Medical publishing has become a pivotal aspect of all stages of career development in medicine in Belgium. Publication pressure is therefore present from the stage of the medical student to the level of the head of an academic medical service. This pressure represents a real danger to commit scientific misconduct, ranging from minor missteps to severe fraud. Recent surveys have shown that scientific misconduct and publication fraud represent an important problem in medical publishing, more than in other scientific fields, also in Belgium. Several factors may explain the increased risk of scientific misconduct in medical publishing. Recent national and international initiatives have emerged in order to better understand the problem of scientific misconduct and to optimize ethics in medical publishing. They aim to increase integrity and transparency at all levels of medical research and publishing, starting at the beginning of a career in medical school. The current review describes the ethical difficulties in medical publishing in Belgium, and offers possible solutions.