Kidneys Inc.

medicine and nephrology updates and interesting cases by a practicing nephrologist in USA

Archive for the month “July, 2012”

Research in medicine

I have been intending write this for a while, just did not know how and where to start, for fear of being considered a fox that could not reach the ‘sour’ grapes. Since I entered this country my perception of research has changed over time significantly. And today I saw an article from a former NEJM editor, Marcia Angell, about how unreliable and untrustworthy research has become. I will put down my two cents before I read what that article has to say

From the perspective of a medical student who is seeking a successful career, a scientific endeavor, eager to prove oneself, I realized early on to get into a residency, having publications is an important part of your resume. Of course one has to reach the mark of standard of ¬†many other medical students. Soon after I started working as a “research assistant,” in a basic science research lab, I understood the complexity of a good research, purposes of research not as I imagined it but as I saw and understood it.

I was overwhelmed by the amount of publications that were out there, the number of medical journals, the complicated way of interpreting the study results. This is after the humongous time consuming laborious painstaking dedicated experiments were conducted. Even though, I was listed as an author in a couple of papers, I struggled to understand and almost felt I was cramming the details just before my interviews. What did I know, I was too new to be critical about this. Then came a day when I had to present a paper for an in-house conference. As I read that long paper assuming it is going to be a cram session, i saw the points were relevant, logical, proven. It required a good deal of time to even figure that out. So I came out of my basic science research with utmost respect for people who do real basic science research

As I entered my residency (not sure how much my publications really helped me in that), I again sought research hoping that this time, it will be different since it is clinical research. Unfortunately, I hardy got to work with people who are PASSIONATE about their research. I don’t mean talking passionately but being passionate about what it is they want to find out. Does not matter even if it seems totally irrelevant, but if it is an unknown and it is a well founded research, someday, it will be a dot that could be joined in the puzzle. But instead what I found was, research more or less followed trends. For example, there would be a slew of articles about hormone X or chemical Z and then they become the be all end all panacea for most researchers out there trying to get a publication out. That brings me to the ‘purpose’ of research.

I imagined purpose of research in the real sense should be to find out something that is not known. It could be as trivial as what is the rate at which a candle burns, or as major as ‘what kind of antibody¬† can possible cause condition A,’ but as long as the very basic methods are strong and founded, the results must be reliable. and it is OK get a negative result or to even not get a result.

But as I understood along the way, there are very few researchers who do this kind of research (and probably they rarely ever publish), But when they do it will be groundbreaking. And then there are others doing run of the mill research, following the trends and fashion of the publication world, adding one more article to the ocean of medical journals. The motivation for research is no longer curiosity but the following:

1. Publish, publish, publish. Conduct one experiment and try and get 3-4 papers out of it, saying the same thing back and forth in several ways

2. Publication is a marker for good research and your academic and scientific skills, so it will help one meet career goals, be it obtaining a position, retaining a position or climbing up the career ladder

3. Publications ensures more funding, more fame. The funding source, if it is the manufacturing company, again dilutes the findings by a some unknown factor. And readers are to read the article with a grain of salt.

There are articles of evidence based medicine, guidelines based on such reliable articles. But if my mailbox is filled with 4 journals each with 15 articles on an average, I read may be 2 from each one. Then 2 months later there is one with opposite conclusions. What should a clinician do? How reliable is the ‘data’ of evidence based medicine? How shaky are the methods used in the trials, how influential was the funding source?

This is enough to steer one away from even reading the articles even from major holy grail journals

This holds good for all the research articles out there medical or not. Since we do not have an alternative an objective scientific research, we are left with no choice but to keep it clean and safe from such alternative motivations and conflicts. If we don’t, we might as well be doing voodoo

now let me read what the former NEJM editor has to say

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