Handling of scientific dishonesty in the Nordic countries. National Committees on Scientific Dishonesty in the Nordic Countries

Mapping nine decades of research integrity studies (1935-2024): A scientometric analysis

BACKGROUND

Research integrity is fundamental to responsible research practice. Despite attention, the intellectual structure and evolution of this field remains underexplored. This study maps the knowledge landscape of research integrity, identifying key themes, contributions, and trends.

METHODS

A scientometric analysis was conducted on 6,895 records from Web of Science and Scopus (1935-2024). CiteSpace facilitated network analysis, including co-authorship, keyword co-occurrence, and co-citation patterns, while burst detection identified topics.

RESULTS

Research integrity studies have grown significantly since the 1980s, with interdisciplinary collaboration. Keyword and co-citation analyses reveal a shift from early discussions on scientific misconduct to concerns such as open science, AI ethics, and research governance. A collaboration network has emerged, with leading contributions from North America, Europe, and Asia.

CONCLUSIONS

Research integrity has matured into an interdisciplinary field, reaching academic consensus with growing integration of policies, regulations, and technology. Future research is expected to focus on AI's role in research integrity. Key areas of concern include algorithmic bias, automation ethics, and implications for scholarly publishing. Open science and transparency will remain central, particularly in addressing data fabrication, paper mills, and predatory publishing. Institutional policies will continue evolving, embedding integrity principles into governance and public engagement initiatives.

Whistleblowing legislation and reporting on research misconduct: A case for mutual learning

Regulations on reporting research misconduct have undergone a remarkable process of development since the 1980s. At the same time, many states have also developed legislation governing the receiving of alerts and for protecting whistleblowers against reprisal. Although these two bodies of legislation share the aim of organizing the practice of reporting, they have been developed in isolation from each other, and without sufficient thought as to how they should be linked. Based on an analysis of European Union law and its transposition in France, this article identifies the convergences and divergences between whistleblowing legislation and the reporting of research misconduct. It then looks at the contributions that each body of law can make to the other, both in terms of the procedures applicable and the protection afforded to whistleblowers. The lessons learned from the comparison of whistleblowing law and the procedures for reporting scientific misconduct allow for the identification of avenues for improvement.

Plagiarism through Paraphrasing Tools—The Story of One Plagiarized Text

This paper describes a unique case study wherein real plagiarism revealed in a scientific journal is compared with the original article. The plagiarized text contains many typical errors, such as inconsistent terminology, unclear meanings of sentence, missing tables and figures, and an incorrect literature list. The occurrence of similar errors in other manuscripts may serve as a warning against plagiarism. During the analysis of the plagiarized text, it was assumed that a paraphrasing tool was used for preparing this plagiarized text. To confirm this assumption, the chosen paraphrasing tool was used to create a paraphrased version of the article and this version was compared with the plagiarized text. The paraphrased version had far fewer changes from the plagiarized text than the plagiarized text had from the original article. Thus, it was confirmed that the plagiarized text was created using a paraphrasing tool. Information contained in this article can be used for detecting this type of plagiarism.

Publication ethics: Role and responsibility of authors

Publication of scientific paper is critical for modern science evolution, and professional advancement. However, it comes with many responsibilities. An author must be aware of good publication practices. While refraining from scientific misconduct or research frauds, authors should adhere to Good Publication Practices (GPP). Publications which draw conclusions from manipulated or fabricated data could prove detrimental to society and health care research. Good science can blossom only when research is conducted and documented with complete honesty and ethics. Unfortunately, publish or perish attitude has led to unethical practices in scientific research and publications. There is need to identify, acknowledge, and generate awareness among junior researchers or postgraduate students to curb scientific misconduct and adopt GPP. This article discusses various unethical publication practices in research. Also, the role and responsibilities of authors have been discussed with the purpose of maintaining the credibility and objectivity of publication.

