NETHERLANDS: World heart research expert fired

A world-renowned expert on the reduction of risks involved in heart surgery has been dismissed from Erasmus University Medical Centre in Rotterdam, The Netherlands, after "violation of academic integrity".

The case of Professor Don Poldermans emerged just two weeks after the sacking of another Dutch scholar, Diederik Stapel, over alleged faking of research.

A statement by Erasmus University, announcing the decision, said: "The professor agrees with the committee's conclusions and expressed regrets for his actions. Poldermans feels that as experienced researcher he should have been more accurate but states that his actions were unintentional."

A summary of the report of an inquiry chaired by Professor Dr PJ van der Maas, former dean of the Erasmus University Medical Centre, and four other senior professors, was also released by the university.

The inquiry concluded that Poldermans was "careless in collecting data for his research. In one study it was found that he used patient data without permission, used fictitious data and that two reports were submitted to conferences which included knowingly unreliable data".

The investigation committee does not imply inaccuracies or fabrication of data in any other of Poldermans' 500 published papers.

Poldermans, 57, is world-renowned for his research into the reduction of risks in heart surgery by the use of beta blockers prior to and after the surgery. For more than 10 years he has delivered papers via highly-ranked journals and conferences, often reporting on the remarkable effects of different drugs on the survival rate of patients who had been operated on.

The study that triggered the inquiry was concerned with establishing what factor can aid better assessment of the risks to patients undergoing heart surgery, according to the university's statement. However, there are no medical implications for the patients involved in the studies under investigation, it said.

Podermans was professor of medicine and head of the perioperative cardiac care unit, where he received his medical degree in 1981.

He is a Fellow of the European Society of Cardiology (ESC), where he has been chair of the European task force for developing guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery, published in the European Heart Journal in 2009.

On 23 November the ESC announced that Poldermans had resigned as chair of the task force, adding that it is "carefully looking into the guidelines" to "decide whether these need to be re-examined".

It added: "We are saddened by Poldermans' situation and, although we are confident that our guidelines are supported by reliable data, we are carefully looking into the guidelines."

Some 22 task force members from the Netherlands and 15 other European countries, two additional contributors and 40 reviewers worked on the guidelines under his chairmanship.

The guidelines were developed by selected experts in the field, following a comprehensive review of the published evidence for management or prevention of a given condition. They focused on the cardiological management of patients undergoing non-cardiac surgery: that is, patients for whom heart disease is a potential source of complication during surgery.

Across Europe an estimated seven million major surgical procedures are carried out annually involving patients with cardiac risks.

One empirical basis for the guidelines is the Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group (DECREASE), a longitudinal study in several phases with trials on almost 4,000 patients.

DECREASE was chaired by Poldermans, and its later phase, carried out after the ESC guidelines were drawn up, involved studies in which the investigation committee has found faking of research data, violation of patients' trust and recorded results that cannot be traced back to patient records.

One of the disputed research questions addressed by DECREASE is to what degree beta blockers reduce risk for perioperative myocardial ichaemia.

One remarkable such effect, which has been reported by the DECREASE trials with Poldermans and his colleagues as authors, is the effect of bisoprolol (Zebeta) on survival rates. But his research in this area and in the use of fluvastin has been challenged by other specialists.

The investigation committee has addressed fabricated results in the DECREASE programme and recommends in its report that the trials be discontinued, and that the sponsoring firm Roche Diagnostics be informed. However, the investigation committee did not demand that any papers published by Poldermans should be retracted.

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