During my graduate school days, I had an idealistic notion about Research. I thought it was the most honorable activity to reach the truth of things that mattered. If you dig long and hard enough, you will find the "a-ha"/Eureka moment. My research professor, Dr. McDonald, taught us the importance of critically reviewing the literature and watching for who's sponsoring a study so we would understand the biases that such sponsorship would breed. And, she was so right.

The most recent publication about the pollution of Research (Vioxx Documents Offer Glimpse Into Ghostwritten Manuscripts, "Hire-A-PI," and Data Manipulation http://www.medscape.com/viewarticle/573075?sssdmh=dm1.345559&src=nldne) once again reinforces the importance of being a critical research consumer.

Unfortunately, not all research is as stellar as the implication behind "randomized controlled studies" would have us to believe. Though research may be a creative venture for the perennial student like myself, the fact of the matter is, there are people who conduct research for a living. Such people are usually involved in academia, in which they are expected to conduct research as a matter of professional advancement and daily livelihood. The more they publish, the greater their chances of getting further funding to do more research.

All sounds well and good. However, for the less creative but clever ones, there is the proliferation of numerous articles reflecting a slice and dice mentality, or milking any particular research project for all its worth, resulting in numerous articles across a variety of journals, with skimpy conclusions, all of which could have been reported in one well-written peer-reviewed article.

Number of publications do not necessarily mean quality research, but is more reflective of the degradation of Research. So is the practice of multiple authorship, which was addressed a few years back by the more prestigious medical journals that put a limit to how many authors could be listed for any particular article. Multiple authorship does a disservice to those who actually did the work, and I just find it incredulous that 25 listed authors could actually put in equal effort to publishing a particular article. When reputation is so important in the Research sector, I certainly wouldn't want my name listed with a slew of people whose work I may not be familiar with, nor would I have the conscience to defend the work should a question of unethical practices come up.

Another problem with research publications have to do with what actually gets published. Such publication bias puts greater pressure on researchers to come up with publishable research, which usually means significant findings, some of which have no clinical significance. This means that a lot of research may be discovering important outcomes that would be useful for the clinician to know, but is not chosen for publication because no statistical significance was found.

Negative significant findings (the new treatment fails) never get published either, although I think this is just as important. This is stifled by the early termination of studies showing too many people are dying. Such studies should be written up and published for future reference, and are just as important, if not more so than studies showing that a new treatment works. And, in cases where there is no difference, such research should be published as well.

For example, for research to be publication-worthy, let's say, a statistically significant difference was reached by the number of deaths that occurred between two comparison groups. As far as I am concerned, one death is one death too many, and therefore should be reported, even if it isn't statistically significant. This is why I find case studies such interesting reading. Unfortunately, such reports are relegated to the letters section of most journals, which then must compete for print space against the rebuttals of prestigious researchers.

How research results are used is problematic as well. The target audience for medical research is usually the medical practitioner, and research consumers make a peripheral audience. But many times, results and conclusions drawn cannot be easily translated into the practice setting. Yet, pharmaceutical companies use research results to try and convince physicians to prescribe their drugs because theirs is better than the competition. Health insurance companies use research results to justify their decisions not to reimburse for services and procedures not considered to be effective. Physicians would just like to use the results to improve the care they are providing to their patients, as should be the case. Unfortunately, the proliferation of "so much research" (some of which is questionable by who is sponsoring it) makes it difficult for even the most vigilant professional to keep up, so research results are "sound-bited" by the press for easy but not necessarily healthy digestion.

JAMA's editorial to make research reporting more transparent is a worthwhile endeavor that at least addresses the sponsorship issue. But, as you can see, there are many issues plaguing Research today that need to be addressed. Researchers need to take the first step in policing themselves and come up with a code of ethics everyone should live by, then work towards adding to the Body of Knowledge lean muscle rather than visceral fat.