Whistle blowing and research integrity: Potential remedy for research misconduct in Malaysian institutions of higher education

This study found that less than half of the respondents are willing to blow the whistle. The results reveal that a lack of protection with regard to the whistleblower's identity, the tedious investigative process, and the notion of avoiding confrontation, which is more apparent in Asian cultures as compared to the West, are among the reasons why individuals who witnessed misconduct chose to remain silent. Adhering to the Asian cultural upbringing where the young must respect the old, those of lower rank must obey those with higher authority, and subordinates do not question the actions of their superior, has become a norm even in the working environment. Therefore, emphasize the need for better protection for whistleblowers including using experienced individuals with a research ethics background to handle allegations from whistleblowers. In addition, established guidelines and procedures for whistleblowers with regard to voicing their allegations against colleagues engaged in research misconduct is still lacking or, to a certain extent, is still unknown to researchers. Thus, the concern indicates a need for institutions to create awareness among researchers regarding the existing platform for whistleblowers, or to develop a systematic and clear procedure which is reliable and independent to promote professionalism in academia.

Scientific Misconduct (Fraud) in Medical Writing

Scientific misconduct (fraud) in medical writing is an important and not infrequent problem for the scientific community. Although noteworthy examples of fraud surface occasionally in the media, detection of fraud in medical publishing is generally not as straightforward as one might think. National bodies on ethics in science, strict selection criteria, a robust peer-review process, careful statistical validation, and anti-plagiarism and image-fraud detection software contribute to the production of high-quality manuscripts. This article reviews the various types of fraud in medical writing, discusses the related literature, and describes tools journals implement to unmask fraud. [Orthopedics. 2018; 41(2):e176-e183].

The visibility of scientific misconduct: A review of the literature on retracted journal articles

Retractions of scientific articles are becoming the most relevant institution for making sense of scientific misconduct. An increasing number of retracted articles, mainly attributed to misconduct, is currently providing a new empirical basis for research about scientific misconduct. This article reviews the relevant research literature from an interdisciplinary context. Furthermore, the results from these studies are contextualized sociologically by asking how scientific misconduct is made visible through retractions. This study treats retractions as an emerging institution that renders scientific misconduct visible, thus, following up on the sociology of deviance and its focus on visibility. The article shows that retractions, by highlighting individual cases of misconduct and general policies for preventing misconduct while obscuring the actors and processes through which retractions are effected, produce highly fragmented patterns of visibility. These patterns resemble the bifurcation in current justice systems.

Interventions to prevent misconduct and promote integrity in research and publication

BACKGROUND

Improper practices and unprofessional conduct in clinical research have been shown to waste a significant portion of healthcare funds and harm public health.

OBJECTIVES

Our objective was to evaluate the effectiveness of educational or policy interventions in research integrity or responsible conduct of research on the behaviour and attitudes of researchers in health and other research areas.

SEARCH METHODS

We searched the CENTRAL, MEDLINE, LILACS and CINAHL health research bibliographical databases, as well as the Academic Search Complete, AGRICOLA, GeoRef, PsycINFO, ERIC, SCOPUS and Web of Science databases. We performed the last search on 15 April 2015 and the search was limited to articles published between 1990 and 2014, inclusive. We also searched conference proceedings and abstracts from research integrity conferences and specialized websites. We handsearched 14 journals that regularly publish research integrity research.

SELECTION CRITERIA

We included studies that measured the effects of one or more interventions, i.e. any direct or indirect procedure that may have an impact on research integrity and responsible conduct of research in its broadest sense, where participants were any stakeholders in research and publication processes, from students to policy makers. We included randomized and non-randomized controlled trials, such as controlled before-and-after studies, with comparisons of outcomes in the intervention versus non-intervention group or before versus after the intervention. Studies without a control group were not included in the review.

DATA COLLECTION AND ANALYSIS

We used the standard methodological procedures expected by Cochrane. To assess the risk of bias in non-randomized studies, we used a modified Cochrane tool, in which we used four out of six original domains (blinding, incomplete outcome data, selective outcome reporting, other sources of bias) and two additional domains (comparability of groups and confounding factors). We categorized our primary outcome into the following levels: 1) organizational change attributable to intervention, 2) behavioural change, 3) acquisition of knowledge/skills and 4) modification of attitudes/perceptions. The secondary outcome was participants' reaction to the intervention.

