Layton F. Rikkers, MD, FACS

In his insightful book “The Wisdom of Crowds” (New York: Anchor Books, 2004), James Surowiecke makes the convincing argument that many heads are wiser than one, even if that one is the sole expert regarding the subject under discussion. As long as the decision-making group is diverse, with each individual being allowed to come to an independent conclusion, this tenet appears to hold, whether the group is estimating the number of jelly beans in a jar or resolving a difficult issue. The message is clear: As a leader your leadership will be more effective if you solicit input from all members of your group, including those who may be reluctant to offer it.

In another excellent book, “Quiet” (New York: Crown Publishers, 2012), Susan Cain posits that, from early in the 20th century on, despite the considerable value it has to offer, introversion has become a “second-class personality trait.” Although highly valued earlier in our history, the thoughtful, introspective temperament was replaced by the aggressive, decisive character as the ideal.
Emblematic of the shift that was taking place in American culture was the publication in 1936 of one of the first self-help books, “How to Win Friends and Influence People” (Dale Carnegie, New York: Simon and Schuster, 1936), which extolled the virtues of an outgoing, dominant personality. That a gregarious, sociable person was more likely to find success than a quiet, contemplative one became a part of common knowledge. The shift was so extreme that many parents became concerned when they detected shyness in their child and often attempted to correct what was thought by many to be an inferior personality trait.

Cain delves deeply into the substantial differences between extroverts and introverts, acknowledging that there are many gradations between the extremes. Extroverts tend to be loquacious and are seldom hesitant to offer their opinions on complex, difficult issues, even when their understanding of them is limited. They don’t always think before speaking and are less skilled listeners than introverts. They prefer to come to decisions rapidly, sometimes with incomplete data, and are much more decisive than introverts.

Introverts, on the other hand, prefer to listen rather than talk and to thoroughly vet an issue before reaching a decision. When they do, they are uncomfortable expressing it in a group setting. They prefer to work alone rather than in groups and, because of their thoughtful approach, their solutions to problems may be more innovative and sound than the shoot-from-the-hip, rapid answers that extroverts frequently propose. They abhor conflict and are likely to remain silent during controversy. In sum, although more difficult to elicit, obtaining input from the quiet members of the group is very worthwhile.

Often the most timely and ideal resolution is reached by balanced contributions from both personality types, the decision-making extroverts and the more thoughtful but reticent introverts. In fact, some of the best team members are those who are not on either extreme of the extrovert-introvert scale. But considering the fact that one-third to one-half of Americans are introverts (I suspect the fraction is a bit less among surgeons) and hesitant to offer their opinions in a group setting, how is this to be accomplished?

First, as a leader, you need to be sensitive to the fact that the introverts in your group are likely out of their comfort zone during communal meetings. It may even be embarrassing for them if they are called upon to offer their advice or opinion. To some degree this reluctance can be overcome by a leader who always attempts to reach consensus by valuing everyone’s opinion. Even the arrangement of the meeting room is important. The ideal is for all participants to be situated around a table rather than facing an imposing leader at the front of the room. This “leveling of the play field” emphasizes equality, de-emphasizes hierarchy, and encourages all to participate. The least likely to contribute can often be nudged from their quiet solitude by gentle urging from the leader with a statement such as: “Joe, I know you have a thoughtful perspective on this. Can you share it with the group?”

However, even the best-run meeting may not result in satisfactory resolution of difficult issues. In my experience, even those toward the extrovert end of the spectrum may be hesitant to offer their honest opinion in a meeting if it is in conflict with that of the leader. It is not uncommon to come to a consensus resolution of a controversial issue in a group meeting only to find out from hallway chatter that many disagree with the agreement reached. It is essential that the leader have access to this hallway chatter. This can be accomplished by way of confidantes who have the trust of both the troops and the leader.

