We need better ways to create new hypotheses and select those to test
BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e7991 (Published 27 November 2012) Cite this as: BMJ 2012;345:e7991All rapid responses
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New hypotheses to test
Davidoff’s personal view on exploring new hypotheses strikes a very important point. In the UK there is a desire to involve the NHS in more research for the benefit of patients. Within hospitals and general practice there is a large number of clinical staff observing a wide range of clinical conditions from the routine to the rare. These staff may not have an ‘academic’ title but may be as astute as many university academics. Although having the ability and opportunity to form new hypotheses it may be difficult for them to find a forum to discuss and explore these and possibly establish more detailed scientific evaluation of their ideas.
In studying children with nocturnal enuresis we made an observation that could be explained by the presence of aquaporin(s) in the human urothelium, something not previously described. We were lucky to be able to link to a group in the University of York who accepted the idea, helped find funding and subsequently showed the presence of aquaporins in the human bladder (1). This work won a number of prizes at international meetings. This is an example of simple clinical observation and basic clinical research led by an NHS consultant subsequently progressing to the laboratory and resulting in a more scientific discovery led by a University academic team. At all times there was mutual respect and understanding between the members. Yet this is often not the case as a clinician. If the idea does not fall into the faculties’ main research interest it is very difficult to proceed further. The York experience was the exception; sadly others have not been so good.
In trying to facilitate this two way debate I suggested to my local university that they might establish a database of research interests across all the faculties with links to members of the departments with whom you could meet and explore ideas. Disappointingly this was received with condescension and a negative response. One recognises that many ideas may not be viable but there needs to be a mutual exchange of ideas and an ability to recognise concepts worth exploring further. Universities and their academic departments will only continue to flourish if they have the willingness to listen and work with those keen and enthusiastic to work with them from within the NHS. As identified by Davidoff, current mechanisms for recognising promising hypotheses and selecting them for testing are haphazard, inefficient and far from rational.
Philip Holland
Consultant Paediatrician Leeds
1. Expression and Localisation of Aquaporin Water Channels in Human Urothelium in Situ and in Vivo. Peter C. Rubenwolf, Nikolaos T. Georgopoulos, Lisa A. Clements, Sally Feather, Philip Holland, David F.M. Thomas, Jennifer Southgate. European Urology: 2009; 56(6) 891-1104.
Competing interests: No competing interests
Re: We need better ways to create new hypotheses and select those to test
I am heartened to read Davidoff's "call to arms" for future hypothesis generation to move beyond traditional boundaries.
As a full-time physiotherapist who undertook an MSc to improve my research knowledge, it can be difficult for full-time employees to collect data, analyse it and collaborate with like-minded individuals at a grass roots level. Any work I have done has been in my own time, at my own expense.
My own interests in back pain and recent insights into femero-acetabular impingement (FAI)have recently been boosted by promising collaborations with colleagues at the University of Nottingham. On the 20th March 2013 there is a full day of lectures and workshops to optimise the clinician and academic relationships within the East Midlands.
Small scale observations allowed patterns to be identified to label diseases such as toxic shock syndrome and Legionairre's. Can we now champion the clinician once more with the added bonus of University faculties helping us out, the enthusiastic majority?
Competing interests: No competing interests