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‘First, do no harm’: the promise of new scientific metrics

So I have just one wish for you—the good luck to be somewhere where you are free to maintain the kind of integrity I have described, and where you do not feel forced by a need to maintain your position in the organization, or financial support, or so on, to lose your integrity. May you have that freedom—Richard Feynman, Nobel laureate (Feynman, 1974)

In the new era of evidence-based medicine, ‘newly qualified doctors must be able to apply scientific methods and approaches to medical research and integrate these with a range of sources of information used to make decisions for care’ (1). Often, professional bodies and institutions measure aptitude for such learning outcomes using number of publications. Although many would argue this is not the case, it is certainly implicit in their actions; “not only do medical students perceive publications as a requirement for their residency applications, but there is also the idea that there’s a preferred number of publications” (2). This fixation on quantity stifles originality and creativity, and prioritises short-term gains at the expense of true innovation. We aren’t fostering the development of the visionary physician-scientists of tomorrow, rather one’s that are preoccupied with empty prestige.

Sadly, the exponential growth of scientific literature has not been paralleled by a growth in scientific knowledge (3). Moreover, the very scientific ecosystem that we engage with contradicts its own commitment to primum non nocere: “an unethical doctor may risk the life of a single patient, whereas an unethical or careless interpreter of statistical data may risk the lives of a whole population” (4).

Clearly, focusing on quantity is not the path to research excellence. Relevant stakeholders need to urgently evaluate and redefine their standards. Efforts to provide guidance on good research practice (5), which focus heavily on best practices for reporting individual studies, sends the message that research integrity at a systemic level is not a priority. Moreover, professional standards are almost exclusively based on using research to inform clinical practice (6), which are not inherently protective against poor scientific practice.

Having identified the problem(s), how do we go about solving it? Kretser et al. (2019) proposed a list of best practices for scientific integrity (7). For those institutions who want to produce graduates that are cognizant of the importance of scientific integrity, I strongly advocate for:

  1. Recognising and rewarding those who have shown a commitment to scientific integrity
  2. Training in:
    a. Scientific methods
    b. Appropriate experimental design and statistics
    c. Responsible research practices
    d. Science communication
  3. Strengthening internal scientific integrity oversight and processes

Institutions now have the chance to grant their candidates the freedom that Feynman wished upon all future scientists, and they need to act now before it is too late.

When you rely on incentives, you undermine virtues. Then when you discover that you actually need people who want to do the right thing, those people don’t exist” (8).


  1. General Medical Council. Outcomes for graduates 2018 [Internet]. 2018. Available from:
  2. Vos E. What motivates medical students to publish? [Internet]. The Wiley Network. 2017 [cited 2019 Jun 30]. Available from:
  3. Fortunato S, Bergstrom CT, Börner K, Evans JA, Helbing D, Milojević S, et al. Science of science. Science (80- ). 2018;359(6379):eaao0185.
  4. Bailar JC. Bailar’s laws of data analysis. Clin Pharmacol Ther. 1976;20(1):113–9.
  5. General Medical Council. Good practice in research [Internet]. 2010 [cited 2019 Jun 30]. Available from:
  6. General Medical Council. Generic professional capabilities framework [Internet]. 2013 [cited 2019 Jun 30]. Available from:
  7. Kretser A, Murphy D, Bertuzzi S, Abraham T, Allison DB, Boor KJ, et al. Scientific Integrity Principles and Best Practices: Recommendations from a Scientific Integrity Consortium. Sci Eng Ethics [Internet]. 2019;25(2):327–55. Available from:
  8. Edwards MA, Roy S. Academic research in the 21st century: Maintaining scientific integrity in a climate of perverse incentives and hypercompetition. Environ Eng Sci. 2017;34(1):51–61.

Conflict of interest: None

Biography: Logan is a final year medical student at The University of Auckland, in New Zealand. He is passionate about academia, especially open science and research integrity, and is pursuing a career as a physician-scientist in neonatal medicine.

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