In recent years, there has been a growing concern over questionable practices and a lack of rigor in scientific activities, particularly in health and medical sciences (Mayta-Tristán et al., 2024; Phogat et al., 2023). These instances of scientific misconduct have profound repercussions, often overlooked by the general population (National Academies of Sciences Engineering Medicine; Policy Global Affairs; Committee on Science, 2017), but increasingly highlighted through scientific literacy and the broader dissemination of science. In response, various researchers, groups, and institutions have developed strategies and metrics aimed at critically and objectively evaluating scientific integrity (Munaf et al., 2017; Chalmers et al., 2014). While this is often measured by publication frequency, there are deeper epistemological dimensions and interpretations, as well as implications for medical practice and social responsibility (Munaf et al., 2017; Chalmers et al., 2014). This is particularly relevant to the intersection of knowledge generation, its transfer, and the influence that health decision-making based on this knowledge has on society (Rahman and Ankier, 2020). The protection of scientific integrity and the generation of new knowledge in health are intrinsically linked to the safeguarding of human rights, human security, and public health outcomes (Khadilkar, 2018).

Universities and research institutes are key players in the development of science, technology, and innovation (Geng and Yan, 2021). In the medical and health sciences, these institutions frequently collaborate with university hospitals, clinical trial centers, and clinical research centers, which provide access to primary data, financial resources, advanced equipment, specialized professionals, and opportunities for international collaboration (Institute of Medicine (US), 2002). This synergy enables the development of increasingly high-quality medical research. Academic institutions, whose primary mission is to generate and disseminate knowledge, bear the responsibility in many parts of the world to act as consultants and guardians of scientific integrity in health research (Robishaw et al., 2020). They are tasked with ensuring the quality of knowledge that informs medical practice. Thus, it is academia itself, primarily represented by universities and research institutes, that must deploy the necessary tools to address lapses in scientific rigor within medical research.

Although scientific rigor and quality research is of great importance in global health, discussions about practical and tangible solutions remain fragmented and limited. The aim of this manuscript is to highlight the significance of employing meta-research within universities and research institutes as a tool to monitor scientific rigor and promote responsible practices in medical research.

In recent decades, there has been a phenomenon of rapid expansion of global scientific output. The outbreak of coronavirus disease 2019 (COVID-19) pandemic further intensified this trend, with some countries increasing their annual medical and health sciences publication output by more than 40% in recent years (Oliveira et al., 2022; Zhang, 2021). This astounding increase brought simmering concerns over publication volume to the forefront and suggested a potential crisis in the field, in addition to general concerns over publication quality (Abbott et al., 2022). The sheer volume of clinical evidence became so vast that it was impossible to rigorously and promptly analyze the data, leading to significant uncertainty in health-related decision-making (Pan American Health Organization, 2024).

This increase sparked a discussion about the excessive number of opinion pieces, commentaries, perspectives, and editorials (Lozada-Martínez et al., 2021). Concerns arose over potential conflicts of interest and the personal benefits of rapidly publishing in indexed journals, even when the resulting literature offered little to no meaningful contribution to the academic community (Lozada-Martínez et al., 2021; Federico, 2020). In response to these concerns, authors have justified the rate of publication as needing to address the 'publish or perish' phenomenon, which reflects the tension between the quantity and quality of publications (Suart et al., 2022). This issue of overpublishing low quality and low impact studies becomes more pronounced when publications are evaluated based not on the quality and potential real-world impact of the scientific evidence itself, but rather on journal metrics like publication rate, impact factor, and prestige (CITE). Consequently, the excessive number of short papers may be associated with the 'publish or perish' phenomenon (Laine et al., 2025).

With the updating of metrics in citation indexes and databases, such as the Scimago Journal and Country Rank (SJR), it became evident that the volume of publications from certain countries had increased by more than 40% compared to just a few years earlier, a trend that warrants closer examination (Lozada-Martinez et al., 2022). While publication frequency alone is not a metric of quality, it is essential to carefully assess the characteristics of scientific output—such as the types of manuscripts, affiliations, scientific and technological capacities, collaboration, and author networks—to ensure that the growth in scientific production aligns with the capabilities of the institutions and research groups. Otherwise, it raises red flags regarding potential research and publication misconduct, particularly when there is no valid justification for the origin of the data, time of analysis and interpretation, or attribution of authorship (Mayta-Tristán and Borja-García, 2022).