MAIN RESULTS

Thirty-one studies involving 9571 participants, described in 33 articles, met the inclusion criteria. All were published in English. Fifteen studies were randomized controlled trials, nine were controlled before-and-after studies, four were non-equivalent controlled studies with a historical control, one was a non-equivalent controlled study with a post-test only and two were non-equivalent controlled studies with pre- and post-test findings for the intervention group and post-test for the control group. Twenty-one studies assessed the effects of interventions related to plagiarism and 10 studies assessed interventions in research integrity/ethics. Participants included undergraduates, postgraduates and academics from a range of research disciplines and countries, and the studies assessed different types of outcomes.We judged most of the included randomized controlled trials to have a high risk of bias in at least one of the assessed domains, and in the case of non-randomized trials there were no attempts to alleviate the potential biases inherent in the non-randomized designs.We identified a range of interventions aimed at reducing research misconduct. Most interventions involved some kind of training, but methods and content varied greatly and included face-to-face and online lectures, interactive online modules, discussion groups, homework and practical exercises. Most studies did not use standardized or validated outcome measures and it was impossible to synthesize findings from studies with such diverse interventions, outcomes and participants. Overall, there is very low quality evidence that various methods of training in research integrity had some effects on participants' attitudes to ethical issues but minimal (or short-lived) effects on their knowledge. Training about plagiarism and paraphrasing had varying effects on participants' attitudes towards plagiarism and their confidence in avoiding it, but training that included practical exercises appeared to be more effective. Training on plagiarism had inconsistent effects on participants' knowledge about and ability to recognize plagiarism. Active training, particularly if it involved practical exercises or use of text-matching software, generally decreased the occurrence of plagiarism although results were not consistent. The design of a journal's author contribution form affected the truthfulness of information supplied about individuals' contributions and the proportion of listed contributors who met authorship criteria. We identified no studies testing interventions for outcomes at the organizational level. The numbers of events and the magnitude of intervention effects were generally small, so the evidence is likely to be imprecise. No adverse effects were reported.

AUTHORS' CONCLUSIONS

The evidence base relating to interventions to improve research integrity is incomplete and the studies that have been done are heterogeneous, inappropriate for meta-analyses and their applicability to other settings and population is uncertain. Many studies had a high risk of bias because of the choice of study design and interventions were often inadequately reported. Even when randomized designs were used, findings were difficult to generalize. Due to the very low quality of evidence, the effects of training in responsible conduct of research on reducing research misconduct are uncertain. Low quality evidence indicates that training about plagiarism, especially if it involves practical exercises and use of text-matching software, may reduce the occurrence of plagiarism.

Ethical issues in gastroenterology research

Ethical issues have become increasingly important in gastroenterology research. This is for several reasons, including (i) an understanding of how conflicts of interest might affect research, (ii) the influence of the drug and device industries on research, (iii) ghostwriting (taking credit for something you did not write), (iv) the occurrence of ethically inappropriate research and scientific misconduct, and (v) respect for the rights of research subjects. These include the rights (i) to give informed consent to participate after understanding the purposes, risks, and benefits of the research; (ii) to ask questions; and (iii) to withdraw from participation at any time. Notions of doing good (beneficence), avoiding harm (non-maleficence), confidentiality, and, most important, the primacy of the welfare of the patient or research subject can be traced to antiquity. In the modern era, the Nuremburg Code (1947), the Declaration of Helsinki (1964), the Belmont report (1979), and other events and reports have led to the refinement of ethical practices in both clinical and research domains, have reinforced those long observed principles, and have given rise to the newer principles of autonomy and justice. The ethical conduct of research not only promotes good research but also is in the best interests of research subjects, investigators, sponsors, patients, and the public.

Authorship: attitudes and practice among Norwegian researchers

Background

Attitudes to, and practices of, scientific authorship vary. We have studied this variation among researchers in a university hospital and medical school in Norway.

Methods

We invited all faculty, researchers and PhD students at Oslo University Hospital and the Faculty of Medicine, University of Oslo (approximately 2700) by e-mail to answer a web-based questionnaire in January 2013. We asked the researchers to report their authorship experiences and to score their agreement with, and ability to practice according to, 13 statements on authorship qualifications and criteria on a five-point Likert scale (1 = completely agree, 5 = completely disagree). The statements were taken from the International Committee of Medical Journal Editors (ICMJE) and other recommendations on authorship.

