The Revelation of Fictional Cases in a Prestigious Paediatric Journal

In a shocking development that has sent ripples through the Canadian medical and academic communities, Paediatrics & Child Health, the official journal of the Canadian Paediatric Society (CPS), has issued corrections to 138 case reports spanning 25 years. These reports, part of the Canadian Paediatric Surveillance Program (CPSP) Highlights series, featured detailed clinical vignettes presented as real patient cases but were later revealed to be entirely fictional. The disclosures aim to clarify that the cases were crafted as teaching tools to illustrate real surveillance data while protecting patient confidentiality.

The controversy erupted following a January 2026 investigative piece in The New Yorker, which highlighted one specific case dubbed "Baby Boy Blue." This prompted editor-in-chief Joan Robinson to act swiftly, adding disclaimers to all affected publications. While the intent was educational, the lack of upfront disclosure has raised serious questions about transparency in peer-reviewed literature, particularly in fields like paediatrics where case reports often inform clinical practice and policy.

Understanding the CPSP Highlights Series and Its Purpose

The Canadian Paediatric Surveillance Program (CPSP), a collaboration between the CPS and the Public Health Agency of Canada, tracks rare diseases and conditions in children through monthly reporting cards sent to over 2,500 paediatricians. The Highlights series in Paediatrics & Child Health (PCH) began in 2000 to summarize key findings from these surveys. Each article opened with a clinical vignette—a narrative description of a child's symptoms, diagnosis, and treatment—followed by "learning points" backed by real CPSP statistics.

From 2000 to 2025, 138 such vignettes were published, covering conditions like congenital syphilis, fetal alcohol spectrum disorder, and hepatitis C in infants. The journal's rationale for fictionalization was to anonymize sensitive paediatric cases, avoiding breaches of privacy under Canada's strict health data laws like the Personal Information Protection and Electronic Documents Act (PIPEDA). However, this practice was inconsistently noted only in some author instructions, not in the articles themselves or abstracts on PubMed Central.

• Common themes: Rare paediatric conditions with public health implications.
• Structure: Vignette + real CPSP data on incidence, risk factors, outcomes.
• Target readers: Paediatricians, trainees, researchers at Canadian universities like the University of Toronto and McMaster University.

This blend of fiction and fact blurred lines, leading to unintended consequences in academic citation chains.

The Trigger: 'Baby Boy Blue' and the New Yorker Exposé

The scandal's flashpoint was the 2010 article "Baby Boy Blue" (DOI: 10.1093/pch/15.9.571), co-authored by Gideon Koren and Michael Rieder. It described a newborn exhibiting opioid toxicity—lethargy, poor feeding, slow breathing—with urine positive for opiates and blood morphine at 55 ng/mL. The mother had taken acetaminophen-codeine postpartum, and genetic testing showed her as an ultra-rapid metabolizer of codeine to morphine, allegedly passing lethal levels via breast milk.

David Juurlink, a University of Toronto toxicologist, investigated similar claims linked to Koren's discredited Motherisk program. Confronting Rieder years later, Rieder admitted, "Oh, we made it up." Even siblings' details (a Sri Lankan-born sister, caesarean-born brother) were invented. Juurlink called it "pharmacologically impossible," as breast milk transfer yields sub-toxic levels. Cited in court cases and theses, it bolstered now-questioned guidelines.

The New Yorker's February 2026 article tied this to Koren's scandals, including flawed hair testing that separated families. No university retraction statements yet, but it underscores risks in Toronto's SickKids-affiliated research.Learn ethical publishing practices for your academic CV.

Journal's Official Response: Mass Corrections and Policy Shifts

On February 23, 2026, PCH published two society notes (DOIs: 10.1093/pch/pxag012, pxag013), listing all 138 DOIs and adding: "Every clinical vignette... describes a fictional case, created as a teaching tool." Editor Joan Robinson explained: "Based on the New Yorker article, we made the decision to add a correction notice to all 138 publications... From now on, the body of the case report will specifically state that the case is fictional."

The CPSP website now disclaims vignettes as fictional. Author guidelines mandate: "Each highlight is a teaching tool that presents a short clinical vignette describing a fictional case." One error: a real case by Farah Abdulsatar (DOI: 10.1093/pch/pxy155) was wrongly corrected; Robinson noted fixing it was challenging.View correction notice pxag013.

Citations and Ripple Effects in Academic Literature

Semantic Scholar data shows 61 of 138 articles cited 218 times in peer-reviewed works, despite not being in Scopus/Web of Science. "Baby Boy Blue" influenced opioid breastfeeding warnings, linking to retracted Koren papers in Canadian Family Physician and Canadian Pharmacists Journal. A 2006 Lancet report (expression of concern pending) cited similar claims.

• Potential harms: Misguided policies, clinician over-caution on codeine.
• Broader: Questions citation vigilance in paediatrics research from Canadian institutions like University of Alberta (Robinson's affiliation).

Juurlink demands retraction: "It’s a fictional case portrayed as real and its scientific underpinnings have collapsed."Explore research integrity roles in Canadian higher ed.

Expert Perspectives and Ethical Debates

David Juurlink: "Readers expect factual accuracy unless specified." George Lundberg (ex-JAMA editor): "Alternative facts have no place in scientific journals." Reactions criticize opaque practices, though defenders note vignettes' educational value for trainees at medical schools like McGill or UBC.

Pros of fictional cases:

• Privacy protection in rare paediatric events.
• Illustrate real data without de-identification risks.

• Undermines trust in peer review.
• Citation contamination.

Canadian universities emphasize research ethics training; this incident highlights needs in case report guidelines.Postdoc advice on ethical research.

Timeline of the Fictional Cases Controversy

• 2000: CPSP Highlights launches in PCH.
• 2010: "Baby Boy Blue" published.
• 2015: Author guidelines first note fictional cases (inconsistently).
• Jan 2026: New Yorker exposé.
• Feb 23, 2026: 138 corrections issued.
• Mar 2026: Ongoing debates, updated CPSP disclaimers.

This timeline reveals a long-standing practice exposed suddenly.Full Retraction Watch coverage.

Implications for Canadian Higher Education and Research Integrity

In Canadian universities, where paediatrics departments at U of T, UBC, and Calgary produce much child health research, this erodes confidence. Medical students and residents rely on journals like PCH; fictional cases risk mislearning. Ties to Motherisk (SickKids/UofT) amplify scrutiny on institutional oversight.

Calls grow for standardized disclosure in teaching case reports. Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans requires transparency. Impacts: Potential guideline revisions by CPS, ethics training boosts.Research assistant jobs emphasizing integrity.

Future Safeguards and Lessons for Academic Publishing

PCH's changes—explicit fictional labels, guideline updates—set precedents. Broader lessons:

1. Always disclose synthetic data.
2. Separate vignettes from data sections.
3. Pre-citation checks via tools like Semantic Scholar.

For higher ed, integrate publishing ethics in grad programs. Positive: Highlights CPSP's real successes tracking 20+ conditions over decades.Professor positions in paediatrics research.

Photo by Myriam Zilles on Unsplash

Stakeholder Views and Path Forward

CPS focuses on education; critics like Juurlink push retractions. No formal university probes, but expect reviews at author institutions. Outlook: Stronger transparency restores trust, benefiting Canadian paediatrics research ecosystem.

Explore Rate My Professor for paediatrics faculty insights, higher ed jobs in research, or career advice on ethical publishing. Share thoughts in comments.