Medical Research: How Valid Is It?

[Emergent, RN]

I don't trust the medical establishment or academia. Covid has heightened these feelings. Research of all kinds is fueled by  ideological or financial agendas. Thanks for the article. 

[UrbanHealthRN, BSN, RN]

As a quick piece of background, I have a Masters in Public Health in addition to my BSN, and I am familiar with research methods as they pertain to healthcare. I find it is interesting that this article contains some of the very problems that the author is writing about, mainly inaccuracy, cherry-picking, and bias.   

Quote

6 hours ago, Brenda F. Johnson said:

In fact, they claim that 85% of the money used for research is not spent on something that the medical community needs, but rather on what individual medical researchers are given incentives for (2020, Bradley, et al). 

The original sentence I found in the article was "avoidable methodological failings and biases lead to ‘research waste’, which is estimated to account for 85% of all medical research funding". This does not sound the same as saying that 85% of medical research is unnecessary to the medical community, or based solely on financial bias. Methodological failings can encompass a wide range of issues. Also, the research topic might be very needed by the medical community, but if the research is poorly conducted, then it is of no help.

 

6 hours ago, Brenda F. Johnson said:

Out of 1528 studies registered in 2020 with using NIPPV (Noninvasive Positive Pressure Ventilation) for Covid patients, only 3 were randomized. (2020, Dobler)

The original sentence stated "On 17 May 2020, 1528 studies were registered on ClinicalTrials.gov using the term “COVID”, of which only three were randomised trials to assess NIPPV, despite the urgent need for evidence to inform clinical practice in this area". This a major oversight to state that 1528 studies were registered for all of 2020 when really that number was only for half the year, AND only about 2-3 months into the pandemic. I understand that importance of producing quality research work, but please understand the emergent nature of this pandemic, and how sometimes research needs to adapt to the situation at hand. 

6 hours ago, Brenda F. Johnson said:

Randomization in medical research using human subjects is a must in order for the results to be unbiased and accurate. 

Except randomization isn't a must. If I want to study the effects of lead on children's development, I don't give some children lead to eat and others none- that would be dangerous. Instead, I have to find pre-existing cohorts of children that I can get my data from. Randomized controlled trials are great, but let's not ignore other types of research that can also be helpful. 

What would be great to see is a follow-up article that talks about how to identify a good piece of research. Between QI projects, patient education, and continuing education, nurses need to know what research can be helpful to their practice. 

[Daisy4RN]

9 hours ago, Emergent said:

I don't trust the medical establishment or academia. Covid has heightened these feelings. Research of all kinds is fueled by  ideological or financial agendas. Thanks for the article. 

Neither do I! It has probably always been bias bit seems worse these days.

2 hours ago, UrbanHealthRN said:

What would be great to see is a follow-up article that talks about how to identify a good piece of research. Between QI projects, patient education, and continuing education, nurses need to know what research can be helpful to their practice. 

So sad that it is indeed so hard to decipher!

[momofm1998]

Urbanhealthrn, would have been nice for you to have offered some more positive input to this poster. She obviously put a lot of thought into a topic that should’ve on a lot of our minds.  
I can’t quote exactly how very very many supposedly respected medical journals research has been proven invalid, fraudulent and false.  Too much “all about the money” too much pharmaceutical influence. As for me, common sense tops all the “papers” written by the so-called “experts”. Covid has laid own a plethora of false “science gods” .. scary! 

[Surfin USA]

On 4/26/2021 at 8:30 AM, Brenda F. Johnson said:

What is Valid Research?

We use peer-reviewed research articles to base our nursing practice on, and it’s called Evidence-Based Practice (EBP). Peer-reviewed means that scholarly experts in the subject have analyzed the information for validity.  For example, the protocol for sepsis is based on EBP. Over time, as more research is conducted, the protocol may be updated as new treatments emerge. However, there are several issues within the medical research community that should give us pause when we are looking at information. In other words, we should not take it for granted that everything we read is completely accurate and unbiased.

Concerns

There are several concerns about medical research, such as wasted money, quality vs. quantity, reporting bias, and cultural issues.

Wasted Funding

There is a lot of waste in the research field according to the article, “Reducing Bias and Improving Transparency in Medical Research: A Critical Overview of the Problems, Progress, and Suggested Next Steps” (2020, Bradley, et al). In fact, they claim that 85% of the money used for research is not spent on something that the medical community needs, but rather on what individual medical researchers are given incentives for (2020, Bradley, et al).  Because of this bias, studies are not conducted properly, and a lot of the research cannot be replicated (2020, Bradley, et al). And if you remember from science class, an experiment is not valid unless it can be duplicated. 

Take for example the research that has come out the past year about Covid-19. There were many publications that published non-peer-reviewed studies (2020, Dobler).  When this happens, inaccurate information can be contained in the article, which is then spread over every media outlet like it’s the gospel truth (2020, Dobler). Unfortunately, there are low medical literacy viewers that believe everything that they see and hear on television. This is not their fault, it is the publishers of the misinformation. Often these studies have very small sample sizes and poor study designs (2020, Dobler). Other faults in rushed research are that they have no group to compare results with, and no protocol that is publicly available (2020, Dobler). When no protocols are available, there is no accountability. 

