Letters

Do Researchers Learn to Practice Misbehavior?

To the Editor:

Those of us with recent experience in clinical research in any country will not be surprised at the findings of Elizabeth Heitman and her colleagues ("Do Researchers Learn to Overlook Misbehavior?" HCR, Sept-Oct 2005). We are familiar with misbehaviors—some serious—and we know from experience that training in research methodology and ethics has little impact. For reasons of personal and institutional self-interest, such training has a tendency to focus on securing approval for studies and publication of interesting results.

But there's more. Heitman et al. are concerned that "universities cannot rely only on the traditional apprenticeship system and role modeling to transmit standards of scientific integrity to trainees." Yet the apprenticeship may be a part of the problem. In part, the reason trainees might keep inadequate records, change methodologies, or drop data that they believe to be erroneous, even though they have been trained to be so scrupulous, is that we are often actively encouraged to do so by those to whom we are apprenticed. I have direct experience (outside the United States, but in a developed country with a comparable academic culture balancing research scrutiny with pressure to undertake and publish research) of: instructions to write mendacious descriptions of interview methodology; patients being misled into participating in research or being recruited under threat of inferior care; instructions to revisit data that appeared inconsistent with the working hypothesis, an inconsistency that was apparent only because mid-study comparisons were being made in violation of a blinded protocol; having decisions on whether to submit work for publication being taken on the basis of whether the study results were "positive"—the most direct form of publication bias that inevitably leads to grossly misleading aggregate evidence in the literature; my inclusion by eminent researchers as a coauthor of papers that I had not even read, in violation of the codes of the journals in which the work was published; exclusion from research groups and from publication of previously undertaken collaborative work as a direct and explicit consequence of raising concerns about some of these irregularities; and stern warnings from senior colleagues (whose own behavior is scrupulous) that I would risk serious harm to my future research and clinical career if I rocked any more boats. I heeded these warnings because I know people who did not—people whose careers, and sometimes lives, are broken.

Training for researchers is necessary and must be aimed at shaping attitudes to—not just knowledge of—responsible conduct of research (RCR). But it is insufficient. Too much misbehavior is taught by the example of some misbehaving teachers and researchers. We should expect deep-seated opposition to discussion of any new rules in this area, but we must consider them simply because their unwritten spirit is so widely flouted. In developing our understanding of what it means to research ethically—and alongside the evolution of our understanding of other important concepts discussed in this issue, such as coercion, consent, and equipoise—we must give urgent consideration to some key questions. How do we remove from senior researchers the incentives to misbehave, including having their progression and tenure dependent on the quantity of their published work? Should we require that research is separated more rigorously from clinical care, perhaps even that clinicians do not undertake research on their own patients, so that professional relationships cannot be abused in recruiting subjects or in creatively reinterpreting results? How do we improve the oversight of clinical research, going beyond mere scrutiny of study design with too exclusive a focus on patient protection and insufficient attention to honesty? Perhaps most importantly, how do we protect trainees from being encouraged to develop behaviors which they know to be wrong, and how do we protect witnesses to research misconduct from retribution or fear of retribution if they speak up? Only by answering these questions, alongside RCR training, can we secure lasting improvements in research conduct.

Anonymous

The Debate over Liberal Eugenics

To the Editor:

Bernard Prusak clarifies and deepens Jürgen Habermas's critique of liberal eugenics; namely that, when the technologies permitting it...