Results

654 questionnaires were returned (response rate 24%); 25% of the respondents had published less than five scientific articles, 43% five to 49, and 32% more than 50 articles. 97% reported knowledge of defined authorship criteria, and 68% regarded breaches of these as scientific misconduct. 36% had experienced pressure to include undeserved authors in their papers, more in basic science (46%) than in community medicine (25%). 29% reported that they had been denied authorship they believed they deserved. Researchers with less than six years of research experience found authorship decisions more difficult than more experienced researchers (48% vs 30%).

The respondents’ agreement with the statements on authorship was higher than their self-reported ability to follow them for all statements. Average scores for agreement and practice for all statements combined were 1.4 vs 2.3. The discrepancy between attitude and practice declined with publishing experience. For the core ICMJE authorship requirements the average difference between attitude and practice was 1.2 among those who had published less than 5 articles and 0.7 among those who had published 50 articles or more (p < 0.05).

Conclusions

Almost all the responding researchers had knowledge of formal authorship requirements. Most of them agreed with the criteria, but found it harder to put them into practice. More experienced researchers found decisions on authorship and about the order of authors easier than less experienced researchers.

Managing Opportunities and Challenges of Co-Authorship

Research with the largest impact on practice and science is often conducted by teams with diverse substantive, clinical, and methodological expertise. Team and interdisciplinary research has created authorship groups with varied expertise and expectations. Co-authorship among team members presents many opportunities and challenges. Intentional planning, clear expectations, sensitivity to differing disciplinary perspectives, attention to power differentials, effective communication, timelines, attention to published guidelines, and documentation of progress will contribute to successful co-authorship. Both novice and seasoned authors will find the strategies identified by the Western Journal of Nursing Research Editorial Board useful for building positive co-authorship experiences.

Prevalence of scientific misconduct among a group of researchers in Nigeria

BACKGROUND

There is a dearth of information on the prevalence of scientific misconduct from Nigeria.

OBJECTIVES

This study aimed at determining the prevalence of scientific misconduct in a group of researchers in Nigeria. Factors associated with the prevalence were ascertained.

METHOD

A descriptive study of researchers who attended a scientific conference in 2010 was conducted using the adapted Scientific Misconduct Questionnaire-Revised (SMQ-R).

RESULTS

Ninety-one researchers (68.9%) admitted having committed at least one of the eight listed forms of scientific misconduct. Disagreement about authorship was the most common form of misconduct committed (36.4%) while plagiarism was the least (9.2%). About 42% of researchers had committed falsification of data or plagiarism. Analysis of specific acts of misconduct showed that committing plagiarism was inversely associated with years in research (Fisher exact p-value = 0.02); falsifying data was related to perceived low effectiveness of the institution's rules and procedures for reducing scientific misconduct (X(2) = 6.44, p-value = 0.01); and succumbing to pressure from study sponsor to engage in unethical practice was related to sex of researcher (Fisher exact p-value = 0.02).

CONCLUSIONS

The emergent data from this study is a cause for serious concern and calls for prompt intervention. The best response to reducing scientific misconduct will proceed from measures that contain both elements of prevention and enforcement. Training on research ethics has to be integrated into the curriculum of undergraduate and postgraduate students while provision should be made for in-service training of researchers. Penalties against acts of scientific misconduct should be enforced at institutional and national levels.

Scientific dishonesty--a nationwide survey of doctoral students in Norway

Background

The knowledge of scientific dishonesty is scarce and heterogeneous. Therefore this study investigates the experiences with and the attitudes towards various forms of scientific dishonesty among PhD-students at the medical faculties of all Norwegian universities.

Method

Anonymous questionnaire distributed to all post graduate students attending introductory PhD-courses at all medical faculties in Norway in 2010/2011. Descriptive statistics.

