Reproducibility and research misconduct: time for radical reform

We know now that much health and medical research which is published in peer-reviewed journals is wrong,[1] and consequently much is unable to be replicated.[2-4] This is due in part to poor research practice, biases in publication, and simply a pressure to publish in order to ‘survive’. Cognitive biases that unreasonably wed to our hypotheses and results are to blame.[5] Strongly embedded in our culture of health and medical research is the natural selection of poor science practice driven by the dependence for survival on high rates of publication in academic life. It is a classic form of cultural evolution along Darwinian lines.[6, 7] Do not think that even publications in the most illustrious medical journal are immune from these problems: the COMPare project[8] reveals that more than 85% of large randomised controlled trials deviate seriously from their plan when the trial was registered prior to its start. An average of more than five new outcome measures was secretly added to the publication and a similar number of nominated outcomes were silently omitted. It is hardly far-fetched to propose that this drive to publish is contributing to the growth in the number of papers retracted from the literature for dubious conduct[9] along with the increasing number of cases of research misconduct.