
Nobody really understands how any statistical test works. None of

them are mathematically "provable." Evil scientists have ample
opportunity to choose a test that supports their favorite hypothesis.
When you commit a Type 4 statistical error, the only people who will
criticize you will be those who favor an opposing hypothesis.
Viral research - Research whose only purpose is to replicate itself and

infect many different laboratories, all devoting research funds to the
same area, without producing anything of value for society. The field
of artificial intelligence, infected hundreds of computer science labs
from 1970 through about 1995. Artificial Intelligence has since lost
some of its virulence. The idea behind artificial intelligence was that
computers could function like the human mind, only better.
Promising results spread from lab to lab, and much of the funding in
computer science was devoted to artificial intelligence. As a field of
science, artificial intelligence is purely pathologic, without
fundamental principles, and built from words that have no single
meaning to different workers in the same field. Many of those
researchers who survived their battle with the artificial research virus
have moved on to healthier areas: collective intelligence, cloud
computing, computer aided decision making, and search engine
algorithms.
Visionary - One of the best titles an evil scientist can hold is

"Visionary." A visionary is a person who has never made any serious
professional contribution to his scientific field, yet wields enormous
influence nonetheless. The major difference between a visionary and
a prophet is salary; visionaries are always well-paid. Prophets live
Page 322 of 355
and die in poverty.
WNL - The intended meaning of "WNL" appearing on multiple

locations throughout a patient's chart, is "Within Normal Limits." In
many instances, the real-life meaning of "WNL" is "We never
looked," indicating that the observation was neither measured or
recorded, but was assumed to be normal just the same.
Zipf law and Zipf bias - George Kingsley Zipf (1902 - 1950) gave us
Zipf's law, asserting that in a text corpus, the frequency of any word
is roughly inversely proportional to its rank in the frequency table. A
practical way of interpreting Zipf's law is that a small number of
words (the, if, of, a, the, is, in, on, for) account for most of the
occurrences of words in any text. Zipf's law can be extended to most
comprehensive collections of objects in the real world. For example,
a few computer companies account for the bulk of computer sales; a
few misbehaving students receive the bulk of the attention from the
school faculty; a few types of tumors (squamous cell carcinoma of
skin, basal cell carcinoma of skin, lung cancer, colon cancer, prostate
cancer, breast cancer) account for the overwhelming majority of
cancers occurring in humans. When people are unaware of the Zipf
distribution in an experimental study, they can be misled into
thinking that a random sampling from a population contains a fair
representation of all the different types of individuals in a population.
In fact, Zipf's law tells us that most random samplings will contain
the most frequently occurring objects in the population and will
exclude almost all of the objects that account for the wide diversity of
unique objects in the population. For example, a martian randomly
extracting 100 animals from earth, might find 40 ants, 30 spiders, and
30 assorted marine organisms. The likelihood that a human would be
included in the mix is virtually nil. If martians were unaware of Zipf's
law, they would leave us with a grossly distorted view of terran life
(i.e., the Zipf bias). Like all eponymous laws, this one may have been
attributed to the wrong person. Vilfredo Federico Damaso Pareto
(1848 - 1923), observed that, for many events, roughly 80% of the
effects come from 20% of the causes. Pareto's principle is the
simplified predecessor to the Zipf law.
Page 323 of 355
CHAPTER 24. REFERENCES
[1] S&E Doctorates Hit All-time High in 2005. National Science

Foundation NSF 07-301, November 2006.
http://www.nsf.gov/statistics/infbrief/nsf07301/
[2] Women, Minorities, and Persons With Disabilities in Science and

Engineering: 1996. National Science Foundation document. NSF-
96311. http://www.nsf.gov/statistics/nsf96311/start.htm
[3] Office of Research Integrity. http://ori.dhhs.gov
[4] Findings of Scientific Misconduct. NIH GUIDE, Volume 26,

Number 15, May 9, 1997. http://grants.nih.gov/grants/guide/notice-
files/not97-097.html
[5] Findings of Scientific Misconduct. NOT-OD-02-020. December

13, 2001. http://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-
020.html
[6] Findings of Scientific Misconduct. NIH GUIDE, Volume 24,

Number 33, September 22, 1995.
http://grants.nih.gov/grants/guide/notice-files/not95-208.html
[7] Scientific Misconduct Investigations. 1993-1997. Office of

Research Integrity, Office of Public Health and Science, Department
of Health and Human Services, December, 1998.
http://ori.dhhs.gov/documents/misconduct_investigations_1993_1997.pdf
[8] Office of Research Integrity Annual Report 2007, June 2008.

http://ori.dhhs.gov/documents/annual_reports/ori_annual_report_2007.pdf
[9] Bogdanich W. At V.A. hospital, a rogue cancer center. The New

York Times June 21, 2009.
[10] Specter Urges Policy Changes at VA After Hearing on

Brachytherapy Program at Philadelphia VA Medical Center. U.S.
Senator Arlen Specter News Room, Washington, D.C. Thursday, July
2, 2009.
Page 324 of 355
[11] To err is human: building a safer health system. Institute of

Medicine, November, 1999.
[12] Seabrook J. Ruffled feathers. The New Yorker, May 29, 2006.
[13] Mendel JG. Versuche uber Plflanzenhybriden Verhandlungen

des naturforschenden Vereines in Brunn, Bd. IV fur das Jahr, 1865
Abhandlungen:3-47, 1865.
[14] Fisher RA. Has Mendel's work been rediscovered? Annals of

Science 1:115-137, 1936.
[15] Seward Z. MIT Admissions dean resigns; admits misleading

school on credentials degrees from three colleges were fabricated,
MIT says. Harvard Crimson, April 26, 2007.
[16] Lewin T. Former Dean Resurfaces, Leaving Scandal Behind.

The New York Times December 7, 2009.
[17] Sekas G, Hutson WR. Misrepresentation of Academic

Accomplishments by Applicants for Gastroenterology Fellowships.
Ann Internal Med 123:38-41, 1995.
[18] Patel MV, Pradhan BB, Meals RA. Misrepresentation of

research publications among orthopedic surgery fellowship
applicants: a comparison with documented misrepresentations in
other fields. Spine 28:632-636, 2003.
[19] Panicek DM, Schwartz LH, Dershaw DD, Ercolani MC,

Castellino RA. Misrepresentation of publications by applicants for
radiology fellowships: is it a problem? Am J Roentgenol 170:577-
581, 1998.
[20] Katz ED, Shockley L, Kass L, Howes D. Identifying

Inaccuracies on Emergency Medicine Residency Applications. BMC
Medical Education 5:30, 2005
[21] Lyons B. Apologies and excuses at VA case sentencing: man

who admitted guilt in Stratton hospital scandal claims he was used by
boss. (Albany) Times Union Tuesday, November 22, 2005.
Page 325 of 355
[22] Sontag D. In harm's way: research, fraud and the V.A.; abuses
endangered veterans in cancer drug experiments. The New York
Times February 6, 2005.
[23] Kolata G. Studies Suggest B Vitamins Don't Prevent Heart

Attacks. The New York Times March 13, 2006.
[24] McCully KS. Homocysteine, vitamins, and vascular disease

prevention. American Journal of Clinical Nutrition 86:1563S-1568S,
November 2007.
[25] Knight, J. Agony for researchers as mix-up forces retraction of

ecstasy study. Nature 425:109, September 11, 2003.
[26] Flores G. Science retracts highly cited paper: Study on the

causes of childhood illness retracted after author found guilty of
falsifying data. The Scientist June 17, 2005.
[27] Gowen LC, Avrutskaya AV, Latour AM, Koller BH, Leadon
SA. Retraction of: Gowen LC, Avrutskaya AV, Latour AM, Koller
BH, Leadon SA. Science. 1998 Aug 14;281(5379):1009-12. Science
300:1657, 2003.
[28] Altman LK. Falsified data found in gene studies. The New York
Times October 30, 1996.
[29] Findings of scientific misconduct. NIH Guide Volume 26,

Number 23, July 18, 1997 http://grants.nih.gov/grants/guide/notice-
files/not97-151.html
[30] Marshall E. How prevalent is fraud? That's a million dollar

question. Science 290:1662-1663, 2000.
[31] Evolution of genes and genomes on the Drosophila phylogeny.