Results

189 of 262 questionnaires were returned (72.1%). 65% of the respondents had not, during the last year, heard or read about researchers who committed scientific dishonesty. One respondent had experienced pressure to fabricate and to falsify data, and one had experienced pressure to plagiarize data. On average 60% of the respondents were uncertain whether their department had a written policy concerning scientific conduct. About 11% of the respondents had experienced unethical pressure concerning the order of authors during the last 12 months. 10% did not find it inappropriate to report experimental data without having conducted the experiment and 38% did not find it inappropriate to try a variety of different methods of analysis to find a statistically significant result. 13% agreed that it is acceptable to selectively omit contradictory results to expedite publication and 10% found it acceptable to falsify or fabricate data to expedite publication, if they were confident of their findings. 79% agreed that they would be willing to report misconduct to a responsible official.

Conclusion

Although there is less scientific dishonesty reported in Norway than in other countries, dishonesty is not unknown to doctoral students. Some forms of scientific misconduct are considered to be acceptable by a significant minority. There was little awareness of relevant policies for scientific conduct, but a high level of willingness to report misconduct.

Perspective: research misconduct: the search for a remedy

Research misconduct-fabrication, falsification, and plagiarism-is an insidious problem in the scientific community today with the capacity to harm science, scientists, and the public. Federal agencies require that research trainees complete a course designed to deter such behavior, but the author could find no evidence to suggest that this effort has been effective. In fact, research shows that most cases of misconduct continue to go unreported.The author conducted a detailed examination of 146 individual Office of Research Integrity reports from 1992 to 2003 and determined that these acts of misconduct were the results of individual psychological traits and the circumstances in which the researchers found themselves. Therefore, a course in research misconduct, such as is now federally mandated, should not be expected to have a significant effect. However, a course developed specifically for support staff, who currently do not receive such training, might prove effective.Improving the quality of mentoring is essential to meaningfully deal with this issue. Therefore, the quality of mentorship should be a factor in the evaluation of training grants for funding. In addition, mentors should share responsibility for their trainees' published work. The whistleblower can also play a significant role in this effort. However, the potential whistleblower is deterred by a realistic fear of retaliation. Therefore, institutions must establish policies that acknowledge the whistleblower's contribution to the integrity of science and provide truly effective protection from retaliation. An increase in whistleblowing activity would provide greater, earlier exposure of misconduct and serve as a deterrent.

Science at the Crossroads: Fact or Fiction?

Modern Academic Science is largely based on the formulation of hypotheses that are then confirmed through observations and experiments. There is little scope forcuriositythat played an important role in early Science. Results carrying negative implications are not easy to publish, and hypotheses have a tendency to take on the mantra of religious beliefs. Academic Science is facing on many fronts pressures that hardly existed in the past. Financial rewards apart from salary can be very high, in the form of fees for consultants, expert legal witnesses, patent development, and even the establishment of private companies. Commercial funding forms a significant percentage of the Total Research Budgets in Science and Medicine, but this often leads to loss of control over research protocols and freedom to communicate the results. Media attention confers fame and prestige that is assiduously sought out by some individual scientists, often supported by University resources, and Press Conferences prior to or synchronous with actual publication. Scientists have long been employed full-time by Government Departments, but research contracts are being increasingly offered by the latter to academic staff on a part-time basis. These pressures and opportunities, together with the priority given to research by most University Tenure and Promotion Committees, are tending to diminish the appetite of scientists for other important responsibilities such as teaching and administration. In a few decades, University scientists have moved from the »Ivory Tower« to the High Street, and many are serving more than one master. The above scenario may bring increased remuneration and the pursuit of research that would be too expensive without these external sources, but adverse consequences have also occurred. They may lead to the complicity of scientists, through no fault of their own, in the introduction of drugs and supplements that: a) fail to deliver the benefits claimed; b) increase the risk of some unrelated illness; c) possess dangerous side effects not known or reported at the time of introduction. Examples include hormone replacement therapy and antioxidant vitamins (A and E) to protect against Coronary Heart Disease; dietary fibre to prevent colon cancer; and arguably calcium supplements to treat osteoporosis. On occasions, academic scientists have served as fronts for the publication by the manufacturers of falsified reports minimizing the risk of serious drug side-effects to ensure Regulatory Approval, as occurred with Vioxx in the treatment of arthritis, and Seroquel for schizophrenia and bipolar depression. Individual fraud or misconduct is more frequent than suspected, because most incidents are without major impact and are suppressed by Universities and Funding Agencies. Major scandals are rare, but may have serious repercussions for the general public and bring science into disrepute. Recent examples include: the Cold Fusion controversy (Low Energy Nuclear Reaction); the link age by Andrew Wakefield of autism with Rubella vaccination; the infamous creation of stem cells by somatic cell nuclear transfer falsely reported by Hwang Woo-Suk. Fraud by commercial companies is subject to the full force of the law, but Science is treated as a self-regulating profession, and as such the punishments handed out are relatively trivial. In essence, Science prior to 1950, except in North America, proceeded along a highway that segregated the traffic into Commercial, Government and Academic streams, and passed through inspiring landscapes and green pastures. It later came to a crossroads from which the alternative road led to the Marketplace, and on which segregation into the above three streams was not enforced. It has now become the main thoroughfare for Science world-wide, but there are reasons to believe that this has increased the incidence of dangerous driving and traffic accidents in the form of conflicts of interest, unethical behaviour, misconduct and even fraud. It may be too late to return to the crossroads and continue along the original highway, but there could be considerable merit in restoring the original segregation between the three streams of Science and in developing, as well as enforcing, a stricter code of behaviour, for which some elements are proposed.

