Prevention cannot be discussed without first attempting to identify the causes. As will become apparent, because of the lack of real evidence and hard data, this will remain a largely speculative exercise. Is fraud and misconduct in medical research a new phenomenon or was it ever thus? Was the culture such that it was deemed inimical to even question the integrity of one's scientific colleagues in the past? On the other hand, is this merely a reflection of the current state of the mores of society at the present time? A random glance at the current newspapers and periodicals shows the crime rate in the UK to be the highest in the developed world apart from Australia (Economist 3 March 2001). In the same issue of this periodical Sotheby's former chief executive was found guilty of collusion with Christies with regard to sales of art works. Finally, in The Times (3 March 2001) the Automobile Association admitted plagiarising Ordnance Survey (OS) original maps and paid the OS £20 million in an out of court settlement.
It was the high profile Darsee fraud, which came to light exactly 30 years ago, that sowed the seeds of the idea that there might be a significant amount of fraud and misconduct in scientific biomedical research (see Chapters 3 and 4). Prior to that time this would have been unthinkable. However, since then, the publicity accorded several other celebrated examples has led to a greater emphasis on the detection of misconduct as well as attempts to determine its prevalence and to understand and diagnose the motivation lying behind such deceptions. It is generally believed, without much evidence, that this greater understanding should enable more effective prevention.
The previous editions of this book did not have a chapter entitled "Prevention", although many of the issues were embedded in the other contributions, in particular that of Povl Riis when he discussed the Danish experience.1'2 Instead, most of the literature has focused on the methodology employed in detecting and dealing with it, rather than the ways of preventing it. Perhaps, there was no chapter in the previous editions solely devoted to prevention because the evidence base of what can be done to prevent research misconduct is mainly absent. Of course this does not mean that we should not try; indeed we have to, because the consequences of research misconduct have profound implications for us all: the public, our patients, and the whole scientific community.
The spectrum of scientific misconduct, defined by the Commission established by the Danish Medical Research Council in 1991, is comprehensive, and they prefer the term "scientific dishonesty" to cover a wide spectrum of offences rather than "fraud or misconduct". This is useful when we consider prevention, because it is my personal belief that the establishment of a culture that prevents the more "minor" dishonesties is likely to prevent major fraud, the latter having huge consequences for society at large. The Consensus Statement of the Royal College of Physicians of Edinburgh, published in January 2000,3 defined research misconduct as "behaviour by a researcher, intentional or not, that falls short of good ethical and scientific standards". It also stated that no definition can or should attempt to be exhaustive and that it should allow for change. Most of the consensus statement focused on the promotion of good research in the belief that it is only within a culture of best research practices that prevention will occur.
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