Selective outcome reporting and data misrepresentation remain hidden but consequential threats to evidence-based medicine. When outcomes are omitted, selectively emphasized, or incompletely reported, systematic reviews and meta-analyses risk overestimating treatment benefits. Studies show that up to 60% of RCTs alter or omit prespecified outcomes, and nearly one in five meta-analyses lose statistical significance once reporting bias is accounted for. Beyond omission, data may be misrepresented—through misleading graphs, selective subgroup analyses, or overstated conclusions—often influenced by pressures to publish or commercial interests. Neuroscience research on ADHD illustrates how strong claims can be built on limited or weak data, fueling distorted interpretations in the media. While tools like ORBIT and cross-checking protocols can help detect gaps, the responsibility ultimately lies with readers and reviewers to approach published findings with structured skepticism, cross-reference protocols, and demand transparency in reporting. Critical appraisal is not optional; it is central to preserving trust in clinical research.