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In Response

Shafer, Steven L., MD

doi: 10.1213/ANE.0b013e31821d1231
Letters to the Editor: Letters & Announcements
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Editor-in-Chief, Anesthesia & Analgesia Department of Anesthesiology Columbia University 630 West 168th St. P&S Box 46 New York, NY 10032 sshafer@columbia.edu (Shafer)

I appreciate Drs. Gravenstein and Rice1 bringing attention to the apparent paradox of the Journal having published a systematic review of the safety of hydroxyethyl starch solutions by Hartog and colleagues2 with references to the work of Joachim Boldt alongside my editorial noting that Boldt's work was under a “Shadow of Doubt.”3 The juxtaposition was intentional.

Hartog et al. concluded that “fifty-six RCTs [randomized controlled trials] were identified on fluid resuscitation with HES 130/0.4. Without exception, they were designed too poorly to allow conclusions about the safety of this compound.” This is an unambiguous conclusion – there is no shadow of doubt. Had Boldt's studies been removed from Hartog's analysis, the review would be open to the criticism that the Boldt studies supporting the safety of HES 130/0.4 were inappropriately censored from the analysis, leading to a biased conclusion.

Hartog's review was accepted for publication on November 30, 2010, several days after I wrote the retraction notice for Boldt's 2009 paper.4 That paper should not have been cited, since the retraction was imminent. I simply missed it.

Fraudulent research leaves us all confused. The confusion is compounded by the ongoing investigations and the shadow cast on the remaining body of Boldt's work. Clinicians make decisions in real time based on available data. My goal is to provide our readers with all available information about findings of fraud, so they can make the most informed decisions possible.

Steven L. Shafer, MD

Editor-in-Chief, Anesthesia & Analgesia

Department of Anesthesiology

Columbia University

630 West 168th St.

P&S Box 46

New York, NY 10032

sshafer@columbia.edu (Shafer)

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REFERENCES

1. Gravenstein N, Rice MJ. A bit confused. Anesth Analg 2011; 112: 1509
2. Hartog CS, Kohl M, Reinhart K. A Systematic Review of Third-Generation Hydroxyethyl Starch (HES 130/0.4) in Resuscitation: Safety Not Adequately Addressed. Anesth Analg 2011; 112: 635–45
3. Shafer SL. Shadow of doubt. Anesth Analg 2011; 112: 498–500
4. Shafer SL. Notice of retraction. Anesth Analg 2010; 111: 1567
© 2011 International Anesthesia Research Society