Publish or Perish

Neglecting to report health research can lead to distorted clinical-practice recommendations, suffering, and death. Yet failure to publish results remains by far the most common form of scientific and ethical misconduct in health research.

OXFORD – A few years ago, two Norwegian researchers presented their version of a scientific-research slippery slope, with honest errors (mistaken observations and analyses) at the top and intentional fraud (plagiarism, falsification, and fabrication) at the bottom. They placed “publication bias” about halfway down the scale – but it should have been much lower. Indeed, failure to publish research results is by far the most common and worrying form of scientific and ethical misconduct in health research – and it has had lethal consequences.

Anecdotal evidence of publication bias has existed for a long time. But, as requirements for registering clinical trials have become more stringent, its magnitude has become quantifiable: the results of at least half of the clinical trials involving patients and healthy volunteers remain unpublished years after completion. Studies with “negative” results are particularly unlikely to see the light of day. But neglecting to report research can lead to distorted clinical-practice recommendations, suffering, and death.

For example, anti-arrhythmic drugs were prescribed widely – with the United States Food and Drug Administration’s approval – to heart-attack victims for more than a decade, under the assumption that reducing heart-rhythm abnormalities would decrease mortality rates. But, as the investigative journalist Thomas J. Moore reported in his book Deadly Medicine, at the peak of their use, these drugs were killing more Americans each year than were killed during the entire Vietnam War.

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