Correspondence
Of Gdansk and Glass Houses I am in receipt of your letter and have reviewed and chosen to publish your response to our serious allegation of duplicate publications.1 On balance, we can agree that there is no question that you failed to disclose that your Cancer publications of 19972 and 19993 included subsets of the data that had previously been published in small specialty journals in Poland. As such, this constitutes a significant ethical violation, one we must take seriously. To determine our course of action, it is important to understand that point, and to try to review and understand the circumstances that may have led and contributed to this mistake. Because this ethical violation does concern us considerably, I am gratified to see that you acknowledge the mistake you have made, accept full responsibility, and commit to not repeating this error again. However, the broader issues of its impact on the field must take precedence. I will attempt to walk through our understanding and our subsequent conclusions. The 2 articles that you authored in Cancer regarding the surgical treatment of patients with brain metastases from breast carcinoma and colorectal carcinoma are important and deserving of the citations (72 and 54, respectively) and downloads they have received over the last 15 years. Simply stated, they are among the early articles in the literature that pointed out to a broad cross-section of investigators and clinicians worldwide the importance of a neurosurgical consultation and indeed, when appropriate, a well-considered craniotomy and therapeutic metastasectomy for brain metastases that were shown to be resistant to radiotherapy. They built on the seminal clinical trial that Patchell et al conducted that first established the importance of the surgical resection of solitary brain metastases in patients with cancer.4 The impact on survival that you pointed out in your 2 articles has been realized in several subsequent institutional and multiinstitutional studies, although no phase 3 study to date has definitively shown this point.5 It has, however, become an accepted standard of practice, and you and your coauthors, Drs. Ehud Arbit and Beryl McCormick, deserve credit for helping bring this important option forward for physicians and patients alike. Although it would be relatively straightforward to sanction you and consider retracting the articles, I am convinced that this approach, while ethically defensible, would not serve the greater good. These publications are important articles that helped cancer neurosurgeons and medical oncologists to meaningfully prolong the lives of 612
many patients with cancer who experienced brain metastases. Cancer was pleased to publish these articles in the 1990s, and we remain proud of the important impact they have had on the field. As such, today we have decided to issue a correction, citing the 2 articles in the Polish literature,6,7 as you should have, as preliminary constructs of these 2 studies. Unfortunately, I, as Editor-in-Chief of Cancer, our Section Editors, and Editorial Board are not able to exonerate you for your questionable decision and this poor exercise of your otherwise considerable judgment. Although acknowledging the previous publications of partial data sets would not likely have detracted from our interest in publishing this work, your failure to acknowledge those articles remains troubling. I have no doubt that my 2 immediate predecessors as Editor-in-Chief would immediately have noted the importance of your observations and sought to publish them to share this important knowledge with as broad an audience as possible. Ultimately, the academic and clinical communities of Cancer are largely dependent on the honor system. In this case, although you made a substantial mistake, I am of the belief that your decisions were motivated by your desire to disseminate these data initially in your native Poland, where access to practice-altering medical information of this type at the time was not available. We find ourselves in a situation in which although we disagree with what you did, it is difficult to condemn your motives for doing so. We therefore find your explanation to be both credible and compelling, given that it is common knowledge that the heroism and patriotism demonstrated by the shipbuilders at Gdansk took almost 15 years to trigger the overthrow of the oppressive government that was opposed to the free sharing of information. Your return to your homeland to better serve your patients is an admirable act, and not significantly diminished by the mistake that you and we herein acknowledge. You are far from the first investigator to err in a manner motivated by the need to disseminate a scientific finding that could meaningfully alter care for patients with cancer, and on rare occasions such as these, one must be careful about being overly judgmental of one’s peers without proper insight into their circumstances, motives, and track records. In your distinguished career as a clinical investigator, we believe that there is much good you have done and can yet do on behalf of patients both here and in your native Poland, not the least of which was the documentation through your careful research of the importance of neurosurgical intervention in patients with breast and colorectal cancer who suffer from the foreboding problem of brain Cancer
February 15, 2014
Correspondence
metastases. Upon issuing the correction to these 2 articles, we consider the matter at an end and will be glad to welcome you back to a long and distinguished circle of distinguished authors and reviewers for Cancer. CONFLICT OF INTEREST DISCLOSURES The author made no disclosures.
REFERENCES 1. Wronski M. Letter to Dr. Khuri. Cancer. 2014;1:120:611. 2. Wronski M, Arbit E, McCormick B. Surgical treatment of 70 patients with brain metastases from breast carcinoma. Cancer. 1997;80:17461754.
Cancer
February 15, 2014
3. Wronski M, Arbit E. Resection of brain metastases from colorectal carcinoma in 73 patients. Cancer. 1999;85:1677-1685. 4. Patchell RA, Tibbs PA, Walsh JW, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med. 1990;322:494-500. 5. Kalkanis SN, Kondziolka D, Gaspar LE, et al. The role of surgical resection in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol. 2010;96:33-43. 6. Wronski M. Results of surgical treatment of brain metastases from colorectal cancer [in Polish]. Nowotwory. 1996;46:520-528. 7. Wronski M, Results of surgical treatment of brain metastases from breast cancer [in Polish]. Pol Przegl Chir. 1996;68:1006-1014.
