These are two postings to WAME (World Association of Medical Editors).
How Does Scientific Research Progress?
Scientific research follows three main processes:
Most scientific studies
are replicative in nature. They just confirm for us the finding and conclusions of a previous research. Till the time and
to the extent they are replicated, the findings stand reconfirmed. All acceptance in scientific research is, therefore, perennially
provisional, and liable to refutation. No scientific progress occurs by replication. But scientific acceptance and stability
of hypotheses is confirmed thereby, and to that extent. Most scientific research falls in this category. It is the bread and
butter of scientific research.
All scientific progress
occurs only when a scientific theory, or finding, gets refuted. In this there is major shift in theorizing and shift of paradigms
may be involved. Few studies can claim to be such, but those that do, bring about epochal changes in scientific thinking and
outlook. It is the crowning glory of research.
While refutation is not
always possible, self-correction is. In this aspects of a finding or theory get replicated, but some are found suspect. The
former are accepted, albeit provisionally, the latter stand refuted, and undergo modification. Most scientific progress takes
place by such incremental means. Major work in scientific research is to find processes whereby it can be done, and samples/evidence
and theories on which it can be applied. It is the jam of scientific research, and the most enjoyable part of scientific sparring
amongst peers. It makes for most of the interesting reading in research work of scientific colleagues. It is refutation applied
in small doses, without any whole-scale rejection of a total scientific construct.
A good researcher must ask these four fundamental questions about his, and
do his findings prove?
do they disprove?
findings will further prove his findings/theories?
findings will disprove his findings/theories?
In answers to questions 1 and 3 lie replication. In answers to questions 2
and 4 lie self-correction, and hopefully, refutation. Good quality scientific work does engage in answering questions 1 and
3, but often tends towards answering questions 2 and 4. And every researcher must make a point to ask these questions about
his, and others’ work.
13 Jan 2006
Anonymity for Authors
Anonymous writing can be for three main reasons:
- To slander someone
- To expose someone without suffering the consequences
of the expose
- If someone does not want to be identified but wants
to excite discussion amongst readers e.g. an editor, editorial board member, well known writer, someone who does not want
his/her position/affiliation to influence readers’ responses to the write-up.
While every well intentioned editor is justified in being wary of anonymous writing whose primary intention
maybe to slander or spread malicious gossip about researchers, editors, journals etc, it is equally his duty to be aware of
the nefarious goings-on in medical research. Now, it is all right to say that a whistle blower must have the courage to get
recognized and adopt a public stand, and most do; but it is equally important to accept that not all can. The line dividing
courage and bravado is thin, and not everyone would risk his/her position to become a messiah of change. That does not, however,
mean what he/she has to say may not be based on evidence. The editor/editorial board’s prime responsibility is to determine
whether it appears prima facie evidence based, like it does for all other manuscripts, and is couched in parliamentary language.
Having ensured this, there is no reason why it cannot go for peer review for which, in any case, it has to be anonymous. If
the editorial board considers it of great import and time is of the essence, it may even consider it for publication if the
journal policies permit such ‘fast track’ publishing. If possible, such publishing should be accompanied by a
rejoinder from the authors/journal concerned. If the latter refuse to respond, the editor/editorial board could always mention
below the article that they welcome a response/rejoinder/rebuttal even later, provided it is couched in parliamentary language
and produces counter-evidence.
In any case, no editor/board/journal should engage in anonymous scandalous writing about another editor/board/journal,
taking cover of anonymity. How to ensure this happens is one vexing issue. However, if the parameters are clear, the evidence
is strong, the other journal/editor is refusing to publish because it stands to get exposed for its wrong doings, I see no
other option but for the article/communication to be published in another journal. The readers will judge it for what it stands,
and will definitely pull it down a peg or two for its anonymity, as well as lack of declaration of ‘conflict of interest’.
But even if pulled down so, it may still stand scrutiny, and become the start of many other skeletons tumbling out of other
In the case of something published in one’s own journal, anonymous rejoinders to published material
may be easier to accept, with the rider of evidence and parliamentary language mentioned earlier.
I realize that accepting anonymous writing can open the floodgates of slander/libelous writing, which maybe
difficult to lock later, but it is equally important that truth prevails. For those who are high and mighty in research, and
who have a reputation of being ruthless towards their detractors, what method of expose is available to those who know about
their wrong doings except to reveal the truth under cover of anonymity? In other words, if anonymous writing is not allowed,
we allow them to continue till Kingdom Come. And help spawn many more of their ilk, for the smart alecks learn quickly the
ropes to climb. Moreover, to expect every truth carrier to also have the strength to bare the consequences of truth telling
is to expect each man to be a Christ or a Gandhi. Is it not a little too much?
