ACADEMIC EMERGENCY MEDICINE • June 2000, Volume 7, Number 6 691

SPECIAL CONTRIBUTIONS

Research Ethics: Ethical Issues of Data Reporting andthe Quest for Authenticity

CATHERINE A. MARCO, MD, GREGORY L. LARKIN, MD, MS, MSPH

Abstract. The search for truth and its unbiased re-porting are ultimate goals of conducting scientific re-search. Ideally, the reporting of research data oughtto be an objective task. In practice, however, it isfraught with numerous statistical and ethical pitfalls,seldom addressed in formal emergency medicinetraining. The lure of academic celebrity and relatedinfluences may persuade researchers to report resultsin ways that make data appear more interesting, orworthy of publication. Several examples of potentiallymisleading data reporting are illustrated, includingusing inappropriate statistical tests, neglecting neg-ative results, omitting missing data points, failing toreport actual numbers of eligible subjects, using in-appropriate graph labels or terminology, data dredg-ing, and others. Although potentially inaccurate or in-flated methods of data reporting may not constituteovert scientific misconduct, the intentional misrep-

resentation of data is a form of fraud or deception.Publicly funded academic inquiry is a privilege andhonor enjoyed by a trusted few. Regardless of out-come, every effort should be made to report data inthe most scientifically accurate method. To this end,the Society for Academic Emergency Medicine Codeof Conduct and American College of Emergency Phy-sicians Code of Ethics provide important guidance to-ward the accurate, compassionate, competent, impar-tial, and honest conduct of scientific research.Accuracy and authenticity in data reporting are firstand foremost a matter of individual integrity, and arecrucial to the preservation of academic credibility, theprotection of future patients, and the public’s trust inthe medical research enterprise. Key words: ethics;research; data reporting; authenticity. ACADEMICEMERGENCY MEDICINE 2000; 7:691–694

CASE PRESENTATION

Dr. A. wanted desperately to get an abstract ac-cepted for presentation at an upcoming researchmeeting. His angst was amplified by his need forone more publication in order to reach his quota forpossible promotion, not to mention the exotic venueand the recognition he would receive in his insti-tution’s newsletter. Due to time constraints, his sub-mission to the local institutional review board(IRB) was written somewhat haphazardly and sub-mitted very late. Although IRB approval wasgranted, there was too little time to allow adequatedata collection. Two days before the abstract sub-

From the Department of Emergency, St. Vincent Mercy Medi-cal Center (CAM), Toledo, OH; and Department of EmergencyMedicine, Mercy Hospital/University of Pittsburgh School ofMedicine (GLL), Pittsburgh, PA.Received January 4, 2000; accepted January 10, 2000.Section editor: James G. Adams, MD, Senior Associate Editor,Academic Emergency Medicine, Harvard Medical School, Bos-ton, MA.Address for correspondence and reprints: Catherine A. Marco,MD, St. Vincent Mercy Medical Center, Department of Emer-gency Medicine, 2213 Cherry Street, Toledo, OH 43608. Fax:419-841-1587; e-mail: cmarco2@aol.comA related commentary appears on page 689.

mission deadline, as computer keyboards in emer-gency medicine offices nationwide clattered away,he and his colleagues felt pressured to present thedata in the best light possible. Because the resultsappeared more favorable with a one-tailed test, hereported these results rather than the more appro-priate two-tailed test. He performed as many sta-tistical tests as his computer program would allow,and then reported only those that were most signif-icant. Because one of the statistical tests ap-proached statistical significance, he surmised thatwith larger numbers, statistical significance wouldbe reached, and so reported a trend toward statis-tical significance, in the absence of a rational poweranalysis. To further camouflage his small numbersof subjects, he reported percentages, omitted rawnumbers, and adjusted the graph axes to magnifysmall differences between groups.

