Sugestão de leitura: What is the purpose of medical research?
One of the conclusions by the authors of the controversial research papers that showed how H5N1 avian influenza strains can be altered to pass between mammals is perhaps unsurprising, but certainly gives pause for thought: the need to discuss the importance of the research earlier in the process of doing it. A year-long voluntary moratorium on this H5N1 work was lifted last week. It came after a long debate about the regulation of such research and whether it should be published only partly or whether its dissemination should be restricted. The answer to these two questions was eventually “no”, from the journals (Nature and Science), which published the papers in full in May and June last year, and from the US oversight committee, the National Science Advisory Board for Biosecurity. The dispute about regulation has been resolved in some countries, and research can now resume, with appropriate biosecurity arrangements, but not yet in the USA and Japan, where the authorities are still reviewing their stance on so-called dual-use research of concern. The careful evaluation of risk versus benefit for this kind of work is clearly complex and debates will continue. However, it is astonishing that all these discussions only started after the papers were submitted for publication.

Yet this course of events is what happens most of the time. As editors, we ask ourselves daily: what does this research mean, and what does it add? And sometimes, why was this research done at all? These questions are about the research findings that make it to the editors' inbox. About US$160 billion is spent every year on biomedical research. In a 2009 Viewpoint, Iain Chalmers and Paul Glasziou estimated that 85% of research is wasteful or inefficient, with deficiencies in four main areas: is the research question relevant for clinicians or patients? Are design and methods appropriate? Is the full report accessible? Is it unbiased and clinically meaningful? These themes will be further explored in a forthcoming Series. The question about the importance, purpose, and impact of research should surely not be an afterthought at publication stage, or even later as part of a research assessment exercise, which happens periodically for many government funded academic institutions. Currently, in the UK many academics are frantically putting together case studies to demonstrate the impact of their research for the 2014 round of the Research Excellence Framework.

When asked about the purpose of medical research most people would hopefully reply: to advance knowledge for the good of society; to improve the health of people worldwide; or to find better ways to treat and prevent disease. The reality is different. The research environment, with its different players, is now much less conducive to thinking about such noble goals. Funders have often adopted long-drawn-out bureaucratic processes for their grant giving, and yet rarely ask for a systematic assessment of the need for the proposed research. Full costing is often demanded at first submission with enormous waste of time and resources. Funders operate within political frameworks that emphasise short-term successes and outcomes. Decisions are dependent on opaque peers' and experts' assessments within each field and take many months. Pharmaceutical companies and industry-sponsored research seek a maximum profitable return on their investment. And academic institutions, which are more and more expected to operate like businesses, think about the economic benefit and the commercial potential of research, or about their performance in a research assessment exercise (measured largely by the surrogate of publications). Research has become an enterprise, an economic engine for nations, a necessary step on the way to economic growth. But surely the purpose of research is more than that.

It is time to stop and reflect on how we got to this point and how we can restructure and reframe the way research is done and rewarded. First, we need to remind ourselves about the real purpose of research. Second, we need to find ways of deciding what research is needed and what impact it is likely to have. Research funders and those who benefit from research—patients, practising clinicians, and policy makers—have a crucial role here. Third, academic institutions should assess and reward researchers on a long-term basis, which will make it much easier to assess the true and meaningful impact of their research. Finally, researchers must remind themselves why they have chosen their career. They must do more to defend an environment conducive to research that is for the benefit and health of people worldwide, not merely as one element of economic policy making.

Fonte: The Lancet

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