Questionable research practices, careerism, and advocacy: why we must prioritize research quality over its quantity, impact, reach, and results

The opinions expressed in this article are not necessarily those of the Editors of the European Journal of Cardiovascular Nursing or of the European Society of Cardiology. Can the public trust research and its researchers? This trust has never been as important—but is at risk from questionable research practices (QRPs)1,2 diverse conduct that undermines the integrity of research and its reporting that arises from systems, universities, and even researchers themselves. Questionable research practices 1,2 are research or reporting practices that contribute to misleading or unsubstantiated claims for research and its potential significance and impact (Table 1). The practices are not as fraudulent as fabricating data1 but span a wide variety of ethically and scientifically dubious techniques around data, its processing, and reporting2 such as p-hacking, selective reporting, analytical fishing, or ending studies early.2 Common questionable research practices and best research practices to maintain quality Data manipulation Common questionable research practices and best research practices to maintain quality Data manipulation Questionable research practices, as well as being both damaging and easy to do, are also startlingly prevalent in published research.3 Meta-analysis estimates 1 in 8 of all research authors engage in QRPs but 4 in 10 are aware that co-authors use the practices.4 Findings from other recent surveys are more grave: the 2020 Dutch National Research Integrity Survey identified that just over half (51.4%) of the 6913 researchers sampled acknowledged using QRPs in their work.5 Of 166 health services research papers using qualitative, quantitative, and mixed methods,6 most contained practice and policy implications unjustified by results (69%) or ignored contradictory evidence (64%). Almost half contained conclusions unsubstantiated by results (47%). Crucially, despite the wide prevalence and potentially cataclysmic harms of QRPs to public trust, editors of numerous international cardiovascular research journals have dismissed the likelihood of the practices occurring in cardiovascular journals, citing a lack of paper withdrawals in cardiovascular research as an indicator of higher standards.7 However, this lack may be more of a symptom than a positive sign. Unlike other disciplines, the prevalence of QRPs has not been assessed in cardiovascular research—and systematic review findings are troubling. Research in exercise and sport8 indicates only 40% of manuscripts published in early 2019 report hypotheses. One-third of meta-analyses in heart failure fail to report or acknowledge high heterogeneity across the studies9—a major flaw in a key reporting requirement. As such, there is no persuasive evidence to justify exceptionalism. Questionable research practices are often attributed to premeditated dishonesty of so-called ‘bad apple’ researchers but are more likely caused by the pressures systems place on researchers.1,2 As such, to address these insidious and worrying practices in cardiovascular research, it is important to appreciate not only the nature and corrosive effects of QRPs but also understand and better reconcile the pressures in cardiovascular research that leads to de-prioritization of research quality (Table 1). Firstly, cardiovascular researchers navigate complex cultural pressures and conflicts between career progression and research quality. Prioritizing research impact and reach over quality is understandable yet problematic. Factors prominent in cardiovascular fields—notably pressure to publish a large number of impactful papers frequently—are the strongest predictors of QRPs.10 Incentives for prioritizing career progression are powerful in non-pharmacological cardiovascular research via exaggeration of research impact and reach over its quality,11 via QRPs like p-hacking, re-classification of data, selective reporting or combining of outcomes/hypotheses, or re-running analysis.1,2 As these practices are much easier to do12 than corroborate,13 such highly competitive and potentially lucrative fields offer low-risk high-reward scenarios ripe for QRPs—compared to social science or elementary education.14 Systems, often in universities, that prioritize and reward research impact and reach over its quality in hiring, performance, and awards processes unintentionally foster ‘unethical pro-organizational’ behaviours linked to QRPs15 related to over-stating research impact. In this instance, institution values and rewards align with personal careerism—but both risks subjugating research quality. Similarly, prioritizing research quantity over quality is problematic. Over-esteeming numbers of research publications incentivizes QRPs, including salami slicing and claiming undue authorship. The common goal of obsessively personally attaining ever-high numbers of publications may well be complicit with the dubious incentives of peers and institutions to do likewise, but this fails to recognize that for 3000 years knowledge has only ever grown via its qualitative contribution. Advocacy, defined as individual and collective action towards a particular cause, is a vital part of raising awareness and support for cardiovascular research. This can be seen when researchers consistently advocate for a particular type of intervention (e.g. heart failure disease management or exercise-based cardiac rehabilitation), mode of care delivery (e.g. home-based or remote provision), or approach (e.g. nurse-led or primary care-based). While this advocacy can benefit career development, reputation, or ‘personal brand’, prioritizing research results over its quality can lead to various QRPs, including downplaying negative evidence, failing to account for alternative explanations or solutions from findings, or cherry-picking hypotheses.1,2 This may be well due to the unintentional effects of cognitive biases but reflects powerful career and disciplinary norms and pressures to be seen to be an expert or ‘leader’ who fosters progress for a defined movement. Nevertheless, if public trust in research is to be maintained, researchers need to prioritize research quality while also being advocacy-minded rather than being advocacy-driven. Leaders in cardiovascular research are shockingly silent and in seeming denial regarding the presence, harms, and prevention of QRPs. Senior researchers, especially, must role-model prioritizing research quality in their research, via Best Research Practices (Table 1). They should lead changes to working cultures, hiring, and reward structures in institutions and review processes that currently under-value research quality compared to quantity, impact, reach, and results. They have a vital responsibility to exemplify conduct, decision-making, and mentorship that truly puts research quality first and empowers researchers and students to do likewise as they navigate competing pressures around advocacy and career progression. To address risks for QRPs linked to careerism and advocacy, cardiovascular researchers must also develop better ethical reasoning and decision-making skills to be and stay reflexive in reconciling the quality, quantity, impact, and reach in their research over their career. Education of emerging cardiovascular researchers in all disciplines should not merely focus on substantive, methodological, and scholarly skills linked to Best Research Practices—but should extend to the self-reflection, emotional intelligence, and ethical reasoning required to successfully reconcile the complex pressures associated with QRPs, career development, and advocacy. Finally, editors of cardiovascular journals, rather than plead exceptionalism, have an obligation to lead and respond to the demonstrable evidence of QRPs. They should openly acknowledge the risks and harms of QRPs and mandate authors of accepted papers to share data, with appropriate permissions, in all published papers. The time to act is now.

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