Abstract Examples of many types of misconduct in medical research continue to be reported. The true incidence is unknown because there is strong evidence of under-reporting as well as suggestions of increased detection. Risks to research participants may also be increasing, with contributing factors such as increased pressure on researchers to publish and to produce commercialization of their research. Institutions are perceived to typically respond slowly and inadequately to allegations of research misconduct. More could be done to try to prevent such mis-conduct, such as: (i) educating researchers about research ethics, (ii) assisting and protecting whistleblowers and (iii) instituting processes to adequately and promptly investigate and deal with allegations. In addition, a debate needs to take place as to whether research misconduct allegations should be dealt with at the institutional level or at a national level and whether medical boards should be routinely involved in the more serious breaches of ethical standards by medical practitioners engaged in research.