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Sunday, 30 September 2018

Egregious - the Richard M. Fleming Story

An RCT paper claiming to show harmful effects of a low-carb diet passed briefly over the internet on the weekend before being shot down in flames.
The title is:

Long‐term health effects of the three major diets under self‐management with advice, yields high adherence and equal weight loss, but very different long‐term cardiovascular health effects as measured by myocardial perfusion imaging and specific markers of inflammatory coronary artery disease.
The paper is published in Clinical Cardiology [edit: not Preventive Cardiology], and is free to access.
https://onlinelibrary.wiley.com/doi/abs/10.1002/clc.23047

[update: the paper above has since been retracted. Its Pubpeer discussion is here
https://pubpeer.com/publications/AA81ABA153565C2A238B191DFE0FB6 ]
[Update: the paper has been quickly republished here, in what may well be a predatory journal https://biomedres.us/pdfs/BJSTR.MS.ID.002006.pdf
Retraction Watch story here: https://retractionwatch.com/2018/11/13/a-convicted-felon-writes-a-paper-on-hotly-debated-diets-what-could-go-wrong/ ]

Three of the authors work at Fleming's medical imaging company in California, one is a deceased psychologist from Iowa, another is a pediatric nutritionist from New York and one is a Kellogg's employee from Illinois.
How this group was able to run a 12-month diet trial in 120 subjects is something of a mystery.

The conclusions:

One‐year body mass changes did not differ by diet (P .999). Effect sizes (R, R2) were statistically significant for all indices. Coronary blood flow, R (CI 95%) = .48 to .69, improved with low‐to‐moderate‐fat and declined with lowered carbohydrate diets. Inflammatory factor Interleukin‐6 (R = .51 to .71) increased with lowered carbohydrate and decreased with low‐to‐moderate‐fat diets.
Conclusions
One‐year lowered‐carbohydrate diet significantly increases cardiovascular risks, while a low‐to‐moderate‐fat diet significantly reduces cardiovascular risk factors. Vegan diets were intermediate.

First I'll consider all the good reasons to reject this study, but after that I'll do something we should always do, even for the worst study - take it at face value.

1) Lead author Dr Richard M. Fleming is a self-confessed and convicted felony fraudster who has admitted falsifying data in another RCT.

Fleming admitted to knowingly executing and attempting to execute a scheme to defraud Medicare and Medicaid healthcare benefit programs in connection with the delivery of and payment for healthcare benefits, items, and services, namely by submitting payment claims for tomographic myocardial perfusion imaging studies that he did not actually perform. Fleming also pled guilty to one count of felony mail fraud in violation of 18 U.S.C. 1341 and 2 for conduct relating to money paid him to conduct a clinical study of a soy chip food product for the purpose of evaluating health benefits. As Fleming admitted during his guilty plea, he received approximately $35,000 for conducting a clinical trial, but he fabricated data for certain subjects.
https://www.federalregister.gov/documents/2018/09/28/2018-21210/richard-m-fleming-denial-of-hearing-final-debarment-order

2) Fleming obtained Robert Atkins' medical records by deception and shared them with Neal Barnard of the vegan activist group PCRM in 2004, another unethical behaviour and one demonstrating that Fleming has a long-standing animus against Atkins and his diet.

https://theskepticalcardiologist.com/2016/12/18/what-does-the-death-of-robert-atkins-tell-us-about-the-atkins-diet/

Now, vegans can do research into this exact question with a high standard of rigour, see Chris Gardner's studies - one can certainly dispute the interpretation of some results, but not the results themselves. And I have reviewed a vegan diet study favourably here (dealing with another Fleming paper in passing) - good results are good results; I don't doubt these diets can have also cardiovascular benefits over the short-to-medium term, but question their long-term effects on mental health, reproductive health, dental health, joint health etc.

3) The trial protocol number on the paper links to a study that was completed in 2002. This explains how a convicted felony fraudster was able to conduct a study. The protocol was posted in 2006, 4 years after the study concluded, which seems unusual on the Clinical Trials website.


https://clinicaltrials.gov/ct2/show/NCT00324545

4) The study has 35 citations - 15 of these are to Fleming's own papers. This self-spamming, which helps boost an author's citation rate, is frowned upon by reputable journals. One of these references has the word "quantum" in the title. Other references are to news articles and book chapters. The low carbohydrate diet references are more than 15 years old. Ref 16 is curious as an anonymous reviewer is given credit for the wording of a paragraph of interpretation, surely a run-of-the-mill interaction with a reviewer.

5) The novel aspect of this paper may lie in the reference to that novel vegan touchstone, Neu5Gc. Pro-tip - if the vegan diet had a magic mechanism, you ought to know it already; some major low-carb mechanisms have been understood for generations. At this rate, if there is a magic mechanism for vegan health benefit, it will be discovered by a low-carb scientist.

We  now  know  that  these  food  choices  and  their  impact  are  at  least partially precipitated by the inflammatory effect of our diets based given our inability to convert Neu5Ac to Neu5Gc and our bodies immune response to the Neu5Gc present in animal protein. 