Drosophila 12 Genomes Consortium, Clark AG, Eisen MB, Smith
DR, et al. Nature 450:203-218, 2007.
[32] Hwang WS, Roh SI, Lee BC, Kang SK, Kwon DK, Kim S, Kim
SJ, Park SW, Kwon HS, Lee CK, Lee JB, Kim JM, Ahn C, Paek SH,
Chang SS, Koo JJ, Yoon HS, Hwang JH, Hwang YY, Park YS, Oh
Page 326 of 355
SK, Kim HS, Park JH, Moon SY, Schatten G. Patient-specific

embryonic stem cells derived from human SCNT blastocysts. Science
308:1777-1783, 2005.
[33] Wade N. Clone Scientist Relied on Peers and Korean Pride. The
New York Times, December 25, 2005.
[34] Office of Research Integrity

http://grants.nih.gov/grants/guide/notice-files/NOT-OD-09-040.html
Jan 23, 2009.
[35] Hajra A, Collins FS. Structure of the leukemia-associated human

CBFB gene. Genomics 26:571-579, 1995.
[36] Bren L. Human Research Reinstated at Johns Hopkins, With

Conditions. U.S. Food and Drug Administration, FDA Consumer
magazine, September-October, 2001.
http://www.fda.gov/fdac/features/2001/501_john.html Comment. On
June 2, 2001, a 24 year old healthy volunteer, Ellen Roche, died in an
asthma study at Johns Hopkins Hospital. The investigation uncovered
irregularities in the process by which human research subjects are
protected from harm. For a short while, federally funded human
research studies at Johns Hopkins were suspended.
[37] Kolata G. Johns Hopkins Admits Fault in Fatal Experiment. The

New York Times July 17, 2001.
[38] Brooks D. The Chosen: Getting in. The New York Times,
November 6, 2005.
[39] http://en.wikipedia.org/wiki/Jesse_Gelsinger. Comment. This

Wikipedia article recounts the tragic death of Jesse Gelsinger, a
volunteer gene theraphy experiment at the University of
Pennsylvania.
[40] Salmon A, Hawkes N. Clone 'hero' resigns after scandal over

donor eggs. The Times, November 25, 2005. Comment. This is one
of the early reports of irregularities in the laboratory of Dr. Hwang
Woo-Suk, a South Korean geneticist.
Page 327 of 355
[41] Wilson D. Harvard Medical School in Ethics Quandary. The

New York Times March 3, 2009.
[42] Brisson M. Impact of Model, Methodological, and Parameter

Uncertainty in the Economic Analysis of Vaccination Programs. Med
Decision Mak 26:434-446, 2006.
[43] Simpson, EH. The interpretation of interaction in contingency

tables. Journal of the Royal Statistical Society B13:238-241, 1951.
[44] Cohen J. The Earth Is Round (p < .05). American Psychologist

49:997-1003, 1994.
[45] Schonemann PH. Better never than late: peer review and the
preservation of prejudice. Ethical Human Sciences and Services 3:7-
21, 2001.
[46] MedicineNet. Better and Longer Survival for Cancer Patients.

http://www.medicinenet.com/script/main/art.asp?articlekey=157
[47] Kaiser J. NCI Goal Aims for Cancer Victory by 2015. Science
299:1297-1298, 2003.
[48] Berman JJ. Precancer: The Beginning and the End of Cancer.
Jones and Bartlett, Sudbury, 2010.
[49] Bailar JC, Gornik HL. Cancer undefeated. N Engl J Med

336:1569-1574, 1997.
[50] Leaf C. Why We're Losing The War On Cancer: And How To
Win It. Fortune Magazine, March 22, 2004.
[51] Hoyert DL, Heron MP, Murphy SL, Kung H-C. Final Data for
2003. National Vital Statistics Report. 54:(13), April 19, 2006.
[52] Ries LAG, Smith MA, Gurney JG, Linet M, Tamra T, Young
JL, Bunin GR (eds). Cancer Incidence and Survival among Children
and Adolescents: United States SEER Program 1975-1995, National
Cancer Institute, SEER Program. NIH Pub. No. 99-4649. Bethesda,
MD, 1999. Comment. Graphs from this resource were reprinted
Page 328 of 355
under rights specified on the SEER monograph front-page, "All

material in this report is in the public domain and may be reproduced
or copied without permission; citation as to source, however, is
appreciated."
[53] Hayat MJ, Howlader N, Reichman ME, Edwards BK. Cancer

Statistics, Trends, and Multiple Primary Cancer Analyses from the
Surveillance, Epidemiology, and End Results (SEER) Program. The
Oncologist 12:20-37, 2007.
[54] Aldhous P. CRAP paper accepted by journal. New Scientist June

27, 2009.
[55] Aldhous P. Editor of journal targeted by hoaxers resigns. New

Scientist June 12, 2009.
[56] Post-Acceptance Rejection of a Manuscript. World Association

of Medical Editors. March 2002. http://www.wame.org/ethics-
resources/post-acceptance-rejection-of-a-manuscript, last viewed
December 19, 2009.
[57] Editorial Decision Overridden By Marketing Department.

January 2004 World Association of Medical Editors, January, 2004.
http://www.wame.org/ethics-resources/editorial-decision-overridden-
by-marketing-department, viewed December 30, 2009.
[58] Altman LK. When peer review produces unsound science. The
New York Times June 11, 2002.
[59] International Committee of Medical Journal Editors. Uniform

Requirements for Manuscripts submitted to Biomedical Journals.
Ann Intern Med 126:36-47, 1997.
[60] Flanagin A, Carey LA, Fontanarosa PB, Phillips SG, Pace BP,
Lundberg GD, Rennie D. Prevalence of Articles With Honorary
Authors and Ghost Authors in Peer-Reviewed Medical Journals.
JAMA 280:222-224, 1998.
[61] Shapiro DW, Wenger NS, Shapiro MF. The contributions of

authors to multiauthored biomedical research papers. JAMA
Page 329 of 355
271:438-442, 1994.
[62] Authorship Guidelines Faculty of Medicine, Harvard University.

http://www.hms.harvard.edu/fa/guide_doc.html, viewed October 8,
2009.
[63] International Committee of Medical Journal Editors,

International Committee of Medical Journal Editors. Uniform
Requirements for Manuscripts submitted to Biomedical Journals.
Ann Intern Med 126:36-47, 1997.
[64] Uniform Requirements for Manuscripts Submitted to

Biomedical Journals: Writing and Editing for Biomedical
Publication. Updated October 2004. International Committee of
Medical Journal Editors. Updated October 2004.
http://www.icmje.org/2004_urm.pdf, viewed October 27, 2009.
[65] Stigler SM. Statistics on the table: the history of statistical

concepts and methods. Harvard University Press, Cambridge, p 277,
1999.
[66] Pearson K. The Grammar of Science, Adam and Black, London,

1900.
[67] Altman LK. When peer review produces unsound science. The
[68] Savitt TL, Goldberg MF. Herrick's 1910 case report of sickle
cell anemia: the rest of the story. JAMA 261: 266-271, 1989.
[69] Herrick JB. Peculiar elongated and sickle-shaped red blood

corpuscles in a case of severe anemia. Arch Intern Med 6:517-521,
1910.
[70] Robot scientist becomes first machine to discover new scientific

knowledge. ScienceDaily Apr 3, 2009.
[71] Hammond KW, Helbig ST, Benson CC, Brathwaite-Sketoe BM.

