When serious fraud, such as fabrication of controlled clinical trial data, is detected, the person or persons concerned would be reported to the GMC. If a preliminary review of the evidence suggests that there were sufficient grounds to proceed, then the GMC would hold a full enquiry and, if the defendant is found guilty, this might result in exclusion from the Medical Register. For lesser crimes and those involving non-clinical scientists, a whistleblower or journal editor might refer the case to the head of the investigator's department or institution. Reporting an individual to the head of institution, however, might not necessarily produce satisfactory outcome, as there may be conflict of interest. For example, the senior author might be a prominent clinical academic within the institution and possibly even a personal friend of the Dean or Vice-chancellor. There are a number of instances of alleged, serious research misconduct that have been "silenced" within the investigator's institution.10 It is difficult to feel confident that internal inquiries into alleged research misconduct held "in camera" will reliably get at the truth, when for the institution there is so much to lose and little to gain.
Editors face some difficult issues when they suspect or detect research fraud. Once a journal has published a paper that is subsequently shown to be fraudulent or redundant, then the paper would be retracted and a notice to that effect published in the journal. This places the case in the public domain and the authors are exposed. In serious cases the editor may, in the case of clinical investigators, refer the matter to the GMC. A recent study has shown, however, that this does not stop the paper being cited in the literature for many years, usually without making any reference to the fabrication or falsification contained therein.13
It is, however, more difficult to know precisely how to act when research misconduct is suspected during the peer-review process before publication. The most common editorial response is to simply reject the manuscript. This is clearly unsatisfactory and one might argue that the editor has not fulfilled his/her duty as a custodian of the biomedical literature, since it is likely that the paper would merely be submitted to another journal. Some editors have taken a "hard line" and have placed sanctions on all authors who engage in redundant publication, such as by refusing to accept further submissions to the journal for a set period, say three years.16 Editors who are members of the Committee for Publication Ethics17 (COPE) have produced some guidelines on Good publication practice (available in the 1999 COPE Report18 or on the COPE website www.publicationethics.org.uk), which set down a hierarchy of sanctions that editors may publish in their journals and use judiciously such that "the punishment fits the crime". These might range from a firm letter to the author pointing out the breach of publication ethics when it is felt that an error occurred through ignorance and not malintent, through to tougher sanctions such as limited access to the journal for a given period as described above, or ultimately to referral of the matter to the author's head of institution or directly to the GMC. The Royal College of Physicians, London and the MRC have produced guidance on the investigation and prevention of research misconduct.14'15
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