Only 2 medical schools in the United States and Canada of 133 that responded to a survey have policy guidelines that address most of the significant ethical and procedural issues related to misconduct and fraud in biomedical research. Some nonacademic research environments have superior guidelines that offer useful models and deserve examination. Prevention of misconduct and fraud in biomedical research and reporting requires thoughtful, proactive change by academic and clinical institutions. While the causes of misconduct and fraud may be sufficiently complex to engender long debate, the methods for minimizing it are relatively straightforward and start with a clear statement of values and acceptance of responsibility. Otherwise, the failure of the biomedicla research community to meet this challenge forthrightly is soon likely to lead to damaging intervention by government agencies and elected officials. The time to act is now.