Are electronic medical records trustworthy? Observations on
copying, pasting and duplication. Proc AMIA Symp 269-73, 2003.
Page 330 of 355
[72] Gribbin M, and Gribbin JG. Flower Hunters. Oxford University

Press, p. 32, New York, 2008.
[73] Wayne L. Raytheon chief's management rules have a familiar

ring. The New York Times April 24, 2006.
[74] Weisman R. Raytheon chief admits using another's aphorisms.

The Boston Globe April 25, 2006.
[75] Wayne L. Raytheon punishes chief executive for lifting text. The
New York Times May 3, 2006.
[76] Findings of scientific misconduct. Department of Health and

Human Services. Notice NOT-OD-01-048. July 10, 2001
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-01-048.html,
viewed October 8, 2009.
[77] Dolnick E. Science police - Walter Stewart and Ned Feder of the
National Institutes of Health. Discover February, 1994.
[78] Boffey PM. Major study points to faulty research at two

universities. The New York Times April 22, 1986.
[79] Feder N, Stewart WW. Integrity: juniors see leaders gain from
calculated dishonesty. Nature 454:574, 2008.
[80] Smith D. Rich M. A Second Ripple in Plagiarism Scandal. The

New York Times May 2, 2006.
[81] Kulish N. Author, 17, says it's 'mixing,' not plagiarism. The New
York times February 12, 2010.
[82] Liu H, Friedman C. A method for vocabulary development and

visualization based on medical language processing and XML. Proc
AMIA Symp 502-506, 2000.
[83] Friedman C, Liu H, Shagina L. A vocabulary development and

visualization tool based on natural language processing and the
mining of textual patient reports. J Biomed Inform 36:189-201, 2003
Page 331 of 355
[84] Ogunyemi O, Clarke JR, Webber B, Badler N. TraumaSCAN:

assessing penetrating trauma with geometric and probabilistic
reasoning. Proc AMIA Symp 620-624, 2000.
[85] Ogunyemi OI, Clarke JR, Ash N, Webber BL. Combining

geometric and probabilistic reasoning for computer-based
penetrating-trauma assessment. J Am Med Inform Assoc 9:273-282,
2002.
[86] Chen W, Foran DJ, Reiss M. Unsupervised imaging, registration

and archiving of tissue microarrays. Proc AMIA Symp 136-139,
2002.
[87] Chen W, Reiss M, Foran DJ. A prototype for unsupervised

analysis of tissue microarrays for cancer research and diagnostics.
IEEE Trans Inf Technol Biomed 8:89-96, 2004.
[88] Miller RA, Hasman A, Haux R, McCray AT, Safran C,

Shortliffe EH. On exemplary scientific conduct regarding submission
of manuscripts to biomedical informatics journals. J Am Med Inform
Assoc 13:113-114, 2006.
[89] Schneier B. Crypto-gram, August 15, 2005.
[90] World Association of Medical Editors. Reviewer Conflict of

Interest. September, 2002 http://www.wame.org/ethics-
resources/reviewer-conflict-of-interest, viewed December 23, 2009.
[91] Campanario JM. Rejecting Nobel class articles and resisting

Nobel class discoveries. http://www2.uah.es/jmc/nobel.html, viewed
October 27, 2009.
[92] Dewey ME. Authors have rights too. BMJ. 1993 Jan 30;306
(6873):318-320, 1993.
[93] Smith R. Journals fail to adhere to guidelines on conflicts of

interest. BMJ 323:651 (inclusive), 2001.
[94] Gross CP, Gupta AR, Krumholz HM. Disclosure of financial

competing interests in randomised controlled trials: cross sectional
Page 332 of 355
review. BMJ 326:526-527, 2003.
[95] Hussain A, Smith R. Declaring financial competing interests:

survey of five general medical journals. BMJ 323:263-264, 2001.
[96] White C. Little evidence for effectiveness of scientific peer

review. BMJ 326:241(inclusive), 2003.
[97] Smith R. Peer review: reform or revolution? BMJ 315:759-760,

1997.
[98] LeVay S. When Science Goes Wrong. Twelve Tales from the
Dark Side of Discovery. Plume, New York, pp 160-180, 2008.
[99] Folkerth RD, Durso R. Survival and proliferation of nonneural

tissues, with obstruction of cerebral ventricles, in a parkinsonian
patient treated with fetal allografts. Neurology 46:1219-1225, 1996.
[100] Maliszewski P. Fakers: Hoaxers, Con Artists, Counterfeiters,

and other Great Pretenders. New Press 2009.
[101] NIH Success Rate Definition.

http://report.nih.gov/UploadDocs/NIH_Success_Rate_Definition.pdf,
[102] Golden F. Science: Fudging Data for Fun and Profit. Time
December 7, 1981.
http://www.time.com/time/printout/0,8816,953258,00.html
[103] Research Project Success Rates by NIH Institute for 2008.

National Institutes of Health.
http://report.nih.gov/award/success/Success_ByIC.cfm, viewed
October 9, 2009.
[104] Garfield E. Essays of an Information Scientist. Current

Contents 5:3, Feb. 2, 1987.
[105] Kolata G. Labs, a scientist's foreign country. The New York

Times April 4, 1993.
[106] Couzin J. Canceling Grants, VA Research Chief Shakes the
Page 333 of 355
System. Science 300:574-575, 2003.
[107] Couzin J. VA Shaken by Plan to Cut Grants, Cultivate the

'Stars'. Science 301:24-25, 2003.
[108] Couzin J. Defunded VA Grants Restored; Wray Returns to

Texas Science 302:1872, December 12, 2003.
[109] Couzin J. IG Report Faults Handling of Veterans Affairs

Funds. Science 304:29 April 2, 2004.
[110] Department of Veterans Affairs Office of Inspector General

Administrative investigation. Use of government funds, travel,
personnel, impartiality, and management issues, Research and
Development Office, Veterans Health Administration. Report No. 03-
03053-115 March 22, 2004
http://www.navref.org/library/pdf/VAOIG-03-03053-115.pdf.
[111] Finder A. Study finds record education earmarks. The New

York Times March 24, 2008.
[112] Pear R. New billions in earmarks approach enactment. The

New York Times September 26, 2008.
[113] Rasch C. The Wall Street performer protocol: using software

completion bonds to fund open source software development. First
Monday Volume 6, Number 6, June 4, 2001.
[114] Scroggins M. The Poem of a Life: A biography of Louis

Zukofsky. Shoemaker & Hoard, Washington, D.C., 2008
[115] Oshinsky D. No thanks, Mr. Nabokov. The New York Times

September 9, 2007.
[116] Asimov I. Asimov's Chronology of Science and Discovery.

Harper Collins, New York, 1994.
[117] Strathern P. A brief history of medicine from Hippocrates to

gene therapy. Carroll and Graf Publishers, New York, pp 169-171,
2005. Comment. This is a well-written and fascinating history of
medicine.
Page 334 of 355
[118] Lemos R. Decades after creation, viruses defy cure. CNET

News.com November 25, 2003. http://news.cnet.com/2009-7349_3-
5111410.html?tag=nefd_lede, viewed December 23, 2009.
[119] Garrison FH. History of medicine. WB Saunders, Philadelphia,

1921.
[120] Lipsett PA, Swoboda SM. Handwashing compliance depends

on professional status. Surg Infect (Larchmt) 2(3):241-245, 2001.
Comment. Physicians washed their hands much less frequently than
nurses. Surprise!
[121] Chen PW. Holding doctors accountable for medical errors. The
New York Times December 17, 2009.
[122] Third of EMS stethoscopes carry MRSA virus: doctor urges

first responders to clean equipment regularly with alcohol wipes. U.S.
News and World Report Health March 27, 2009.
[123] Abramson H. Accidental mechanical suffocation in infants. J

Pediatr 25:404-413, 1944.
[124] Vennemann MM, Fischer D, Jorch G, Bajanowski T.