The legacy of the Hwang case: research misconduct in biosciences

This paper focuses on the infamous case of Hwang Woo Suk, the South-Korean national hero and once celebrated pioneer of stem cell research. After briefly discussing the evolution of his publication and research scandal in Science, I will attempt to outline the main reactions that emerged within scientific and bioethical discourses on the problem of research misconduct in contemporary biosciences. What were the ethical lapses in his research? What kind of research misconduct has been identified? How this kind of misconduct affects scientific integrity? How to avoid it? Focusing on these questions, the paper interprets the Hwang's case as a case study that might shed light on the worst aspects of highstakes global science. This case presents a group of problems that might endanger scientific integrity and public trust. Regulatory oversight, ethical requirements and institutional safeguards are often viewed by the scientific community as merely decelerating scientific progress and causing delays in the application of treatments. The Hwang's case represents how unimpeded progress works in contemporary science. Thus, the case might shed light on the often neglected benefits of "the social control of science".

Research misconduct

Good research practice is important to the scientific community. An awareness of what constitutes poor practice is important. Various types of research misconduct are defined in this article. The extent of research misconduct in the field of radiology has been assessed by contacting five English language radiology journals. Redundant or duplicate publication has been reported infrequently, Radiology (1), American Journal of Roentgenology (3), Clinical Radiology (3), British Journal of Radiology (2) and European Radiology (1). The issue of how the radiology community might tackle research misconduct is discussed with reference to guidance from the Medical Research Council, the Wellcome Trust and the Committee of Publication Ethics.

Publication ethics in gastroenterology and endoscopy

Research and the publication of research findings must be performed within an ethical framework of the highest standards. Although the majority of these principles would be regarded by most as being 'common sense', it is apparent that both research and publication misconduct occurs too frequently not to provide clear guidance as to what is expected by all involved in the research and publication arena. This review covers a variety of topics including study design and ethical approval, data analysis, authorship, conflict of interest, the peer review process, redundant publication, plagiarism, duties of editors, media relations, advertising and how to deal with misconduct.

Misconduct in medical research: whose responsibility?

Abstract Examples of many types of misconduct in medical research continue to be reported. The true incidence is unknown because there is strong evidence of under-reporting as well as suggestions of increased detection. Risks to research participants may also be increasing, with contributing factors such as increased pressure on researchers to publish and to produce commercialization of their research. Institutions are perceived to typically respond slowly and inadequately to allegations of research misconduct. More could be done to try to prevent such mis-conduct, such as: (i) educating researchers about research ethics, (ii) assisting and protecting whistleblowers and (iii) instituting processes to adequately and promptly investigate and deal with allegations. In addition, a debate needs to take place as to whether research misconduct allegations should be dealt with at the institutional level or at a national level and whether medical boards should be routinely involved in the more serious breaches of ethical standards by medical practitioners engaged in research.

