Risk of low impact research
I AGREE with the observations of the author of “On the track of the silent killer” (The Star, March 6) and would like to add another. Clinical research only becomes useful if it is of technically high quality. The problems are summarised in the paper “Why Most Clinical Research Is Not Useful”, PLoS Med 2016.
Many, if not most, of the problems identified in the paper, stem from lack of a properly trained clinical research workforce. Much of the clinical research workforce are either untrained and/or itinerant (comprising of students of some sort).
Many clinicians realise that they require clinical research training prior to undertaking clinical research if their aim is to help patients. But there seems to be widespread confusion regarding the type and availability of the required qualifications.
A popular qualification is the “Academic PhD”, where the holder chooses a “novel” research question to answer. The primary goal here is to make a new discovery and add to existing knowledge. This is the sort of research that will hopefully win a Nobel Prize or the Lasker Award.
This is usually a by-research only PhD where the student thinks of a novel research question and enlists the help/supervision of research methodologists, statisticians and laboratory scientists to complete the project. The advantage is that it is cheaper to undertake both for the student and the university.
However, the student usually does not receive formal training in the underlying required skill sets such as research methodology, statistics and laboratory methods. This makes it difficult for him/her to conduct further research or to understand published studies containing complex methodology or statistics.
A more difficult to obtain qualification is the “Professional” PhD. Here, the holder is normally required to choose a non-novel research topic to learn about and apply the process of research itself. The primary goal is to become a trained researcher.
This is usually a mixed-mode or course-based PhD. Instead of enlisting the help of research methodologists, statisticians and laboratory scientists, the student acquires the skill sets herself. The pros are that the student can go on to do other clinical research (career researcher) and can read and understand complex research papers.
The disadvantage is that this is a very expensive undertaking because, in addition to the research project, the university has to provide a range of taught and examined skill sets.
Currently, the only group of physicians who seem to be able to access a proper Professional PhD are the public health physicians.
However, clinical research often involves more complex issues than public health research.
Furthermore, unlike public health research, clinical research is often used to directly treat individual patients without further vetting once it is published. So, the dangers of low quality clinical research by untrained/inadequately trained researchers is obvious.
Efforts have to be made to train professional clinical researchers. It is unlikely that any one university can provide all the necessary teaching, hence it may be necessary to form a consortium of universities to do this. If not, the money allocated for clinical research will be wasted and patients treated on the basis of such research may be harmed.
DR MANIMALAR SELVI NAICKER Histopathologist and statistician Subang Jaya