Prevention of sudden infant death syndrome (SIDS) due to an active
health monitoring system 20 years prior to the public "back-to-sleep-
campaigns." Arch Dis Child. Jan 6, 2006. Comment. In the early
1970s, the East Germans had shown that the prone sleeping position
was dangerous for infants.
[125] Baade W. Zwicky F. On Super-Novae. PNAS (U.S.

Proceedings of the National Academy of Sciences) 20:254-259, 1934.
[126] Jacobs MT, Frush DP, Donnelly LF. The right place at the
wrong time: historical perspective of the relation of the thymus gland
and pediatric radiology. Radiology 210:11-1, 1999.
[127] National Science Board, Science & Engineering Indicators -

2000. Arlington, VA: National Science Foundation, 2000 (NSB-00-
1).
Page 335 of 355
[128] Innovation or Stagnation: Challenge and Opportunity on the

Critical Path to New Medical Products. U.S. Department of Health
and Human Services, Food and Drug Administration, 2004.
http://www.fda.gov/oc/initiatives/criticalpath/whitepaper.html
Comment. The FDA explores the apparent slowdown in the release
of new and innovative medical products.
[129] Angell M. The Truth About the Drug Companies. The New
York Review of Books Vol 51, July 15, 2004.
[130] Crossing the Quality Chasm: A New Health System for the
21st Century. Quality of Health Care in America Committee, editors.
Institute of Medicine, Washington, DC., 2001.
[131] Wurtman RJ, Bettiker RL. The slowing of treatment discovery,

1965-1995. Nat Med 2:5-6, 1996. Comment: From paper "Successes
have been surprisingly infrequent during the past three decades. Few
effective treatments have been discovered for the diseases that
contribute most to mortality and morbidity."
[132] Furedi F. Downsizing the Status of Science. The Scientist

volume 18, Issue 21, Number 10, Nov. 8, 2004.
[133] Fifty-six Year trends in U.S. cancer death rates. SEER Cancer
Statistics Review 1975-2005 National Cancer Institute.
http://seer.cancer.gov/csr/1975_2005/results_merged/topic_historical_mort_trends.pdf,
[134] Walt V. Diarrhea: the great zinc breakthrough. Time August

17, 2009.
[135] Warren JR, Marshall BJ. Unidentified curved bacilli on gastric

epithelium in active chronic gastritis. Lancet 1:1273-1275, 1983.
[136] Kidd M, Modlin IM. A century of Helicobacter pylori:

paradigms lost-paradigms regained. Digestion 59:1-15, 1998.
[137] Writing Group; Hennekens CH, Dyken ML, Fuster V. Aspirin

as a therapeutic agent in cardiovascular disease: a statement for
Page 336 of 355
healthcare professionals from the American Heart Association.

Circulation 96:2751-2753, 1997.
[138] Michiels S, Koscielny S, Hill C. Prediction of cancer outcome

with microarrays: a multiple random validation strategy. Lancet
365:488-492, 2005.
[139] Eccles M, McColl E, Steen N, Rousseau N, Grimshaw J, Parkin

D, Purves I. Effect of computerised evidence based guidelines on
management of asthma and angina in adults in primary care: cluster
randomised controlled trial BMJ 325, October 26, 2002.
[140] De La Garza P, Nohlgren S. VA yanks troubled computer

system: the $472-million computer system being tested at Bay Pines
just doesn't work, veterans officials say. St. Persburg Times July 27,
2004.
[141] GAO United States Government Accountability Office

Testimony Before the Subcommittee on Health, Committee on
Veterans' Affairs, House of Representatives. VA HEALTH CARE:
Ineffective Medical Center Controls Resulted in Inappropriate Billing
and Collection Practices. Statement of Kay L. Daly Director
Financial Management and Assurance. GAO-10-152T October 15,
2009.
[142] Littlejohns P, Wyatt JC, Garvican L. Evaluating computerised

health information systems: hard lessons still to be learnt British
Medical Journal 326:860-863, April 19, 2003.
http://bmj.com/cgi/content/full/326/7394/860. Comment. The authors
report that about about three quarters of installed hospital information
systems are considered failures.
[143] Barnard A. Got paper? Beth Israel Deaconess copes with a

massive computer crash. Boston Globe November 26, 2002.
[144] Schwartz E. Shopping for health software, some doctors get

buyer's remorse. The Huffington Post INvestigative Fund Jan 29,
2010.
[145] Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E,
Page 337 of 355
Morton SC, Shekelle PG. Impact of health information technology on

quality, efficiency, and costs of medical care. Ann Intern Med
144:742-752, 2006.
[146] Han YY, Carcillo JA, Venkataraman ST, Clark RS, Watson
RS, Nguyen TC, Bayir H, Orr RA. Unexpected increased mortality
after implementation of a commercially sold computerized physician
order entry system. Pediatrics 116:1506-1512, 2005. Computerized
physician order entry (CPOE) adds complexity to hospital
information systems, and complexity can be detrimental to patient
care. In this study the mortality rate significantly increased from
2.80% to 6.57% (36 of 548) when CPOE was implemented.
[147] The Standish Group Report: Chaos.

http://www.projectsmart.co.uk/docs/chaos-report.pdf, 1995
[148] Gardner A. Radiation from medical scans soaring. U.S. News

and World Report Thursday, October 29, 2009.
[149] Leveson N. Medical Devices: The Therac-25. Appendix A in:

Leveson N. Safeware: system safety and computers, Addison-
Wesley, Reading, 1995.
[150] Bogdanich W. Radiation offers new cures, and ways to do

harm. The New York Times January 24, 2010.
[151] Bogdanich W. As technology surges, radiation safeguards lag.

The New York Times January 27, 2010.
[152] General Principles of Software Validation; Final Guidance for

Industry and FDA Staff. January 11, 2002. Comment. See Section
2.4.
[153] Taubman P. Failure to Launch: In death of spy satellite

program, lofty plans and unrealistic bids. The New York Times.
November 11, 2007.
[154] Bogdanich W, Ruiz RR. Radiation Bills Raise Question of

Supervision. The New York Times February 25, 2010.
Page 338 of 355
[155] Spruce R.Report on the expedition to procure seeds and plants

of the cinchona succirubra, or red bark tree. Her Majesty's Stationery
Office, London, 1861.
[156] Russo E. AACR convenes SARS-cancelled meeting. The

Scientist 4:20030711-04, 2003.
[157] Berman JJ. Biomedical Informatics. Jones and Bartlett,

Sudbury, MA, 2007. Comment. Describes the fundamental issues and
questions in the field, and reviews the different types of biomedical
data resources and open source tools needed to fully utilize
biomedical data. Shows how to navigate through the legal, ethical,
and technical hazards of biomedical informatics to become self-
sufficient and productive. Teaches readers how to acquire, organize,
annotate, and share biomedical data, how to render confidential data
harmless through de-identification, and how to use a variety of free
and open source utilities to solve common computational tasks.
[158] U.S. Patent Activity Calendar Years 1790 to the Present. U.S.
Patent and Trademark Office. April 16, 2009.
[159] Crichton M. Patenting life. The New York Times February 13,
2007.
[160] Thirty-five U.S.C. 287 Limitation on damages and other

remedies; marking and notice.
http://www.uspto.gov/web/offices/pac/mpep/documents/appxl_35_U_S_C_287.htm
Comment. This important patent provisions provides a level of
protection to healthcare practitioners from patent infringement
claims. It permits healthcare practitioners to perform customary
medical activities (e.g. surgical procedures), even when a patent
claim may apply to the procedure.
[161] KSR International Co. v. Teleflex Inc. et al. Supreme Court of

the United States April 30, 2007.
[162] Poste G. The case for genomic patenting. Nature 378:534-536,