During my years of leadership, a useful and productive technique I fostered to prompt input from introverts and honest assessments from all was to visit individual offices after the busy work day had quieted down, usually after 5 p.m. Meeting with individual faculty in their offices rather than in mine lent an informality to the conversation that could not be duplicated in the office of the chairman. In these one-on-one encounters, I found that even my relatively quiet faculty members felt comfortable in expressing their views regarding controversial issues facing our department. These informal chats also allowed me to become aware of problems they were facing in their professional and personal lives. They were great opportunities for mentoring and bonding as well. When these individual discussions precede what is anticipated to be a contentious group meeting, the likelihood of a successful conclusion is significantly enhanced.

Although my leadership experience was confined within the walls of academe, I believe these principles apply to anyone invited to lead a group in virtually any setting. Individual meetings are not an efficient way to lead, but they may provide a more effective and, in some cases, more rapid means of reaching consensus than innumerable group meetings with follow-up emails. When the group is too large to conference with everyone individually, one-on-one meetings with several key players may achieve the same result. During the process, don’t forget the quiet ones. They sometimes contribute the best and most innovative solutions to complex problems. There is power in quiet.

Dr. Rikkers is Editor in Chief of ACS Surgery News.

In his insightful book “The Wisdom of Crowds” (New York: Anchor Books, 2004), James Surowiecke makes the convincing argument that many heads are wiser than one, even if that one is the sole expert regarding the subject under discussion. As long as the decision-making group is diverse, with each individual being allowed to come to an independent conclusion, this tenet appears to hold, whether the group is estimating the number of jelly beans in a jar or resolving a difficult issue. The message is clear: As a leader your leadership will be more effective if you solicit input from all members of your group, including those who may be reluctant to offer it.

In another excellent book, “Quiet” (New York: Crown Publishers, 2012), Susan Cain posits that, from early in the 20th century on, despite the considerable value it has to offer, introversion has become a “second-class personality trait.” Although highly valued earlier in our history, the thoughtful, introspective temperament was replaced by the aggressive, decisive character as the ideal.
Emblematic of the shift that was taking place in American culture was the publication in 1936 of one of the first self-help books, “How to Win Friends and Influence People” (Dale Carnegie, New York: Simon and Schuster, 1936), which extolled the virtues of an outgoing, dominant personality. That a gregarious, sociable person was more likely to find success than a quiet, contemplative one became a part of common knowledge. The shift was so extreme that many parents became concerned when they detected shyness in their child and often attempted to correct what was thought by many to be an inferior personality trait.

Cain delves deeply into the substantial differences between extroverts and introverts, acknowledging that there are many gradations between the extremes. Extroverts tend to be loquacious and are seldom hesitant to offer their opinions on complex, difficult issues, even when their understanding of them is limited. They don’t always think before speaking and are less skilled listeners than introverts. They prefer to come to decisions rapidly, sometimes with incomplete data, and are much more decisive than introverts.

Introverts, on the other hand, prefer to listen rather than talk and to thoroughly vet an issue before reaching a decision. When they do, they are uncomfortable expressing it in a group setting. They prefer to work alone rather than in groups and, because of their thoughtful approach, their solutions to problems may be more innovative and sound than the shoot-from-the-hip, rapid answers that extroverts frequently propose. They abhor conflict and are likely to remain silent during controversy. In sum, although more difficult to elicit, obtaining input from the quiet members of the group is very worthwhile.

Often the most timely and ideal resolution is reached by balanced contributions from both personality types, the decision-making extroverts and the more thoughtful but reticent introverts. In fact, some of the best team members are those who are not on either extreme of the extrovert-introvert scale. But considering the fact that one-third to one-half of Americans are introverts (I suspect the fraction is a bit less among surgeons) and hesitant to offer their opinions in a group setting, how is this to be accomplished?

First, as a leader, you need to be sensitive to the fact that the introverts in your group are likely out of their comfort zone during communal meetings. It may even be embarrassing for them if they are called upon to offer their advice or opinion. To some degree this reluctance can be overcome by a leader who always attempts to reach consensus by valuing everyone’s opinion. Even the arrangement of the meeting room is important. The ideal is for all participants to be situated around a table rather than facing an imposing leader at the front of the room. This “leveling of the play field” emphasizes equality, de-emphasizes hierarchy, and encourages all to participate. The least likely to contribute can often be nudged from their quiet solitude by gentle urging from the leader with a statement such as: “Joe, I know you have a thoughtful perspective on this. Can you share it with the group?”