At this point, let's take the study at face value. the vegan diet avoided animal protein and Neu5Gc, the low carb diet probably included twice as much protein as the other diets (based on reference 6), but the low fat diet included more animal protein and Neu5Gc than the vegan diet.

One‐year lowered‐carbohydrate diet significantly increases cardiovascular risks, while a low‐to‐moderate‐fat diet significantly reduces cardiovascular risk factors. Vegan diets were intermediate.

So Fleming's own study, taken at face value, doesn't support the Neu5Gc hypothesis. In fact, it's unusual for the vegan diet to be inferior to the low-fat diet in any vegan study, and it's unusual for the low carb diet to be inferior to the low-fat diet in any low-carb study.

6) adherence to diets over 12 months was 100%. Of course, this is unheard of and entirely implausible; if honestly reported, it seems to show considerable gullibility or self-deception in the study team.


 That 100% of participants continued on their respective diet plans through a full year of dieting contrasts  sharply  with  much  of  diet  research  experience  with  drop outs  and  with  common experience with difficulties of dieting and remaining on diets. This success can be attributed to attention to well-established psychological principles of habit acquisition and extinction and of behaviour modification through Bandura [17] counseling.

Bandura's ethos seems sensible enough and appropriate for such a project, except perhaps when the people using it for counselling already believe that one approach is preferable to another.

7) the original report of the 2002 study (ref 6), if it is the same study, reports diet groups differently.





8) Implausible randomisation was the red flag that saw the PREDIMED study and many others retracted. Here randomisation of n=120 into 6 groups produced this result:


The  58  female  and  62  male  participants  were  randomly  assigned  to  equal  dietary  groups  by casting  a  die.  There  were  no  statistical  demographic  differences  between  group  assignments. There  were  no  statistically  significant  differences,  or  even  trends,  between  diet  groups  at  the initiation of the study. Since the groups were unequivocally randomized for all fifteen-baseline indices, statistical inference to the initial population, described by Table 1, is appropriate. 


9) Fleming et al state "A  four-month  post-intervention  analysis was obtained to determine post-intervention treatment, which has not previously been reported in the literature."

Post intervention status was in fact reported at 4 years by the Shai et al DIRECT study group.



10) the sponsor is listed as the Camelot Foundation. A search turned up this mention - Dr Fleming is the editor of a predatory journal, and the Camelot Foundation has little other existence online, it seems to be a 501(c)(3) legal tax-avoidance scheme within Fleming's own business.
https://www.omicsonline.org/editor-profile/richard-maximus-fleming/

11) Cardiovascular improvement by Fleming's medical imaging method correlates with improvement in the TG/HDL ratio. Taken at face value, although TG/HDL doesn't improve in Fleming's "low carb" arm, it does in most of the people reading this who have tried a low carb approach, so if Fleming's diagnostics are accurate this is not bad news. Interleukin 6 also improves during fasting but not a ketogenic diet in a 6-day study, but improves in a low carb diet vs a low fat diet in a 6 month study here (as there was at least one previous study in the literature that came to different conclusions from Fleming et al with regard to an outcome they highlighted, this should really have been cited).





Both LFD and LCD led to similar reductions in body weight, while beneficial effects on glycaemic control were observed in the LCD group only. After 6 months, the levels of IL-1Ra and IL-6 were significantly lower in the LCD group than in the LFD group, 978 (664–1385) versus 1216 (974–1822) pg/mL and 2.15 (1.65–4.27) versus 3.39 (2.25–4.79) pg/mL, both P < 0.05.

Taken at face value, Fleming's possibly fraudulent paper predicts cardiovascular benefit from a low carb diet if people get different results from the ones he claims to have produced, which is usually the case in other studies and in real life...


The question is, how did this paper pass peer review with all the red flags above? [edit]



Credit to @MacroFour and Ivor Cummins @FatEmperor for the links regarding Dr Fleming's colourful past.


72 comments:

George Henderson said...

Curiouser and Curiouser - Dr Fleming studied anti-matter for one year, and seems to have acted the part of James Woods acting the part of Max in Sergio Leone's Once Upon a Time in America.
https://www.imdb.com/name/nm6222842/

valerie said...

The abstract also has this gem:
"One‐year body mass changes did not differ by diet (P>.999)."

How can you possibly get P >.999?
Are we supposed to believe that all three groups had precisely the same weight loss after one year?

George Henderson said...

Wow.

I also call this implausible - the best TG/HDL ratio he reports is 2.4.
At this ratio, not great for this kind of study, small dense LDL will predominate, it's less likely that conditions for regression of CAD are present.

Bruce Wilson said...

How did the paper pass peer review? Perhaps Fleming owns the journal.

On a more serious note, you should be careful before accusing somone of fraud.

George Henderson said...