Fadlo R. Khuri, MD Editor-in-Chief, Cancer DOI: 10.1002/cncr.28460, Published online November 15, 2013 in Wiley Online Library (wileyonlinelibrary.com)
613
Of Gdansk and Glass Houses I am in receipt of your letter and have reviewed and chosen to publish your response to our serious allegation of duplicate publications.1 On balance, we can agree that there is no question that you failed to disclose that your Cancer publications of 19972 and 19993 included subsets of the data that had previously been published in small specialty journals in Poland. As such, this constitutes a significant ethical violation, one we must take seriously. To determine our course of action, it is important to understand that point, and to try to review and understand the circumstances that may have led and contributed to this mistake. Because this ethical violation does concern us considerably, I am gratified to see that you acknowledge the mistake you have made, accept full responsibility, and commit to not repeating this error again. However, the broader issues of its impact on the field must take precedence. I will attempt to walk through our understanding and our subsequent conclusions. The 2 articles that you authored in Cancer regarding the surgical treatment of patients with brain metastases from breast carcinoma and colorectal carcinoma are important and deserving of the citations (72 and 54, respectively) and downloads they have received over the last 15 years. Simply stated, they are among the early articles in the literature that pointed out to a broad cross-section of investigators and clinicians worldwide the importance of a neurosurgical consultation and indeed, when appropriate, a well-considered craniotomy and therapeutic metastasectomy for brain metastases that were shown to be resistant to radiotherapy. They built on the seminal clinical trial that Patchell et al conducted that first established the importance of the surgical resection of solitary brain metastases in patients with cancer.4 The impact on survival that you pointed out in your 2 articles has been realized in several subsequent institutional and multiinstitutional studies, although no phase 3 study to date has definitively shown this point.5 It has, however, become an accepted standard of practice, and you and your coauthors, Drs. Ehud Arbit and Beryl McCormick, deserve credit for helping bring this important option forward for physicians and patients alike. Although it would be relatively straightforward to sanction you and consider retracting the articles, I am convinced that this approach, while ethically defensible, would not serve the greater good. These publications are important articles that helped cancer neurosurgeons and medical oncologists to meaningfully prolong the lives of 612
many patients with cancer who experienced brain metastases. Cancer was pleased to publish these articles in the 1990s, and we remain proud of the important impact they have had on the field. As such, today we have decided to issue a correction, citing the 2 articles in the Polish literature,6,7 as you should have, as preliminary constructs of these 2 studies. Unfortunately, I, as Editor-in-Chief of Cancer, our Section Editors, and Editorial Board are not able to exonerate you for your questionable decision and this poor exercise of your otherwise considerable judgment. Although acknowledging the previous publications of partial data sets would not likely have detracted from our interest in publishing this work, your failure to acknowledge those articles remains troubling. I have no doubt that my 2 immediate predecessors as Editor-in-Chief would immediately have noted the importance of your observations and sought to publish them to share this important knowledge with as broad an audience as possible. Ultimately, the academic and clinical communities of Cancer are largely dependent on the honor system. In this case, although you made a substantial mistake, I am of the belief that your decisions were motivated by your desire to disseminate these data initially in your native Poland, where access to practice-altering medical information of this type at the time was not available. We find ourselves in a situation in which although we disagree with what you did, it is difficult to condemn your motives for doing so. We therefore find your explanation to be both credible and compelling, given that it is common knowledge that the heroism and patriotism demonstrated by the shipbuilders at Gdansk took almost 15 years to trigger the overthrow of the oppressive government that was opposed to the free sharing of information. Your return to your homeland to better serve your patients is an admirable act, and not significantly diminished by the mistake that you and we herein acknowledge. You are far from the first investigator to err in a manner motivated by the need to disseminate a scientific finding that could meaningfully alter care for patients with cancer, and on rare occasions such as these, one must be careful about being overly judgmental of one’s peers without proper insight into their circumstances, motives, and track records. In your distinguished career as a clinical investigator, we believe that there is much good you have done and can yet do on behalf of patients both here and in your native Poland, not the least of which was the documentation through your careful research of the importance of neurosurgical intervention in patients with breast and colorectal cancer who suffer from the foreboding problem of brain Cancer
February 15, 2014
Correspondence
metastases. Upon issuing the correction to these 2 articles, we consider the matter at an end and will be glad to welcome you back to a long and distinguished circle of distinguished authors and reviewers for Cancer. CONFLICT OF INTEREST DISCLOSURES The author made no disclosures.
REFERENCES 1. Wronski M. Letter to Dr. Khuri. Cancer. 2014;1:120:611. 2. Wronski M, Arbit E, McCormick B. Surgical treatment of 70 patients with brain metastases from breast carcinoma. Cancer. 1997;80:17461754.
Cancer
February 15, 2014
3. Wronski M, Arbit E. Resection of brain metastases from colorectal carcinoma in 73 patients. Cancer. 1999;85:1677-1685. 4. Patchell RA, Tibbs PA, Walsh JW, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med. 1990;322:494-500. 5. Kalkanis SN, Kondziolka D, Gaspar LE, et al. The role of surgical resection in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol. 2010;96:33-43. 6. Wronski M. Results of surgical treatment of brain metastases from colorectal cancer [in Polish]. Nowotwory. 1996;46:520-528. 7. Wronski M, Results of surgical treatment of brain metastases from breast cancer [in Polish]. Pol Przegl Chir. 1996;68:1006-1014.
Fadlo R. Khuri, MD Editor-in-Chief, Cancer DOI: 10.1002/cncr.28460, Published online November 15, 2013 in Wiley Online Library (wileyonlinelibrary.com)
613