In this context, universities and research institutes must act as guardians of the research and technological development process, utilizing methodological and operational evaluation tools to validate the rigor and quality of the research. In recent years, there has been a significant increase in cases of questionable conduct in medical research, including an unjustified rise in scientific production (Baumeister et al., 2021; McDermott et al., 2024; Jung et al., 2021). This trend has raised concerns about potential data falsification, low-quality research, and “salami” publications. Notably, this phenomenon became particularly evident during the pandemic and post-pandemic phases (Baumeister et al., 2021; McDermott et al., 2024; Jung et al., 2021; Mayta-Tristan, 2024). Thus, while global scientific and technological progress is directly correlated with nations' ability to generate new knowledge (Munaf et al., 2017; Chalmers et al., 2014), it is evident that the abrupt and rapid growth of scientific production in certain countries presents significant challenges regarding scientific relevance and pertinence that must be addressed (Munaf et al., 2017; Chalmers et al., 2014).

Although numerous examples and scenarios related to questionable or uncertain practices in medical research have historically existed, raising concerns about the validity of evidence, the recent surge of publications generated during the COVID-19 pandemic represents a notable academic case for analysis (Schonhaut et al., 2022). This phenomenon posed a significant challenge in editorial management and meta-research, as suspicious findings emerged regarding the quality of some representative studies.

Due to the need to accelerate research processes, a variety of study designs were developed and executed to understand the pathophysiology, complications, and potential therapies for COVID-19, including its variants and disease phenotypes (Sousa Neto et al., 2023). Unfortunately, with the emergence of numerous clinical trials and systematic reviews, there was significant uncertainty regarding the quality of clinical evidence and evidence-based recommendations (Baumeister et al., 2021; McDermott et al., 2024; Jung et al., 2021). Meta-epidemiological studies demonstrated that original COVID-19 research, when compared to historical studies, had a significantly shorter median acceptance time (13 vs. 110 days; p < 0.001; Jung et al., 2021). Regardless of the study design used, all COVID-19 studies had significantly lower median methodological quality scores (as assessed by the Newcastle–Ottawa Scale and QUADAS-2 for observational and diagnostic studies, respectively) compared to historical studies. Diagnostic studies on COVID-19 exhibited the highest risk of bias (93.6%; Jung et al., 2021). However, there were notable shortcomings in the fulfillment of essential methodological quality criteria in randomized controlled trials, such as sequence generation risk of bias, allocation concealment, blinding of participants and personnel to all outcomes, blinding of outcome assessors for all outcomes, and selective outcome reporting (Jung et al., 2021). These findings led to the conclusion that the low quality of evidence found in some COVID-19 studies generated substantial uncertainty, particularly regarding the certainty of the evidence and the methodological quality of the studies.

Other exploratory and comparative analyses identified a similar trend when evaluating the methodological and reporting quality of systematic reviews that served as the basis for health decision-making during the COVID-19 pandemic (Baumeister et al., 2021; McDermott et al., 2024). Therefore, one of the most significant criticisms was the implication of using evidence of very low quality or uncertain certainty for mass health decision-making during the global health crisis.

This uncertainty further increased during the transition to the post-pandemic phase, as concerns about the quality and rigor of evidence were accompanied by a notable number of retractions of original COVID-19 studies due to questionable research practices and deficiencies in the peer review process (Schonhaut et al., 2022; Taros et al., 2023). The acceleration of the review and acceptance processes in journals (on average, < 10 days), as well as ethical and scientific concerns (Schonhaut et al., 2022), highlighted the lack of control over the quality of medical research—not only by journals but also by institutions. It became apparent that there were specific niches where a common group of authors had numerous retractions (Schonhaut et al., 2022; Taros et al., 2023).

Interestingly, a scientometrics analysis revealed that even after the retraction of these documents, they continued to be cited up to 45 [standard deviation (SD) 138.9] times more than the average article in the Scopus database (p = 0.01; Taros et al., 2023). In 3 out of 10 retracted articles (n = 27/90), the guidelines established by the Committee on Publication Ethics (COPE) were not followed, preventing the identification of the reasons for the retraction (Taros et al., 2023). Although the pandemic and post-pandemic phase created an intense scenario in which this phenomenon may have been exacerbated, researchers in the field of meta-research generally emphasized the importance of transparency and clearly understanding the direct causes of withdrawals and retractions, given the implications for health policies, public health, and medical interventions that arise from the use of data of questionable quality (Besançon et al., 2021; Stoto et al., 2022; Raynaud et al., 2021; Lozada-Martinez et al., 2024).