Hi Bruce,

thanks, but the FBI have provided the claim, and I am not accusing this paper of being fraudulent but of being poorly presented and reviewed, so that 1) the methods are not clear, 2) the citations are all over the place rather than addressing the unusual findings, and thus does not explain how another researcher would need to proceed to replicate the results.
The metabolic results are more explicable if the low carb arms were not particularly adherent, but are inexplicable in terms of the literature if adherence was 100% as stated and this was any normal low carb diet advice.
The date of the study, description of location and some other methods should have been supplied. Dr Fleming has contacted me but not contradicted any claim, only stressed the value of his work and the difficulty of running and publishing a private trial in general, as well as the hostile attitude of the soy industry, FDA, AHA etc (he didn't mention the FBI). I can sympathise with this - I'd just like to understand what we're seeing better, I just can't have 100% confidence in 100% adherence and convergence in a randomised trial without knowing a lot more. Dr Fleming also tells me that word and reference count explain some omissions, again I sympathise and know what he means, but I ask you, does it look like these were used wisely?
Reviewers...

Unknown said...

Is the method of measuring cardiovascular risk (perfusion imaging) a validated method of predicting cardiovascular risk? Or is it another well intentioned surrogate? He sounds like an interesting chap bet his talks are well presented.

George Henderson said...

One of his points is that it avoids dangerous imaging radiation. A criticism I've seen of it is, that it's not measuring CVD - no-one in this study was diagnosed with it, for example - but flow-mediated dilation, which is a situational adjustment of blood vessels. FMD is reduced in atherosclerosis, but can be limited without athero being present, and the higher nitrate content of various diets, different electrolytes, etc. could be enough to explain the differences.
I do think it likely that Fleming has good ideas about the causes of inflammation, at least in the context of the usual diet (e.g. I had an inflammatory reaction to beef, but not lamb, before I went keto, but have no such reaction to it now). I am willing to believe that this knowledge indeed benefits his patients. But wishful thinking in the way some things are being reported cannot be ruled out - no-one else has reported metabolic results anything like this from a low-carb diet, especially one with weight loss, and what that diet actually was like is going begging.

Unknown said...

Thanks for the response George. Love your work on here and on twitter. As someone with high cholesterol (LMHR) getting an idea of the total picture of health rather than one lipid metric has helped. I did consider getting a CAC but I don't fit the criteria really (too young), been trying to find other total health metrics to make sure I'm not going down a wrong path, which is why I was asking about that test.

keep at it.
John (UK)

Regret said...

Out of curiosity, are you able to find information on "The Camelot Foundation?" The limited online information that I can locate appears to show the organization went dormant sometime in the early 2000s, but I may be looking in the wrong places.

Dr. Richard M. Fleming said...
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Regret said...

With all due respect, I have no interest in your beliefs or "research" findings regarding diets.

I did ask a question about "The Camelot Foundation" which remains unanswered, but the lack of a response and the relative lack of publicly available information on this entity suggest that it may have been created to give the appearance of reputability in the studies that you have published (in, as is suggested in this post, in some less reputable journals). If true, this creates doubt in my mind about the credibility of the research conclusions. If you would like to erase this doubt in readers' minds, you may wish to provide further details on the Foundation. A Google search turns up a Guidestar page noting that the IRS has revoked the tax-exempt status of a foundation with this name.

Also, as you have a law degree, you must know that your argument that "I never said I committed any crimes," seems nonsensical as a matter of law, when you plead guilty. If you believe you are being defamed by people noting that you plead guilty for a crime, you can go ahead and sue, but I'd suggest hiring a lawyer this time rather than representing yourself.

Dr. Richard M. Fleming said...
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George Henderson said...

Quite simply, Dr Fleming, we are unhappy that you do not describe the low carb diets you use.
If there is an unhealthy keto or LCHF, we would like to know what amounts of what foods it contains so that we can avoid such a diet. After all, we know that other LCHF or keto diets used in trials have not had the same detrimental cardiometabolic effects; we just want to avoid yours. The references you give for diet data refer to different experiments, the macronutrients are missing, and so on.
A secondary consideration is the lack of discussion. That weight loss did not improve cardiometabolic health on the putative low carb diet in this latest paper is a unique finding - even if we assume low carb is harmful, weight loss should still not produce these effects. The reviewer you cited knew that.
A third consideration is the lack of description of the circumstances of the trial. Where were the subjects seen, over what time period, how often, and so on. This lack of detail makes it hard to visualise proceedings taking place under rigorous supervision. It also prevents us explaining satisfactorily the trial registration dates.

Regret said...

Google: ‘Richard Fleming felon’ and the first hit is the FDA debarment order including,

“Fleming submitted multiple documents in support of his arguments that his guilty plea “does not state a crime” and that he is “actually innocent.” However, section 306(l) of the FD&C Act defines conviction as when a Federal or State court's judgment of conviction or when a Federal or State court's acceptance of a guilty plea. In Fleming's “Petition to Enter a Plea of Guilty,” he stated that he understood the charges against him and that he was voluntarily entering his guilty plea. The court entered a judgment of conviction after accepting Fleming's guilty plea. Federal court is the proper venue for any challenge to Fleming's guilty plea based on a claim of actual innocence, not this remedial proceeding. OSI carefully reviewed Fleming's submission in its entirety, and Fleming does not dispute that the court entered a judgment of conviction or that the court accepted his guilty plea; therefore, Fleming's arguments regarding his actual innocence fail to raise a genuine and substantial issue of fact warranting a hearing”

Dr. Fleming, your repeated protestations of your innocence have already been dismissed by the FDA as bogus, as you plead guilty to multiple felonies.