1995.
Page 339 of 355
[163] Eisenberg RS. Biotech patents: looking backward while

moving forward. Nature Biotechnology 24:317-319, 2006.
[164] Barlett DL, Steele JB. Monsanto's Harvest of Fear. Vanity Fair,
May, 2008.
[165] Neuman W, Pollack A. Farmers Cope With Roundup-Resistant

Weeds. The New York Times May 3, 2010.
[166] Jensen K, Murray F. Intellectual property. Enhanced:

intellectual property landscape of the human genome. Science
310:239-240, 2005.
http://web.mit.edu/fmurray/www/papers/JensenMurray_SciencePolicyForum.pdf
Comment. This paper contains a fascinating graphic of the human
"patome." 4382 of 23,688 human genes in NCBI are patented.
[167] U.S. Supreme Court ruling sets limits on patent royalties. The
[168] Jones KJ, Whitham ME, Handler PS. Problems with royalty
rates, royalty stacking, and royalty packing issues. In: Intellectual
Property Management in Health and Agricultural Innovation: A
Handbook of Best Practices, eds. A Krattiger, RT Mahoney, L
Nelsen, et al. MIHR, Oxford, U.K., pp. 1121-1126, 2007
[169] Uniform Declaratory Judgments Act. National Conference of

Commissioners on Uniform State Laws. August 2 - 8, 1922.
[170] Johnsen K, Pugh N. NISTIR 6778 Guidelines for NIST Staff

Participating in Voluntary Standards Developing Organizations'
Activities. US Department of Commerce, June 2002.
http://ts.nist.gov/ts/htdocs/210/nttaa/ir6778.pdf Comment. Excellent
discussion of the standards development process on pages 5-7.
[171] Besen SM, Levinson RJ. Standards, intellectual property

disclosure, and patent royalties after Rambus. North Carolina Journal
of Law and Technology. Volume 10, Issue 2, 2009.
[172] Title 18. Crimes and criminal procedure. Part 1, Crimes.
Page 340 of 355
Chapter 95. Racketeering. Sec. 1951, Interference with commerce by

threats or violence.
[173] Department of Justice. Siemens AG and three subsidiaries

plead guilty to foreign corrupt practices act violations and agree to
pay $450 million in combined criminal fees. Coordinated
enforcement by DOJ, SEC and German authorities result in penalties
of $1.6 billion. December 15, 2008.
[174] Singer N. Medical papers by ghostwriters pushed therapy. The

New York Times August 5, 2009.
[175] Singer N, Wilson D. Menopause, as brought to you by big

Pharma. The New York Times December 13, 2009.
[176] Harris G, Halbfinger DM. FDA reveals it fell to a push by

lawmakers. The New York Times, September 25, 2009.
[177] Zoellner T. Uranium: war, energy, and the rock that shaped the
world. Viking, New York, 2009.
[178] National Academy of Sciences News Release. Radiation From

Bomb Tests Could Cause Thyroid Cancer, But Screening Program
Not Advisable. Date: Sept. 1, 1998.
[179] Weiner T. Lies and rigged "Star Wars" test fooled the Kremlin,
and Congress. New York Times, Aug. 18, 1993.
[180] Ricks TE. Data Faking Could Lower Osprey's Prospects

Further. Washington Post Jan 21, 2001.
[181] Berler R. Saving the Pentagon's Killer Chopper-Plane. 22

years. $16 billion. 30 deaths. The V-22 Osprey has been an R&D
nightmare. But now the dream of a tilt-rotor troop transport could
finally come true. Wired 13.07, July 2005.
[182] Leveson NG. A new approach to system safety engineering.

Self-published ebook, 2002. Comment. This incredible book
describes how you can analyze large systems breakdowns. After a
disaster, there is a natural tendency to find the "one thing" that broke
Page 341 of 355
and led to everything that followed. Actually, disasters are always

preceded by multiple systemic problems, and fixing the proximate
event is just the beginning of disaster prevention plan. Her discussion
of the Bhopal tragedy is particularly engrossing.
http://ocw.mit.edu/NR/rdonlyres/Aeronautics-and-Astronautics/16-
358JSpring-2005/7A17C38C-F622-4244-ABF0-
5BD2B768661C/0/book2.pdf
[183] In darkness of apartheid, it was science gone mad. The Sun

(Baltimore) June 12, 1998.
[184] LaFraniere S. Files Vanished, Young Chinese Lose the Future.

The New York Times, July 27, 2009.
[185] Liptak A. Justices, 5-4, reject corporate spending limit. The

New York Times January 22, 2010.
[186] Kelo v. New London (04-108) 545 U.S. 469 (2005) 268 Conn.
1, 843 A. 2d 500, affirmed. Cornell Univesity Law School Supreme
Court Collection, http://www.law.cornell.edu/supct/html/04-
108.ZO.html, viewed January 27, 2010.
[187] Lichtblau E, Dougherty C. Siemens to pay $1.34 billion in

fines. The New York Times December 16, 2008.
[188] Manville personal injury settlement trust. April 30, 2007.
[189] King C, Siegel M. The master settlement agreement with the

tobacco industry and cigarette advertising in magazines. NEJM
345:504-511, 2001.
[190] Smith A. ImClone bets the pharm on Erbitux. CNNMoney.com

January 7, 2008.
[191] Randal J. Erbitux Trial Flawed From the Beginning,

Committee Finds. Journal of the National Cancer Institute 94:1824-
1825, 2002.
[192] U.S. Securities and Exchange Commission, Litigation Release

No. 19456, Zvi Fuks and Sabina Ben-Yehuda settle SEC insider
Page 342 of 355
trading charges. November 3, 2005.
[193] United States District Court Southern District of New York

Securities and Exchange Commission Plaintiff, against Zvi Fuks And
Sonia Ben Yehuda Defendants.
[194] United States Attorney, Southern District of New York. Two

friends of Samuel Waksal arrested on federal insider trading charges.
March 9, 2005.
[195] Timeline: The Rise and Fall of Samuel Waksal. Reuters

Tuesday, June 10, 2003.
[196] ImClone to pay Repligen $65M in Erbitux case. Pharma

Marketletter September 17, 2007.
[197] Saul S. Pfizer to End Lipitor Ads by Jarvik. The New York
Times February 26, 2008.
[198] United States Court of Appeals for the Federal Circuit. 01-
1567. John M.J. Madey, Plaintiff-Appellant, v. Duke University,
Defendant-Appellee. Decided: October 3, 2002. Comment. The 2002
Madey v Duke court decision challenged the long-held belief that
educational institutions and their academic faculty serve the public,
without commercial motivations and without conflicts of interest.
[199] Cummings MR. Human Heredity: Principles and Issues, 8th

edition. p. 344. Brooks/Cole, 2008.
[200] Kocieniewski D. University Gave No-Show Job to Legislator,

U.S. Reports. The New York Times September 19, 2006.
[201] DeQuine J. Volatile Mix of Corporate Cash and Academic

Ideals. The Christian Science Monitor. Thursday, July 11, 1996.
[202] Cohen WM, Florida R, Randazzese L, Walsh J. Industry and

the Academy: Uneasy Partners in the Cause of Technological
Advance. In: Roger Noll, ed., Challenge to the Research University.
Washington, DC: Brookings Institution,1998.
[203] Masson M. NCRC offers fertile ground for research growth.
Page 343 of 355
University of Michigan News Service. July 13, 2009.

http://www.ur.umich.edu/0809/Jul13_09/02.php, viewed October 12,
2009.
[204] O'Riordan M. UMDNJ fires two cardiologists: Kickback

scheme took in $36 million in illegal payments HeartWire (from
WebMD) November 20, 2006.
[205] United States Department of Justice U.S. Attorney, District of

