Q&A with Dr. Bruce Flamm: Promoting sketchy science harms medicine and faith

Most reporters never have the misfortune of being sued for libel. If they are, there are broad free speech protections in court precedent, especially in California, that make it unlikely a plaintiff will win, unless a reporter has been truly reckless.

Dr. Bruce Flamm isn't a reporter by training. He's an obstetrics and gynecology specialist in Riverside. He is the one writer in the country, though, who has thoroughly watchdogged the South Korean prayer study that appeared in the Journal of Reproductive Medicine in 2001. Flamm's pursuit of that story and of the authors of the study resulted in his being sued for libel. When he thought he had won, he was dragged back into Superior Court a second time. When he thought he had won then, the case was brought to the California Court of Appeals. With a decision in October in Flamm's favor, the case appears to have been decided.

I wrote about the study on Monday. I posted the first part of my interview with Flamm last week. The second part is below. It has been edited for space and clarity.

Q: You said that you had tried repeatedly to reach the authors after the study was published in 2001. When did you first hear from any of them?

A: Rogerio Lobo never returned any of my calls. Kwang Cha left Columbia University, and then I started calling his fertility center in Los Angeles. Generally, I was told he would call back, but he never did. One day I was put through to a doctor at the clinic. He said that Dr. Cha had been getting my letters and he planned to get back to me soon but he was in Korea. Of course, he never got back to me. The first time I heard from him was when the Journal of Reproductive Medicine finally published one of my letters. I had written like 30 letters to the journal. By 2004, newspapers were questioning why the journal had published this unusual paper, but the journal editors weren't even commenting. At that point, the journal decided to publish a letter from me, along with a letter from Kwang Cha, in which he took the amazing step of defending the paper. He said there was no reason to believe that Daniel Wirth wasn't doing legitimate research just because there were other issues, which, I would add, included the fact that he was going to federal prison for fraud. That was the only communication I ever had from him before the lawsuit.

Q: Up until the point that letter was published, you thought that maybe he had been duped?

A: My honest belief was that Daniel Wirth was a good con man who had bamboozled both Lobo and Cha. And so I expected that both Lobo and Cha, if they were going to write to the journal, would write a letter to the editor saying, "Mea culpa. We all make mistakes." But instead Cha defended the results. My wife's theory is one word: pride.

Q: Why were you sued?

A: It was over only one piece I had written. It was in Ob. Gyn. News, entitled "Three Strikes." It detailed what had happened to Daniel Wirth and his fraud case. Then I discussed Lobo and the idea of deception. Then I discussed that Cha had been accused of plagiarism over a paper that had nothing to do with prayer, and I quoted Dr. Alan DeCherney who said, "It's plagiarism. I'm sure of it." He said it in the Los Angeles Times and in The Scientist. I said this may be the first time in history where all three authors of a scientific journal article have been convicted of fraud, deception or plagiarism. The plagiarism part was aimed at Cha. By using the word convicted and by using him in the same sentence, his lawyers said that I was saying he had been convicted by a jury of plagiarism. The minor point is that plagiarism is not a crime, so you can't be convicted by a jury. So my understanding is that the only person who can make that determination is a journal editor. If the editor-in-chief of a journal says it's plagiarism, that pretty much seals the deal.

Q: Do you regret writing that?

A: In hindsight, I wish I had phrased the last sentence differently. How could you write that sentence?

Q: How about, "This might be the first time that all three writers of a scientific journal article have faced serious allegations of fraud, deception or plagiarism."

A: That would have been reasonable but not as powerful. It's really just a semantic question.

Q: When you were sued, how did the scientific community respond?

A: I got a lot of support. They thought that this was obviously aimed at shutting me up. That's not the way science works. We're supposed to be able to criticize each other and write letters to the editor. If you read the letters to the editor, they can get pretty heated, but you don't respond by suing somebody. My comment about Cha on the plagiarism issue was a speck compared that what I had said about the prayer study. My understanding was that he was looking for something to pounce on, and by using that word, he felt he had a legal reason to go after me.

Q: How did you pay to fight the case?

A: Initially out of my pocket. I ended up receiving assistance from colleagues. The first go around alone, not the appeal, cost more than $50,000 in defense fees. Cha's fees, I speculate, were much higher because he hired a very ritzy Beverly Hills law firm that deals with movie stars and sports stars, Glassman, Browning, Saltsman and Jacobs. Anthony Glassman himself handled the case.