On the Camelot Foundation issue: Since you have admitted that foundation is not currently active (you appear to have set up shop in California or Nevada after your medical licenses were revoked in the Midwest?), can you give us a date that the Foundation ceased operations? In the FBI press release discussing your conviction, it appears that you moved to Nevada no later than 2009. Was the Foundation operating after that date? The last date I see for the foundation’s 990 IRS return is 2002. However, your LinkedIn profile claims it is still active and a recent paper authored by you lists your affiliation as The Camelot Foundation, with a Yahoo email address.

Medical Director
The Camelot Foundation
February 1999 – Present 20 years
Studio City, CA
A 501(c)(3) designated to investigate heart disease and breast cancer with emphasis on women's health issues.

(So much confuseds my head hurts)

Dr. Richard M. Fleming said...
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Dr. Richard M. Fleming said...
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Regret said...

Dr. Fleming - Discussions of health issues in a forum such as this are valuable as they permit people to discuss subjects of concern to professionals as well as the public-at-large. In my opinion as a lay person, your lack of candor and attempted misdirection are fooling no one.

As an example of your lack of candor: the fact that you will not be forthcoming about the details of "The Camelot Foundation" suggests that you CANNOT provide any evidence to refute the possibility that this is a fictitious* entity that you use to fluff up your credibility and credentials. In fact, your 2018 Clinical Cardiology paper was withdrawn "due to concerns with data integrity and an undisclosed conflict of interest by the lead author." Retraction notice from the journal available here: https://onlinelibrary.wiley.com/doi/abs/10.1002/clc.23047 Maybe the journal too was unable to confirm the existence of any such foundation?

What explanation can you provide that explains why you are still claiming affiliation and funding from an entity that apparently no longer exists, and hasn't existed since ~2010? I can't think of an innocuous answer, and the fact that you would prefer to question my motives rather than answer the question speaks to your personal integrity as well as the integrity and quality of your research.

As a research scientist and attorney you must understand that hard evidence counts more than opinions or motives. Shouldn't the scientific community, and the public at large, view the possible use of fictitious affiliations and failure to disclose funding sources as signs of possible research misconduct on the part of a researcher? Wouldn't a researcher who is concerned about "setting the record straight" provide clear, concise and responsive answers to questions? Doesn't the public have a right to be sure the health conclusions rendered by research scientists is free from bias or fraud?

I suspect that you will either: a) not reply or b) obfuscate further. In my mind, either of those reactions totally validates the skepticism about your "research" findings expressed on this blog and elsewhere.


*fictitious, in that it no longer exists and has not since its 501(c)3 status was revoked on or around May 2010; for reference see https://apps.irs.gov/app/eos/displayAll.do?dispatchMethod=displayAllInfo&Id=349351&ein=470831590&country=US&deductibility=all&dispatchMethod=searchAll&isDescending=false&city=&ein1=&postDateFrom=&exemptTypeCode=al&submitName=Search&sortColumn=orgName&totalResults=1&names=The+Camelot+Foundation&resultsPerPage=25&indexOfFirstRow=0&postDateTo=&state=All+States

P.S. My use of a commenting "handle" is not to hide my identity, but is an attempt to separate my professional and personal Internet profiles

Dr. Richard M. Fleming said...
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Regret said...

Well, I appreciate the schooling you are providing. To wit, while your 3 responses did not completely confirm my suspicions (which were that you would, a) not reply or b) obfuscate further), I neglected to include an alternative: c) further ad hominem attacks, to which you have resorted before. So yes, I am learning from you.

Your replies did provide a sliver of a response in that you have confirmed that The Camelot Foundation is not a currently active entity. Whatever you mean by "retaining the rights to the name," you did not specify the year in which the foundation ceased operations, which was one of my questions.

Assuming that the IRS website has the right end date (and you can certainly still correct the record by answering my question directly), the foundation was dead as of 2010 and perhaps earlier. Although more than 8 years have passed, you are still claiming an affiliation with The Camelot Foundation in your publications and online. See https://www.oatext.com/pdf/IMM-4-313.pdf for one example of an article you submitted in 2017 and see your current LinkedIn profile. Your replies did not clear up why you still are claiming a current affiliation with a long defunct foundation, which suggests you are using it to dishonestly inflate your reputation.

The reason this is important: in my online perusal of the topic, the discovery of misrepresentations on a researchers resume have lead to discovery of research misconduct. How can we know if that is the situation here if you will not answer simple questions directly?

Q: When did The Camelot Foundation cease operations?
Q: Why have you continued citing an affiliation with the foundation (in publications and in your online CV) after it ceased operations?

Dr. Richard M. Fleming said...
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Regret said...