In the light of the above, I wonder if we could come to the following conclusions:
- Editors should be very wary of anonymous writing
landing on their desks, and in general should be very suspicious of the motives of such writing. Something couched in slander
and abuse should be rejected outright.
- However, if an editor feels there is substantial
evidence produced, it conforms to journal style and is in line with journal policies, a serious second/third read must be
given. The editor may at this stage encourage the writer/s to remove the anonymity condition so that the writing stands complete,
and the authors muster courage. Sometimes an editor’s persuasion may work for the welfare of all concerned.
- The editorial board then discusses the issues raised
in the anonymous article threadbare. If the evidence produced appears irrefutable, it must be sent for peer review, and considered
for publication according to the regular process. It must be sent to the concerned person/persons for a rejoinder, wherever
- The rejoinder, if forthcoming, and only if couched
in parliamentary language producing counterevidence, or accepting totally or partially the claims of the anonymous article,
whatever, should be similarly considered for publication.
- In any case, anonymous writing should form only
a miniscule part of the journal’s writings, and its rejoinder and counter to the rejoinder should not be used to convert
the journal into a tabloid.
- The controversy should be swiftly resolved. The
journal should never play ‘running with the hare and hunting with the hound’ to extract mileage and increase circulation
at the cost of researchers’ reputation.
- No journal should encourage people to write anonymously
as a part of its policy, but accept an occasional work of this type in extraordinary circumstances, if and only if there is
sufficient prima facie evidence for such an acceptance, and due process of submission and review are followed. Editorial discretion
and judiciousness are of paramount importance here.
- Proper statutory bodies, or judicial process should
deal with any journal that indulges in anonymous writing to spread malice and slander about researchers and other journals.
- Rarely should the editor/editorial board ever associate
itself publicly with anonymous writing. The disclaimer about all other work published applies equally to anonymous writing,
in fact more so. A clause that it is an anonymous writing and should be judged accordingly is to be added below, and is itself
a declaration of conflict of interest of sorts. The editor/editorial board only considers it print worthy based on its content.
It does not endorse its contents, however.
I am aware many editors who read this may be tempted to play it safe and avoid anonymous publishing altogether.
And maybe they are doing the pragmatic thing after all. For don’t we all know that every editor who survives learns
to play it safe. But every editor who not only survives but makes a mark also makes bold to play it on the front foot at times.
Well, each one to decide his course, and his destiny.
Business as usual
The Lancet - Vol. 364, Number 9441, 2 October 2004, Pages
|Viewing 1-1 of 1 Comments|
|Angell's Anguish, Horton's Balance|
September 19 2005
Dr Ajai R.Singh, Editor, Mens Sana Monographs, Mens Sana Research
|Marcia Angell's book is necessarily
polemical. It cannot present the other viewpoint. That is the job of the opponents of her stand. A crusader can hardly be
expected to balance and weight contrary opinions. That's our job. |
In the atmosphere of massive industry funding and
control that prevails, and the concern and disquiet it has aroused in those who have the long-term interests of medicine at
heart, I think a no holds barred expose like Angells come as a welcome addition. Her clear and unequivocal stand is a much
needed, if rather caustic, expose. It is in sharp contrast to the ambivalence and resultant confusion that prevails in most
who study the Academia-Industry connect in some detail, and have the long-term interests of both sides at heart.
is not to deny the importance of balance that Richard Horton emphasises. But that's for those who are masters of the balancing
act, like Horton maybe, not crusaders like Angell.
This phase of awakening of the conscience of medicine is important,
very important. And is to be supplemented with, and go along with, the balancing that Horton indicates. But at no time the
balancing should over ride the ethical awakening.
We do want a few crusaders to put medicine back on track before
we mellow down and settle in our comfortable positions in academia, research, practice or wherever.
Let the Angells
do their job.
And let's do ours.
Dr Ajai R. Singh
Competing Interests: None
(This is a comment on the Lancet Website)
diseases must include psychiatric conditions
Neglect of chronic diseases from the Millennium Development
Goal (MDG) parallels neglect of chronic psychiatric conditions like Chronic Schizophrenia and Chronic Depression from the
medical agenda of those who care, but need to be better informed. While inclusion of cardiovascular disease, chronic respiratory
disease and diabetes are laudable, exclusion of chronic schizophrenia and chronic depression are surprising. This when we
know that in the Global Burden of Disease projected for 2020 (Muray and Lopez, 1996), for example, Unipolar Major Depression
is expected to be the second highest cause of disease burden worldwide (5.7%), after Ischaemic Heart Disease (5.9%). And ahead
of Cerebrovascular accidents (4.4%) and Chronic Obstructive Pulmonary Disease (4.2).
I think chronic psychiatric conditions need to be
given some serious attention too, if disease amelioration is truly our goal.