The lessons learned from research processes during the COVID-19 pandemic demonstrated that open science, and the careful enforcement of scientific rigor and transparency in medical research, saves lives (Besançon et al., 2021). Misinformation, infodemics, and questionable research practices create confusion within the general community, academia, and healthcare workers, disrupting the consistency and coherence needed to implement effective health prevention and education strategies. Therefore, the responsibility to monitor and correct questionable practices and uncertainty in medical research lies with society as a whole, but especially with those equipped with technical and methodological tools (academia and the state).

Meta-research is defined as the research of research itself (Ioannidis, 2018; Ioannidis et al., 2015; Ioannidis, 2016). Given that science and innovation are key to human progress and the generation of health knowledge that advances human security, it is essential to ensure the highest standards of research in medical sciences to achieve a real impact on the population (Ioannidis, 2018). Meta-research encompasses five domains of focus: methods, reporting, evaluation, reproducibility, and incentives in science (Ioannidis et al., 2015; Ioannidis, 2016). Some of the most important specific objectives of meta-research include the assessment of research relevance, the evaluation of evidence validity, and the exploration of scientific integrity (Ioannidis, 2016). This emerging discipline, therefore, has the potential to address the challenges and opportunities in studying and strengthening scientific activity.

Medical and health sciences are arguably the fields where meta-research has been most extensively applied in recent years (Rahman and Ankier, 2020). Over the past two decades, the increasing volume of scientific publications in medical sciences made it necessary to develop tools to assess the true value and practical utility of clinical evidence (Rahman and Ankier, 2020; Robishaw et al., 2020). Similarly, it has become essential to employ methods capable of identifying evidence that presents serious concerns and poses risks to the community (Mayta-Tristán et al., 2024).

Through meta-research, it has been identified that some systematic reviews and meta-analyses in medical and health sciences have been redundant, misleading (by overestimating or underestimating the effects of interventions), and inconsistent (Lund et al., 2022). Initially, it has been observed that the growth of systematic review publications has reached “epidemic proportions” (Lund et al., 2022). In some areas of medical research, such as the use of antidepressants, the frequency of overlapping studies is particularly high. Moreover, significant conflicts of interest associated with the industry have been found in these publications (Lund et al., 2022).

Given the relevance and importance of medical research, meta-research in health sciences has revealed opportunities to address knowledge gaps and align them with the real needs of society (Luchini et al., 2021). This does not only pertain to the various knowledge areas and disciplines but also to the methodological limitations of previous studies that must be addressed to improve the quality and certainty of evidence used for decision-making in health (Luchini et al., 2021). These gaps should be evaluated from the characteristics of the study design protocol to the perceptions of the end-users of the information, who are theoretically the ones to benefit from this new knowledge (Luchini et al., 2021). To achieve this goal, there are guidelines and tools available to assess domains of interest and uncover the real and priority gaps (Luchini et al., 2021). Previous research has shown that the use of these guidelines allows researchers to specifically identify which items are not fulfilled during the design or reporting of clinical studies, affecting reproducibility, reliability, and confidence in the evidence within health sciences (Grosman and Scott, 2022).

Over the years, with the adoption of new guidelines that strengthen the reporting and methods of clinical studies, there has been a notable improvement in the quality patterns of clinical research (Nguyen et al., 2022). Additionally, the continuous evaluation of scientific practice has helped identify preventable and overlooked errors throughout history, even among Nobel laureates (Else, 2024) or in cases of scientific fraud (Orfila, 2023), which unfortunately is a phenomenon that is becoming increasingly frequent and threatens the rigor and integrity of science. Therefore, promoting meta-research as a tool to reduce the scientific fracture and monitor scientific activity should be a responsibility of key stakeholders in community-oriented medical research, including academia (represented by universities and institutes) and the government.