Thank you for answering my questions. I now understand that on your CV and research papers you are claiming a research affiliation with an organization that only exists in your head.

Maybe to avoid future confusion, you could update your CV and research affiliation to remove references to you as a "Medical Director" at an organization that only exists in your mind, a Federal tax exempt status that isn't accurate, and is operating in a state that never registered such a foundation. Otherwise, people might get the wrong idea:

Medical Director
The Camelot Foundation
February 1999 – Present 20 years
Studio City, CA
A 501(c)(3) designated to investigate heart disease and breast cancer with emphasis on women's health issues.

Dr. Richard M. Fleming said...
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Regret said...

Dr. Fleming: I think we’ve covered The Camelot Foundation enough and I appreciate you answering my questions. I’d like to move along to the Fleming Heart and Health Institute, which is also an organization with which you claim a current association.

As the FDA noted (https://www.federalregister.gov/documents/2018/09/28/2018-21210/richard-m-fleming-denial-of-hearing-final-debarment-order): “Fleming [is], the president of, and sole physician at, Fleming Heart and Health Institute, P.C. (FHHI).” This organization was previously registered with the State of Nebraska and you (Dr. Fleming) were the sole officer listed. The state site shows the registration for this entity expired in May of 2004 for non-payment of taxes. In their 2010 article about your sentencing, https://journalstar.com/news/state-and-regional/nebraska/former-omaha-doctor-faces-possible-sanctions-for-fraud/article_04877e84-3dda-11df-a936-001cc4c03286.html, the Lincoln Journal Star notes, “Fleming, formerly of the Fleming Heart and Health Institute in Omaha, lives in Reno, Nev.” (emphasis mine).

A similarly entitled entity, “Fleming Heart and Health Institute L.L.C.” appears on the records for the state of Nevada, with Prof. Richard M. Fleming, M.D., J.D., listed as the registered agent. However this registration shows “revoked,” and may never have been issued. I have been unable to locate any physical address for an institute in Nevada or California with this name, and there is no record of such an organization ever registered with the Secretary of State in the state of California.

So while it appears that FHHI does not appear to have been in operation since at least 2004, you appear to have continued to include the claim that you are affiliated with FHHI for approximately 15 more years including in multiple journals in 2018, and on your current CV on LinkedIn.

Once again, Dr. Fleming, I’d ask for your help in clearing up this misunderstanding.

Q: Is there a current entity called the Fleming Heart and Health Institute (PC or LLC), and if so, in what state is it registered?
Q: If it is no longer operating, in what year did its operations cease?
Q: If it is no longer operating, do you believe it is appropriate, or even ethical, to continue claiming a current affiliation with a now defunct organization?
Q: As you seem to find my inquiries aggravating, don’t you agree that its proper for the public to scrutinize published research for evidence of mistakes, bias or misconduct before accepting the conclusions of the research?

Dr. Richard M. Fleming said...
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Regret said...

Thus ends our conversation with the self-described “Father of Modern Nuclear Cardiology & Nuclear Medicine.” TTFN

Regret said...

Holy cow, I wasn't intending to return to this, but I just happened to click on Dr. Fleming's Twitter account and saw this tweet from *yesterday* (1/25/19)

"Dr. RM Fleming @NuclearCard / Jan 25 / We're delighted to be included in Women Fitness Magazine where we have the opportunity to help so many women." The "magazine" appears to be a clickbait health blog where people can self-publish articles.

Anyway, Dr. Fleming is glowingly profiled in a puff piece authored by freelancer Jules Lavallee here: https://www.womenfitnessmag.com/what-are-diets-really-doing-to-people/, at the bottom of which appears a "for more information" link to Dr. Fleming's own site: https://rmfmd71.wixsite.com/fhhi-omnific

Following this link, I discover that he is still using his "fictitious" or defunct entities but in this case to market his patented imaging system. He also references the Omnific Imaging, LLC, which I've seen elsewhere, but I can't find this entity registered in California, Nevada or Nebraska, and I found nothing helpful on Google.

"Fleming Heart & Health Institute
FHHI is (sic) the Parent Company for (1) Omnific Imaging, LLC and (2) The Camelot Foundation a 501(c)(3) (sic)..."
"Doing the Right Thing for the Right Reasons (sic)"

Isn't advertising a medical process using false information illegal?

Regret said...

Dr. Fleming-I saw your question on Twitter this morning and suggestion that I am a “KETO stalker.” As I said before, I have no axe to grind in your diet debates and I have no background (or really any interest) in your field(s).

My interest was piqued when I read the Retraction Watch story about your retracted paper and saw your odd defense of your felony conviction in the comments there. I hold no personal animus toward you, but I am questioning the veracity in your many public statements and representations, and am perplexed that you do not seem interested in clearing up the many inconsistencies of your professional background.

In my opinion, the loose way you seem to play with your credentials and background details are consistent with the behavior of a person committing fraud. To be clear, I am not accusing you of fraud, but your responses to questions on these forums have done little to clear up what could otherwise be considered honest mistakes.

