A Dartmouth College investigation has concluded that Dr. H. Gilbert Welch, one of the country’s most prominent health care policy scholars, committed research misconduct in connection with a paper published in a top medical journal.
Welch plagiarized material from a Dartmouth colleague and another researcher at a different institution, according to a letter from the college’s interim provost obtained by Retraction Watch. The material was included in a 2016 paper published by the New England Journal of Medicine. The work found that breast cancer screening was more likely to overdiagnose tumors (leading to unnecessary treatments) than pick up early cases that are destined to become life-threatening.
Welch is a well-known critic of unnecessary medical screening and interventions, and has written several popular books on the topic. He is frequently quoted in media discussions of health care costs.
A June 14 letter from Dartmouth Interim Provost David Kotz says a committee assigned to investigate the allegations determined that Welch “engaged in research misconduct, namely, plagiarism, by knowingly, intentionally, or recklessly appropriating the ideas, processes, results or words of Complainants without giving them appropriate credit …”
The interim provost’s letter is addressed to Samir Soneji, an associate professor at Dartmouth who works alongside Welch at the Dartmouth Institute for Health Policy and Clinical Practice. Soneji and his colleague Hiram Beltrán-Sánchez, an associate professor at the University of California, Los Angeles, raised their concerns in 2016, alleging Welch appropriated their work.
Welch challenged the college’s findings, telling Retraction Watch that the NEJM paper is a “natural progression” of his work,” and that “the underlying data are publicly available — all the analyses, all the figures and all the writing in the article are my co-authors’ and mine.” The dispute, he added in an email, is “about the origin of the idea — not about the validity of the work,” which is not in question.
A spokesperson for Dartmouth declined to say whether Welch had been sanctioned, instead referring a reporter to the institution’s research misconduct policy. The policy outlines a range of possible disciplinary actions, including a letter of reprimand, monitoring future work, suspension, and even demotion or termination.
The spokesperson, Justin Anderson, refused to provide a copy of the investigative committee’s report, noting it is “private and confidential.”
It has been a time of turmoil at the Dartmouth Institute, where Welch is a professor of medicine. Last month, Welch’s boss, Dr. Elliott Fisher, the head of the institute, was placed on administrative leave. Fisher, along with the institute’s chief of strategy and operations, has been banned from the campus while the school conducts an investigation into a complaint about workplace conduct. Dartmouth has not provided details about the nature of the investigation, but told Retraction Watch the incident involving Welch is unrelated.
This isn’t the only department facing problems: Also last month, the last of three Dartmouth psychology professors accused of sexual misconduct resigned, following a nearly yearlong investigation.
Welch joined the Dartmouth medical school faculty in 1990. He has also worked for the Veterans Affairs Medical Center in White River Junction, Vt., the Indian Health Service in Alaska, Oregon, and Arizona, and the Public Health Service, including a stint as a ship physician. He received his medical degree from the University of Cincinnati, a master’s in public health from the University of Washington, and a B.A. from Harvard.
The paper at the heart of the allegations against Welch reported that mammograms were more likely to provoke unnecessary treatment for tumors that would never become life-threatening than to save lives. The article received significant press attention, and is considered “highly cited” by researchers in the field, according to Clarivate Analytics’ Web of Science — meaning it was ranked in the top 1 percent of all papers in its field for the year it was published.
Less than a week after the paper was published, Soneji contacted Martin Wybourne, Dartmouth’s vice provost for research, alleging that Welch appropriated “my research ideas and research results.”
In the email, Soneji explained that, in May 2015, Welch emailed him asking for a copy of a slide Soneji had presented at a lecture Welch attended. Soneji sent the slide, noting: “If this result/figure ultimately becomes part of a paper, I’d like the opportunity to be a coauthor (sorry if this comes across as a bit odd — I’ve had a few negative experiences this year when sharing results).”
Welch responded: “No worries about this appearing in a paper — this is for class …. Sorry to hear you have been burned in sharing results.”
Soneji and Beltrán-Sánchez submitted a paper to the New England Journal of Medicine in August 2015 that included the findings sent to Welch, but it was rejected, they told Retraction Watch by email. Welch submitted his paper the following year. Soneji and Beltrán-Sánchez said they submitted their paper to another journal in the fall of 2016, and a peer reviewer flagged it as being too similar to the recently published article by Welch and his colleagues.
Soneji and Beltrán-Sánchez said the two papers are “identical or virtually identical … in numerous key aspects,” such as the idea and motivation for the research, and the analytic approach. For instance, at the workshop attended by Welch, Soneji explained he was using the size of tumors, and how those change over time, to measure the effect of screening mammography. After the workshop, Soneji wrote in his 2016 complaint email, he and Welch met, and Welch said he “had never thought of” some of Soneji’s research ideas. Yet, according to Soneji, his ideas were incorporated into the NEJM paper.
Welch disagreed: “The idea that changes in tumor size and stage provide insight into the effectiveness of screening predates me,” he said in an email. “These ideas certainly do not originate with the complainant.”
In an email to Retraction Watch, Soneji and Beltrán-Sánchez wrote, “Of course, it was a difficult decision to make such a serious allegation against a colleague. And making such an allegation can come at personal and professional costs, especially since we were both untenured assistant professors at the time. However, we believe the risk to the ethical conduct of science is greater than any risks we face.” When the investigation began, they did not try to publish their own paper elsewhere.
Dartmouth forwarded its findings to the NEJM; on Aug. 10, the journal wrote back, saying it had concluded that the matter was an “authorship dispute” — meaning other researchers claim they deserve to be recognized for their contributions to the paper. This is not “sufficient grounds” for retracting the article, the journal determined. “We are happy to work with you and the article authors to reach a solution whereby sufficient acknowledgment is given so that the contribution of the complainant is adequately recognized,” Editor-in-Chief Dr. Jeffrey Drazen and Deputy Editor Dr. Dan Longo wrote.
Soneji and Beltrán-Sánchez called for the paper to be retracted based on Dartmouth’s findings.
The Dartmouth spokesperson said the institution informed the U.S. Office of Research Integrity (ORI), which investigates allegations of biomedical research misconduct that involve federal funds, throughout the investigation process. ORI has not issued a finding against Welch, and a spokesperson for the agency said it “does not confirm or deny the existence of an investigation.”
Welch said that the ORI concluded in May 2017 that there was “no research misconduct,” but he provided no evidence of such a statment. The agency typically does not clear researchers of misconduct; it simply declines to issue a finding. According to the ORI website, “If ORI does not issue findings against a respondent, this does not negate the institution’s findings.”
The NEJM editors’ letter noted that their opinion that the matter is an authorship dispute is “concordant with that of the United States Office of Research Integrity.” It’s unclear whether that means the ORI has shared an opinion on the Welch investigation, or whether the editors were citing previous statements by ORI saying it does not investigate authorship disputes. A NEJM spokesperson wouldn’t comment.
Since they lodged their allegations, Beltrán-Sánchez has received tenure at UCLA. Soneji is working remotely for up to one year in North Carolina, where his wife has a new job.
This story is a collaboration between STAT and Retraction Watch.