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Editor’s note: Dr. Novella is away, so we are reposting this article from his personal blog, NeuroLogica.

There is plenty of fraud and corruption in the world, even in the halls of science. No one has a monopoly. But there are some hot spots that deserve specific attention. Recently significant concerns have been raised about the published research of Xuetao Cao, a Chinese immunologist. This story is newsworthy because Cao is not just any immunologist – he is also the President of Nankai University, in Tianjin, China. But more to the point – he is the Chairman of research integrity for all Chinese research. When your head of research integrity is exposed for massive scientific fraud, you have a problem.

Here is a thorough treatment of the evidence for fraud, which covers over 50 published papers. The fabrication of data was noticed because much of it has to do with pictures, of western blots, gels, flow cytometry images, and microscopy images. There appears to be two general types of fabrication going on. One type results from sending the same sample multiple times through analysis, but treating the data as if it came from different samples. In this case the resulting imaging will be strikingly similar in pattern, but not identical. The second type of fabrication is to simply Photoshop copy and paste images.

Either way, the resulting data fabrication is undeniable once it is noticed. The images are simply too similar (and again, sometimes identical) to be genuine data. Once researchers started pouring through Cao’s other papers, the extensive fraud became obvious. When confronted with this revelation online, Cao responded by first standing behind his work, then stating:

Nevertheless, there is no excuse for any lapse in supervision or laboratory leadership and the concerns you raised serve as a fresh reminder to me just how important my role and responsibility are as mentor, supervisor, and lab leader; and how I might have fallen short.

Wow – you see what he just did there? He simultaneously apologized and took responsibility, but only for failure of supervision. So essentially he is throwing all of the people who work for him under the bus. Either way, however, this is really bad for Cao. Even in the best-case scenario, all the fraud was perpetrated by others under his watch. Keep in mind, he is in charge of research integrity for all of China, but apparently can’t keep an eye on his own lab. There are certainly famous cases where research assistants were the ones perpetrating the fraud. Another immunologist, Jacques Benveniste, claimed to have evidence of immunological activity from high “homeopathic” dilutions. An investigation found his results to be highly unreliable at least, and likely straight-up fraudulent (although may have been due to really sloppy techniques and bias). But it also appears that the positive results all seemed to come from one lab assistant, Elizabeth Davenas – certainly a disturbing pattern.

Perhaps a similar pattern will emerge from Cao’s lab, but it seems unlikely that an overzealous assistant can be responsible for data fabrication in 50 published studies. This is clearly a systemic problem.

But there have always been reasons to suspect that Cao’s research, and the rocketing trajectory of his resultant career, were dubious. In 1988 Cao published a paper in which he claimed that the energy produced by Qi was able to prevent melanoma metastasis in mice. Whenever research claims that magic works, you have to be suspicious. But if the magic is politically favored by the powers that be, that can do wonders for your career.

The debate now focuses on how to interpret this incident, specifically what does this say about Chinese scientific research in general? There are those who point out that scientific fraud exists everywhere, so we shouldn’t over interpret the implications of this case. But I don’t buy that. While every country has its scientific fraud, there seem to be clusters that require special attention – and China is a cluster. We can only speculate, however, about the causes. The simplest explanation (so simple that it doesn’t really add much insight) is that it comes down to culture. Well, sure. Integrity is mostly about culture, the culture that exists in a profession, in a society, and in institutions. Science only works when most people follow the rules, when there are guardrails in place to maximize quality control, and when there is zero-tolerance for breaking the rules. When the single person in charge of enforcing those rules in China is exposed as a massive violator, there is a systemic problem.

There is also strong cultural pressure in China to prove that the core beliefs of their culture (traditional Chinese medicine and Qi) are real and powerful. This is ideological science. As powerful evidence for this effect is acupuncture research. Two reviews, in 1998 and again in 2014, found that 100% of acupuncture studies coming out of China were positive. This is statistically impossible, even if acupuncture worked (and it almost certainly doesn’t). This is also a bit much even for just publication bias. It could all be incredible researcher bias, but bias blurs imperceptibly into fraud. When you are fudging your research methods, and you know this isn’t pristine, how much of that is bias and how much fraud? In the end, it doesn’t really matter.

There is also legitimate concern that totalitarian governments do not create an environment in which science can flourish. Science requires transparency, it requires valuing method over results, and it should be ideologically neutral. These are not concepts that flourish under a totalitarian regime. Also, the scientists who get promoted to positions of respect and power are likely to be those who please the regime, by proving, for example, that their cultural propaganda is real. So the selective pressures for advancement do not prioritize research integrity.

Cao, I think, embodies all of this. This should not be viewed as an isolated incident, or even researcher. The very fact that Cao has risen to the highest heights of setting the standards for science in China means that we have to look at the systemic implications of this case.

There are a couple of other lessons we should note as well. First, and unfortunately, we need to look at all research coming out of China with an especially careful eye. The system is broken, and cannot be given the benefit of the doubt.

But even more broadly, scientific journals need to evaluate their methods for rooting out fraud before it is published. The existing filter is not adequate. It is unfortunate that journals need to expend resources just looking at submitted papers to detect sloppy techniques, bias, and conscious fraud, but nothing less is now acceptable. Trust in published peer-reviewed science is critical to the system, and after a blow like this (and the many others) steps need to be taken to restore trust by raising the bar of quality control.