MD, PhD, MAE, FMedSci, FRCP, FRCPEd.

A recent paper entitled “Research Ethics and Integrity and the Different Forms of Misconduct: Applications and Challenges in Traditional, Complementary, and Integrative Medicine Research” caught my eye. As the subject is close to my heart and often covered on this blog, I studied it carefully. Here is the abstract:

Research ethics and integrity are foundational to the credibility, safety, and societal trust of scientific inquiry. As the use of traditional, complementary, and integrative medicine (TCIM) grows globally, concerns about research misconduct (including fabrication, falsification, and plagiarism) have become increasingly salient. With up to 80% of populations in certain countries utilizing TCIM, the field’s expansion underscores the need for rigorous, ethically grounded evidence to guide practice and policy. However, around 470 TCIM-related articles have been retracted to date, as indicated on the Retraction Watch database, which may be due to ethical or non-ethical concerns. This educational article critically examines the state of ethics and integrity in TCIM research, drawing on case studies of misconduct and highlighting the broader consequences for patient safety, scientific credibility, and healthcare integration. In addition, the educational article explores emerging ethical dilemmas posed by artificial intelligence (AI), including risks of automated fabrication, falsification, plagiarism, and opacity in research reporting. To strengthen ethical conduct, we propose strategies spanning four domains: 1) improving education and fostering interdisciplinary collaboration to enhance research literacy, 2) embedding open science practices to promote transparency and reproducibility, 3) leveraging meta-research to monitor and advance research quality, and 4) developing policies and safeguards for responsible AI use. Upholding high ethical standards in TCIM research is essential not only to ensure reliable evidence but also to protect patients, sustain public trust, and enable meaningful integration of TCIM within evidence-based healthcare systems.

The full conclusions of the authors are as follows: “With the increasing global use of TCIM therapies, it is crucial for TCIM researchers to uphold high ethical standards to ensure the feasibility, validity, efficacy and safety of TCIM interventions. TCIM research challenges such as heterogeneity, complexity, and lack of standardization practices, alongside issues with research training and funding, create both transformative opportunities and ethical dilemmas that require reflection. Addressing these challenges requires a firm commitment to enhancing research ethics and integrity in TCIM. This commitment must be translated into action through multifaceted strategies: improving research and ethics literacy, fostering open science practices, and ensuring the transparency, integrity, and reproducibility of TCIM research. Strengthening ethical and research practices will not only support its continued development as a discipline but also maximize its potential to contribute to global health.”

I find it most commendable that this subject has finally been addressed by a group of researchers, most of who are known advocates of so-called alternative medicine (SCAM). I hope that this is proves to be a step in the right direction for the fileld of SCAM.

Yet, I fear that it is a small or even tiny step. The reason for my fear is that several important issues related to research ethics and integrity in SCAM are let untouched by the authors. In my view, the one of the most important amongst them is the SCAM researcher him/herself. As often discussed on this blog, SCAM research is unique amongst all areas of medical research for being populated by individuals who have a strong ideological bias in favour of SCAM.

These (pseudo)scientists tend to abuse science by trying to prove that their beliefs are correct. Rather than trying to falsify their hypotheses, they would bend over backwards to show that their favourite SCAM is effective. I tried to demontrate this clearly by establishing my ALTERNATIVE MEDICINE HALL OF FAME on this blog.

As to the many other omissions of important ethical concerns from the above paper, I recommend having a look at our book “More Harm than Good?: The Moral Maze of Complementary and Alternative Medicine“. It offers a much more complete review of the ethical issues involved in SCAM research (amusingly, it was not cited in the paper above).

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