However, even the best-run meeting may not result in satisfactory resolution of difficult issues. In my experience, even those toward the extrovert end of the spectrum may be hesitant to offer their honest opinion in a meeting if it is in conflict with that of the leader. It is not uncommon to come to a consensus resolution of a controversial issue in a group meeting only to find out from hallway chatter that many disagree with the agreement reached. It is essential that the leader have access to this hallway chatter. This can be accomplished by way of confidantes who have the trust of both the troops and the leader.

During my years of leadership, a useful and productive technique I fostered to prompt input from introverts and honest assessments from all was to visit individual offices after the busy work day had quieted down, usually after 5 p.m. Meeting with individual faculty in their offices rather than in mine lent an informality to the conversation that could not be duplicated in the office of the chairman. In these one-on-one encounters, I found that even my relatively quiet faculty members felt comfortable in expressing their views regarding controversial issues facing our department. These informal chats also allowed me to become aware of problems they were facing in their professional and personal lives. They were great opportunities for mentoring and bonding as well. When these individual discussions precede what is anticipated to be a contentious group meeting, the likelihood of a successful conclusion is significantly enhanced.

Although my leadership experience was confined within the walls of academe, I believe these principles apply to anyone invited to lead a group in virtually any setting. Individual meetings are not an efficient way to lead, but they may provide a more effective and, in some cases, more rapid means of reaching consensus than innumerable group meetings with follow-up emails. When the group is too large to conference with everyone individually, one-on-one meetings with several key players may achieve the same result. During the process, don’t forget the quiet ones. They sometimes contribute the best and most innovative solutions to complex problems. There is power in quiet.

Dr. Rikkers is Editor in Chief of ACS Surgery News.

In his insightful book “The Wisdom of Crowds” (New York: Anchor Books, 2004), James Surowiecke makes the convincing argument that many heads are wiser than one, even if that one is the sole expert regarding the subject under discussion. As long as the decision-making group is diverse, with each individual being allowed to come to an independent conclusion, this tenet appears to hold, whether the group is estimating the number of jelly beans in a jar or resolving a difficult issue. The message is clear: As a leader your leadership will be more effective if you solicit input from all members of your group, including those who may be reluctant to offer it.

In another excellent book, “Quiet” (New York: Crown Publishers, 2012), Susan Cain posits that, from early in the 20th century on, despite the considerable value it has to offer, introversion has become a “second-class personality trait.” Although highly valued earlier in our history, the thoughtful, introspective temperament was replaced by the aggressive, decisive character as the ideal.
Emblematic of the shift that was taking place in American culture was the publication in 1936 of one of the first self-help books, “How to Win Friends and Influence People” (Dale Carnegie, New York: Simon and Schuster, 1936), which extolled the virtues of an outgoing, dominant personality. That a gregarious, sociable person was more likely to find success than a quiet, contemplative one became a part of common knowledge. The shift was so extreme that many parents became concerned when they detected shyness in their child and often attempted to correct what was thought by many to be an inferior personality trait.

Cain delves deeply into the substantial differences between extroverts and introverts, acknowledging that there are many gradations between the extremes. Extroverts tend to be loquacious and are seldom hesitant to offer their opinions on complex, difficult issues, even when their understanding of them is limited. They don’t always think before speaking and are less skilled listeners than introverts. They prefer to come to decisions rapidly, sometimes with incomplete data, and are much more decisive than introverts.

Introverts, on the other hand, prefer to listen rather than talk and to thoroughly vet an issue before reaching a decision. When they do, they are uncomfortable expressing it in a group setting. They prefer to work alone rather than in groups and, because of their thoughtful approach, their solutions to problems may be more innovative and sound than the shoot-from-the-hip, rapid answers that extroverts frequently propose. They abhor conflict and are likely to remain silent during controversy. In sum, although more difficult to elicit, obtaining input from the quiet members of the group is very worthwhile.

