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Clinical research should conform to high standards of ethical and scientificintegrity, given that human lives are at stake. However, economic incentivescan generate conflicts of interest for investigators, who may be inclined towithhold unfavorable results or even tamper with data in order to achievedesired outcomes. To shed light on the integrity of clinical trial results,this paper systematically analyzes the distribution of p-values of primaryoutcomes for phase II and phase III drug trials reported to theClinicalTrials.gov registry. First, we detect no bunching of results just abovethe classical 5% threshold for statistical significance. Second, a densitydiscontinuity test reveals an upward jump at the 5% threshold for phase IIIresults by small industry sponsors. Third, we document a larger fraction ofsignificant results in phase III compared to phase II. Linking trials acrossphases, we find that early favorable results increase the likelihood ofcontinuing into the next phase. Once we take into account this selectivecontinuation, we can explain almost completely the excess of significantresults in phase III for trials conducted by large industry sponsors. For smallindustry sponsors, instead, part of the excess remains unexplained.

P-hacking in clinical trials and how incentives shape the distribution of results across phases