Britain prefers talk to action

The first article in Britain on the subject of research misconduct was published about 23 years ago.¹ Unfortunately, after 23 years we in Britain have got nowhere near tackling research misconduct. The clear signs are that we are not about to get the national body which other countries have had for years, and which our medical mandarins have continually promised us.

We have had a report from the Royal College of Physicians²—which wasn't implemented; we had fine words in a report from the Royal College of Physicians of Edinburgh,³ about which nothing has been done; and we have had undertakings from the Academy of Medical Sciences, which again haven't been addressed. And this is rather strange if you look at the mission statements of these bodies. The Royal College of Physicians of London states that for over 450 years it has had a pivotal role in maintaining standards of medical practice in hospitals in England, Wales, and Northern Ireland. The Edinburgh college speaks of "promoting the highest standards of internal medicine around the world," while the Academy of Medicine states that it "campaigns for better structures in support of the medical sciences, promotes excellence in research, provides scientific advice, and encourages better communication of science." Surely none of these mission statements can escape a responsibility for the active prevention and management of research misconduct. So far we have tried argument—and it's failed. Why is Britain so behind the rest of the world? Can we come up with some proposals for action?

We have a tradition in this country in following that delicious practice of dolce far niente, doing nothing at all in a very gentle fashion. It is true that this phrase is usually applied to practice in Italy. But instead it is quite obvious that, except where it comes to making unjustified wars, as a nation, the British are the masters in preferring talk to action. Many advances in everyday life have taken scores if not hundreds of years. When the Royal Society was formed in 1660, for example, it owned two black slaves; the abolition movement started in Pennsylvania in 1688 and was copied in England by the Quakers in 1783, but slavery was abolished only in 1834. Fulminations against the smoking chimneys of London went on for centuries, but it took a great smog and the deaths of hundreds of people with bronchitis in 1952 to bring about the Clean Air Acts. A hundred and fifty years ago the Thames had been known for decades to be an open sewer dangerous to health. Yet it took the Great Stink in 1858, which forced parliament to stop sitting, to get Joseph Bazalgette to provide London with main drainage, completed in 1875. Despite years of talk, even today we are still a long way, say, from any Freedom of Information Act or any reasonable reform of the House of Lords. In medicine we still have the half hearted attempts at major restrictions on cigarette smoking in public as well as the lingering permissions on advertising.

Why as a nation are we so slow to follow the rest of the world in introducing obviously needed and proved reforms? I believe that we British have a fundamental smugness and complacency. Listen to any Today programme on Radio 4. Almost certainly you will hear some politician say in response to a difficult question—"After all, I think it's generally acknowledged that we have the best army/transport system/health service/teaching profession/financial regulation in the world"—all without being challenged or asked for evidence. Similarly, then, some people believe that misconduct doesn't occur in Britain—or if it does is confined to badly educated, single handed general practitioners.

More serious is what Senator William Fulbright called the "arrogance of power"—that is to say, the people whom we have elected as leaders of our country or our profession come to believe that they can act independently of general opinion or logical arguments. We see the arrogance of power in the British medical mandarin's approach to research misconduct. One can understand the glitterati's reluctance to deal with such dirty linen. It needs courage, persistence, and involvement. Investigating research misconduct is an unhappy business. In the last 10 years I have served on two inquiry panels. Both took an inordinate amount of time, not only for the actual hearings, but also for reading all the documents. For a retired person, the time was there. But for someone active and expert in their field, to devote so much time to a delicate and unpleasant situation is not easy, particularly if the accused is accompanied by a clever lawyer who can run rings round the committee members. Unless you have sufficient, experienced, and willing backup it is likely that any such process will founder in the individual case. We must have encouragement from our mandarins that taking part in inquiries is an essential component of professional life and crucially such activity must be based on a permanently established body for reasons that we all know about. Otherwise we are condemned to perpetuate dishonest and unethical practices, let alone being a laughing stock to those who have solved these problems some time ago.

What do we need to make progress? I believe that two features are required. Firstly, we need a major scandal in the public domain. For example, some dramatic deaths clearly resulting from research misconduct. These would get repeated coverage in the media, with repeated calls for the medical mandarins finally to take some action on agreed lines. Secondly, we need a leader of charisma to badger and provoke his colleagues into action. To put it briefly, this needs a medical Mandela, rather than a Mbeki. (This isn't being insulting—after all, most of us are Mbekis, or achieve comparably much less than he has.) The trouble is that medical Mandelas are as short on the ground as political ones.