Often the most timely and ideal resolution is reached by balanced contributions from both personality types, the decision-making extroverts and the more thoughtful but reticent introverts. In fact, some of the best team members are those who are not on either extreme of the extrovert-introvert scale. But considering the fact that one-third to one-half of Americans are introverts (I suspect the fraction is a bit less among surgeons) and hesitant to offer their opinions in a group setting, how is this to be accomplished?

First, as a leader, you need to be sensitive to the fact that the introverts in your group are likely out of their comfort zone during communal meetings. It may even be embarrassing for them if they are called upon to offer their advice or opinion. To some degree this reluctance can be overcome by a leader who always attempts to reach consensus by valuing everyone’s opinion. Even the arrangement of the meeting room is important. The ideal is for all participants to be situated around a table rather than facing an imposing leader at the front of the room. This “leveling of the play field” emphasizes equality, de-emphasizes hierarchy, and encourages all to participate. The least likely to contribute can often be nudged from their quiet solitude by gentle urging from the leader with a statement such as: “Joe, I know you have a thoughtful perspective on this. Can you share it with the group?”

However, even the best-run meeting may not result in satisfactory resolution of difficult issues. In my experience, even those toward the extrovert end of the spectrum may be hesitant to offer their honest opinion in a meeting if it is in conflict with that of the leader. It is not uncommon to come to a consensus resolution of a controversial issue in a group meeting only to find out from hallway chatter that many disagree with the agreement reached. It is essential that the leader have access to this hallway chatter. This can be accomplished by way of confidantes who have the trust of both the troops and the leader.

During my years of leadership, a useful and productive technique I fostered to prompt input from introverts and honest assessments from all was to visit individual offices after the busy work day had quieted down, usually after 5 p.m. Meeting with individual faculty in their offices rather than in mine lent an informality to the conversation that could not be duplicated in the office of the chairman. In these one-on-one encounters, I found that even my relatively quiet faculty members felt comfortable in expressing their views regarding controversial issues facing our department. These informal chats also allowed me to become aware of problems they were facing in their professional and personal lives. They were great opportunities for mentoring and bonding as well. When these individual discussions precede what is anticipated to be a contentious group meeting, the likelihood of a successful conclusion is significantly enhanced.

Although my leadership experience was confined within the walls of academe, I believe these principles apply to anyone invited to lead a group in virtually any setting. Individual meetings are not an efficient way to lead, but they may provide a more effective and, in some cases, more rapid means of reaching consensus than innumerable group meetings with follow-up emails. When the group is too large to conference with everyone individually, one-on-one meetings with several key players may achieve the same result. During the process, don’t forget the quiet ones. They sometimes contribute the best and most innovative solutions to complex problems. There is power in quiet.

Dr. Rikkers is Editor in Chief of ACS Surgery News.

During my mostly enjoyable 14 years as editor of a mainstream surgical publication, one of my less enjoyable but necessary functions was to detect and police author misconduct. Most instances of wrongdoing involved duplicate or redundant publication or the awarding of authorship when it was not deserved. I considered these infractions to be misdemeanors. The more serious sins of plagiarism and fabrication or falsification of data were considerably less common or at least infrequently detected. Based on my experience, one might conclude that most scientific findings are reported accurately and with integrity. In other words, we should be able to believe what we read. Unfortunately this may not be the case.

Compared to prior years, the past decade has seen a 10-fold increase in the number of articles retracted from the scientific literature. Although retractions account for well less than 1% of published articles, it is disturbing that fraudulent research and publishing rather than inadvertent errors underlie up to two-thirds of cases. Of note is that there appears to be a direct correlation between a journal\'s impact factor and the number of articles that are retracted from it. This may be due to a closer scrutiny by the scientific community of what initially were thought to be seminal contributions. Thus the limited number of retracted articles may, and probably does, represent the tip of an iceberg.