New Jersey. sett0630.rel June 30, 2008.
[206] Jaffe H. Ben Ladner's Years of Living Lavishly: American

University president Ben Ladner and his wife, Nancy, were behaving
like billionaires-until their years of living lavishly caught up with
them. Washingtonian.Com April 1, 2006.
[207] Revkin AC. Hacked e-mail is new fodder for climate dispute.
The New York Times November 21, 2009.
[208] Department of Health and Human Services.45 CFR (Code of

Federal Regulations), 46. Protection of Human Subjects (Common
Rule). Federal Register, Volume 56, p. 28003-28032, June 18, 1991.
http://www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.htm
Comment. Although HIPAA (Health Insurance Portability and
Accountability Act) privacy regulations seem to get all the attention,
the Common Rule sets the basic principles for protecting patients
from research risks, mandating the activities of Institutional Review
Boards, and using human tissues in support of medical research. It is
essential reading for anyone involved in human subject research.
[209] World Medical Association Declaration of Helsinki. Ethical

Principles for Medical Research Involving Human Subjects. Adopted
by the 18th WMA General Assembly, Helsinki, Finland, June 1964,
and amended by 1975, 1983, 1989, 1996, 2000, 2002, and 2004.
[210] Re: Human research protection under federalwide assurances

FWA-5173 and 2292. Office for Human Research Protections. HHS.
June 9, 2009.
[211] Re: Human research protection under federalwide assurances
Page 344 of 355
FWA-5173 and 2292. Office for Human Research Protections. HHS.

September 21, 2009.
[212] Keith-Spiegel P, Koocher GP. The IRB paradox: could the

protectors also encourage deceit? Ethics and Behavior 15:339-349,
2005.
[213] Young P. Should the NCI worry about community research?

Community Oncology 6:581-582, December 12, 2009.
[214] Getler W. U.S. use of PB pills in gulf should be investigated

now. The Sun (Baltimore) November 23, 1997.
[215] Batdorff A, Allen D. Refusing anthrax shot means disobeying

order. Stars and Stripes Pacific edition March 22, 2007.
[216] Kaufman M. Court strikes down FDA rule. Washington Post,

October 18, 2002.
[217] Department of Health and Human Services. 45 CFR (Code of

Federal Regulations), Parts 160 through 164. Standards for Privacy of
Individually Identifiable Health Information (Final Rule). Federal
Register, Volume 65, Number 250, Pages 82461-82510, December
28, 2000. http://aspe.hhs.gov/admnsimp/final/PvcPre01.htm
Comment. This is the much-feared HIPAA rule for protecting patient
privacy.
[218] Stelfox HT, Chua G, O'Rourke K, Detsky AS. Conflict of

interest in the debate over calcium channel antagonists. N Engl J Med
338:101-105, 1998.
[219] Ehringhaus SH, Weissman JS, Sears JL, Goold SD,

Feibelmann S, Campbell EG. Responses of medical schools to
institutional conflicts of interest. JAMA 299:665-671, 2008.
[220] Weiss R. U.S., Researchers Reach Deal in '99 Gene Therapy

Case. The Washington Post February 10, 2005.
[221] Wilson JM. Lessons learned from the gene therapy trial for
ornithine transcarbamylase deficiency. Genetics and Metabolism
Page 345 of 355
96:151-157, April 2009.
[222] Saul S. Former F.D.A. Chief Is Charged With Conflict. New

York Times October 17, 2006.
[223] Frieden T. VA will pay $20 million to settle lawsuit over stolen
laptop's data. CNN January 27, 2009.
[224] Powers T. Computer security; the whiz kid vs. the old boys.
The New York Times December 3, 2000.
[225] Holmes SA. Report says census bureau helped relocate

Japanese. The New York Times March 17, 2000.
[226] Sandoval G. Failed dot-coms may be selling your private

information. CNET News June 29, 2000.
[227] Beinfield H, Beinfield MS. Revisiting accepted wisdom in the

management of breast cancer. Alternative Theerapies in Health and
Medicine 3:35-53, 1997.
[228] Tuskegee Syphilis Study.

http://www.cdc.gov/nchstp/od/tuskegee/ Comment. This clinical
study, conducted between 1932 and 1972, followed the natural
history of untreated syphilis on 399 black men. It stands as one of the
most shameful episodes in American medical history.
[229] Lerner BH. Sins of Omission - Cancer Research without

Informed Consent. NEJM 351:628-630, August 12, 2004. Comment.
A 1963 study at Memorial Sloan-Kettering involved injecting
hundreds of patients with cancer cells. The study was done without
informed consent.
[230] Prostate, lung, colorectal & ovarian cancer screening trial

(PLCO) http://www3.cancer.gov/prevention/plco/ Comment. PLCO
is an example of a large, long and expensive clinical trial.
[231] Framingham Heart Study. Clinical Trials.gov.

http://www.clinicaltrials.gov/ct/show/NCT00005121. Comment. This
is the web site for the Framingham Heart Study, one of the most
Page 346 of 355
expensive and longest clinical studies ever planned, extending from

1948 to 2008.
[232] Expert scientific group on phase one clinical trials: final report.
Her Majesty's Stationery Office November 3O, 2006.
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalas
[233] Karlberg JPE. Industry clinical testing of new medicinal

products requires 95,000 study sites and 1,300,000 subjects annually.
Clinical Trial Magnifier 1:101-103, 2008.
[234] Altman LK. FDA Faults Johns Hopkins over process in fatal
study. The New York Times July 3, 2001.
[235] Boosting Cancer Trial Participation. National Cancer Institute.

http://www.cancer.gov/clinicaltrials/digestpage/boosting-trial-
participation, viewed January 9, 2010.
[236] Khurana V, Bejjanki HR, Caldito G, Owens MW. Statins

reduce the risk of lung cancer in humans: a large case-control study
of US veterans. Chest 131:1282-1288, 2007.
[237] Luke C, Priest K, Roder D. Changes in incidence of in situ and

invasive breast cancer by histology type following mammography
screening. Asian Pac J Cancer Prev 7:69-74, 2006.
[238] Gorey KM, Holowary EJ, Fehringer G, Laukkanen E,

Moskowitz A, Webster DJ, Richter NL. An international comparison
of cancer survival: Toronto, Ontario, and Detroit, Michigan,
metropolitan areas. Am J Public Health 87:1156-1163, 1997.
[239] Bernig T, Chanock SJ. Challenges of SNP genotyping and

genetic variation: its future role in diagnosis and treatment of
cancer.Expert Rev Mol Diagn 6:319-331, 2006.
[240] Dickersin K, Rennie D. Registering Clinical Trials. JAMA

290:51, 2003.
[241] Curran C. The Medical Journal Meets the Internet. First
Page 347 of 355
Monday 7:(6), June 2002.

http://firstmonday.org/issues/issue7_6/curran/index.html
[242] Yank V, Rennie D, Bero LA. Financial ties and concordance

between results and conclusions in meta-analyses: retrospective
cohort study. BMJ 335:1202-1205, 2007.
[243] Sakr WA, Haas GP, Cassin BF, Pontes JE, Crissman JD. The
frequency of carcinoma and intraepithelial neoplasia of the prostate
in young males. J Urol 150:379-385, 1993.
[244] Guileyardo JM, Johnson WD, Welsh RA, Akazaki K, Correa P.