MOTIVATION TO CONDUCTSCIENTIFIC RESEARCH

There are numerous factors that may motivate ac-ademicians to conduct scientific research. Perhapsthe most laudable motivation is the desire to bringto light information that will contribute to the body

692 DATA REPORTING Marco, Larkin • ETHICS OF DATA REPORTING

of medical knowledge and ultimately benefit pa-tient care in a meaningful way. However, all re-searchers experience external forces that promoteor prevent the promulgation of quality research.Several examples of these external motivationalforces may include:1. Departmental publishing requirements.2. Requirements for promotion.3. Competitive pressures.4. Institutional, regional, and national recogni-tion.5. Financial remuneration.6. Media publicity.

The elimination of external forces in academiccenters is unrealistic. Rather, individual research-ers must strive to remain cognizant of these biases,and attempt to minimize their influence on thepursuit of truth. The validity and intellectual hon-esty of conducting and reporting analysis are crit-ical, since the ramifications of published data, ac-curate or misleading, may have consequences foryears to come. Any misrepresentation, whetherovertly fraudulent, or merely inflated, may carryboth short-term and long-term ramifications, andmay adversely affect the integrity of the academicenterprise, and potentially even the well-being offuture patients.

ETHICAL ISSUES OFDATA REPORTING

Although many consider the reporting of researchdata to be a purely objective task, the availabilityof numerous statistical analysis techniques and re-porting techniques presents numerous options,some of which are more scientifically valid and eth-ical than others.

External forces may negatively impact the hon-est and accurate reporting of research data. Re-searchers may wish to present their work in themost favorable light to improve chances of accep-tance for publication or presentation. Although allof the following examples may not necessarily beimmoral or unethical, a few potential examples ofinaccurately reporting data may include:1. Failing to include number of eligible partici-pants. For example, if a large number of eligibleparticipants refused consent, or were not includedfor other reasons, failure to report this may falselymislead the reader to believe that study partici-pants are representative of the entire body of eli-gible participants.2. Inaccurate reporting of missing data points. Forexample, in a study with a large number of partic-ipants, but high fractions with missing data points,the reporting of data could be manipulated to cam-ouflage missing data points.3. Failing to report all pertinent data. Some re-

searchers purposely neglect to report sections ofdata that are inconsistent, or unexplainable, withother results. This unscientific selection of datapoints is misleading.4. Failing to report negative results. Although pos-itive results appear more interesting, and maycarry increased probability of acceptance for pub-lication, negative results are scientifically as im-portant to report. A failure to demonstrate a sta-tistically significant difference between groups isnot a failure to demonstrate meaningful results.Demonstration of negative results may be valuableto the medical community, and may obviate theneed for additional financial or time investmentsfrom other researchers. Particularly in this era ofcost containment, the demonstration of a lack ofbenefit of a new therapy may be valuable.5. Allowing research sponsors to influence report-ing of results. For example, pharmaceutical spon-sors may pressure researchers to report only re-sults favorable to their product or may prohibitpresentation or publication of the results alto-gether.6. Inappropriate graph labels. For example, show-ing only a fraction of the y-axis scale, or unclearaxis labeling, may magnify small differences be-tween data points.7. Reporting percentages rather than actual num-bers. Although this may be appropriate in somecases, if the intent is to deceive, it represents in-accurate and perhaps unethical reporting.8. Reporting results of inappropriately applied sta-tistical tests. For example, several statistical testsmay be applied to the same data set, and the re-searcher may elect to report only the test thatyielded the most favorable results, rather than de-termining a priori the most appropriate statisticaltests to use.9. Reporting differences, when statistical signifi-cance is not reached. For example, although thep-value is not significant, some researchers reporta ‘‘trend’’ toward significance. This is inaccurate,as, per convention, unless otherwise stated, a p-value $ 0.05 is accepted as not significant; that is,a difference was not found. Some authors suggestthat reporting confidence intervals is a superiormethod of reporting, because of improved infor-mational content, in a more explicit and preciseformat.1,2