Deliberate fraud is an important issue in academic publishing, but an even greater problem is the abundance of poorly designed studies and the misuse of data. A significant fraction of the information available to us for clinical decision-making are underpowered studies with type I or II statistical errors, biased analyses, articles with data that cannot be reproduced by others, inappropriately done meta-analyses based on heterogeneous rather than homogeneous trials, and inaccurate conclusions based on erroneous manipulation of data.

In his analysis of the scientific literature in 2005, John Ioannidis, M.D., Ph.D. (PLoS 2:696-701) postulated that the majority of published articles were inaccurate. Flawed studies were more likely to result when sample sizes were small, the effect between tested variables was small, the number of tested relationships was large (at a P < .05, 5% will be statistically significant by chance), and conflicts of interest were present. Unsound studies were more likely to occur when they took place within popular and highly competitive scientific fields where the timing of publication was of the essence in order to claim primacy.

Compounding this cascade of misleading information is the reluctance of journals to publish negative studies, thereby giving greater weight to positive studies testing the same hypotheses.

These revelations regarding our research enterprise are not widely appreciated. In fact, in surveys of the public who are responsible for funding much of it with their tax dollars, biomedical research occupies an exalted position in comparison to most other endeavors. Why in recent times has it become tainted and what can be done to reverse the present trend? First, and probably most importantly, scientific research has become a highly competitive game. The battle for available research faculty positions in our universities is more intense than ever with room for only one of every six Ph.D. graduates. Once an appointment is attained, promotion and tenure are dependent on obtaining federal funding from an increasingly shrinking pool of money and publishing in high impact journals, many of which have rejection rates in excess of 90%. It is not surprising that minor or even major massaging of data to reach the magic 0.05 P value is probably not uncommon. Surveys of scientists regarding misconduct indicate that up to 20% have either participated in questionable practices themselves or know of colleagues who have.

The onus is not only on the researcher. Journal peer reviewers and editors are exerting much of their effort in looking for the rare seminal paper that would be attractive to their readers. Less attention is paid to the details of scientific rigor. Negative studies and those that are only confirmatory of previously published investigations are generally not given high enough grades to reach the threshold for publication.

Science has and continues to contribute much to the quality of human life. Most research scientists in the academic world operate with integrity and make a sincere effort to uncover truth in their fields. Marginally done and underpowered studies are the culprits leading to misinformation much more often than are issues of scientific honesty.

So what is to be done to right a somewhat listing research enterprise? From the researcher’s perspective, more attention to study design and rigid adherence to it to avoid bias is essential. Pre-study statistical consultation, especially regarding power calculation, is also a key to obtaining reliable results and conclusions. The editorial boards and editors of journals need to be more accepting of negative and confirmatory analyses than they have been in the past. The recent stance of most reputable journals to require registration of all clinical trials and to provide the data from those trials, positive or negative, to one of several web based repositories for review by others is a step in the right direction. It is the responsibility of our academic institutions to detect and police poor research design and implementation in addition to outright academic misconduct and, when necessary, to change the culture within their research establishments. Finally, it behooves us as readers and consumers of new information to realize that science marches forward in only small incremental steps. Important new findings need to be confirmed before they are adopted. The adage of never being the first to accept the new or the last to abandon the old still conveys a great deal of wisdom.

Dr. Rikkers is Editor in Chief of Surgery News.

During my mostly enjoyable 14 years as editor of a mainstream surgical publication, one of my less enjoyable but necessary functions was to detect and police author misconduct. Most instances of wrongdoing involved duplicate or redundant publication or the awarding of authorship when it was not deserved. I considered these infractions to be misdemeanors. The more serious sins of plagiarism and fabrication or falsification of data were considerably less common or at least infrequently detected. Based on my experience, one might conclude that most scientific findings are reported accurately and with integrity. In other words, we should be able to believe what we read. Unfortunately this may not be the case.