My long practice of using a “handle” isn’t intended to hide my identity but to avoid unnecessarily mixing my personal and professional internet profiles. If you’d like me to contact you directly to “unmask” myself to you I can do so, although I don’t know why it matters to you. Just let me know which email address you’d like me to use for this purpose.

I would caution you not to threaten me, either physically, professionally or legally. I am fully prepared to defend myself and as a non-public figure I may have legal options available to me, that a public figure, such as yourself, may not.

Regret said...

Details about appearance in court and appeal: https://www.courtlistener.com/opinion/2476421/fleming-v-united-states/

Dr. Richard M. Fleming said...
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Regret said...

Shorter Dr. Fleming: “Please look at me.”

Regarding your current GoFundMe attempt, why exactly do you need $50,000 in order to give away a *free* license to a hospital? Is the money to cover the cost of your self-promotion at “journals” and conferences?

Dr. Richard M. Fleming said...
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Regret said...

Sigh. As I previously explained, I don’t know anything about diets, and don’t care to. I’m perfectly happy that you believe the Keto diet is bad for you... for all I know you are right, and I would never argue otherwise.

My questions have been about what I believe are your exaggerated or fabricated credentials, and your unwillingness to simply answer those questions here (and elsewhere) appear to prove my suspicions correct. I truly am sorry that your career appears to have ended with the criminal charges and conviction. I imagine it has been very difficult, financially and personally.

However, it appears that instead of trying to rebuild a medical or teaching career you are trying to hock a new medical process by using exaggerated and/or inaccurate claims about your background and the “research” that may support the efficacy of your process. Further, you are raising funds while continuing the practices that I am questioning. That could be considered fraud, and it appears to violate the terms and conditions of GoFundMe, if my suspicions are accurate.

I doubt you’d credit an anonymous critic with having your best interests at heart, but I recommend you stop any misrepresentation of your credentials or research before you get in legal trouble again. You went to law school: What could happen if you receive money from a donor or medical center and they later sue you for misleading them or turn you over to the state attorney general?

Anyway if you continue down the path you’ve been on, I’m sure you’ll continue to attract critics and observations that your practices appear sketchy. I have almost no hope that you can stop yourself from this behavior at this point.

Dr. Richard M. Fleming said...
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George Henderson said...

Really? I am surprised you still trust the US authorities, given that they railroaded you last time by your own account. In any case, you should consult a lawyer, because it would be a civil case, were it in fact a case.

Regret said...

I really am sorry for you and do not wish you harm.

As you claim to have a law degree, I’m certain you know that defamation in California is a civil matter, so “authorities” will not be interested.

In addition, the alleged defamatory statements must be demonstrably false, and here I am only expressing an opinion or asking you for information. Please point me to a statement of fact where I am wrong, provide evidence of the correct fact, and I will admit to my mistake.

Further, as you are a public figure you would also have to prove “actual malice” on my part, meaning that I must have made the defamatory statement either with knowledge that it was false or with reckless disregard for the truth. Since I am explicitly asking you to provide information so I and other readers can learn the truth, you would have no shot at winning a defamation lawsuit. If I did accidentally make a false statement of fact, you have made no effort to correct me (with facts in rebuttal), so any damages suffered by you as a result of any unintentional error are limited.

Lastly, and as I explained elsewhere, you should be careful about filing a defamation lawsuit because California has an anti-SLAPP measure that would likely apply.

Regret said...

G: Thank you for the insightful comment - I should have thought of that. If you do get a subpoena let me know. I know a fantastic First Amendment attorney that I would love to get involved.

Dr. Richard M. Fleming said...
This comment has been removed by the author.
Regret said...

Dr. Fleming, I have no ability to help you get on TV, and again: I don't disagree with your views on diets or medical imaging procedures.

The questions I (and others) have asked center around your credentials, background, research methods and publication ethics. As you do not appear interested in assuaging those concerns in this forum or elsewhere, readers of your work are understandably confused or left with an unfavorable impression.

It seems to me that if your claims are legitimate, and you would really like to help patients, you would do more to answer the questions that you have been asked. Rather, you seem very unprofessional: belligerently calling people names and concocting conspiracies among anyone who challenges you. Those behaviors do not seem likely to help you achieve your goals.

Dr. Richard M. Fleming said...
This comment has been removed by the author.
Regret said...

"What I won't do is have social media discussions with people I don't know...."

Well, I can't say you don't have a sense of humor.

Regret said...

Will be interesting to see Dr. Fleming's reaction to the summary judgement entered on the FTC suit vs. OMICS (although I would be surprised if OMICS doesn't delay enforcement via appeal).

It appears that the monetary award ($50,130,810) is partially "to be used for equitable relief, including consumer redress." The FTC claimed OMICS made misrepresentations about their conferences and labelled the peer review process a "sham." As he lists multiple OMICS conferences and journal articles published by OMICS in his CV, maybe the good doctor can get a refund. In fact, he is on the editorial board of at least one of their "journals"... how embarrassing.

https://retractionwatch.com/2019/04/02/court-orders-publisher-omics-to-pay-u-s-govt-50-million-in-suit-alleging-unfair-and-deceptive-practices/

https://www.courthousenews.com/wp-content/uploads/2019/04/Publishing.pdf

Regret said...

