Health Care

Trial in medical research scandal at Duke postponed

Dr. Anil Potti, was a cancer researcher, at Duke University.
Dr. Anil Potti, was a cancer researcher, at Duke University. NYT

A judge in Durham County Superior Court has postponed the first civil trial against Duke University by the estate of a patient who had enrolled in one of a trio of clinical cancer studies that were based on bogus science.

The case is part of what the investigative TV news show “60 Minutes” said could go down in history as one of the biggest medical research frauds ever.

The trial had been scheduled to start Monday, but several attorneys involved contracted the flu. Judge Robert C. Ervin hasn’t settled on a new start date, but after a conference call with him Monday night, attorneys in the case said it could be as late as this fall.

The postponement delayed resolution in the long-running case for the two patients still alive among the eight who filed suit. It also prolonged a lengthy public relations headache for Duke Medicine that has included retraction of research papers in major scientific journals, the embarrassing segment on “60 Minutes” and the revelation that the lead scientist had falsely claimed to be a Rhodes Scholar in grant applications and credentials.

Because it’s not considered a class action, the eight cases may be tried individually. The one designated to come first was brought by Walter Jacobs, whose wife, Julie, had enrolled in an advanced-stage lung cancer study based on the bad research. She died in 2010.

“We regret that our trial couldn’t go forward on the scheduled date,” said Raleigh attorney Thomas Henson, who is representing Jacobs. “As our filed complaint shows, this case goes straight to the basic rights of human research subjects in clinical trials, and we look forward to having those issues at the forefront of the discussion when we are able to have our trial rescheduled.”

It all began in 2006 with research led by a young Duke researcher named Anil Potti. He claimed to have found genetic markers in tumors that could predict which cancer patients might respond well to what form of cancer therapy. The discovery, which one senior Duke administrator later said would have been a sort of Holy Grail of cancer research if it had been accurate, electrified other scientists in the field.

Then, starting in 2007, came the three clinical trials aimed at testing the approach. These enrolled more than 100 lung and breast cancer patients, mostly from the Triangle, and were eventually expected to enroll hundreds more.

Duke shut them down permanently in 2010 after finding serious problems with Potti’s science.

Now some of the patients – or their estates, since many have died from their illnesses – are suing Duke, Potti, his mentor and research collaborator Dr. Joseph Nevins, and various Duke administrators. The suit alleges, among other things, that they had engaged in a systematic plan to commercially develop cancer tests worth billions of dollars while using science that they knew or should have known to be fraudulent.

Whistleblower spoke up early

The latest revelation in the case, based on documents that emerged from the lawsuit and first reported in the Cancer Letter, a newsletter that covers cancer-research issues, is that a young researcher working with Potti had alerted university officials to problems with the research data two years before the experiments on the cancer patients were stopped.

The whistleblower, Brad Perez, is now finishing up a medical residency at Duke. Perez declined to be interviewed but responded by email that the issues with the research led him to quit working with Potti, though that cost him an extra year in medical school.

“In the course of my work in the Potti lab, I discovered what I perceived to be problems in the predictor models that made it difficult for me to continue working in that environment,” he wrote. “I raised my concerns with my laboratory peers, laboratory supervisors and medical school administrators. I chose to take an additional year to complete medical school in order to have a more successful research experience.”

In an emailed statement in response to questions about the case, Michael Schoenfeld, Duke’s vice president for public affairs and government relations, said Perez had passed his concerns about the lab through proper channels at Duke and that the resulting review didn’t find research misconduct.

Since then, though, Perez’s concerns have been fully appreciated and recognized, Schoenfeld wrote.

“We can say with great confidence that any concerns like this received today would be handled very differently,” Schoenfeld wrote. “Despite his experience in Dr. Potti’s lab, we’re pleased that Dr. Perez elected to complete his medical education and research training at Duke, and is currently completing his residency in radiation oncology at Duke.”

Through his Raleigh attorney, Dan McLamb, Potti declined an interview, citing the pending court action. Potti now works at another cancer clinic, in Grand Forks, N.D.

Trials suspended, then restarted

Potti, Nevins and various collaborators published studies in major research journals based on Potti’s findings beginning in 2006. But researchers elsewhere couldn’t reproduce their results and quickly began to raise questions. In particular, Keith Baggerly and Kevin Coombes, biostatisticians at MD Anderson Cancer Center in Houston, brought problems they found to the attention Duke officials and began questioning the research publicly.

In 2009 Duke suspended the enrollment of new patients and commissioned an outside review. But the reviewers reported that Potti’s work seemed fine, and Duke rebooted the trials. University leaders later said those reviewers hadn’t looked at the basic data had Potti used.

Only after the Cancer Letter, which has followed the case closely for years, published a report in 2010 saying that Potti had falsely claimed a Rhodes Scholarship in grant applications and elsewhere did Duke’s official support for the research finally began to crumble. It again suspended new enrollments and ended the studies.

Outside scientists who raised questions about the research said they were most worried about the prospect that patients were being put at risk by their participation in the clinical trials. They said the unproven genetic analysis could result in patients being prescribed an improper treatment.

Duke has maintained, though, that the patients received proper care.

“The criticism in the lawsuit is not related to the high quality of care this patient received,” Schoenfeld wrote in his statement. “While the science behind the genomic predictor used in the trials was ultimately found to involve falsified data, a key factor in the approval of the trial protocols provided that every patients would receive standard of care therapy for their disease whether or not the predictor ultimately proved to be useful.”

Regardless of which treatment patients in the clinical trials received, it was considered a best one for treating their disease, he wrote.

The lawsuit charges, among other things, that in grant applications for the clinical trials that Potti intentionally lied and included false and fraudulent information about the research results. Nevins, as his research supervisor, and Duke should have known what was wrong, the lawsuit says, because Baggerly, Coombes and others had made numerous attempts to call attention to flaws in the science.

The suit also charges that the clinical trials began after Duke had been “placed on notice” of the flawed underlying science and suggests that the relationships among researchers and administrators were too cozy within the university for it to properly pursue questions about the research.

Duke has made substantive changes to prevent the problems brought to light in the Potti case from recurring, Schoenfeld said. These include better data management, new reviews of potential conflict of interest and improvements in handling reports related to the integrity of research.

“Many lessons learned from this situation have led to significant improvements in both basic and clinical research processes including many new and expanded programs related to scientific accountability, reporting of concerns related to research integrity, multiple improvements in data management and governance, and new scientific and conflict of interest review processes,” he wrote.

Journal articles retracted

Duke put Potti on administrative leave in July 2010 after the charges about his credentials emerged. The next month, Duke announced that he had indeed padded his résumé. Potti resigned six months later, and Nevins began the process of retracting the journal articles. Nevins retired from Duke in 2013.

In 2012, Potti accepted a reprimand from the N.C. Medical Board. He remains licensed to practice here and in a few other states. According to records posted online by the N.C. Medical Board, Potti had agreed to settlements in at least 11 malpractice cases against him, each resulting in a payment of at least $75,000.

In a consent order negotiated with the medical board, Potti agreed to accept a formal reprimand for unprofessional conduct and admitted to having inaccurate information on his résumé and in official Duke biographical sketches and to using those flawed credentials in research grant applications.

After leaving Duke, Potti worked awhile in a clinical role rather than in research at a cancer clinic in South Carolina. He was fired from that job after the “60 Minutes” segment aired, though the company he had worked for there, Coastal Cancer Center, said in a news release that his work had been exemplary.

The news release also said that the company had hired him after it received glowing letters of recommendation from top medical officials at Duke.

While the trial may be delayed for months, the judge still is expected to hear motions in the case Thursday.

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