Academic institutions, particularly universities and research institutes, play a critical role in shaping the scientific landscape by generating, disseminating, and applying knowledge in health and medical research (Ioannidis, 2018; Ioannidis et al., 2015). Beyond their role as knowledge producers, these institutions must function as scientific auditors, ensuring that research practices align with methodological rigor, transparency, and ethical principles (Macleod et al., 2014; Ioannidis, 2014; Begley and Ioannidis, 2015). The increasing volume of scientific publications, combined with concerns regarding low-quality research, necessitates institutional engagement in meta-research to uphold the credibility of scientific outputs and reinforce the social responsibility of academia (Ioannidis, 2018; Ioannidis et al., 2015; Ioannidis, 2014; Begley and Ioannidis, 2015).

Meta-research, defined as the study of research itself, provides universities and research institutes with an essential mechanism to evaluate and improve the quality of scientific publications (Ioannidis, 2018). While regulatory bodies and funding agencies establish broad guidelines for research integrity, institutions are uniquely positioned to implement proactive, data-driven approaches that scrutinize the reliability, reproducibility, and validity of medical research. Universities and research institutes possess inherent advantages that make them suitable for this role (Macleod et al., 2014; Ioannidis, 2014), including:

Why meta-research should be an institutional priority? Despite growing awareness of research misconduct and questionable publication practices, many institutions remain reactive rather than proactive in addressing these challenges (Ioannidis, 2014; Begley and Ioannidis, 2015). The assumption that scientific journals and peer review systems serve as sufficient safeguards against low-quality research is demonstrably flawed, as evidenced by the high prevalence of retracted publications and reproducibility crises across medical sciences (Ioannidis et al., 2015; Ioannidis, 2016). Institutions must assume a more direct role in addressing these deficiencies by integrating meta-research into their research governance frameworks.

Institutions that actively engage in meta-research can enhance their academic reputation and credibility by demonstrating a commitment to high-quality, evidence-based inquiry. This approach not only benefits individual researchers but also strengthens the institution's competitiveness in securing grants, forming international collaborations, and influencing health policies based on robust scientific evidence (Ioannidis, 2018; Ioannidis et al., 2015; Ioannidis, 2016; Lund et al., 2022).

Furthermore, meta-research aligns with the mission of universities to serve as knowledge custodians for society. By scrutinizing the validity of published medical research, institutions can prevent the dissemination of misleading findings that could negatively impact clinical practice, public health policies, and patient outcomes (Ioannidis, 2018).

While there is limited published evidence regarding the effectiveness of specific institution-level interventions to enhance the quality of publication practices, there are a number of potential opportunity areas to integrate meta-research and quality initiatives into existing institutional structures and functions. Establishing institutional policies and local meta-research efforts to evaluate and address factors influencing the researcher experiences that drive research behaviors, could serve as a means to engage with the need for improved quality regulation in academic publishing and research practices. We propose the following intervention points that may serve as opportunities to operationalize meta-research in academic institutions (Figure 1):

This framework consists of five metrics: two assess adherence to best practices—the number of correctly attributed background statements and the number of genuinely original claims. The remaining three identify deviations from best practices—the number of misattributed background statements, the number of background statements lacking proper references, and the number of claims falsely presented as original (Craig and Taswell, 2018). By guiding researchers in properly documenting the accessibility and reusability of their data, FAIR metrics can reduce the incidence of scientific fraud and enhance the reliability of meta-analyses and systematic reviews, which depend on the availability of primary data for accurate execution (Craig et al., 2023, 2019).

The evolving challenges of scientific integrity necessitate that universities and research institutes embrace meta-research as a fundamental institutional responsibility. Rather than functioning solely as producers of research, academic institutions must adopt a dual role as evaluators of knowledge quality, ensuring that medical research serves its intended purpose—advancing human health and wellbeing. By implementing structured meta-research programs, institutions can lead the transformation toward a more transparent, reliable, and impactful scientific ecosystem.

This perspective emphasizes the importance of utilizing meta-research within universities and research institutes as a key tool for monitoring scientific rigor and promoting responsible practices in medical research. By integrating meta-research into institutional frameworks, developing clear guidelines, fostering interdisciplinary collaboration, and enhancing transparency, these institutions can effectively safeguard the quality and integrity of scientific output. Additionally, establishing educational pro-grams in meta-research will further equip researchers with the necessary skills to ensure high standards in medical research and its application to public health.