Dr. Fleming’s upcoming conference schedule might get derailed by the judgement against his favorite publisher and organizer OMICS: https://www.nytimes.com/2019/04/03/science/predatory-journals-ftc-omics.html (possible paywall)

Regret said...

Listened to a few minutes of Dr. Fleming's monologue on an obscure Scottish internet radio station which was "broadcast" today, couldn't put up with it for long. The little bit I listened to was a rehash of "I'm not guilty," "they are all out to get me," "I'm the only one speaking truth to power."

He also continues to attempt to get Congress to acknowledge his claims that Big Pharma and the FDA are in a conspiracy against all of us (a claim I'm sympathetic to): https://www.facebook.com/rm.fef/posts/1490652897738432

"I ask for The House Committee on Energy & Commerce and Chariman (sic) Frank Pallone, Jr. (202-225-2927; Press # 202-225-5735) to investigate these Companies and ask for copies of the paper being published in a Peer Reviewed Pharmacy Journal including evidence showing Big Pharma lied to the FDA, HHS, Insurance Companies, Doctors, Hospitals, Clinics, the Federal Courts and you-the patient. All so they could sell more drugs and increase the amount of radiation you received from their drugs."

If I locate the paper, I'll post a link here. I would be shocked if he gets a paper of this sort published in a respectable "peer reviewed" journal. Look also for a likely PubPeer thread on that paper.

Regret said...

Interesting to see that Dr. Fleming has recently removed all of his comments from the blog. Odd.

Puddleg said...

Odd of him to post them in the first place too - I will have copies of some in emails.
I guess he finally took legal advice.

Regret said...

Probably redundant at this point, but to add to the record. Dr. Fleming was a "Conference Organizer" at an iMedPub conference in October 2018 (iMedPub is affiliated with the OMICS International group of companies recently targeted by the FTC). His conference biography is pasted below.

In this he now claims he received his "Doctorate in Particle Physics through the JFK administration," which is slightly different than before (his CV before said 1964, when he was 18). Since the JFK administration was done in 1963, the doctor now apparently claims to have received a Doctorate at age 7. Literally unbelievable. Reading this quite generously, I think he is saying again (see RW for more) that he participated in a program initiated during the JFK administration during high school in 1974 and got a certificate of completion. He has not been willing to share the name or date any institution through which he received a PhD, so I personally don't believe he has one.

In this bio he also again repeats his claim that "many" consider him to be the "Father Modern Nuclear Cardiology... blah blah blah," which is bunk. He is the only one to have used this phrase, and only in a couple of conference bios.

I won't bother identifying the other misstatements in the bio, which we have seen discussed elsewhere.

Below is the bio, retrieved here:https://eurobreastcancer.cancersummit.org/ocm/2018/richard-m-fleming-fleming-heart-health-institute-united-states

"Professor Fleming is a direct descendant of Rollo. He was born in Cedar Falls, IA and received his Doctorate in Particle Physics through the JFK administration. He has additional degrees in Biology, Chemistry, Psychology, Medicine and Law. He is specifically trained as a Nuclear and Preventive Cardiologist in addition to Nuclear Imaging. He is one of three Physicians in the world Certified in PET Imaging and the only American. He is the founder of the theory of "Inflammation and Heart Disease" and is considered by many to be the Father of Modern Nuclear Cardiology and Nuclear Medicine since his development of the first truly quantitative AI system for detection and treatment monitoring of Heart Disease & Cancer. He has published more than 150 papers in the field, reviews for more than a dozen peer reviewed medical journals, has published three books, 8 chapters in medical textbooks and been Editor-in-Chief of the medical textbook "Establishing Better Standards of Care in Doppler Echocardiography, Computed Tomography and Nuclear Cardiology." "

Regret said...

I noticed today that Dr. Fleming is no longer listed as an editor of the Journal of Nuclear Medicine & Radiation Therapy (OMICS). A Google search still shows that he was, and a cached image of his editor page is available. Wonder if this action was taken by the journal or by Dr. Fleming.

Regret said...

I've noticed that several (all?) of Dr. Fleming's papers are no longer accessible on the OMICS International site, the publisher of the Journal of Nuclear Medicine & Radiation Therapy. The header of the article shows at the link, but not the body. I wonder if they are having problems with their site or if this is related to the FTC enforcement action (this is the case for multiple journals and papers on the OMICS site). If the latter, might be frustrating for Dr. Fleming to have his published "research" disappeared like this.

Examples:
https://doi.org/10.4172/2155-9619.1000350
https://doi.org/10.4172/2155-9619.1000353
https://doi.org/10.4172/2155-9619.S9-006

Puddleg said...

I can read all 3 of those. I wish OMICs would disappear, because then I could republish the paper I gave them - the whole of this unedifying story can be read here:
https://hopefulgeranium.blogspot.com/2016/09/court-of-last-appeal-early-history-of.html

Regret said...

