Domhnall MacAuley: Research of doubtful relevance

Domhnall MacauleyWhat happened? Remember your first days at medical school
—wide eyed optimism and how you were going to change the world, save lives, cure disease, help the sick, make a difference to people lives. Looking at a lifetime dedicated to medical research
—how much have you achieved when measured against the ambitions of youth. As I troop around conferences, read abstracts, attend presentations, and appraise research papers I cannot help wondering if we have lost our way. Most of what is on view and, dare I say, published in medical journals is of tangential relevance to patient’s health.

It is our fault really. We have created a system where the volume of publication seems more important than the quality, where authors focus on chopping the data into multiple publications rather than a single meaningful paper, and where outputs are stretched across multiple journals reflecting different perspectives. If asked to pick just one research paper that represents your best work, your contribution to medical research, would you be happy with it?

Journals are not blameless. A correspondent wrote recently pointing out that we published a meta-analysis of 8 papers and this was the 8th meta-analysis of more or less the same basic original papers. He was right. Medical journals also play this circular game.

Maybe its the metrics. Achievement is measured on research output rather than research outcomes. Research excellence is based on points won on an arbitrary scale. Research income is a key metric with success measured on how much money you accumulate in research grants. Playing medical monopoly. And, yes, I do appreciate that research must be built on an overall understanding of the background to a topic, often piecemeal and based on exploratory and  observational work, and that research costs money. But, the balance seems skewed. Academic recruitment stresses research output and grant income rather than health gain. One may argue that these are proxy measures of quality. But, the process itself has become the outcome.

So, lets take a long hard look at ourselves. As a successful researcher with long list of publications- what do they mean? Looking honestly on your research career, how much of what you published really matters? How much really makes a difference? How does your research measure up against your own early aspirations.

Domhnall MacAuley is primary care editor, BMJ