Q&A with Dr. Bruce Flamm: Doubting the science, and the scientists, behind a celebrated prayer study

Dr. Bruce Flamm, a professor of obstetrics and gynecology at the University of California at Irvine, has been waging a lonely war for nearly a decade. He took the unusual step of accusing fellow scientific researchers of fakery. In 2001, the Journal of Reproductive Medicine published a paper titled, "Does prayer influence the success of in vitro fertilization-embryo transfer? Report of a masked, randomized trial." The paper claimed that previously infertile Korean women were 100 percent more successful using in vitro fertilization to get pregnant if people in the United States, Canada and Australia prayed for them.

In 2004, Flamm started criticizing the study in the Skeptical Inquirer and other publications. One by one, all the researchers involved had subsequent legal or ethical troubles. In 2007, reporters at the Los Angeles Times, including this one, wrote about a dispute between one of the paper's authors, Kwang-Yul Cha. One of Cha's former employees had published a paper previously in South Korea under that researcher's name. The same paper showed up in an English translation under Cha's name in the journal Fertility & Sterility.

Flamm wrote about the dispute in an article entitled in Ob. Gyn. News in March 2007, saying, "This may be the first time in history that all three authors of a randomized, controlled study have been found guilty of fraud, deception, and/or plagiarism." Cha sued. The case went to a Superior Court judge twice and then to the California Court of Appeals. Flamm won every time. The case is a fascinating example of the scientific community collectively letting down its guard. Antidote will write more about that on Monday.

I reached Flamm at his home in Riverside. The first part of our conversation is below. It has been edited for space and clarity.

Q: What was it about this study that got under your skin?

A: As soon as I got that issue of the Journal of Reproductive Medicine I was shocked. It was the lead story in the issue. And it showed a phenomenal change. It wasn't 10 percent or 4 percent of the women becoming more fertile. It was a 100 percent jump. If it were true, it would have changed the whole field of infertility. That's what got my attention. All the doctors I know of in my field were talking about this. They said, "If this is true, it is going to change everything." I have many different colleagues with different religious beliefs. Some were very hopeful that this was a big breakthrough not only in medicine but in spirituality - that prayers could make a difference. But most of my other colleagues were smiling in disbelief, saying this was very odd that this got into a peer-reviewed journal.

Q: So you didn't believe the research. So what did you do?

A: I wouldn't say that I didn't believe it entirely. I talked with a few of my colleagues to bounce things off them to see if I was missing the boat. It did seem to be incomprehensible. It seemed to be impossible that this could be true. This wasn't prayer, necessarily. It could be a whole slew of potential logical explanations that could fit with natural laws. Mind over body. If you were holding the hand of the patient and praying for them, there are many things that could come into play that would not defy the laws of nature. But these patients in Korea were unaware they were being prayed for. They were even unaware they were in the study. So this means that prayers were traveling over the oceans and changing the fertility of these women. That seemed to break every law of nature we could think of. So we thought either there is something very wrong, like fraud, or there was some sort of mistake or this would clearly demonstrate a miracle. I was going along with perhaps there had been a mistake made.

Q: But then you started to lean toward the idea that something else was going on. What made you think that?

A: Just looking through the methodology, things jumped out. And I noticed right away that one of the authors. Daniel Wirth, wasn't a doctor or a PhD. He was a lawyer. I had never seen that before, a lawyer co-authoring a study in a major research journal. So I Google-searched his name and came up with all sorts of very bizarre things. Paranormal healing research. And therapeutic touch, which doesn't actually involve touch. It's about waving your hand above someone and altering their auras.

Q: Was this akin to faith healing?

A: Some of his studies were. I know there was at least one study where he talked about some sort of Christian faith-based surgery where someone used his mind to operate on people through God. All of his papers up until that time were in paranormal journals, not real medical journals.

Q: When did you start writing the Journal of Reproductive Medicine to ask why they published this study?

A: Within a few weeks of reading the article, I sent an email. I've written many letters to the editor before and always gotten a response. And when I published an article, I would sometimes get letters that had been written about it to the journal and forwarded to me. That's the way we do things in evidence-based medicine.

Q: What happened in this case?

A: I didn't get anything back. Then I sent another email, and then waited for a few days and got no response. Not even an acknowledgement that it had been received. So I wrote letters to Donna Kessel, and Dr. George Wied, the editor-in-chief, who has since died. And I didn't get responses to either of those letters.

Q: Why do you think they didn't respond?

A: I was shocked. It didn't seem to make any sense.

Q: At this point, no one was really questioning the study publicly, right? This was long before Rogerio Lobo backed away from the study.

A: RogerioLobo was on Good Morning America saying he was the lead author of the study. The New York Times covered it. Several other magazines wrote about it. It was only later that Lobo said he didn't hear about the research until six to 12 months after it was published. That's on the record. This was coming from the Columbia University Department of Medicine and Rogerio Lobo was professor and chairman of the OB/GYN department. That gave it credibility.