10. Reporting no difference, when power is inade-quate. If the study sample size is too small, a typeII error may be committed. Although power of 0.8is acceptable by convention, this allows a 20%chance of incorrectly accepting the null hypothesis.In some cases, researchers should consider beingmore fastidious, and strive for a power of 0.9 orhigher. In any case, alpha and beta should be con-sidered prior to beginning the study and a deter-

ACADEMIC EMERGENCY MEDICINE • June 2000, Volume 7, Number 6 693

mination should be made of what type I or type IIerrors are acceptable.11. Data ‘‘dredging.’’ Although for some studies,multiple looks at the data may be appropriate,merely performing multiple tests to search for sig-nificant associations can be misleading and statis-tically inaccurate. If multiple comparisons areused, correction should be performed, using a testsuch as the Bonferroni or Scheffe methods.3

12. Splitting data into multiple publications. Re-lated data from a single study are usually mostpowerful when presented in a single publication,although this may not always be feasible, espe-cially in abstracts. Splitting data into multiplepublications, merely for the purpose of increasednumber of publications, is unethical and should beavoided.13. Inappropriate use of terminology without pre-cise definitions. For example, words such as‘‘rarely’’ and ‘‘commonly’’ may have differing im-plied meanings to researchers and readers. If only48% of patients had a given outcome, it is probablymisleading to report this occurred ‘‘rarely.’’14. Reporting conclusions that are not supportedby data. Opinion or conjecture should not be pre-sented as research findings.15. Ignoring citations or prior work that challengestated conclusions or call current findings intoquestion. Rather than considering disparate cita-tions as a threat, they may be used as importantcomponents of discussion.16. Inflation of research results for the media. Al-though media coverage of significant research isimportant, the quest for a pithy soundbite oughtnot supersede the duty to accurately portray find-ings in the most intellectually honest way.

Many researchers claim to conduct scientificallyaccurate and honest research, but may fail to re-alize that such exaggerations and errors as listedabove may in fact constitute an element of scien-tific misconduct.4–7 Although the methods of de-signing the research study, obtaining institutionalapproval, obtaining informed consent, and appro-priate study methods are all crucial to the perfor-mance of scientifically accurate and ethically legit-imate research, the honest and accurate reportingof data is also an essential component.8,9 In fact,scientific fraud, in any form, sows seeds of myththat may plague future generations of cliniciansand researchers, and may take decades to debunk.Thus, we sin twice; against our divinity within andthe honored profession without.

Reviewers, editors, and publishers involved inthe peer-review and publication processes sharethe burden of responsibility for the disseminationof accurate, relevant research data. Recognition ofpotential inaccurate data reporting methods is animportant part of the peer-review process.

DUTY TO SOCIETY

In addition to the self-motivating elements thatdrive researchers to pursue meaningful academicinquiry, a societal duty to conduct and report re-search accurately must be recognized. Unambigu-ous public funding (such as National Institutes ofHealth or Centers for Disease Control and Preven-tion grants) creates an obvious public duty to em-brace rigorous integrity in the conduct of medicalresearch. Additionally, other more camouflagedpublic funding, such as government support ofmedical education, graduate medical education,hospital support, and government-funded medicalinsurance, must also be recognized. These multi-valent contributions from the public purse providean optimal environment for researchers, which inturn creates a social contract, an onus that re-searchers have to steward hospital, laboratory, andpatient resources wisely. The accurate and honestreporting of research results is an important ele-ment of fulfilling this social contract.

THE QUEST FOR AUTHENTICITY

Authenticity and honesty are crucial toward pre-serving individual integrity, as well as that of theentire scientific enterprise. The true scientist rev-els in the pursuit of truth and knowledge. The in-ternal satisfaction derived from accurate and sig-nificant scientific findings (including negativestudies) should transcend potential disappoint-ments, such as lack of media coverage, rejection bycertain publications, or lack of approval from col-leagues. In fact, the importance of many scientificdiscoveries initially went unrecognized. A sincereresearcher realizes that the quality of work is moreimportant than the quantity of publications andpresentations, which may not accurately reflect thesignificance of the research findings.

