[HN Gopher] Medical journal says the case reports it has publish...
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Medical journal says the case reports it has published for 25 years
are fiction
Author : Tomte
Score : 144 points
Date : 2026-03-04 15:02 UTC (7 hours ago)
(HTM) web link (retractionwatch.com)
(TXT) w3m dump (retractionwatch.com)
| october8140 wrote:
| I think research should be assumed fiction until it's peer
| reviewed.
| contubernio wrote:
| There is not good evidence that peer review improves quality
| and there is perhaps some to the contrary (many predatory
| journals are peer reviewed). The arxiv (unreviewed) is among
| the most reliable sources available.
| ranger_danger wrote:
| What do you suggest instead? Certainly not giving up I hope.
| observationist wrote:
| Yeah, it's almost like science is better when the scientific
| method is applied to everything, instead of delegating
| validation to some third party based on credentials or
| authority or social status.
| moi2388 wrote:
| Independently replicated. Reviewed says pretty much nothing.
| kergonath wrote:
| Peer review is a sniff test. It cannot guarantee that the
| results are correct and the conclusions are right. It is just
| designed to limit some kinds of errors. Replication is
| important.
| roywiggins wrote:
| Case studies can't be replicated. They aren't experiments.
| em-bee wrote:
| you can find multiple cases that are comparable. one case
| study is an anecdote. multiple studies for the same kind of
| case...
| ambicapter wrote:
| Tough to replicate an isolated case study?
| Rallen89 wrote:
| I think it's a bit different considering the goal was a
| teaching tool of well recognised conditions
|
| >all or almost all were cases of very well recognized
| conditions [...] where a single case report would not generate
| any interest or ever be cited.
| readthenotes1 wrote:
| That is an ironic proviso given that the article clearly states
|
| "The peer-reviewed articles don't state anywhere the cases
| described are fictional."
|
| Peer review by peers who are trained by non-replicable science
| is not helpful...
| newzino wrote:
| The detail that makes this more than a labeling error: the
| fictional nature appeared in the journal's author guidelines, not
| in the published articles. Researchers who cited these 61 papers
| had no way to distinguish them from genuine case reports. 218
| citations later, the fiction is embedded in secondary analyses
| and literature reviews written by people who had no idea.
|
| The "Baby Boy Blue" (2010) case is the clearest example of the
| harm. An infant allegedly exposed to opioids through breast milk.
| That case influenced clinical guidance on codeine safety in
| nursing for years. The CARE guidelines (Consensus-based Clinical
| Case Reporting Guidelines) exist specifically to create
| transparency in case reporting. They're voluntary, which is how a
| journal can run a 25-year undisclosed fiction program and
| technically say the authors knew.
| SiempreViernes wrote:
| Doesn't sound like these works were "full" articles, but rather
| something more like short review articles.
| programmertote wrote:
| Speaking this as a spouse of a medical doctor -- case reports are
| sometimes a good way to increase the bullet point count in your
| CV if you are a medical resident. A lot of residents do that just
| for the sake of beefing up their CVs (to apply for fellowship for
| example).
| copperx wrote:
| I don't see anything wrong with that by itself; with the amount
| of patients doctors see there should be one once in a while
| that is worth reporting. Or are such cases so rare that the
| doctor is incentivized to lie?
| sxg wrote:
| I think you may have missed the original commenter's point.
| Residents (and medical students) are highly incentivized to
| publish unrealistic numbers of papers and case reports. One
| case report doesn't cut it--you need literally dozens of
| publications to match into some of the most competitive
| residency and fellowship programs. The NRMP (match organizer)
| publishes a document every 2 years that summarizes all of
| these stats. The 2024 version is in the link below, and page
| 12 supports what I'm saying.
|
| https://www.nrmp.org/wp-
| content/uploads/2024/08/Charting_Out...
| digitalPhonix wrote:
| This is another example of Goodhart's law in action, right?
|
| Weirdly Pediatrics (chart 7) skews the other way (less
| publications tended to get into residency programs)? Are
| those doctors/administrators/programs somehow seeing
| through the nonsense?
| husarcik wrote:
| I wonder if it's because pediatrics is not competitive
| unless applying to a top program.
| peyton wrote:
| 27.7 works to match derm. Holy crap that's a lot. No way.
| We would be gods of skincare by now.
| snapetom wrote:
| In vet med, case studies are still pretty important, but that's
| because vet med is in its infancy compared to human medicine.
| At least one case study, usually two, are required to be
| eligible to take boards. Future board renewals, I think for
| most boards, are "published one original piece of research or
| two case studies" among a slew of other requirements.
| sourcegrift wrote:
| In the era of GitHub etc, if you're not giving out every single
| data point of your research, it should be assumed it's fake.
| avs733 wrote:
| out of context that makes sense...but in the context of a case
| report how do you implement that? The patients have privacy
| rights and the authors/doctors have a responsibliity to protect
| them. That doesn't justify this but it does force a
| conversation about what 'every single data point' means. Does
| it mean the patient's real name and social security number?