Prevalence of latent prostate carcinoma in two U.S. populations. J
Natl Cancer Inst 65:311-316, 1980.
[245] Tatsioni A, Bonitsis NG, Ioannidis JP. Persistence of

contradicted claims in the literature. JAMA 2007 Dec 5;298
(21):2517-2526, 2007.
[246] Ioannidis JP. Why most published research findings are false.
PLoS Med 2:e124, 2005.
[247] Ioannidis JP. Some main problems eroding the credibility and
relevance of randomized trials. Bull NYU Hosp Jt Dis 66:135-139,
2008.
[248] Ramesh R. Bhopal water still toxic 25 years after deadly gas
leak, study finds. The Guardian, UK, December 1, 2009.
[249] Court issues arrest warrant for former CEO of Union Carbide
in gas leak case. Associated Press (in The Guardian, UK) , July 31,
2009.
[250] Mehta S. A cloud still hands over Bhopal. The New York
Times, December 3, 2009.
[251] Sharp GB. The relationship between internally deposited alpha-

particle radiation and subsite-specific liver cancer and liver cirrhosis:
an analysis of published data. J Radiat Res 43:371-380, 2002.
[252] International Notes Follow-Up on Epidemic Pneumonia with
Page 348 of 355
Progression to Neuromuscular Illness -- Spain. MMRW (Morbidity

and Mortality Weekly Report) 31:93-95, March 05, 1982.
[253] Hayden T. Why Things Suck: Science. Wired Magazine 16.02,

January 18, 2008.
http://www.wired.com/culture/culturereviews/magazine/16-
02/su_science, viewed January 8, 2010.
[254] Csikszentihalyi M. The Evolving Self: A Psychology for the

Third Millennium. Harper Perennial, New York, 1994.
[255] Findings of Scientific Misconduct Notice Number: NOT-OD-

06-028. Department of Health and Human Services (DHHS), January
6, 2006. http://grants.nih.gov/grants/guide/notice-files/NOT-OD-06-
028.html, viewed December 28, 2009.
[256] Vogeli C, Yucel R, Bendavid E, Jones LM, Anderson MS,

Louis KS, Campbell EG. Data withholding and the next generation of
scientists: results of a national survey. Acad Med 81:128-36, 2006.
[257] Richtel M. U.S. Withheld data on risks of distracted driving.

The New York Times, July 21, 2009.
[258] NIH Public Access Working Group of the NLM Board of

Regents Meeting Summary. April 10, 2006.
[259] Revised Policy on Enhancing Public Access to Archived

Publications Resulting from NIH-Funded Research. Notice Number:
NOT-OD-08-033. Release date: January 11, 2008. Effective date:
April 7, 2008.http://grants.nih.gov/grants/guide/notice-files/not-od-
08-033.html, viewed December 28, 2009.
[260] National Academy of Sciences Report. Sharing Publication-

Related Data and Materials: Responsibilities of Authorship in the
Life Sciences. The National Academies Press, Washington, D.C.,
2003. Comment. This National Academy of Sciences Report,
endorsed by many journal editors, clarifies that authors must submit
to journals the primary data supporting their conclusions.
[261] Policy on Enhancing Public Access to Archived Publications
Page 349 of 355
Resulting from NIH-Funded Research. Notice Number: NOT-OD-

05-022, 2005. http://grants.nih.gov/grants/guide/notice-files/NOT-
OD-05-022.html Comment. This NIH policy statement specifies that,
"Beginning May 2, 2005, NIH-funded investigators are requested to
submit to the NIH National Library of Medicine's (NLM) PubMed
Central (PMC) an electronic version of the author's final manuscript
upon acceptance for publication, resulting from research supported,
in whole or in part, with direct costs from NIH.
[262] Meier B. For drug makers, a downside to full disclosure. The

New York Times, May 23, 2007.
[263] Sass JB, Devine JP Jr. The Center for Regulatory Effectiveness
invokes the Data Quality Act to reject published studies on atrazine
toxicity. Environ Health Perspect. 112:A18, 2004.
[264] Tozzi JJ, Kelly WG Jr, Slaughter S. Correspondence: data

quality act: response from the Center for Regulatory Effectiveness.
Environ Health Perspect 112:A18-19, 2004.
[265] Wade N. Scientist at work: David B. Goldstein, a dissenting

voice as the genome is sifted to fight disease. The New York Times
September 16, 2008.
[266] Young BD. Molecular biology in medicine. Postgrad Med J

68:251-262, 1992
[267] Langreth R, Waldholz M. New era of personalized medicine:

Targeting drugs for each unique genetic profile. The Oncologist
4:426-427, 1999.
[268] Le Fanu J. The Rise and Fall of Modern Medicine. Little

Brown, London, 1999.
[269] Belluck P. Giving sight by therapy with genes. The New York
Times November 3, 2009.
[270] Nanoscience and Nanotechnology in Biology and Medicine

(R01). NIH Funding Opportunity Announcement. January 4, 2007,
http://grants.nih.gov/grants/guide/pa-files/PA-08-052.html, viewed
Page 350 of 355
October 26, 2009.
[271] Arango T. Seeking a Missing Link, and a Mass Audience. The

New York Times, May 18, 2009.
[272] Tomar SL, Winn DM, Swango PA, Giovino GA, Kleinman
DV. Oral Mucosal Smokeless Tobacco Lesions among Adolescents
in the United States. J Dent Res 76: 1277-1286, 1997.
[273] Richtel M. Promoting the car phone, despite risks. The New
York Times, December 7, 2009.
[274] Kluger J. Simplexity: Why Simple Things Become Complex

(and How Complex Things Can Be Made Simple). Hyperion, 2008.
[275] Klein RD, Campbell S. Health care fraud and abuse laws. Arch
Pathol Lab Med 130:1169-1177, 2006.
[276] Kolata G. Sick and scared, and waiting, waiting, waiting. The
New York Times August 20, 2005.
[277] AMA Code of medical ethics. American Medical Association.

http://www.ama-assn.org/ama/pub/physician-resources/medical-
ethics/code-medical-ethics.shtml, viewed October 12, 2009.
[278] Singer N. The price of beauty: as doctors cater to looks, skin

patients wait. The New York Times July 28, 2008.
[279] Montague P. The Environmental causes of cancer why we can't

prevent cancer. Counterpunch November 4, 2005.
http://www.counterpunch.org/montague11042005.html
[280] Holmes OW. Medical Essays. The Boston Society for the
Diffusion of Useful Knowledge, Boston, pp 378-379, 1883.
[281] Witter DC, LeBas J. Cancer as a Chronic Disease. OncoLog

53, No. 4, April, 2008 (a newsletter published by the M.D. Anderson
Cancer Center).
[282] Panush RS. Upon finding a Nazi anatomy atlas: The lessons of
Nazi medicine. The Pharos pp 18-22, 1996.
Page 351 of 355
[283] Proctor RN. The Nazi War on Cancer. Princeton, 1999.
[284] Pollack A. Forty years' war: taking risk for profit, industry
seeks cancer drugs. The New York Times September 2, 2009.
[285] Erlotinib plus gemcitabine boosts one-year survival in

pancreatic cancer. NCI Clinical Trial Results. May 14, 2005.
http://www.cancer.gov/clinicaltrials/results/erlotininb-and-pancreatic-
cancer0505, viewed January 27, 2010.
[286] Berkrot B, Pierson R. OSI sees $2 billion Tarceva sales by

2011. Reuters Feb 23, 2006.
[287] Avastin Fails Clinical Trial for Prostate Cancer (Reuters). The
New York Times March 12, 2010.
[288] Kolata G. Pollack A. Costly cancer drug offers hope, but also a
dilemma. The New York Times, July 6, 2008.
[289] Goldberg P. An Old drug's 21st century makeover begins with

84-fold price increase. Cancer Letters, May 13, 2005.
[290] Harris G. Where Cancer Progress Is Rare, One Man Says No.
The New York Times September 15, 2009.
[291] Evans D. When drug makers' profits outweigh penalties.