Dishonesty, misconduct and fraud in clinical research: an international problem

Clinical research misdemeanours include a broad spectrum of misdeeds that misappropriate an unfair advantage or harm the rights of others. There is no internationally accepted definition of such malpractices and no generalized procedure to facilitate their reporting or correction. Those who do report research misdemeanours are often stigmatized as 'whistleblowers', a term that has acquired many negative connotations. Frequently, whistleblowers encounter many personal conflicts and/or may suffer victimization in their working environment. There remains a need for an internationally harmonized approach to manage these unacceptable problems. Resolution of such important issues should be catalysed by the impending need for European Union states to implement Good Clinical Practice Directive 2001/20/EC into national law.

The true and the false: pixel-byte syndrome

The possible use of retouched images for fraudulent purposes in scientific articles, posters, and conferences is not a future but a present possibility (probably already used) that poses serious questions as to the need for additional control mechanisms other than scientific peer quality review in evaluating and accepting articles. We propose the term "pixel-byte syndrome" to illustrate how easy it might be to electronically create a new syndrome for fraudulent purposes. The aim of this article is to stimulate discussion among professionals, add some examples of easy-to-realize frauds and sow the seeds of doubt in the minds of some of the referees of journal articles and the scientific secretariat of congresses in reviewing digitally retouched images.

Research ethics: ethical issues of data reporting and the quest for authenticity

The search for truth and its unbiased reporting are ultimate goals of conducting scientific research. Ideally, the reporting of research data ought to be an objective task. In practice, however, it is fraught with numerous statistical and ethical pitfalls, seldom addressed in formal emergency medicine training. The lure of academic celebrity and related influences may persuade researchers to report results in ways that make data appear more interesting, or worthy of publication. Several examples of potentially misleading data reporting are illustrated, including using inappropriate statistical tests, neglecting negative results, omitting missing data points, failing to report actual numbers of eligible subjects, using inappropriate graph labels or terminology, data dredging, and others. Although potentially inaccurate or inflated methods of data reporting may not constitute overt scientific misconduct, the intentional misrepresentation of data is a form of fraud or deception. Publicly funded academic inquiry is a privilege and honor enjoyed by a trusted few. Regardless of outcome, every effort should be made to report data in the most scientifically accurate method. To this end, the Society for Academic Emergency Medicine Code of Conduct and American College of Emergency Physicians Code of Ethics provide important guidance toward the accurate, compassionate, competent, impartial, and honest conduct of scientific research. Accuracy and authenticity in data reporting are first and foremost a matter of individual integrity, and are crucial to the preservation of academic credibility, the protection of future patients, and the public's trust in the medical research enterprise.

High-dose chemotherapy for high-risk primary breast cancer: an on-site review of the Bezwoda study

BACKGROUND

The efficacy of high-dose chemotherapy with progenitor-cell rescue for women with breast cancer is a controversial issue. Although historically controlled trials have suggested a survival advantage for high-dose chemotherapy, several randomised studies have yet to confirm this advantage. Two studies, however, by Bezwoda, of patients with high-risk and metastatic disease, seemed to show a significant survival advantage for high-dose compared with conventional-dose chemotherapy for metastatic and high-risk primary breast cancer.

METHODS

To corroborate the study results before starting a large international confirmatory study, a US team did an on-site review of records for patients in the high-risk study. Limited numbers of records were made available for review, all of which were for patients who received the high-dose-chemotherapy regimen.

FINDINGS

There was much disparity between the reviewed records and the data presented at two international meetings. In addition, the reviewers saw no signed informed consent, and the institutional review committee had no record of approval for the investigational therapy. After the site visit, Bezwoda admitted scientific misconduct by using a different control chemotherapy regimen from that described in presented data.

INTERPRETATION

The Bezwoda study should not be used as the basis for further trials to test the efficacy of the cyclophosphamide, mitoxantrone, etoposide regimen for high-dose chemotherapy in women with high-risk primary breast cancer. This review validates the essential nature of on-site audits, especially in single-institution studies.