Q: To play Cha's advocate for a minute, he ostensibly knew you had been writing for years about him and his study, and he never made a peep about you. Why assume that he cared that much and that he was trying to shut you down? By all accounts, he is a very busy man.

A: I don't think he could make a peep. It's horrendous to say someone's colleague in a research study has just been convicted of fraud. But that was an indisputable fact. How do you sue someone for that? Perhaps reviewing what I had written with his attorneys they couldn't find anything that was actionable. But then, in this one small paper in an ob/gyn journal, they found something that was actionable. I thought you were going to ask about why I used "convicted" instead of saying "charged." If Cha had just called me and said, "Bruce, you made a mistake here. I haven't been convicted of anything," I would have immediately had an article published apologizing and explaining his point of view. But I was not contacted and asked to make a correction. I was just served with a lawsuit.

Q: Have you ever had to write a correction in the past?

A: There are times where I've seen someone else's point of view and sent a conciliatory letter. If he had contacted me and stated the facts and pointed out that the charge of plagiarism had even been dropped to duplicate publication, because the journal article in question had been published in Korean first in one journal and then English in a second journal, I would have insisted that Ob. Gyn. News publish an erratum, and I know they would have done that.

Q: What did your legal victory turn on, ultimately?

A: In a libel suit, the first thing is you have to have said something that was not factual. The absolute defense is what you said was the truth. And then there are many other things having to do with whether the person is a public figure, which he is. In the original Superior Court case, the judge felt that it was a frivolous lawsuit, that Cha would not have prevailed in a jury trial and that it was an attempt to silence me, which it did for a long, long time.

Q: And in the case of the appeal?

A: Glassman and the Beverly Hills attorneys came in with what they claimed was astounding new evidence, and so the judge reinstituted the Superior Court case. The new evidence was a DVD of me giving a lecture where I was talking about Daniel Wirth. The judge reviewed the evidence, and he threw the case out a second time. Then, within a few weeks of that, they filed the appeal. The appellate court decision was 2-1.

Q: Is this case gone for good now?

A: My understanding is that there are two ways it could come back. Cha could appeal to the appeals court, the way he did to the Superior Court. Or he could go to the California Supreme Court. This was an unpublished opinion and, according to my attorneys, the Supreme Court of the state rarely looks at unpublished opinions. You never know.

Q: Throughout all these years, has there been another prayer study that has bolstered the case that was being made in that study?

A: There were two big studies that came after this one. The STEP study and the MANTRA study. Both were huge, multi-center studies funded by millions of dollars and looking at thousands of people. They were looking at prayer in healing, not necessarily infertility. Both of them concluded that prayer had no effect on medical outcomes.

Q: Do you still see the Cha-Wirth-Lobo study cited by advocates of faith healing?

A: It has been cited for many years. You can still go to PubMed and find the abstract online. There have been many small prayer studies over the years. Usually they found a 1% or 2% improvement. The amazing thing about the Cha-Wirth-Lobo study was the 100% improvement they found.

Q: Were there any reporters who you think did a good job early on pushing back on the validity of this study?

A: I don't think it really caused much skepticism or criticism. I would think if I were a journalist working at The New York Times, I would call other experts and see what they think. But I didn't see any of that.

Q: Isn't this really a collective failure? The editors who accepted the paper? The editors who peer-reviewed the paper? The journalists who covered its publication?

A: You just hit the nail on the head. I have tried to explain this to every lawyer. If you could search my heart right now, you would find that I have nothing against Kwang Cha or Rogerio Lobo or Daniel Wirth. I have been, from the get-go, trying to fix the system. The peer review system broke down at the Journal of Reproductive Medicine and at Columbia. Then the journalists who covered it showed no good sense. If the journal had retracted this paper at any point, I would have just backed away from it. But the paper is still there.

Q: What do you say to people who do have a religious faith and do believe in the power of prayer?

A: I take the Pope's approach when it comes to scientific matters like evolution. The Catholic Church has said, "We're going to teach evolutionary biology because it's sound science. It may take us down a path that will question some of our core beliefs, but the faith might actually be made stronger as a result." For some religious leaders, it harms their own cause to say that the devil planted all the dinosaur bones and that carbon dating is phony and that the earth is not as old as scientists say. You should be courageous in your faith and follow the questions where they lead you. That's what I've tried to do here because I think this study actually harms medical science.