Moreover, suicide risk is very great in all chronic
conditions, not only Depression, where of course it is a major risk. For example, one out of six long-term dialysis patients
over the age of 60 stops treatment, resulting in death ( Neu and Kjellstrand, 1986). Suicide rates among cancer patients are
one and half times greater than that amongst non-ill adults (Marshall et al, 1983). Suicide amongst men with AIDS is
estimated at more than 36 times the national rate for their age group (Mazurk et al, 1988).
reason why suicides are great here is likely to be undiagnosed, untreated chronic depression. Hence a concerted effort to
include chronic depression too in our global effort to fight chronic diseases is a must. The hidden cost of depression as a considerable burden on society and the individual, especially in terms of incapacity
to work, has been noted in the UK (Thomas and Morris, 2003). The hidden cost of not treating depression is 30,000 to 35,000
suicides per year in the United States alone (Stahl, 2003).
The figures are equally applicable to the other countries, including India.
Similarly, 1% of the population suffers from Schizophrenia.
The efforts to treat and rehabilitate this chronic condition need to be highlighted and put on a war footing too. Why? Because
Schizophrenia is not just a chronic condition, it greatly affects the quality of life of a huge chunk of the populace. It
is severely incapacitating in those who become chronic.
Some attention to these rather neglected public health
issues in those who genuinely hold the interests of medical care at heart would be in order.
Dr Ajai R. Singh
1. Marshall J., Burnett W., and Brasure J. (1983), On Precipitating
factors: Cancer as a cause of suicide, Suicide
and Life Threatening Beh., 13, p 15-27.
2. Mazurk P. M., Tierney H., Tarfidd K., Gross E. M., Morgan E. B., Hsu
M.A., and Mann J. G. (1988), Increased Risk of Suicide in persons with AIDS, JAMA,
259, p 1332-33.
3. Murray C.J.L. and Lopez A.D. (ed), (1996), The global burden of
disease: a comprehensive assessment of mortality
and disability from disease, injury and risk
factors in 1990 and projected to 2020, Cambridge Mass., Harvard. Uni Press.
4. Neu S. and Kjellstrand C. M. (1986), Stopping long term dialysis:
An empirical study of withdrawal of life-supporting
treatment, New Eng. Jr. of Med., 314, p 14-19.
5. Stahl, S.M. (2003), Depression and Bipolar Disorders. In Essential Psychopharmacology: Neuroscientific Basis and Practical Applications, Second Edn, Cam. Uni. Press 2000, First South Asian Ed. 2003, Foundation
Books, New Delhi. p 139-41.
6. Thomas, C. M. and Morris, S. (2003), Cost of depression among adults
in England in 2000, Br. Jr. Psy. 183,
of this on the Lancet website too. See below.)
The neglected epidemic of chronic disease
The Lancet - Vol. 366, Number 9496, 29 October 2005, Pages 1514
|Viewing 1-4 of 4 Comments|
|Chronic diseases must include chronic
psychiatric illnesses too|
October 06 2005
Dr Ajai R. Singh, Editor, Mens Sana Monographs.
Neglect of chronic diseses by the Millenium
Development Goal (MDG) parallels neglect of chronic psychiatric conditions like Chronic Schizophrenia and Chronic Depression
in the medical agenda of those who care. While inclusion of cardiovasculat disease, chronic respiratory disease and diabetes
are laudible, exclusion of chronic schizophrenia and chronic depression are surprising. This, when we know that in the Global
Burden of Disease projected for 2020, for example,Unipolar Major Depression is expected to be the second highest cause of
disease burden worldwide(5.7%),after Ischaemic Heart Disease (5.9%). And ahead of Cerebrovascular accidents (4.4%) and Chronic
Obstructive Pulmonary Disease (4.2%).
I think chronic psychiatric conditions need to be given some serious attention too,
if disease amelioration is truly our goal.
Moreover, suicide risk is very great in all chronic conditions, not only Depression,
where of course it is a major risk. For example, one out of six long term dialysis patients over the age of 60 stops treatment,
resulting in death. Suicide rates among cancer patients is one and half times greater than that amongst non-ill adults. Suicide
amongst men with AIDS is estimated at more than 36 times the national rate for their age group.
The main reason why suicides
are great here is likely to be undiagnosed, untreated chronic depression. Hence a concerted effort to include chronic depression
too in our global effort to fight chronic diseases is a must.
Similarly, 1% of the population worldwide suffers from Schizophrenia.
The efforts to treat and rehabilitate this chronic condition need to be highlighted and put on a war footing too. Why? Because
Schizophrenia is not just a chronic condition, it greatly afects the quality of life of a large chunk of the populace. It
is severely incapacitating in those in whom it becomes chronic. Some attention to this rather neglected public health issue
in those who genuinely hold the interests of medical care at heart would be in order.
-Dr Ajai R. Singh
|Competing Interests: None|
Mens Sana Monographs [MSM]: A Mens Sana Research Foundation Publication