Compared to prior years, the past decade has seen a 10-fold increase in the number of articles retracted from the scientific literature. Although retractions account for well less than 1% of published articles, it is disturbing that fraudulent research and publishing rather than inadvertent errors underlie up to two-thirds of cases. Of note is that there appears to be a direct correlation between a journal\'s impact factor and the number of articles that are retracted from it. This may be due to a closer scrutiny by the scientific community of what initially were thought to be seminal contributions. Thus the limited number of retracted articles may, and probably does, represent the tip of an iceberg.

Deliberate fraud is an important issue in academic publishing, but an even greater problem is the abundance of poorly designed studies and the misuse of data. A significant fraction of the information available to us for clinical decision-making are underpowered studies with type I or II statistical errors, biased analyses, articles with data that cannot be reproduced by others, inappropriately done meta-analyses based on heterogeneous rather than homogeneous trials, and inaccurate conclusions based on erroneous manipulation of data.

In his analysis of the scientific literature in 2005, John Ioannidis, M.D., Ph.D. (PLoS 2:696-701) postulated that the majority of published articles were inaccurate. Flawed studies were more likely to result when sample sizes were small, the effect between tested variables was small, the number of tested relationships was large (at a P < .05, 5% will be statistically significant by chance), and conflicts of interest were present. Unsound studies were more likely to occur when they took place within popular and highly competitive scientific fields where the timing of publication was of the essence in order to claim primacy.

Compounding this cascade of misleading information is the reluctance of journals to publish negative studies, thereby giving greater weight to positive studies testing the same hypotheses.

These revelations regarding our research enterprise are not widely appreciated. In fact, in surveys of the public who are responsible for funding much of it with their tax dollars, biomedical research occupies an exalted position in comparison to most other endeavors. Why in recent times has it become tainted and what can be done to reverse the present trend? First, and probably most importantly, scientific research has become a highly competitive game. The battle for available research faculty positions in our universities is more intense than ever with room for only one of every six Ph.D. graduates. Once an appointment is attained, promotion and tenure are dependent on obtaining federal funding from an increasingly shrinking pool of money and publishing in high impact journals, many of which have rejection rates in excess of 90%. It is not surprising that minor or even major massaging of data to reach the magic 0.05 P value is probably not uncommon. Surveys of scientists regarding misconduct indicate that up to 20% have either participated in questionable practices themselves or know of colleagues who have.

The onus is not only on the researcher. Journal peer reviewers and editors are exerting much of their effort in looking for the rare seminal paper that would be attractive to their readers. Less attention is paid to the details of scientific rigor. Negative studies and those that are only confirmatory of previously published investigations are generally not given high enough grades to reach the threshold for publication.

Science has and continues to contribute much to the quality of human life. Most research scientists in the academic world operate with integrity and make a sincere effort to uncover truth in their fields. Marginally done and underpowered studies are the culprits leading to misinformation much more often than are issues of scientific honesty.

So what is to be done to right a somewhat listing research enterprise? From the researcher’s perspective, more attention to study design and rigid adherence to it to avoid bias is essential. Pre-study statistical consultation, especially regarding power calculation, is also a key to obtaining reliable results and conclusions. The editorial boards and editors of journals need to be more accepting of negative and confirmatory analyses than they have been in the past. The recent stance of most reputable journals to require registration of all clinical trials and to provide the data from those trials, positive or negative, to one of several web based repositories for review by others is a step in the right direction. It is the responsibility of our academic institutions to detect and police poor research design and implementation in addition to outright academic misconduct and, when necessary, to change the culture within their research establishments. Finally, it behooves us as readers and consumers of new information to realize that science marches forward in only small incremental steps. Important new findings need to be confirmed before they are adopted. The adage of never being the first to accept the new or the last to abandon the old still conveys a great deal of wisdom.

Dr. Rikkers is Editor in Chief of Surgery News.

During my mostly enjoyable 14 years as editor of a mainstream surgical publication, one of my less enjoyable but necessary functions was to detect and police author misconduct. Most instances of wrongdoing involved duplicate or redundant publication or the awarding of authorship when it was not deserved. I considered these infractions to be misdemeanors. The more serious sins of plagiarism and fabrication or falsification of data were considerably less common or at least infrequently detected. Based on my experience, one might conclude that most scientific findings are reported accurately and with integrity. In other words, we should be able to believe what we read. Unfortunately this may not be the case.

