Everything you ever wanted to know about scientific research…but were afraid to ask
There is an awful lot of talk in the Network about the importance of research. Not everyone wants to know more, but if you are curious, I’d like to help you understand: 1. What it is 2. How it is made 3. How it is used by doctors 4. And most importantly, what kind of things masquerade as science, but aren’t? And why do we need to watch out for this?
So, first some basics. Let’s start with something called Scientific Method. This is an empirical method for acquiring knowledge. Empirical means “based on observation”. The course of scientific method will go something like this:
Start with an idea
Research the topic - find out about the background
Form a hypothesis, or a theory about something
Test with an experiment
Analyse the results
Form some conclusions
In medical research, it is really important to publish the results– both when you think you have found something interesting (like “smell training is helpful”) and when you have had a disappointing result (for instance the most recent paper on PRP injections). Publishing disappointing results helps us understand what doesn’t work. As Thomas A Edison said “I have not failed. I have found 10,000 ways that won’t work”!
So that’s the method. Let’s zoom in on research for smell dysfunction.
There are all kinds of research studies that are relevant to us as a patient group (trials of drugs or treatments, longitudinal studies about how people progress over time, reviews that take in all the published work on one subject. There’s more on this in the link at the bottom). For new treatments that people don’t know enough about, small pilot studies will be done. Pilot studies need lower numbers, but anything less than ten participants can be unreliable. A study of one person is called a case study, and that means it is anecdotal - interesting, but not enough information.
If a pilot study looks interesting, and I’m thinking here of, for instance, Theophylline research, PRP, Vitamin A, etc then a follow up study is warranted. That seems easy enough, but for every study, funding is needed run the study, hire the scientists, organise the participants, and so on. Sometimes, an idea looks really promising but funding for it doesn’t happen, and that is always a disappointment.
Once a principle has been established, for instance the use of smell training for olfactory loss, then other researchers will want to try this out themselves, using the same principles wherever possible, to replicate and validate the findings of the first study. A great example of this is that many of the early papers on smell training used the same odorants: lemon, rose, clove, eucalyptus. Nothing particularly magical about those, but they were repeated in so many studies that they became the standard. If that study works out well, then sometimes new research will branch out and try something a little bit different. As an example, the research that looked at modified smell training, with different odorants. That builds on the original evidence, and solidifies the “evidence base” for that principle.
All this takes time. Establishing the hypothesis can go quite quickly, as we saw during the pandemic. Getting the funding? The timeline on that will depend on who is doing the work. How long does the experimental phase last? It might be relatively quick if you are just asking people to fill out a survey, but if you are observing how people are doing 3 years after Covid, well, that will be in the making for three years and then some. The analysing, writing up, and putting out for publication can also take some time.
Once the research is written up into a paper, it is put out for review with a scientific journal. Some scientific journals have a better reputation than others–google the journal to find out. The editor takes the paper, sends it out to some reviewers who have experience in the research area, and waits to hear what they say. Do the reviewers think the research was done well? Is it interesting? Does it bring something new to the table? Reviewers will give feedback and expect changes. Sometimes, the editor turns down the paper from the get go, and it is up to the authors to find a new publication to apply to. So all that can take time too.
Next important step: the research has to get in front of the doctors who treat the condition. So for us, if the ENT is not watching the news on smell loss, they may not have heard the latest news on treatments. A doctor will only give advice that has an evidence base. They won’t prescribe something that they have heard an anecdote about. There needs to be published evidence. And they need to know about it.
Finally, what kinds of things do not fit into this picture of evidence based medicine? What is not, actually, good research? What is not research at all? That’s easy: anything that doesn’t follow the scientific method. So the TikTok cures we heard about during the start of the pandemic are not scientific, nor are news reports from television stations about a person who went to a herbalist and was cured. When you see reports in the news or in your social media feed, always ask: where did this come from? This is why I always post links to the research I discuss.
Whew! If you’ve made it this far–congratulations! You’ve graduated from my crash course on understanding research.
If you are a glutton for punishment, you might enjoy this: The Art of Reading a Journal Article