Thanks, I can read them now too. Must have just been a site glitch.

Regret said...

Found a summary of Dr. Fleming’s claimed credentials. It confirms (for me) my suspicion that he doesn’t have a PhD in any field. His claim to a Doctorate in physics is a program he did in 1974, when he was 18. Whatever he thinks of the program, it predates his BS degree(s) by 2 years and he shows no masters degree in this CV.

Found this at https://rmfmd71.wixsite.com/fhhi-omnific/about but saved below as a backup.

His tenure (as the sole physician and “professor”) at The Camelot Foundation ended in 2004, which confirms information found on the IRS site that this organization, such as it ever was, has been defunct for 15 years, which makes it inappropriate for him to continue using as a funding organization on his “research” papers after 2004.

https://m.imgur.com/a/Cq8MBaa

Regret said...

Dr. Dooley ("one of the Best Cancer Surgeons in the USA") and his co-author, Dr. Fleming, advertise that they are "Finding Cancer Before It Becomes Cancer."

See link: https://rmfmd71.wixsite.com/fhhi-omnific/finding-cancer-before-it-s-cancer

Also: https://rmfmd71.wixsite.com/fhhi-omnific/expert-testimonials

I have saved copies of the content on those pages

Regret said...

Should We Debunk Junk Science Or Not?

“Junk science is everywhere, and it takes many pernicious forms. There are the outright scams, of course, advertised by charlatans aiming to make a quick and easy buck. There are the malicious actors, trying to spread falsehoods and misinformation to score political or economic points instead of promoting honest scientific debate. And there are the lazy and flawed scientists themselves, trumpeting poorly-done, low-quality, and even outright sketchy work in a bid to get some media and public attention on themselves.” Any of this sound familiar?

http://www.forbes.com/sites/paulmsutter/2019/01/21/should-we-debunk-junk-science-or-not/amp/

Regret said...

Predatory journal tweets

At the link, a wonderful tweetstorm by Dr. Bik on how a predatory "scientific" journal used by Dr. Fleming will publish almost anything. Read on Twitter at the link above.

Published side-by-side with Dr. Fleming's "peer reviewed" lament about conspiracies between Big Pharma and the FDA, is a long-awaited nonsense article by Yosemite Sam (aka Ottawa Citizen reporter Tom Spears): "Re-Examining the Genetic Bottleneck: Atavistic Regression in Acquired Traits Affects the Outcome for Many Subspecies at the Allelic Level"

BTW, Dr. Fleming, in case you still read these comments, I tire of your poor grammar. I suggest you and your peer reviewers read up on the difference between its and it's.

Related links below:
Tom Spears' March article about these fake journals
RW's article about Yosemite Sam
Fleming's "peer reviewed" diatribe
Yosemite Sam's article

(I have PDF copies of both articles and if they disappear, I can upload them somewhere for posterity).

Puddleg said...

That's very entertaining - I had no idea that even predatory journal "science" got quite that loose. Thank you for the links!

Regret said...

ICYMI: https://twitter.com/MicrobiomDigest/status/1128548632108494848?s=20

Regret said...

Oh my word. From Fleming v. Sims
https://www.courtlistener.com/docket/6282193/247/fleming-v-sims/

“Plaintiff (Fleming) allegedly responded to the advertisement and represented himself as an adult film actor and model. (Id.) It appears that during Plaintiff’s interview for the position, the parties first discussed Plaintiff’s research regarding breast and heart disease, the Grant, and the Rental Payment.”

Puddleg said...

Oh dear. That may be his role as Commissioner Parker in "Vice Squad LA". I was wondering why this "TV series" didn't have a wiki page.
https://www.imdb.com/name/nm6222842/

Smut Clyde said...

Dr Bik reports that this "paper" has now been duplicated in a second predatory publisher.

https://www.actascientific.com/ASPS/pdf/ASPS-03-0309.pdf

Regret said...

Another “paper” by Dr. who? and his cronies.

https://lupinepublishers.com/cancer-journal/pdf/OAJOM.MS.ID.000153.pdf

Regret said...

For the record, I found a Spring 1980 commencement program? here: https://scholarworks.uni.edu/cgi/viewcontent.cgi?article=1089&context=commencement_programs that appears to show that Richard Max Fleming received 2 Bachelor of Arts degrees (with high honors) from University of Northern Iowa in “Science and Biology A.” See page 27. This addresses one of my earliest questions about the degrees he claimed in “Physics, Biology, Chemistry and Psychology graduating second in his class“ on his IMDB profile.

Regret said...

:-) I think Dr. Fleming got me banned on Twitter for poking fun at him, aka “targeted harassment,” because of a republished YouTube photo of him with (probably fake) blood on his face, similar to his (probably fake) science. Caption: “I fought the law and the law won.”

I will stop poking fun at Dr. who? when he stops publishing his (probably fake) papers in (probably fake) journals.

Smut Clyde said...

Good luck with reversing the ban!