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A proposal for publication of manuscript critiques in the American Journal of Orthodontics
GUEST
EDITORIAL
A proposal Jbr publication of manuswipt critiques in the American Journal of Orthodontics
T
he questionable quality of research being published in our clinical journals is a growing problem. The purpose of this editorial is to suggest how these shortcomings originate and how the quality of scientific articles can be improved. A critical review of current literature shows three areas in which the scientific process is deficient: methodology , techniques, and interpretation. Each represents a different problem. Methodology
Although clinical practice may be called an art, the documentation and communication of what has been learned from this art are based upon the rules of scientific methodology. An audience can evaluate only clinical evidence-not clinical experience. Failure to make this conversion while collecting data and writing an article is the main reason clinical research has developed an inferior reputation. Behind this problem lies the attitude that “I am a clinician, not a researcher!” This fallacy could be gradually corrected by appropriate changes in our dental curricula. The harm done by this attitude is spreading to include laboratory research because these clinically oriented studies also rely heavily on investigators who have been trained basically as clinicians, with or without some secondary experience in a scientific discipline. Behind this circumstance lies a related problem-that of the basic scientist who is expected to participate in clinically oriented teaching and research but who is administratively isolated from the stimulus of a clinical milieu. This underlying problem also must be corrected by appropriate administrative changes within the dental schools. Techniques
It is clear that present techniques in both clinical and basic research now are becoming so sophisticated that all research activity must involve active collaboration between the clinician-investigator and technically competent scientific specialists. Non-grant-supported 94
research usually has not been subjected to this type of evaluation, and much that is grant-supported shows little evidence that this type of collaboration has been carried out effectively. Interpretation
Orthodontics continues to shift its research base from empiricism to those biologic disciplines which deal with skeletal growth and remodeling. Therefore, it is increasingly desirable that biologic interpretations of scientific data be made in collaboration with, or evaluated by, persons with a thorough knowledge of current biologic concepts. When this fact is ignored, the investigator often arrives at erroneous or unsubstantiated conclusions which create a cresting wave of misinformation in subsequent literature and in the minds of many readers. Editorial policies of most clinical journals ignore the consequences of these problems and thus contribute to the decreasing scientific quality of published research. In the context being discussed, research can be defined as an intellectual process beginning with the conception of an idea and ending with its eventual reception or rejection by an audience. In between the start and the finish of this process is a sequence of intellectual steps called scientific methodology which, in simplest terms, must be logical and self-critical. There is logic to be found in almost all that passes as research but, unfortunately, the element of self-criticism is frequently lacking. In fact, it often seems that the investigator has avoided the critical experiment in his protocol which might disprove his idea. The intentional or inadvertent consequence of this approach would be more correctly called conceptual promotion rather than research. It is a search from which the element “re ” has been eliminated. This approach to research is so common in clinical journals that the gap between the investigator and his readers must be closed from both ends. This can be done editorially in ways that will quickly and appropriately stimulate the investigator to aim at higher re-
Volume 85 Number 1
search quality and will also assist the reader to critically evaluate published research. The first method appears to have been accomplished by the editor. Here the manuscript is reviewed by two consultants and the editor. Information that appears to be missing, inaccurate, or misleading is pointed out to the author. Other points of view must then be addressed in the discussion section. This allows for discussion without the involvement of personalities in the self-critical portion of scientific methodology. Another policy that could be established in the JOURNAL would be to publish, together with the more complex scientific articles, a dispassionate, critical analysis of its contents written by appropriate reviewers in the fields of methodology, techniques, and interpretations of findings. Why not? Research, whether it is done well or not, is an expensive activity, the cost of which is provided directly or indirectly by its recipient, the public. In this
Guest editorial
95
age of increasing accountability by those in positions of public responsibility, persons who carry out and publish clinically oriented research should also be intellectually accountable for their efforts. The mechanism for communicating research findings in journals could be modified to include the simultaneous publication of critical reviews, when available, designed to (1) raise the scientific quality of published research and (2) facilitate scientific discussion between the investigator and his readers. I propose that an attempt be made to publish manuscripts and their critiques simultaneously in the AMERICAN JOURNAL OFORTHODONTICS. Benjamin Moffett Department of Orthodontics University of Washington School of Dentistv Scuttle, WA 98195
