Roughly one new investigated case of alleged dishonesty per year in a country with 4.5 million inhabitants, four medical schools, and 18 000 physicians seems low and this gives cause for reflection.7 The most probable explanation for the low figure may be summarised by four hypotheses:

• The most obvious explanation is that there simply are no more cases than the few reported in Norway. This does not, however, fit with national surveys.4'5 Moreover, anecdotal accounts and confidential inquiries indicate that there is at least a suspicion of dishonesty on many occasions.

• In spite of its six years' history, the existence of the National Committee is not sufficiently well known. Experience from other countries shows that press coverage in the wake of major disclosures helps to make such committees widely known. As there have been no major cases in Norway in recent years, the media coverage of the activities of the committee has been modest.

• The committee, and its methods, do not enjoy sufficient confidence. The committee does not define what constitutes "accepted research ethics" but builds on the understanding the committee members have of accepted research ethics in Norway. Thus the members must have a knowledge of the research community as well as its confidence. Even though the scepticism towards the committee has diminished over the years, it still exists.

• Potential complainants hesitate to report cases because of fear of jeopardising their career. It is well known that whistleblowers may end up worse off than the person who engaged in the misconduct.8 The National Committee in Norway does not consider anonymous inquiries and a complainant must be prepared to be identified and be held publicly accountable for the complaint.

The presumption of misconduct is the core of any case, but the mere existence of misconduct or the suspicion of dishonesty does not in itself initiate an investigation. There must be a complaint and most likely the complainant will be involved in or related to the case in one way or another. Often there is a particular situation that triggers the complaint. Such "situations" may include competition, disagreement, jealousy, or other interpersonal relations. Without a "situation" suspected or even obvious, cases of dishonesty might not be reported and investigated.

A small number of investigated cases and even fewer cases of verified dishonesty may be seen as an argument against the existence of a national system for dealing with scientific dishonesty. A score of cases gives, however, the minimum of experience that is needed to handle possible future events. The cooperation between the Nordic countries exchanging information and meeting on a regular basis adds to this experience. Last but not least, the number of cases investigated and disclosure of misconduct is not the only and perhaps not even the most important measure of success. The preventive work at a national level and the existence of the Committee in itself might have a prophylactic effect.

The resistance against a national body for dealing with scientific dishonesty has gradually declined in Norway during the last decade, even though some scepticism still exists. Nevertheless, from the Norwegian experience a coherent system for handling of misconduct based on a broad definition combined with preventive efforts is feasible and effective.

Box 10.1 Cases investigated by The National Committee for the

Evaluation of Dishonesty in Health Research in Norway

1. Two new co-authors had been included on a scientific paper without consulting the other authors according to the complainant. Even though the committee found that one of the authors did not fully qualify for authorship, it did not characterise this as a serious violation of ethical research practice.

2. Claims of unreliable measuring methods, publication of misinterpreted data, erroneous statistical analyses, and unqualified co-authorship were made in a research project. Scientific dishonesty could not be established but the committee underlined the importance of good routines for laboratory practice and keeping logs, and for clarifying authorship.

3. The complaint concerned a researcher's contribution to a government report. The main points of the discussion were whether the work that had been done was research or the reporting of research. The complaint was withdrawn and accordingly no final decision was taken by the committee.

4. A researcher had presented results to the general public in a press interview without prior scientific presentation according to the complainant. The committee found that the results had been presented scientifically prior to the interview and that the incident did not represent scientific dishonesty.

5. A researcher was accused of plagiarism in a textbook. The committee found that the case showed a deviation from accepted practice in terms of research ethics. The breaches were found to be blameworthy but, viewed as a whole, not sufficiently serious to be characterised as scientific dishonesty.

6. The case involved a conflict between a former research fellow and the research group represented by the research fellow's supervisor. The research fellow wanted to patent a technical invention that was part of the research group's work. The supervisor rejected this idea, but the research fellow continued to try to get a patent, partly in secret from the rest of the research group. The committee found the research fellow's actions to be dishonest.

7. This was a claim made by two researchers against a third colleague, who allegedly neglected to include several patients in a study in which they were registered and to report serious side effects observed in several of the patients in the same study. This case is currently under consideration.

8. This case refers to a complaint about the presentation of a preliminary report without accessible scientific documentation and of suppression of other findings.The committee concluded that there had been no withholding or distorting of data in the preliminary report, even if the analyses had been insufficiently performed. The committee criticised the researcher for not publishing the article in full until many years later, but did not find him dishonest.

9. The first author of a paper published in an international journal had included several Norwegian co-authors who had not taken part in the study and without their knowledge or consent. The committee concluded that the publication represented a serious offence against accepted norms and procedures of scientific publication and was considered scientific dishonesty.

10. A junior researcher made a complaint against a senior researcher, who did not accept the publication of an article based on data collected at the hospital where the senior was in charge. According to the senior researcher, the data were not collected in a proper way and there was no protocol for the project. This case was referred to the Danish Committee, which concluded that the senior researcher had the right to stop the publication and that the actions were not unethical.

11. A junior researcher accused a professor of claiming authorship in a scientific paper without being involved in the research. According to the complaint the junior researcher was not allowed to publish the study without including a senior who did not qualify for authorship. The case is still under investigation.

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