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Regardless of the statements in the author guidelines, the fact the cases are fictional should have been conveyed to the readers of all of these articles, Juurlink said. In the case of Baby boy blue, “the article was structured as an authentic clinical case, indexed as such, and cited as an actual clinical observation. Readers had no way of knowing it was fictional,” he said. “A narrative that is fictional but published in the format of a genuine case report, without disclosure at the time of publication, is functionally indistinguishable from fabrication in the scientific record.”