“Searching” for the Right “Research”

Once again, I hope all my seniors, colleagues, juniors, and fellow patrons are safe and are vaccinated or are in the process of vaccination. I look forward to meeting many of you once again once our physical conferences resume, but until then, I pray that all of you and your families stay safe and secure. As editor of this illustrious journal, peer reviewer of several other reputable journals along with being an astute researcher myself, I have the distinct fortune of scrolling through several early drafts of health and dental-based research both nationally and internationally. While it is encouraging that the number of research papers, especially from our country has increased dramatically, I could not help notice a worrisome trend in this regard. Much of the literature reported is either on narrowed spectrum topic rather than investigating the whole picture, or most often, the research question at hand focuses on a low priority topic rather than core questions pertaining to the specialty. What is further disturbing is the drawing of quasi or near fictitious conclusions based on the conclusions of these studies without giving much regard to the existing literature, especially the systematic reviews available for a particular topic. I have also unfortunately noticed that in order to increase their respective number of publications or overglorify the research undertaken, several articles are often segmented in parts or worse are only published partly giving neither the complete context nor full details of the intervention and observation method used to derive the results and conclusion of a particular trial. Cumulatively, this limits the information available to both clinicians and researchers and, thus, restricts their combined ability to recommended a particular course of action for a specific problem, thereby hampering the best accepted practice of evidence-based therapy. In recent years, the best example was the overzealous usage of the finite element method and drawing inferences from the results of these tests which, at the end of the day, were either computer mimicking or simulating “clinical situations.”

Coming onto the next problem—funding for proper oriented research—sadly, it has been reported that the total funding available for health research in India is much lower than that estimated previously, and only a miniscule proportion is available for dental-based research.^{1, 2} This is despite the fact that close to one-third of the world’s dental colleges are situated in India. The sheer lack and limited amount of funding diminishes and reduces the option of a holistic approach to clinical-based and -oriented research, which often leads private researchers and students to cut corners and reduce costs to make ends meet, and most often, it causes serious mismatches between the actual treatment and reported treatment/study effect. While the representation of our fraternity has considerably improved among policymakers, it still needs to go a long way. COVID-19 exposed worldwide the laxities and gaping holes in public health policies; thus, in my humble opinion, we do not need a dental health situation of a similar nature to expose our vulnerabilities in this regard as well. Most studies on health (general, dental and orthodontic) should and are usually based on sound research platforms, and the lack of properly available research pertaining to key research areas poses a grave threat to jeopardize this platform if prompt action is not taken. Quality of life (general health and oral-related) is a major information lacuna point where ample studies related to various aspects of orthodontic interventions are not available. While the developed countries have taken strides in this regard, our country is yet to conduct and make such data available that is useful for future practice assimilation.

Another recent development in the legal world has brought a major issue of research publishing to the forefront, that is, visibility of the publication. The recent lawsuits on Sci-Hub by major publishing houses have polarized a considerable section of researchers, academicians, and editors. However, when it all comes down to developing sound guidelines, it does make a difference if the research is widely available free of cost to aid in its visibility. Unlike other content producing industries, while a substantial portion is charged either from the authors to publish or from the readers to view the content (research item in this case), none of the royalties reach the reviewer, editor, or the author who is core creator in this case. In any field, having financial incentives to publish, most always provides for a wonderful external motivation for the parties involved and fosters a healthy cycle where research is undertaken in a more fruitful and often time bound manner. This is also for many of the institutions to ponder upon as to how to motivate their employees to contribute and work toward actual “meaningful” research rather than concentrating on a particular volume of articles published.

Lastly, I come to the reporting aspect of applied research. Here, I do not just refer to orthodontics but also to dentistry in a broad sense. It is in human nature to shine or stand out from the crowd; therefore, on some level, we are all enticed by the prospect of reporting a “novel” or unique feat in our research. Unfortunately, many a times, while reporting the same, several research studies either intentionally or unintentionally skip out of several key context points and interventional and observational parameters in order to boost the supposed “publishability” of their study. While it may achieve the desired reward of a publication in a reputed journal, it does little or in fact works in a counter-productive manner when a compendium of supposed therapies, that is, systematic reviews, is attempted. Thus, in such reviews (often far too many times in my opinion), we end up reading that, either due to large heterogenicity or lack of standardization, no decisive conclusion can be derived from this area of study. It is prudent that research ultimately help in improving patient outcome rather than just being a publication for the sake of it. ³ I truly feel that the entire spectrum of “accelerated orthodontics” falls in this problematic domain.

Problems as presented above and in general have two usual solutions—maintain the status quo or fix the problem in hand through constructive collaboration and rethinking the current strategies and protocol operational at hand. I sincerely do not think that status quo would help us in the long run, and as orthodontists, we are already attuned to long-term thinking. Thus, open forums discussing these issues at hand would be a great first step to rectifying the issues mentioned above along with core health and dental policy change initiated through active dialogue with our lawmakers. Open access sharing must ideally be encouraged and practiced to aid in maximum dissemination of fruitful basic and applied research. Additionally, refinement and reinforcement of proper reporting protocols would also help further streamline the issue and aid in development of a proper benevolent practice guidelines.

As always, I would love to hear feedback, suggestions, and thoughts on this subject matter from all our readers.

Jai hind, Jai IOS