Dr. Peeples goes Cherry-Picking — Tasty and Tempting, but Unethical

In nearly every one of Dr. Peeples’ reports, he concludes that “[m]edicine is an inexact science; however, the opinions stated above are based on a reasonable degree of medical certainty.” The only way science comes into play in Dr. Peeples’ opinions is that he cherry-picks individual sentences from free articles on the Internet and calls that “science.” Unfortunately for the people he testifies against, Dr. Peeples ignores his ethical duties and instead raises out-of-context blurbs up like gospel. In technical terms, Dr. Peeples’ actions are known as “confirmation bias,” which is the tendency to favor information that confirms ones own beliefs and ignore information that does not conform to those beliefs.

One example of Dr. Peeples’ confirmation bias comes from a Chaney Law Firm case tried to a Pulaski County jury in October of 2011. During that trial, Dr. Peeples testified against a gentlemen who sustained permanent low back injuries as a result of a violent T-bone collision between a 30,000-pound delivery truck and a Ford F-150 that totaled both vehicles. Predictably, Dr. Peeples opined that the collision was “low energy” and did not cause our client’s injuries. Instead, our client’s injuries were the result of the degeneration process, or in other words, the normal process of aging. (That comes up a lot on this blog, doesn’t it?)

In his written report, Dr. Peeples stated that “[m]edical knowledge indicates that minor trauma does not cause serious low back illness,” and the following citation was given:  (Spine, v. 31 (25), p. 2944-2949). Vague and obscure references to medical literature have become routine in Dr. Peeples’ reports. The full citation to the article is as follows:  Eugene Carragee, Todd Alamin, Ivan Cheng, Franklin Thomas & Eric Hurwitz, Does Minor Trauma Cause Serious Low Back Illness? 31(25) Spine 2942-2949 (December 1, 2006). The full-text article may be located here: http://scholar.googleusercontent.com/scholar?q=cache:6NMz4vIWpDcJ:scholar.google.com/&hl=en&as_sdt=0,4 . This medical article states:

MRI after serious LBP (low back pain) episodes and minor trauma rarely demonstrated significant new findings. The vast majority of incident-adverse LBP events may be predicted, not by structural findings or minor trauma, but by a small set of demographic and behavioral variables.

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Chronic pain, emotional issues and the perception of fault and entitlement appear to affect adversely symptoms, despite the native structural resilience [of the spine].

Dr. Peeples then states:  “I agree with this information; it is illustrative for this medical record.” No other information about the article was mentioned.

While the first impression of Dr. Peeples’ use of this medical article might appear to support his conclusion, actually reading the study’s limitations shows that Dr. Peeples irresponsibly overstated the authors’ conclusions.  For instance, the study only included 200 working people who did not have low back symptoms, or described their low back pain as mild enough to not have any functional loss or medical treatment. In addition, “minor trauma” was defined as an injury occurring in the absence of clear ligamentous injury. The study went on to state that it has design limitations that limited its ability to be generalized across the general population, and that the predictive model needed to be replicated and validated in other studies.

During cross-examination, Dr. Peeples was questioned extensively about the American Medical Association’s Code of Medical Ethics. When asked if he followed the AMA’s Code of Medical Ethics, Dr. Peeples responded by saying “it depends on what aspects of the code.” He was pressed and again stated that it depended “on the situation and part of the code.” Incredibly, he wouldn’t even agree that he followed the medical profession’s ethical code! The very first ethics opinion of the American Medical Association states that a failure to follow the Code of Medical Ethics is unethical conduct. Dr. Peeples was asked to read this during the trial, and only at that time did he change his tune and agree that it was unethical for a doctor not to follow the Code of Medical Ethics.

Another one of the Opinions in the Code of Medical Ethics, No. 9.07, states that “if a medical witness knowingly provides testimony based on a theory not widely accepted in the profession, the witness should characterize the theory as such.” When asked if Dr. Peeples could show in his report where it says that the study he relied upon needs to be validated, Dr. Peeples evasively attempted to distinguish between a “predictive model” and a “theory.” Rather than addressing the study’s limitations straight-up, Dr. Peeples played word games. This will start to sound familiar for regular readers of this blog.

Dr. Peeples’s report never mentioned these limitations on the study, and his testimony against an injured Arkansan completely ignored the negative information in the study. When he got caught cheating, he resorted to verbal gymnastics. These displays of confirmation bias are one of Dr. Peeples’ trademarks. They are also unethical according to the American Medical Association.  

S. Taylor Chaney