Abstract
Research is the quest for information. It is not an excuse for attending meetings in exotic places, nor is it an escape from clinical work that has become uninteresting. The early orthopaedic joumals contained reports of patients who have been treated by individual surgeons in specific, often novel, ways. There was little scientific structure, but nevertheless these papers were valuable as they disseminated knowledge to other Surgeons and also stimulated enquiry.
Orthopaedic research has developed dramatically over the last two or three decades. Patient related research has been advanced as a result of the availability of new techniques for example electron microscopy, DNA sequencing and the Genome, together with the discovery of the fine details of the cytokine control of cellular processes. This has gone hand in hand with the development of surgical sophistication allowing more adventurous interventions.
Joint replacement and internal fixation have led to close associations between orthopaedic surgeons and scientists from other disciplines, notably engineers and material scientists. This multi-disciplinary involvement is typical of orthopaedic surgeons and results in each discipline benefiting from the specialist knowledge of the others. The natural tendeney for orthopaedic surgeons to be interested in mechanical items is clear from a study of the distribution of interesting cars in the hospital car park!
The efficacy of different treatment methods should be challenged and this has resulted in the need for careful audit and epidemiological review. In some instances this has resulted in the conclusion that often used treatments are not effective. The assiduous application of the Cochrane principles is often very revealing, not least in that it indicates the lack of properly conducted orthopaedic trials.
Academic orthopaedics is in danger. In many countries the speciality is under pressure, normally as a result of economic measures that restrict the avallability of salarles and grants. In spite of these restrictions, it is surprising that there is a steady supply of excellent papers. How much better it could be with more funding.
The purpose of publícation is to share information. It should be the aim of every research worker to make a contribution to the understanding of the subject and to share his findings with his colleagues. Curiously many researchers feeI that their commitment to their project is complete as soon as they finish the trial and have the results. The preparafion of their work for dissemination through publication is often a very weak link and in some instances is absent. This is a dangerous tendency as their information may not be broadcast, wasting the scientific endeavour and endangering the status of the fundíng organisation, whose charitable status often depends on sharing the fruitg of research.
The incentive to publish is very variable. In some institutions the very existenee of a research department depends on a ‘paper score’ which is normally calculated from the product of the number of papers and the impact factor of the j ournal in which they are published. The calculation used to determine the impact factor of ajournal does not favour orthopaedic journals, as most orthopaedic papers are not quoted prolifically within the first year of publication. In contrast orthopaedic papers tend to have a much longer and more valuable lifetime and to some this is the more important and relevant feature. Unfortunately, the long-term value of the papers is not part of the calculation of impact factor. In order to achieve a high impact factor the publication must be in a rapidly changing field and contain at least a tiny element of special originality, which leads to it being quoted by most of the workers in that field. In the publishing world there is an ongoing discussion conceming an index that is more relevant than the impact factor.
For some, the competition for publication is so intense that there is ‘salami slicing’. Salami slicing is a process of publishing very small morsels of information in short papers instead of producing the complete study. It is done intentionally to increase the number of papers published and is frowned upon by scientific editors. Even worse there are cases of plagiarism and fraud, sadly occurring more commonly in surgical publication, than in other disciplines.
It may be time to ask fundamental questions about the need for research, articularly the need for every doctor in training to improve or embellish his or her Curriculum Vitae by decorating it with published works. There ís a tendeney for the more wealthy and better respected grant awarding bodies to fund successful rescarch teams, rather than to risk their limited resources on a spectacular project from an unknown team.
Funding is avallable from commercial sources. The role of this type of rescarch may require special assessment. There are issues of intellectual property rights and instances of commercial organisations delaymg or preventing publication if the findings of the study are not favourable. Many cynical readers give no weight to papers that are sponsored by commercial sources.
It is essential that rescarch in orthopaedics continues and that every possible step is taken in order to facilitate high quality research. There may be strength in numbers and it could be that the newly revitalised European Orthopaedic Research Society could help in supporting the endeavours of rescarch workers, particularly when it comes to European funding.
The abstracts were prepared by Ms Grazia Gliozzi. Correspondence should be addressed to her at the Italian Orthopaedic Research Society, Laboratory for Pathophysiology, Instituti Ortopedici Rizzoli, University of Bologna, Bologna, Italy.