Bloomberg News, published in the Washington Post, March 21, 2010
[292] Radley DC, Finkelstein SN, Stafford RS. Off-label Prescribing

Among Office-Based Physicians. Arch Intern Med 166:1021-1026,
2006.
[293] Pierson R, Pelofsky J. Pfizer to pay $2.3 billion, agrees to

criminal plea. Reuters, September 2, 2009.
[294] Tansey B. Huge penalty in drug fraud Pfizer settles felony case
in Neurontin off-label promotion. Bernadette Tansey, San Francisco
Chronicle May 14, 2004.
[295] Berenson A. Eli Lilly said to encourage use of pill for
Page 352 of 355
unapproved illnesses. The New York Times December 18, 2006.
[296] Berenson A. Lilly settles with 18,000 over Zyprexa. The New
York Times January 5, 2007.
[297] Fisk MC, Feeley J, Henderson G. Lilly settles suit with South
Carolina over Zyprexa (Update3). Bloomberg News October 7, 2009.
[298] Berner ES, Graber ML. Overconfidence as a cause of

diagnostic error in medicine. American J Med 121:S2-S23, 2008.
[299] Harris G, Carey B. Researchers fail to reveal full drug pay. The
[300] Ross JS, Keyhani S, Korenstein D. Appropriateness of

Collaborations between Industry and the Medical Profession:
Physicians' Perceptions. AJM 122:955-960, October 2009.
[301] Adler WM. How original...These scholars shared a ghost. Who

knew? Washington Post April 25, 2004.
[302] Phillips ML. Journal retracts chromium study. The Scientist

June 7, 2006.
[303] Brandt-Rauf P.J. Editorial retraction. Cancer mortality in a

Chinese population exposed to hexavalent chromium in water. Occup
Environ Med 48:749, 2006.
[304] Pear R. In House, Many Spoke With One Voice: Lobbyists'.

The New York Times November 15, 2009.
[305] Larkin JE, Frank BC, Gavras H, Sultana R, Quackenbush J.

Independence and reproducibility across microarray platforms. Nat
Methods 2:337-344, 2005.
[306] Irizarry RA, Warren D, Spencer F, et al. Multiple-laboratory

comparison of microarray platforms. Nat Methods 2:345-350, 2005.
[307] Jaffe S. Scientists Abandon their Software: Good biology

programs abound in universities, but academia offers little incentive
to keep them current. The Scientist 18:47, Feb. 16, 2004.
Page 353 of 355
[308] Frey CM, McMillen MM, Cowan CD, Horm JW, Kessler LG.
Representativeness of the surveillance, epidemiology, and end results
program data: recent trends in cancer mortality rate. JNCI 84:872,
1992. Comment. The Surveillance, Epidemiology, and End Results
(SEER) project collects cancer-related incidence and mortality data
collected from residents in geographically defined populations,
representing about 10% of the U.S. population.
[309] Ashworth TG: Inadequacy of death certification: proposal for

change. J Clin Pathol 44:265, 1991. Comment. A British perspective
on the importance of the death certificate.
[310] Kircher T, Anderson RE: Cause of death: proper completion of

the death certificate. JAMA 258:349-352, 1987. Comment. Though
every physician is expected to complete death certificates,
surprisingly few physicians understand how to do the job. As a
consequence, death certificates are notoriously inadequate records of
the cause of death. The authors explain the differences between the
underlying and immediate causes of death, between the mechanism
and manner of death. They also describe how to complete the medical
certification section of the death certificate.
[311] Walter SD, Birnie SE: Mapping mortality and morbidity

patterns: an international comparison. Intl J Epidemiology 20:678-
689, 1991. Comment. This survey of 49 national and international
health atlases has shown that there is virtually no consistency in the
way that death data are presented.
[312] LSU Law Center's Medical and Public Health Law Site. Cancer
Registry Data May Be Available Through FOIA.
http://biotech.law.lsu.edu/cases/adlaw/southern_illinoisan_brief.htm
Comment. A judicial ruling permitted a newspaper to receive cancer
registry data through a FOIA (Freedom of Information Act) request.
Though the data was not identified, the Illinois Department of Public
Health, argued that there was sufficient information in the records to
permit a determined individual to discover the identities of some
patients. The court ruled in favor of the newspaper, finding "Public
health data collection is a worthwhile cause in the name of reducing
Page 354 of 355
morbidity and mortality. Although the strict confidentiality of health

data is a noble cause and is worthy of statutory protections, ultimately
a balance must be struck between public health concerns and privacy
concerns."
[313] Douglas L. Why the Human Genome Diversity Project is

problematic for the indigenous community.
http://homepages.wmich.edu/~bstraigh/AN490/LIZ.htm, visited
January 8, 2010.
[314] Swift, J. Gulliver's Travels into Several Remote Nations of the

World. George Bell and Sons, 1892.
[315] United States Court of Appeals for the eighth circuit, No. 06-
2286, Washington University, Appellee v. William J. Catalona, M.D.,
Appellant. http://www.ca8.uscourts.gov/opndir/07/06/062286P.pdf
[316] Perens B. The Problem of Software Patents in Standards.

http://perens.com/Articles/PatentFarming.html site verified October
7, 2009.
[317] Fuyuno I., Cyranoski D. Doubts over biochemist's data expose

holes in Japanese fraud laws. Nature 439:514, February 1, 2006.
Web site: http://www.julesberman.info/

Machiavelli's Laboratory blog site: http://machiavelli-
lab.blogspot.com/
Page 355 of 355

Machiavelli's Laboratory A Satire

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Machiavelli's Laboratory A Satire

Uploaded by

Copyright:

Available Formats

Page 1 of 355

0.2 Nota bene

0.3 Book cover

Chapter 1 Falsification And Fabrication Of Data

1.1 Lessening the guilt: retractions, scapegoats, and clueless

1.2 Elite liars

1.3 When you are caught

1.4 Advice for evil scientists

Chapter 2 Improving The Truth: The Art Of Scientific

2.1 All statistical studies are open to misinterpretation

2.2 Introducing biases into your study

2.3 Falsification of conclusions

2.4 Misrepresenting progress in the war against cancer

2.5 Advice to evil scientists

Chapter 3 The Evil Writer

3.2 First credit

3.3 Evil books

3.4 Altering the past

3.6 Plagiarism in a computer world

3.7 Advice for evil scientists

Chapter 4 Evil Editors And Reviewers

4.1 Advice for evil scientists

5.1 True funding means never having to say you're sorry

5.2 Investing in science

5.3 Advice for evil scientists

6.1 Applauding bad science

6.2 Progress? what progress?

6.3 The consequences of rejection

6.4 Advice to evil scientists

Chapter 7 Complexity: The Devil Is In The Details

7.1 Advice for evil scientists

Chapter 8 Scientific Globetrotting

8.1 Advice for evil scientists

Chapter 9 Evil Intellectual Property

9.1 Advice for evil scientists

Chapter 10 Evil Standards

10.1 What the standards development organizations never do

10.2 Advice for evil scientists

Chapter 11 Abusing Power

11.1 The department chief

11.2 Advice for evil scientists

Chapter 12 Governments And Evil Science

12.1 Government cover-ups

12.2 Government against the people

12.3 The power of bureaucrats

12.4 Advice for evil scientists

Chapter 13 Corporations And Evil Science

13.2 It pays to advertise

13.3 Scientific organizations are instruments of large corporations

13.4 Advice for evil scientists

Chapter 14 Universities And Evil Science

14.1 Academic freedom is the freedom to lie to your students

14.2 The fertile ground excuse

14.3 Advice for evil scientists

Chapter 15 Ethics, And The Avoidance Of Same

15.1 Consent and unconsent

15.2 Conflicts of interest

15.3 Betraying confidentiality

15.4 Evil patients

15.5 Harming animals

15.6 Advice for evil scientists

Chapter 16 Clinical Trials On Trial

16.1 Biases in survival data