Compared to prior years, the past decade has seen a 10-fold increase in the number of articles retracted from the scientific literature. Although retractions account for well less than 1% of published articles, it is disturbing that fraudulent research and publishing rather than inadvertent errors underlie up to two-thirds of cases. Of note is that there appears to be a direct correlation between a journal\'s impact factor and the number of articles that are retracted from it. This may be due to a closer scrutiny by the scientific community of what initially were thought to be seminal contributions. Thus the limited number of retracted articles may, and probably does, represent the tip of an iceberg.

Deliberate fraud is an important issue in academic publishing, but an even greater problem is the abundance of poorly designed studies and the misuse of data. A significant fraction of the information available to us for clinical decision-making are underpowered studies with type I or II statistical errors, biased analyses, articles with data that cannot be reproduced by others, inappropriately done meta-analyses based on heterogeneous rather than homogeneous trials, and inaccurate conclusions based on erroneous manipulation of data.

In his analysis of the scientific literature in 2005, John Ioannidis, M.D., Ph.D. (PLoS 2:696-701) postulated that the majority of published articles were inaccurate. Flawed studies were more likely to result when sample sizes were small, the effect between tested variables was small, the number of tested relationships was large (at a P < .05, 5% will be statistically significant by chance), and conflicts of interest were present. Unsound studies were more likely to occur when they took place within popular and highly competitive scientific fields where the timing of publication was of the essence in order to claim primacy.

Compounding this cascade of misleading information is the reluctance of journals to publish negative studies, thereby giving greater weight to positive studies testing the same hypotheses.

These revelations regarding our research enterprise are not widely appreciated. In fact, in surveys of the public who are responsible for funding much of it with their tax dollars, biomedical research occupies an exalted position in comparison to most other endeavors. Why in recent times has it become tainted and what can be done to reverse the present trend? First, and probably most importantly, scientific research has become a highly competitive game. The battle for available research faculty positions in our universities is more intense than ever with room for only one of every six Ph.D. graduates. Once an appointment is attained, promotion and tenure are dependent on obtaining federal funding from an increasingly shrinking pool of money and publishing in high impact journals, many of which have rejection rates in excess of 90%. It is not surprising that minor or even major massaging of data to reach the magic 0.05 P value is probably not uncommon. Surveys of scientists regarding misconduct indicate that up to 20% have either participated in questionable practices themselves or know of colleagues who have.

The onus is not only on the researcher. Journal peer reviewers and editors are exerting much of their effort in looking for the rare seminal paper that would be attractive to their readers. Less attention is paid to the details of scientific rigor. Negative studies and those that are only confirmatory of previously published investigations are generally not given high enough grades to reach the threshold for publication.

Science has and continues to contribute much to the quality of human life. Most research scientists in the academic world operate with integrity and make a sincere effort to uncover truth in their fields. Marginally done and underpowered studies are the culprits leading to misinformation much more often than are issues of scientific honesty.

So what is to be done to right a somewhat listing research enterprise? From the researcher’s perspective, more attention to study design and rigid adherence to it to avoid bias is essential. Pre-study statistical consultation, especially regarding power calculation, is also a key to obtaining reliable results and conclusions. The editorial boards and editors of journals need to be more accepting of negative and confirmatory analyses than they have been in the past. The recent stance of most reputable journals to require registration of all clinical trials and to provide the data from those trials, positive or negative, to one of several web based repositories for review by others is a step in the right direction. It is the responsibility of our academic institutions to detect and police poor research design and implementation in addition to outright academic misconduct and, when necessary, to change the culture within their research establishments. Finally, it behooves us as readers and consumers of new information to realize that science marches forward in only small incremental steps. Important new findings need to be confirmed before they are adopted. The adage of never being the first to accept the new or the last to abandon the old still conveys a great deal of wisdom.

Dr. Rikkers is Editor in Chief of Surgery News.