Some of the research done on Covid-19 was performed by people who had no experience with respiratory infections, let alone any associates that could help produce authentic work (2020, Dobler). As a result, many gross misunderstandings were accepted by the public. To help us understand the disproportionate accurate versus inaccurate research trials we will look at the trials that took place last year. Out of 1528 studies registered in 2020 with using NIPPV (Noninvasive Positive Pressure Ventilation) for Covid patients, only 3 were randomized. (2020, Dobler). Randomization in medical research using human subjects is a must in order for the results to be unbiased and accurate. 

Quality Vs Quantity

Academics are pressured to publish regardless if there is interest or not (2020, Bradley, et al). As you may already know, what is published, studied, and the conclusions are widely based on financial incentives (2020, Bradley, et al). This creates a culture within research to conduct studies that are not objective. For example, the pharmaceutical companies (that we know are rolling in money) often have an institution do a study for them, creating a conflict of interest (2020, Bradley, et al). Pharmaceutical companies evidently can opt-out of proclaiming conflicts of interest, 

Bias

 Every day that we look at a news article, or watch it on television, information is cherry-picked according to the message that they want to convey. The same thing happens with research published by journals or scholarly publications (2020, Bradley, et al). In many cases, if the results of a study have a negative result, then that study is not published (2020. Bradley, et al). What may happen, is that a spin is applied to the information so that it comes across in a more positive, or different manner. 

When a study goes through peer review, and the scholars report a bias or that the study does not state the limitations of the study, the report can be ignored (Bradley). And even worse, some researchers are developing their hypothesis after the study is conducted in order to match the results of the study (2020, Bradley, et al). 

Cultural Issues

Some of you may remember when cardiac research was done, it only included men in the study. How then can the results be applied to women? It doesn’t make any sense. Just as doing research without including minorities creates health disparities (2021, Heath). According to the article by Sara Heath, “Why Poor Diversity in Medical Research Threatens Health Equity”, an oncology study in 2019 was broken down as follows:

• 76% White
• 18% Asian
• 6% Hispanic
• 3% Black

Due to this process, the complete awareness of a disease process is not being learned. 

Ways to Improve

As stated before, in order for the study to be taken seriously, it has to be reproducible. Bradley writes that transparency and positive guidance will improve honesty (2020). He also thinks that there should be a limit on how many studies can be submitted for institutional assessment (2020, Bradley, et al). Also, they need to register their hypothesis, methods, and analysis before a conclusion is found (2020, Bradley, et al). There is a problem, however, with producing individual patient information, so sometimes the data is private and cannot be revealed.

Conclusion

As nurses, we must recognize that there are flaws in the research process that can cause misunderstandings in the patient community. Hopefully, in the future, there will be more regulation of studies performed as well as what is published as unbiased facts. 

References

Bradley, S.H., Devito, N.J., Lloyd, K.E., et al (2020). Reducing Bias and Improving Transparency in Medical Research: A Critical Overview of the Problems, Progress, and Suggested Next Steps. Journal of the Royal Society of Medicine, 113(11).

Dobler, C., (2020). Poor Quality Research and Clinical Practice During Covid-19. Breathe: Practice-Focused Education for Respiratory Professionals, 16(2). 

Heath, S., (2021). Why Poor Diversity in Medical Research Threatens Health Equity PatientEngagementHit. 

What I find odd is that the person who supposedly peer reviewed this paper is actually a lay editor for a website called healthwatch, and someone who maybe used to be a pediatric dentist, and may also be a painter. 

Shes definitely an editor for the uk based healthwatch site. 

Peer review is supposed to be done by people in similar fields. Not journalists.. 

I mean, the article has merit. Im not saying its baseless.. its just not really *peer* reviewed. More like media exec reviewed.

I think hes on to something. I looked up the article and skimmed through it. 

IDK. Seems like a lot of cherry picking is all.

Look.. everyone wants to be published. For better or worse, being published is ultimately a good thing. This guy threw this article out there just in time for covid related research to be seen being peer reviewed in a matter of weeks or months, when real peer review usually takes a lot longer. 

And he himself tossed all sorts of stuff out there just to get more stuff published as well. 

Im not saying hes dishonest. I am saying lets call a spade a spade. 

[UrbanHealthRN, BSN, RN]

22 hours ago, momofm1998 said:

Urbanhealthrn, would have been nice for you to have offered some more positive input to this poster. She obviously put a lot of thought into a topic that should’ve on a lot of our minds.  
I can’t quote exactly how very very many supposedly respected medical journals research has been proven invalid, fraudulent and false.  Too much “all about the money” too much pharmaceutical influence. As for me, common sense tops all the “papers” written by the so-called “experts”. Covid has laid own a plethora of false “science gods” .. scary! 

I agree that a positive post is usually the best choice. But like I said above, the article seemed to have nothing good to say about researchers, and on top of that did not seem well thought out (ex. there were errors in how the cited articles were reported). Regarding your claim that there is a ton of bad research out there, I can't believe that if you're not going cite your claim. Without citation, this sounds like more fear mongering to me. There are certainly good researchers out there who work very hard to help others- it's how we got to where we are today in medicine and nursing! Look at the works of Florence Nightingale, John Snow, Jonas Salk, Rosalind Franklin, Robert Gallo....the list goes on and on. And it would be great to see a follow up article here that talks about how to recognize sound, ethical research and incorporate it into practice. Nursing is as much a science as it is an art, and we should respect the scientific side.