Q: Did you contact Lobo and the other researchers directly?

A: Eventually, I did. I sent the letters to the editor return receipt so I know that someone was getting them. But nobody ever responded. I tried to reach Daniel Wirth at a law firm in Pennsylvania, and that letter was returned. I sent letters and emails to Rogerio Lobo and Kwang Cha and those were never responded to.

Q: What were you saying in the letters?

A: I was asking if I could have access to data. I asked also specific questions about the methodology of the study. At that point my best hypothesis was that Daniel Wirth was an unusual man, and he had somehow led two professors into something that was kind of odd that perhaps they regretted.

Q: When you started to criticize the researchers, what sort of help and encouragement, if any, did you receive from fellow researchers?

A: It wasn't for a long time that I found out I wasn't the only one with questions. I had published a couple of articles in Scientific Review of Alternative Medicine. But it was when the Skeptical Inquirer article broke in October 2004 that people started finding out what I had been doing and contacting me. There were professors in Canada who sent me new information on Daniel Wirth. They said they had tried to contact him about another study and he threatened to sue them. So that was very intriguing. They sent me an article, called the "Missing Experimenter," with researchers saying that they had tried to track him down and tried to track down colleagues who had allegedly worked on his papers. They reached these people, and they said they had never worked on the papers. Then I got emails from Irwin Tessman at Purdue, an evolutionary biologist, and he had also been sending letters and never gotten a response.

Q: What was it about Wirth that was causing people to question his research?

A: There were a lot of things. Daniel Wirth produced a video where he did an experiment in a white lab coat and was identified as Dr. Wirth. It was a BBC production in the 1990s, and he was doing an experiment in therapeutic touch. The study subjects would come and put their arms through a hole in the wall. A doctor would cut a hole in their arm, and then a healer would run their hands around the wound without touching it and without the person being able to see them doing this. And here is Daniel Wirth with a clipboard taking notes. And he narrates it. It turns out he was no medical doctor or PhD. He has a degree in parapsychology, which is ghostbusting.

Q: You've said that all the researchers involved in the study have had, shall we say, issues that might cause one to question the veracity of their work. Which was the first researcher to have trouble after this prayer study came out?

A: In The New York Times, it was mentioned that the patients did not know that they were partaking in a study. And so that tipped off the NIH Office of Human Subjects Research, which mounted an investigation of Columbia. I had nothing to do with that. It turns out that Lobo was the first one to be sanctioned because he had conducted a study with no informed consent. That document is still online today.

Q: And then Daniel Wirth got caught stealing people's identities.

A: He pleaded guilty to felony fraud, just before the Skeptical Inquirer piece. I had heard that he had been arrested and indicted. I had some alerts set up in Google, and one day I got an email alert about a Daniel Wirth who had been arrested in Pennsylvania and charged with defrauding Adelphia. It said something about a Daniel Wirth who had been charged with practicing medicine without a license in California. It talked about Healing Sciences Research International, and if you look at the original paper there was something like that in there. That clicked that it was the same Daniel Wirth who had been involved in these medical studies, but I wanted to be 100 percent sure. He and his accomplice were using all these different pseudonyms, so that made it even more difficult to track down the right person. But it was eventually verified by the indictment.

Q: How did you get a hold of the indictment?

A: I contacted a newspaper in Pennsylvania that was running a series of stories likening this to that movie Catch Me If You Can. This seemed even more convoluted than the movie. Wirth and his accomplice were using passports for boys who had been dead for more than 20 years. Two people who were apparently Wirth's parents died, and he continued to collect their Social Security by using false names. He was apparently making a goodly amount of money that way. Then one of his colleagues got hired by Adelphia and hired Wirth for computer consulting. Initially, there were checks for a few thousand dollars and over time it got up into the millions of dollars. He set up phony bank accounts all over the place. I contacted that reporter and then had the indictment sent to me from a federal district attorney out there.

Q: When did Dr. Lobo start to back away from the paper, and did you have any role in that?

A: It was after the Skeptical Inquirer article and all the other articles started to break. He already admitted to the dean of Columbia Department of Medicine that he hadn't participated in the study. But nobody had heard about it. As far as everybody knew, Lobo was still the lead researcher. It was still his baby. It wasn't until the scandal broke in 2004 that he took his name off the paper. That was first reported by Benedict Carey in The New York Times.

Q: And what about Dr. Cha? He started to have problems after he went after that stem cell grant in California, or was there something before that?

A: At the time the Cha-Lobo-Wirth paper was written, Cha was the head of the Cha Columbia Infertility Center in New York City. It catered to the Korean population and had his picture on the Columbia Web site right next to Lobo's. Soon after the NIH investigation, Lobo was no longer the chairman of the department and the Cha Columbia Infertility Center disappeared.

Q: But Cha at this point had not come after you in any way?

A: He hadn't even communicated with me in any way.

Next week: How one tough-talking quote triggered a legal avalanche.