| their complete medical chart?
|
| Case reports are descriptive not determinative and should be
| treated as such by other scholars. They are 'I saw this' not
| 'this is generalizably true'. They can (and often are)
| replicated or countered but they are not per se research as you
| are thinking about it. Whether it is fictitious or not, other
| scholars should be cautious in citing them as proof/evidence in
| papers that fit into the 'research' mold.
| nradov wrote:
| From a legal perspective, journal article authors can
| implement this by following the official HHS guidance for de-
| identification. This applies to any use of protected health
| information (PHI), not just case reports.
|
| https://www.hhs.gov/hipaa/for-professionals/special-
| topics/d...
|
| The IRB for a particular organization can impose additional
| restrictions.
| fsh wrote:
| The article is about case reports, not about empirical studies.
| Putting a fake case report on GitHub wouldn't make it any less
| fake.
| qwertox wrote:
| > Putting a fake case report on GitHub wouldn't make it any
| less fake.
|
| Much easier to review for whomever wants to review it.
| SiempreViernes wrote:
| Obviously just sending it via email to the reviewers works
| just fine in practice anyway, the problem is really that
| they published a summary piece about research that was
| later retracted, but didn't take down their own article.
| NewsaHackO wrote:
| Do you know what a case report is?
| drivingmenuts wrote:
| Would it be easier, though? Medical records (in the US) are
| covered by HIPAA and, to my knowledge, there is no
| anonymized canonical record, similar to what we have for
| legal decision. Without that, how difficult would it be to
| just "make shit up"?
| Towaway69 wrote:
| And then there be large amounts of fake data for the next
| generation of AIs to learn from.
|
| What is stopping anyone from faking the data they use in their
| research papers?
|
| Sure it might be verifiable but if the data was made to give
| the desired results, i.e. faked to be what is required for the
| paper.
| helsinkiandrew wrote:
| > The articles usually start with a case description followed by
| "learning points" that include statistics, clinical observations
| and data from CPSP.
|
| I can see the reason where fictional cases could be used here as
| teaching aid - based on real cases/ilnesses but simplified to
| make the learning points succinctly, but surely if the cases are
| being cited elsewhere someone should have raised the issue
| earlier?
| SiempreViernes wrote:
| Since it was for teaching I expect the case studies were always
| showing typical features of real cases, so there's nothing in
| the case vignette itself to give it away unless the author
| picks a funny name or something like that.
|
| Rather it would be the entire form of these short highlight
| articles that would make you keep searching for a proper
| citation, unless you're lazy or pressed for time.
| ultropolis wrote:
| Wouldn't citing actual cases be a HIPAA violation? I can see
| why they would invent example cases, based on real ones,
| especially if they are fairly pedestrian cases.
|
| I mean. Except if your pedestrian example does not reflect
| reality, then that is bad.
| reenorap wrote:
| HIPAA is American, not Canadian.
| fc417fc802 wrote:
| It's a privacy violation to reveal information that
| identifies the patient. It is not a violation (and is
| extremely common) to recount details without noting names,
| places, or even dates. Unless you already have access to a
| database of records you won't be able to track it down.
|
| It's even common during talks to display diagnostic images
| that have had any identifying marks redacted.
| learingsci wrote:
| "Pics or it didn't happen," goes a long way in my book.
| MarkusQ wrote:
| You may want to update that, given recent advances in
| generative AI.
|
| No idea what you should update to, mind you, but the old era of
| photographic evidence is on its last jpgs.
| krisoft wrote:
| What a mess.
|
| > One author of a case report was surprised to learn of the
| correction -- because the case described in her article is true.
|
| So they managed to mess up even the correction of their giant
| mess.
|
| > correcting the correction "would be difficult."
|
| I bet. That's why they should have got it right in the first
| place. I would be absolutely ballistic if they would be libelling
| my work like that.
| SiempreViernes wrote:
| Yeah, they seem to have been quite sloppy with these vignettes.
|
| Thought note that in the situation of the mislabeled real case,
| the formal solution is could be a retraction of the entire
| highlight article since it is against the (poorly implemented)
| policy to have a real case study.
|
| Don't know how patient consent for being used in a case study
| works, did this author get a perpetual license, did they just
| copy something from another article they wrote, or from an
| article someone else wrote?
| smelendez wrote:
| You can see the full article here: https://www.cpsp.cps.ca/up
| loads/publications/pxy155-Teething...
|
| It looks like it has a short intro paragraph that talks about
| a specific case with no identifying details (beyond "a
| previously healthy 4-month-old boy"), citing this report by
| other doctors: https://pubmed.ncbi.nlm.nih.gov/27503268/
| followed by further discussions of physician reports and
| survey data.
|
| The correction is explicitly listed as applying to that
| article (https://academic.oup.com/pch/article-
| abstract/24/2/132/51642...), which itself seems false since
| that article doesn't seem to include a fictional vignette.
