Indian doctors at the Government Medical College and Hospital, Chandigarh have their ‘Image in Clinical Medicine’ photo published in the New England Journal of Medicine (NEJM) retracted. It is not only a case of image plagiarism, but concoction of a medical case they never came across.

If by now researchers in India have become aware of how papers published even from reputed institutions and labs in India contain images that have been duplicated and/or manipulated, here is a something that is quite different, and shocking too.

It is not one of the problematic images in a paper which could have either been due to a honest mistake and which when replaced with another image would still not affect the main conclusion of the study. It is a single image that has been published in the New England Journal of Medicine (NEJM) under the much-followed section “Images in Clinical Medicine”. Here, doctors share clinically important images that were taken during the course of investigation of their patients. It is for this reason that this section is much eagerly followed by physicians.

The case of imaginary patient

On December 5, 2019, Dr. Jitender Jinagal and Dr. Poonam Dhiman from the Government Medical College and Hospital, Chandigarh published their image of a person who had suffered retinal bleeding when a tennis ball hit his eye with the title “Retinal Haemorrhage from Blunt Ocular Trauma”. Dr. Jinagal is an Assistant Professor at the Department of Ophthalmology, GMCH.

The doctor pair provided a short description of the case saying: “A 24-year-old man presented with pain, swelling, and decreased vision in his right eye after it had been struck by a tennis ball. Examination showed a retinal haemorrhage. Physical examination of the right eye showed a visual acuity of 20/400, with an intraocular pressure of 20 mm Hg (reference range, 10 to 21) and a sluggish pupillary response to light. The left eye appeared normal…”

Then they mention about what they observed during examination of the damaged eye: “On examination of the fundus, however, the foveal reflex was absent…”

And finally ended with surgical details and clinical features on a follow-up visit: “At the 8-week follow-up visit, the patient’s visual acuity in the right eye had improved to 20/30, and examination of the fundus showed resolution of the retinal haemorrhage and a normal foveal reflex.”

A fellow Indian calls the fraud

According to Retraction Watch which reported the case of retraction, a fellow Indian doctor Dr. Rajesh Rao of the Kellogg Eye Center at the University of Michigan immediately recognised the image as it was published by Dr. Mark Clark from the Wake Forest University Eye Center, North Carolina, U.S. It was published as a cover image of the journal Ophthalmology in December 2015 for a completely different eye problem altogether. Dr. Rao had even shared the image on his Instagram page.

On being altered by Dr. Rao, NEJM promptly retracted the image on December 23.

Dr. Rao describes the sequence in his tweet.

The retraction note has a letter written by Dr. Jinagal and Dhiman wherein they state: “We would like to retract the Image in Clinical Medicine entitled “Retinal Hemorrhage from Blunt Ocular Trauma,” which was published in the December 5, 2019, issue of the Journal. The image had been previously published elsewhere.”

There is also Editor’s note which is damning: “The clinical details associated with the retracted Image in Clinical Medicine do not reflect those of the originally published case.”

On December 24, a day after the image was retracted Dr. Rao took to Twitter to amplify the retraction status of the image. In one of the images shared on his tweet, he has attached the letter he had sent to NEJM where he concludes saying: “The case records provided by Jinagal and Dhiman, such as the cause of injury, details of the ocular examination, surgical management, and post-operative course are spurious.”

On December 30, I emailed Dr. Jinagal and asked for his comments and answers to a few questions. But I have not heard from him so far. Meanwhile, I came across another image of an eye problem published by Dr. Jinagal in Indian Journal of Ophthalmology. The ophthalmic image description is of Petaloid cataract.

Should one believe this physician who not only steals an image and publishes it in a reputed journal with a completely made-up case, surgery, and post-operative details to be honest with the Petaloid cataract case? This was one of the questions I had asked him in my email and I am yet to hear from him. I rest my case.