Federal regulations that govern research misconduct in biomedicine have not prevented ongoing high-profile cases of fabrication, falsification or plagiarizing (FFP) in scientific research. Current policy holds individual scientists or team members responsible for FFP. But a fair and effective policy must take into account the context in which this behavior is embedded -- in the pressure to publish positive findings in order to obtain tenure or grant money, or in institutions that may not be supportive of ethical practice but themselves carry no risk. This book analyzes a series of clinical research cases in which reported misconduct went undetected for a decade or more and finds laxity of oversight, little attention to harm done and inadequate correction of the scientific record. Goals of research misconduct policy must be to: protect scientific capital (knowledge, scientists, institutions, norms of science), support fair competition, contain harms to end users and the public trust, and enable science to meet its societal obligations. Reaching these goals will require a system-wide evolution of responsibility to promote and ensure scientific integrity.