Yesterday, my colleague the Skeptical Scalpel wrote about an interesting (?) paper published in Emergency Medicine Australasia. It was a small study that concluded that ED wait times decreased as the number of people presenting to be seen decreased. Where’s the mystery in that? Overstating the obvious?

But if you look through almost any journal today, you will find studies that leave you wondering how they ever got published. And this is not a new phenomenon. Look at any journal a year ago. Five years ago. Twenty years ago. And even older. The research landscape is littered with their carcasses. 

And on a related note, sit down with any serious clinical question in your field you want to answer. Do a deep dive with one of the major search engines and try to get an answer. Or better yet, let the professionals from the Cochrane Library or other organization do it for you. Invariably, you will find hints and pieces of the answer you seek. But never the completely usable solution you desire. 

Why is it so hard? With tens of thousands of articles being published every year?

Because there is no plan! Individuals are forced to produce research as a condition of their employment. Or to assure career advancement. Or to get into medical school, or a “good” residency. And in the US, Level I trauma centers are required to publish at least 20 papers every three years to maintain their status. So there is tremendous pressure across all disciplines to publish something. 

Unfortunately, that something is usually work that is easily conceived and quickly executed. A registry review, or some other type of retrospective study. They are easy to get approval for, take little time to complete and analyze, and have the potential to get published quickly.

But what this “publish or perish” mentality promotes is a random jumble of answers that we didn’t really need. There is no planning. There is no consideration of what questions we really need to answer. Just a random bunch of easy to get published thoughts that never get cited by anyone else. 

Bottom line: How do we fix this? Not easily. Instead of focusing on the quantity of publications, the “authorities” need to focus in on their quality. Extra credit should be given to multicenter trial involvement, prospective studies, and other higher quality projects. The actual number of publications should not matter as much as how much high quality work is in progress. Sure, the sheer number of studies published will decline, but the quality will increase exponentially!