Towards evidence based research
BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i5440 (Published 21 October 2016) Cite this as: BMJ 2016;355:i5440
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Dear Editor
The authors make a valid and convincing argument regarding the need for looking at systematic reviews of existing evidence before embarking on new research, and point out that many funders now require this. It would be helpful if funders had a mechanism for allowing the costs of this prior review to be retrospectively funded, especially when a new systematic review is required, should the funding bid prove successful.
Yours sincerely
Susan Walker
Competing interests: No competing interests
The authors have rightly pointed out the need for doing a systematic review of existing research before starting new research to avoid research waste. We do agree to the views, however, with some reservations.
Research can be conducted in different ways such as basic research focusing on minute aspects of a phenomenon, observational, interventional or experimental and health systems research. Observational studies and some of the interventional/experimental mostly clinical trials and community trials could be subjected to systematic review before embarking on a research project. However, where evaluation of health programmes is concerned for some aspects of health systems, there is always a felt need to assess the effectiveness on a periodic basis, and the impact of the programme in the longer duration. In such a scenario, doing a systematic research may not be able to tell the current status since the review pertains to a period which occurred earlier, and we need to generate new data/information on the progress of the health programme. In such a condition, there is a redundancy of the earlier data, and we need not rely on the systematic review. Hence, the universal application of systematic review for all kinds of research is not a viable option.
Further, it is usual for researchers to look into the existing literature before going into new research to identify gaps for a research question. If the researcher feels the need and if such research has not been frequently done earlier, the need for systematic review of research does not arise at all.
Competing interests: No competing interests
Dear Editors
I support the call of Lund et al to reduce research waste by performing a systematic review of existing evidence, specifically "to identify and refer to earlier research when justifying, designing, or discussing new research".
It is a common pitfall that researchers have relied on third party reports (and interpretation) of original research on which to base the foundation of their new study: they often assumed other authors has performed due diligence themselves in actually performing a critical review of seminal papers involved.
Much like chinese whispers, one can see the deterioration of information through various editions of te same book over decades; similarly the circumstances, conditions and limitations in which the original authors performed their groundbreaking study are lost in the course of time. These works are often constrained by time, costs and technology as well as the prevailing socio-philosophical environment of the era.
Similarly some basic assumption of what constitutes an "active ingredient" needs to be reexamined; for example, the lack of additives in sterile water does not mean sterile water injection is not effective (ref 1). Please not that this example of sterile water is distinct from the claims of homeopathic practitioners with their highly diluted solutions (after Hahnemann) to improve potency in pursuit of "water memory"
Some studies listing sham surgery do not actually reflect the absence of intervention; what one person calls "sham surgery" is not the same as another's (ref 2,3). The content of placebos used in trials is often more mysterious than the test drug (ref 4)!
This is not a call to review the basis of everything we "know", but careful review of the actual pioneering studies may surprise more than a few researchers about the works of the giants.
In the current era of information technology, lack of access is no longer a valid excuse: using the vast network of medical libraries through the work, it is not difficult to access an ancient paper from an out-of-print journal. Similarly through various medical communities and international collaborations, language difficulties pose little barriers to modern investigators.
Afterall, before one is to climb to stand on the shoulders of giants, it is most wise to check that these sages themselves are standing on terra firma.
References:
1. Cui JZ, Geng ZS, Zhang YH, Feng JY, Zhu P, Zhang XB. Effects of intracutaneous injections of sterile water in patients with acute low back pain: a randomized, controlled, clinical trial. Braz J Med Biol Res 2016 Mar;49(3).
2. Moseley, J. B., O'Malley, K., Petersen, N. J., Menke, T. J., Brody, B. A., Kuykendall, D. H., et al. (2002). A controlled trial of arthroscopic surgery for osteoarthritis of the knee. The New England Journal of Medicine, 347(2), 81–88.
3. Sihvonen, R., Paavola, M., Malmivaara, A., Itälä, A., Joukainen, A., Nurmi, H., et al. (2013). Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. The New England Journal of Medicine, 369(26), 2515–2524.
4. Beatrice A. Golomb, Laura C. Erickson, Sabrina Koperski, Deanna Sack, Murray Enkin, Jeremy Howick. What's in Placebos: Who Knows? Analysis of Randomized, Controlled Trials. Annals of Internal Medicine, 2010; 153: 532-535
Competing interests: No competing interests
Re: Towards evidence based research
I fully support the need for systematic reviews prior to funding to help reduce waste. It may also be useful for applicants to be asked to search clinical trial registries (e.g., clinicaltrials.gov) to make sure their planned study is not already happening. Perhaps better still, the funding agencies could run searches of registries based on the authors title and abstract, and then ask the applicants to comment on any potential overlap.
Competing interests: No competing interests