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Research realpolitik
  1. P McCrory

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Having recently returned from a series of meetings around the world I am amazed at the extreme variability in clinical sports medicine and research that exists in different countries. I am struck by many similar complaints by geographically disparate clinicians. They are all either “too busy” to write something for the journal or else “just about” to write. It seems that this author's pre-launch phase is a phenomenon not limited to sports medicine however the need in this discipline is urgent.

This is also something that is seen first hand in the journal. Manuscript submissions from Britain are declining while those from Australia, Europe, and Asia are increasing. This is particularly noticeable in clinical papers. While it may be easy to blame a new editor for this revolution, closer inspection shows that this change has been happening inexorably over a number of years. The journal hasn't changed, the world has!

There are also a number of big picture issues that deserve discussion. Our specialty suffers from a number of credibility issues that are critical. As various sports medicine colleges and organisations worldwide gather impetus to achieve full specialist recognition, we are all too often regarded by our collegiate peers as being part of a Cinderella specialty. Certainly we lack the historical roots that many Colleges take for granted yet we offer something that is new, important, and distinctly different.

To survive the blowtorch to our collective bellies, we desperately need an evidence base upon which we can develop our guidelines and management pathways. Without this we are lost. Remember the old adage that the plural of anecdotes is not data. How can we develop this evidence base without the involvement of our clinical brethren? It seems our sports science colleagues take much of this for granted. Largely academically based, they have long had the “publish or perish” imperative. In many countries, the sports science leads they way. If only the clinicians would follow.

What then are the barriers for clinicians to publish? I suspect is cultural or political in the broadest sense of those words. Research groups around the world that foster a philosophy of publishing quality research continue to build respect and influence at an international level. This is somewhat limited by the “critical mass” phenomenon. It takes time to build up to a level that sustains itself but when that happens the growth tends to be exponential. The rate-limiting step seems to be leadership. The right person can inspire others to great deeds whereas the wrong person generates mediocrity. The selection of leaders for such groups should be based more on academic merit and/or personal ability than on any “old boy” network.

For solo or small groups where critical mass is difficult or nigh on impossible to achieve, life is tough. Thrown back on limited resources one's goals have to start small. Having said this, it is a salutary exercise to read the recent obituary of Dr Will Pickles published in the Journal of the Royal Society of Medicine (2001;94:536–40). As a busy country GP, this man single handedly discovered or characterised many common illnesses simply by good documentation and an inquiring mind. Yet when I hear clinicians' talk of needing “protected research time” from their employers to be able to write whatever magnum opus is within them I shudder. Time is not the answer for an excess of academic inertia.

Other new developments may also influence this culture. The privatisation of sports medicine clinics may seem an interesting step but if it comes at the price of stifling research and reducing publication output, is it worth it? This development could be a potential boon to researchers with computerised databases of diagnoses allowing large scale or even multicentre studies to occur. It needs leadership in order to convince health bureaucrats and bean counters that research will actually improve quality and may have the positive spin off of good publicity. Heaven knows some of these health bodies could do with good news from time to time!

What about trainees? Clearly to foster a culture of research and publication amongst registrars is important. These are the people who hopefully will continue these habits long into their careers. In Australia, it is a requirement of the College training programme that all registrars must have at least one paper published in a peer reviewed journal prior to being admitted to Fellowship. Simple but effective. To do this on a wider scale requires some academic mentoring and access to research infrastructure, which is largely the province of academia rather than privatised or corporatised medicine. Still with an administrative body behind the initiative it can easily be achieved. That body may be a medical one or a sports medicine umbrella organisation. The issue is the culture not the name. Unfortunately when the focus is on the development of splinter groups not the broader picture, research gets lost in the mix.

In part, some of the difficulty may relate to the need to demystify the publication process be it the writing, submission, or publication of a journal article. Reading the various journals could be a starting point for some clinicians. There is no point having “a dozen cases ready to write up” if nothing happens. Although most people think of publishing a paper as stroking their ego, the process can be a learning one for the author involved. If someone reads it and gets the message or changes their management appropriately then that is a bonus.

In sports medicine, we have a clear choice. Publish or perish. We have reached a level of medical sophistication where to go upward we need to have solid foundations of evidence beneath us. As they say in the Olympics; Citius, Altius, Fortius