Publication Bias: Its Role in Medical Literature & the Ethical Implications Open Access

Roome, Kerryn (Spring 2021)

Permanent URL:


Publication bias, also called positive-outcome bias and dissemination bias, has been a long standing and prominent problem in the scientific community. Publication occurs for several reasons, but this thesis aims to analyze the ethical implications of such bias in medical literature through the lens of several different moral theories – feminist ethics, the ethics of care, utilitarianism, and Kantian ethics. This thesis also explores the ethical obligations all stakeholders have in publishing in an ethically sound manner as well as identifying the powers at play in a competitive and high stakes environment. Additionally, since this specifically has not been quantitatively measured or assessed, this thesis quantifies the status of publication bias in today’s medical society as well as determines the changes that have occurred over a 30-year time period. Every original, hypothesis-driven research article in the top 3 and bottom 3 medical journals, ranked by impact factor, are coded and assessed in the years 1998, 2008, and 2018. This sampling technique shows trends in publication bias and provides insight into the status of publication bias. It was found that non-significant studies were more likely to be published if they were experimental studies rather than observational studies. Additionally, a significant change over time was found within high impact journals and observational studies.

Table of Contents

I. An Introduction                                                                                         1

         Publication Bias: What is it and why is it a problem?                             2

Structure                                                                                             7

II. Ethical Obligations and the Powers at Play                                      9

III. Feminist & Virtue Ethics                                                                       21

         Feminism Overview                                                                            22

         Bias, Objectivity, and Empiric Research                                                   23

         Virtue Ethics                                                                                         26

         The Nature of Flourishing                                                                  30

IV. A Utilitarian Approach                                                                          32

V. A Kantian Approach                                                                              39

VI. Counter-arguments                                                                              46

VII. Methods                                                                                                  49     

Specific research questions                                                           50

Data sources and selection of journals and years of publication (process and rationale)                                                                                          51

Criteria used to select articles for the final analysis                            53

Specific information extracted from each article that met inclusion criteria       54

Second Coder                                                                                   56

Second Coder Results                                                                    57

Data analysis                                                                           58

VIII. Results                                                                                                   59     

         Study sample (Table 1)                                                                      60

         Association between journal, journal group, and study type (Table 2)       61

                   Journal Title                                                                                61

Journal Group: High vs. Low Impact Factors                                     62

                   Study Type                                                                                  62

         Changes over time (Table 3)                                                            63

                   By Impact Factor                                                                         63

                   By Study Type                                                                   63

IX. Discussion                                                                                     65

         Interpretation of Findings                                                                   66

         Notable Observations                                                                         68

         Limitations                                                                                            69

X. Conclusion & Reflections                                                                     71

         Recent Events                                                                            74

References                                                                                                   77

About this Master's Thesis

Rights statement
  • Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.
  • English
Research Field
Committee Chair / Thesis Advisor
Committee Members
Last modified

Primary PDF

Supplemental Files