Dr. Eisenach articulately develops a plan for Anesthesiology to deal with what is arguably the largest case of author misconduct in our specialty's history.1However, I have concern for the statement regarding the lack of interest in publishing confirmatory studies. Is the “bias against confirmatory research” in the best interests of the reader, the journal, or scientific investigation? The Reuben episode is ample evidence that more confirmatory investigations (not less) should be published. Even in the absence of academic fraud, as Ioannidis has documented, data from approximately one-third of “highly cited” publications cannot be supported (or the treatment effect is greatly diminished) by subsequent studies.2For example, two large recent investigations have dampened the enthusiasm for the pivotal studies that supported perioperative administration of β blockers and tight control of glucose in the intensive care unit.3–4 

In essence, by requesting manuscripts reexamining some of Reuben's hypotheses, the editors are actually seeking confirmatory studies. I realize that Anesthesiology receives many meritorious studies that because of a number of factors will not achieve priority for publication. Perhaps some of these confirmatory studies (undergoing the same rigorous editorial review as printed articles) could be published in an electronic format so that they will be available to scientists and the readership. The New England Journal of Medicine  and Circulation  are just two examples of high-impact journals that promote “seminal discovery” and publish selected communications in an electronic rather than print format.

The signposts are already in the woods and as skillful explorers we have to read them.

Yale University School of Medicine, New Haven, Connecticut. paul.barash@yale.edu

Eisenach JC: Data fabrication and article retraction: How not to get lost in the woods (editorial). Anesthesiology 2009; 110:955–6
Ioannidis JP: Contradicted and initially stronger effects in highly cited clinical research. JAMA 2005; 294:218–28
POISE Study Group ISE: Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE Trial): A randomized controlled trial. Lancet 2008; 371:1839–47
POISE Study Group ISE
The NICE-SUGAR Study Investigators: Intensive versus  conventional glucose control in critically ill patients. N Engl J Med 2009; 360:1283–97
The NICE-SUGAR Study Investigators