'Deeply troubling': Pediatric journal's fictional cases affect more than 2,000 studies
More than 2,000 academic papers have cited or based some of their content on fictional case studies that have now been retroactively corrected by Canada’s leading pediatric journal, the Investigative Journalism Bureau (IJB) has found.
Paediatrics & Child Health , published by Oxford University Press for the Canadian Paediatric Society, publicly announced in February the blanket corrections of 138 articles, following a New Yorker investigation that reported on outrage in the academic community over fictional cases being presented as verifiable research.
Among them was a notorious fictionalized case study backing a controversial theory that babies could overdose on codeine through breast milk.
“This is a huge stain on medical literature,” said Dr. David Juurlink, head of the clinical pharmacology and toxicology division at Sunnybrook Health Sciences in Toronto. “They are fabrications, full stop.”
But the problem didn’t stop with those 138. These articles were cited at least 117 times in peer-reviewed publications. Those papers were, in turn, cited at least 2,194 times in academic research.
The fictionalized articles have had practical and far-reaching impacts on academic literature.
“It is deeply troubling to discover the scale of the citations and downstream impact associated with a fabricated case report,” said Dr. Farah Abdulsatar, an assistant professor of pediatrics at Western University in London, Ont.
“This represents a serious lapse in academic integrity and raises important concerns regarding the journal’s editorial standards and academic reputation.”
Journal editors did not respond to questions from the IJB beyond the public statement the journal released in February about correcting the reports.
The 138 case reports now labelled as fictional were never originally presented or declared as such.
From 2001 through at least 2012, case reports published in the Paediatrics and Child Health series — called CPSP Highlights — were framed as “short clinical examples” drawn from pediatric survey findings. That wording suggested these were real patient cases, not invented ones.
Only in 2015 did author submission guidelines explicitly start mentioning “fictional” cases.
None of the so-called case studies has been retracted; instead they have been corrected to make it clear the examples used are fiction.
In its February statement, the Paediatrics & Child Health journal acknowledged that assumptions about the veracity of the case studies were “understandable given the columns had no disclaimer to indicate the cases are fictionalized.”
The fallout from fiction
Perhaps the most compelling example of the fallout such fictionalized cases can have involves the work of former SickKids hospital researcher Dr. Gideon Koren and his co-author, Dr. Michael Rieder.
Koren co-authored the fictionalized “Baby Boy Blue” case study, a 2010 Paediatrics & Child Health paper that built upon his now discredited hypothesis that infants could suffer opioid toxicity through breast milk.
The article, which centred on a single dramatic infant case and a detailed pathophysiologic explanation, circulated for years as genuine clinical evidence, and drove years of warnings against codeine use while breastfeeding.
“It led to babies in large numbers not being breastfed, and being given formula in the interest of safety,” says Juurlink, who spent more than a decade challenging Koren’s theory. Koren, who surrendered his Canadian medical licence in 2019 in the wake of professional misconduct investigations, now lives abroad.
Rieder, Koren’s co-author on the “Baby Boy Blue” case, is a senior reviews editor and associate editor at Paediatrics & Child Health and a member of the Canadian Paediatric Society’s Drug Therapy and Hazardous Substances Committee. He referred IJB questions to the Canadian Paediatric Society and the journal.
The IJB contacted 18 physicians who had contributed articles to CPSP Highlights. Several said their case studies or examples were intentionally fictional, meant for teaching purposes. None agreed to be publicly identified.
Fictional teaching cases are not inherently problematic, said Juurlink, so long as this is disclosed at the time of publication. “One of the jobs of journals is to educate readers and sometimes they do it with fictional case reports.”
Without clear disclosures by journals, however, well-intentioned fictional teaching material becomes indistinguishable from fabrication, Juurlink says.
Adding to the confusion, at least one academic contributor to the journal says she was blindsided by the blanket corrections — because her examples were not fictional.
“I’m deeply disappointed that my research is being labelled as fictional when it clearly isn’t,” said Western University’s Abdulsatar, whose paper was included among the 138 corrections.
“The ideal solution is to treat it case-by-case, paper-by-paper,” Abdulsatar told the IJB. “Their response was too quick for them to have done any investigation.”
Currently, it is not clear if Paediatrics & Child Health will revisit individual articles. For now, 138 studies remain online under identical corrections, even though contributors’ accounts and archived journal descriptions suggest a more complicated record.
The Investigative Journalism Bureau (IJB) at the University of Toronto’s Dalla Lana School of Public Health is a collaborative investigative newsroom supported by Postmedia that partners with academics, researchers and journalists while training the next generation of investigative reporters.
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