Although external forces can have far-reachingeffects on actions involving data reporting, it is theinternalization of those external influences that al-lows these phenomena to occur. Similarly, the res-olution of these issues must also come from within,from the quest for scientific authenticity.

Several steps may be taken toward ensuringthe scientifically and ethically most valid reportingmethods. One method is the advance determina-tion of the most appropriate statistical and report-ing techniques. Some advocate that a research pa-per can be written in large part prior to datacollection, with only specific numbers missing, tobe filled in after data collection. A carefully for-mulated research question and study design en-ables the investigator to establish scientificallyvalid statistical analysis, possible results, and con-clusions, prior to the potential influence of external

694 DATA REPORTING Marco, Larkin • ETHICS OF DATA REPORTING

forces on reporting methodology. The Society forAcademic Emergency Medicine Code of Conduct10

and American College of Emergency PhysiciansCode of Ethics11 provide important guidance to-ward the accurate, compassionate, competent, im-partial, and honest conducting and reporting of re-search results.

Researchers not only should take care to avoidevery aspect of scientific misconduct in research,but should take responsibility for mentoring younginvestigators regarding appropriate scientific con-duct, and for reporting and investigating allegedscientific misconduct.12 Researchers should beaware of and support institutional compliance pro-grams that help to promote accurate and honestresearch.13

CONCLUSIONS

An academic inquiry is a privilege and an honor,to be guarded like a sacred trust. The influence ofdata reporting on current and future generationsmust never be underestimated. Although all re-searchers experience both internal and externalforces that may influence the conduct of scientificresearch, every attempt should be made to recog-nize such forces, and resist their influence. Re-searchers should avoid conducting empty researchunlikely to result in meaningful knowledge, andconsider potentially better application of time andresources to other academic or personal endeavors.The reporting of data should be done with honestyand integrity, and every effort should be made toreport data in the scientifically most accuratemethod. Only conclusions that are supported by ac-

curate data should be stated, in efforts to preservethe integrity of medical research, to protect futurepatients, and the public’s trust in the research es-tablishment.

The authors gratefully acknowledge the input and editorial as-sistance of Susan S. Fish, PharmD, MPH.

References

1. Gallagher EJ. p < 0.05: threshold for decerebrate genuflec-tion [commentary]. Acad Emerg Med. 1999; 6:1084–7.2 Glantz SA. Primer of Biostatistics (3rd ed). Boston: NEJMBooks, 1992, pp 181–200.3. Lang TA, Secic M. How to Report Statistics in Medicine.Annotated Guidelines for Authors, Editors, and Reviewers.Philadelphia: American College of Physicians, 1997, pp 65–92.4. Report of the Commission of Research Integrity. Integrityand Misconduct in Research. Washington, DC: US Departmentof Health and Human Services, Public Health Service, 1995.5. Engler RL, Covell JW, Friedman PJ, et al. Misrepresenta-tion and responsibility in medical research. N Engl J Med.1987; 317:1383–9.6. Evans I. Conduct unbecoming—the MRC’s approach. BrMed J. 1998; 316:1728–9.7. Dresser R. Defining scientific misconduct: the relevance ofmental state. JAMA. 1993; 269:895–7.8. Fish SS. Research ethics in emergency medicine. Am MedClin North Am. 1999; 17:461–74.9. Nylenna M, Andersen D, Dahlquist G, et al. Handling ofscientific dishonesty in the Nordic countries. Lancet. 1999; 354:57–61.10. Larkin GL, for the SAEM Ethics Committee. A code of con-duct for academic emergency medicine. Acad Emerg Med.1999; 6:45.11. American College of Emergency Physicians. Code of Ethicsfor Emergency Physicians. Dallas, TX: ACEP, 1997.12. Biros MH, Fish SS, Taggart P. Research fundamentals VI:misconduct in biomedical research. Acad Emerg Med. 1999; 6:840–8.13. Grant G, Guyton O, Forrester R. Creating effective re-search compliance programs in academic institutions. AcadMed. 1999; 74:951–71.