Oncology Fellow Stresses Integrity in the Lab and Clinic

Nirmish Singla, MD

Research undoubtedly forms the backbone of our medical knowledge. Whether this comprises basic science research, translational research, clinical trials, or outcomes and epidemiological research, every form plays a key role in the pipeline of scientific discovery, which naturally builds on itself.

Research integrity, then, is a crucial responsibility of any scientist. Scientific publishing has enabled the wide dissemination of knowledge gleaned from research. This is critical for communication with other scientific investigators and potential collaborators, physicians who care for patients, and even patients themselves, who may rely on some combination of journal articles and the media to understand their diagnoses and options.

Integrity means objectively presenting results without overselling conclusions and, more important, not falsifying data. Indeed, research relies on the generation of hypotheses, but investigators must recognize that hypotheses are not always correct. We cannot simply make our data fit our hypotheses; rather, we must acknowledge that the deviations in our observations from our expectations carry importance and may even result in serendipitous discoveries.

With discovery come more questions and hence more opportunities for research. Rather than just searching for answers, much research entails asking the right questions, ones that ultimately advance the medical field and lead to new treatment options for patients on a larger scale.

Although the excitement of conducting scientific research lies in the ability to advance knowledge and make new discoveries, the purity of research is too often tainted by political motives. In academia, research successes often correlate with career promotion, increased funding opportunities, and visibility and reputation within the field. These factors impose external pressures on the need to publish, as a scientist’s h-index and quantity of publications form the basis for academic currency. As a result, negative findings are often released quietly or even buried despite their vital importance.

Responsible investigators must be careful not to allow these pressures to affect the integrity of their reporting. Research misconduct carries with it a substantial cost, with potentially dire consequences for society. Beyond affecting the funding and reputation of individual scientists and institutions, misrepresented data and their portrayal by the media may have a broader impact, affecting scientific colleagues or collaborators and the public health at large.

Patients have entrusted physicians and investigators with their lives. We have been granted a unique privilege and opportunity to partake in their care and to use their tissue or information to generate data. In turn, we owe it to them to practice our trade responsibly. This means conforming to the standards of regulatory bodies, protecting privacy, and engaging in a proper discussion of the risks, benefits, and alternatives of participation in a research study while appropriately addressing any questions the patient may have—that is, respecting the “informed” component and voluntary nature of informed consent.

Ethics in the Clinic

The tenets of the Hippocratic Oath—by which all physicians must abide, the ethical code that forms the moral basis for the privilege of practicing medicine—are principles we must uphold in research, which is itself a privilege. Traditionally, these include beneficence (supporting the best interests of our subjects and patients), nonmaleficence (doing no harm to subjects and patients, ie, primum non nocere), justice, and respect for autonomy (ensuring the capacity of subjects and patients to make an informed, uncoerced decision). Contemporary extensions of the oath include the realms of veracity and confidentiality, which are undoubtedly just as critical in the research setting as they are in clinical practice.

That same integrity must extend to our day-to-day work in the clinic and our interactions with patients. As physicians, we have the privilege and responsibility of managing individual patients. Patient management does not simply mean equating a diagnosis with a treatment. Instead, we are tasked with educating the lay public about the knowledge and limitations in our field to enable our patients to make shared, informed decisions about their care.

We must learn the art of synthesizing data and distill this information to patients in an interpretable fashion. At the same time, we must stay abreast of the latest treatments and technologies while recognizing the potential drawbacks and limitations of emerging developments.

To communicate our findings with utmost precision, we may be enticed to use technical, often subspecialized, jargon. Although this is necessary for publishing in scientific journals and communicating with other experts, it is important to communicate research with the lay public and the media in an accurate yet understandable manner, tailored appropriately to the audience—a skill set analogous to communicating with patients in the clinic. Striking the appropriate balance between accuracy and clarity can indeed be challenging, especially when communicating with a populace who may misunderstand or misconstrue medical information.

Likewise, as the media and other nonscientific sources often serve as the primary information outlet for the public, the onus is on investigators and physicians to ensure that data are not only reported but also translated accurately to these sources.

Not all physicians are investigators, and vice versa; however, a mutual reliance exists. Research forms the foundation of clinical guidelines and evidence-based medicine, and when its integrity is compromised, the quality of patient care may, too, suffer. Thus, those who engage in research activity of any kind must recognize the multidimensional responsibilities they have assumed and appreciate the potential consequences of their work.

Nirmish Singla, MD, is a clinical instructor/fellow in Urologic Oncology at Memorial Sloan Kettering Cancer Center.