EDITORIAL
A proposal Jbr publication of manuswipt critiques in the American Journal of Orthodontics
T
he questionable quality of research being published in our clinical journals is a growing problem. The purpose of this editorial is to suggest how these shortcomings originate and how the quality of scientific articles can be improved. A critical review of current literature shows three areas in which the scientific process is deficient: methodology , techniques, and interpretation. Each represents a different problem. Methodology
Although clinical practice may be called an art, the documentation and communication of what has been learned from this art are based upon the rules of scientific methodology. An audience can evaluate only clinical evidence-not clinical experience. Failure to make this conversion while collecting data and writing an article is the main reason clinical research has developed an inferior reputation. Behind this problem lies the attitude that “I am a clinician, not a researcher!” This fallacy could be gradually corrected by appropriate changes in our dental curricula. The harm done by this attitude is spreading to include laboratory research because these clinically oriented studies also rely heavily on investigators who have been trained basically as clinicians, with or without some secondary experience in a scientific discipline. Behind this circumstance lies a related problem-that of the basic scientist who is expected to participate in clinically oriented teaching and research but who is administratively isolated from the stimulus of a clinical milieu. This underlying problem also must be corrected by appropriate administrative changes within the dental schools. Techniques
It is clear that present techniques in both clinical and basic research now are becoming so sophisticated that all research activity must involve active collaboration between the clinician-investigator and technically competent scientific specialists. Non-grant-supported 94
research usually has not been subjected to this type of evaluation, and much that is grant-supported shows little evidence that this type of collaboration has been carried out effectively. Interpretation
Orthodontics continues to shift its research base from empiricism to those biologic disciplines which deal with skeletal growth and remodeling. Therefore, it is increasingly desirable that biologic interpretations of scientific data be made in collaboration with, or evaluated by, persons with a thorough knowledge of current biologic concepts. When this fact is ignored, the investigator often arrives at erroneous or unsubstantiated conclusions which create a cresting wave of misinformation in subsequent literature and in the minds of many readers. Editorial policies of most clinical journals ignore the consequences of these problems and thus contribute to the decreasing scientific quality of published research. In the context being discussed, research can be defined as an intellectual process beginning with the conception of an idea and ending with its eventual reception or rejection by an audience. In between the start and the finish of this process is a sequence of intellectual steps called scientific methodology which, in simplest terms, must be logical and self-critical. There is logic to be found in almost all that passes as research but, unfortunately, the element of self-criticism is frequently lacking. In fact, it often seems that the investigator has avoided the critical experiment in his protocol which might disprove his idea. The intentional or inadvertent consequence of this approach would be more correctly called conceptual promotion rather than research. It is a search from which the element “re ” has been eliminated. This approach to research is so common in clinical journals that the gap between the investigator and his readers must be closed from both ends. This can be done editorially in ways that will quickly and appropriately stimulate the investigator to aim at higher re-
Volume 85 Number 1
search quality and will also assist the reader to critically evaluate published research. The first method appears to have been accomplished by the editor. Here the manuscript is reviewed by two consultants and the editor. Information that appears to be missing, inaccurate, or misleading is pointed out to the author. Other points of view must then be addressed in the discussion section. This allows for discussion without the involvement of personalities in the self-critical portion of scientific methodology. Another policy that could be established in the JOURNAL would be to publish, together with the more complex scientific articles, a dispassionate, critical analysis of its contents written by appropriate reviewers in the fields of methodology, techniques, and interpretations of findings. Why not? Research, whether it is done well or not, is an expensive activity, the cost of which is provided directly or indirectly by its recipient, the public. In this
Guest editorial
95
age of increasing accountability by those in positions of public responsibility, persons who carry out and publish clinically oriented research should also be intellectually accountable for their efforts. The mechanism for communicating research findings in journals could be modified to include the simultaneous publication of critical reviews, when available, designed to (1) raise the scientific quality of published research and (2) facilitate scientific discussion between the investigator and his readers. I propose that an attempt be made to publish manuscripts and their critiques simultaneously in the AMERICAN JOURNAL OFORTHODONTICS. Benjamin Moffett Department of Orthodontics University of Washington School of Dentistv Scuttle, WA 98195