http://bmj.com/cgi/content/full/323/7327/1462

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BMJ 2001;323:1462-1463 ( 22-29 December )

Publish and be damned

Wantedmore answers than questions: literature review

Anthony S David, professor. 

Institute of Psychiatry and Guy's, King's College, and St Thomas's School of Medicine, London SE5 8AF

a.david@iop.kcl.ac.uk

The purpose of medical research is to advance knowledge and solve clinical problems. These high ideals are difficult to achieve. Instead, academia sometimes draws criticism for apparently doing research for its own sake. I therefore carried out a systematic literature review to examine whether published research was providing more questions than answers, or vice versa.

I used "more questions than answers" as a search term in the Medline database, spanning from 1966 to March 2001. To limit the potential number of hits, only the title and abstract were used as search fields. I also searched on the phrase "more answers than questions." All article types were included if they had an English abstract.

Two terms occurred in 166 articles (reference list available on request). However, only three articles (0.018%) purported to describe more answers than questions. Of the remaining 163, 119 used the term in the title and 13 prefixed the phrase with the word "still." No article suggested an equal number of answers and questions. Had the prevalence of answers to questions been a matter of chance, each search term would have yielded 83 articles (95% confidence interval 70 to 97); hence the finding is highly significant (P<0.001, binomial test).

The articles seem to be evenly distributed between basic science and clinical publications. The journals ranged from the Acta Gastroenterologica Belgica to Zeitschrift für Gastroenterologie (but gastroenterologists were not over-represented). I also tested a secondary hypothesis: are psychiatrists, notorious for answering one question with another, over-represented? Apart from two psychiatrically related articles, one on methadone treatment and the other on counselling, and a third written by two psychiatrists on the epidemiology of fatigue,¹ there were only two articles in mainstream psychiatric journals (not including the must-read "Pornography, erotica, and behavior: more questions than answers"²). Only one article used the phrase legitimately: "More questions than answers: a study of question-answer sequences in a naturalistic setting"this was published in the Journal of Child Language.³ Comments on the proportions of such articles in different branches of medicine, and indeed as proportions of all scientific publications, are at best speculative since the denominators are unknown.

No particular theme unified the three papers that valiantly claimed to have more answers than questions. One was a review of advances in ischaemic heart disease research, and one was about newly discovered neurosecretory functions of the hypothalamussuddenly we have a whole range of proteins that we weren't expecting, and questions on what they do soon followed. The third article considered the mysterious case of spontaneous regression of Merkel cell carcinoma. The authors' solemn answer? It regressed spontaneously.

As a follow on, I carried out a similar literature search for the phrase "need more research." This yielded 162 articles, only one of whicha thought provoking polemic on aromatherapysuggested the need for less research.⁴

Overwhelmingly more medical publications conclude that there are more questions than answers. Those claiming the opposite turn out on closer scrutiny to have an excess of questions too. The negative stereotype of medical research as being of little practical help finds support in these data. The frequent claim that we need more research is hard to sustain given the apparent outcome of this effort. It could be argued that the phrase "more questions than answers" is merely a cliché and not an accurate representation of the state of the field, or that finding the right question is a worthy aim. Hence it would be premature to advocate a major reduction in research funding on this basis. Nevertheless there is clear need for a moratorium on the use of clichés in scientific writing. For researchers aspiring to write a "classic paper"⁵ there can be only one conclusion: avoid clichés like the plague.

   Contributors: ASD put the jokes in and the BMJ's editorial team took them out.

Competing interests: ASD is an academic.

© BMJ 2001

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