| andrewflnr wrote:
| It looks like they labelled all of them fiction based on a
| single instance of one of the authors fabricating their case, a
| gross overcorrection. I wonder if they flinched at the prospect
| of actually assessing the validity of all of them and decided
| it was safer to just disclaim them.
| petesergeant wrote:
| > It looks like they labelled all of them fiction based on a
| single instance of one of the authors fabricating their case
|
| Does it? That's directly at odds with what the article and
| editor say
| andrewflnr wrote:
| > The corrections come following a January article in New
| Yorker magazine that mentioned _one of the reports_ --
| "Baby boy blue," ... was made up.
|
| > "Based on the New Yorker article, we made the decision to
| add a correction notice to _all 138 publications_... "
|
| Emphasis mine.
| crummy wrote:
| > While the instructions for authors for Paediatrics &
| Child Health has at times indicated the case reports are
| fictional, that disclosure has never appeared on the
| journal articles themselves.
|
| Sounds like they were asking authors for fiction, so
| probably plenty of them are.
| RobotToaster wrote:
| > I would be absolutely ballistic if they would be libelling my
| work like that.
|
| Genuine question, could they sue for this? It seems like a
| pretty good case.
| kittikitti wrote:
| https://onlinelibrary.wiley.com/doi/10.1111/jpc.14206
|
| Maybe we should revisit the routine practice of infant male
| genital mutilation?
| SiempreViernes wrote:
| I think this is mainly a case of the common "didn't notice when
| crucial literature for own published content was retracted, get
| caught with pants down when the replication police come
| knocking".
|
| Obviously the poor labelling is bad, but 9 bad citations per year
| isn't the end of science and better labelling wouldn't discourage
| all the lazy authors who chose to cite these highlight articles,
| it'll just shift whos is to blame.
|
| The real problem is hosting a review article about research that
| was retracted, and it sounds like they aren't moving very quickly
| on taking that piece down.
| insane_dreamer wrote:
| I don't mind the fact that the case reports were fictional --
| actual cases can be problematic in terms of privacy as it may be
| easy to ascertain the patient's identity from the details -- but
| not putting a notice that it was fictional (or altered from a
| real case for privacy), for teaching purposes, is pretty bad.
| snapetom wrote:
| Original HN discussion about the case:
|
| https://news.ycombinator.com/item?id=46789205
| skyberrys wrote:
| Thank you, this really adds the missing context to this update
| about fictional case studies. The original read was compelling
| and also alarming.
| TomMasz wrote:
| This is fine, though somewhat belated. But it does nothing to
| deal with the public's growing distrust of science in general,
| and medical science in particular.
| jfengel wrote:
| The "growing distrust" is due to a concerted disinformation
| campaign which is independent of the facts.
|
| There was indeed much negative information that the public was
| not aware of, and they should perhaps have held more skepticism
| than they did. But the gleeful acceptance of outright anti-
| science lies implies that they were never really in a position
| to make a sound judgment one way or the other.
|
| In those circumstances I'll settle for people reaching the
| correct action: that practically all accepted medicine is
| correct and they should follow their doctor's advice. If they
| choose to over-inflate the importance of things that do indeed
| go wrong, then they are the ones failing to reach valid
| conclusions.
| tw85 wrote:
| No, it isn't. Anthony Fauci and Rochelle Walensky were both
| on record, on television, claiming that anyone who takes the
| covid vaccine will not contract the virus (sterilizing
| immunity). The medical community and public health in
| particular disgraced themselves by going all in on demonizing
| anyone who raised questions about the covid jabs, mocking
| Ivermectin as "horse paste", claiming cloth masks were very
| effective against respiratory viruses (they are not, and this
| has been known for decades), and even that the concept of
| acquired immunity from recovering from an infection doesn't
| exist. These are all trivially verifiable things that
| happened during covid madness, and instead of walking back
| some of their false claims they simply doubled down on
| blaming the anti-vaxxers (even after jab uptake exceeded
| 80%).
| jfengel wrote:
| Like I said: every word out of your mouth there is a lie.
| Yes, I know the links you're about to hand me, to right-
| wing disinformation sites and actual news articles that
| don't say what you're pretending they say.
|
| These are straight out falsehoods, collected for you
| deliberately, which you are repeating because you didn't
| even pretend to examine them critically. There is no way to
| discuss the actual mistakes made during the pandemic when
| it takes me ten times as long to refute the lies you're
| spreading.
| casey2 wrote:
| I thought it was "contract and spread" you can't even get
| your own disinfo straight
| damnesian wrote:
| Too late, it's already in the bloodstream, LLMs will be
| recommending things to pediatric doctors and families from
| fabricated archives for years, probably.
| Towaway69 wrote:
| It's all an hallucination.
| mmooss wrote:
| That's a serious issue: How could retractions work with LLMs?
| How could they be made to work?
|
| Accuracy rots over time, and at varying rates. It's not just
| scientific research.
| sekuraai wrote:
| They had access to ChatGPT for last 25 years!
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