Should clinical research be curtailed?

The amount of clinical research taking place is excessive.[1] Out of the 6 million articles published in a year, half are never cited and a good percentage of the cited articles are self-cited.[2] Would medicine be just as effective, and not as expensive, if clinical research was replaced with quality improvement?[3] Somewhat cynically, this could be called trial and error based on doctors’ coffee room chat.

As a counterpoint, the world has just benefited from a truly amazing public health research project on COVID-19. Initial vaccine trials involved 75 000 patients, with the results saying, “go ahead, it is safe,” and data are now being collected on the hundreds of millions of people who are vaccinated, saying it is safe. When one considers that vaccines in the not-too-distant past took years to come online, the mRNA rollout is an unbelievable triumph.

However, regardless of what modern monetary theory says, money is finite, so perhaps research should be limited to really serious problems of a public health nature. Quality improvement would be cheaper and less bureaucratic than conducting clinical trials as there is no self-serving demand for people to publish in order to get tenure. A nice way to think about quality improvement is trial and error, which is how the Silicon Valley brings technology products to market. So assuming funding is finite, the question becomes which 1000 small studies of 10 patients each should be defunded to allow the money to be redirected to a big public health issue study of 10 000 patients?
—Mark Elliott, MD
Vancouver

hidden


Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

1.    Noorden RV, Maher B, Nuzzo R. The top 100 papers. Nature. 29 October 2014. Accessed 30 November 2021. www.nature.com/news/the-top-100-papers-1.16224.

2.    Noorden RV, Singh Chawla D. Hundreds of extreme self-citing scientists revealed in new database. Nature. 19 August 2019. Accessed 30 November 2021. www.nature.com/articles/d41586-019-02479-7.

3.    Ioannidis JPA. Why most published research findings are false. PLoS Med 2005;2:e124.

Mark Elliott, MD, FRCPC. Should clinical research be curtailed?. BCMJ, Vol. 64, No. 1, January, February, 2022, Page(s) 8 - Letters.



Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.


For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org

BCMJ Guidelines for Authors

Leave a Reply