File That One in the Round Cabinet
(or "Why your research paper got rejected")
By Melainie Cameron

Research articles submitted to Australasian Chiropractic & Osteopathy (ACO), Chiropractic & Osteopathic College of Australasia (COCA)’s journal, are subject to peer review. These papers are sent, with the authors’ identifiers removed, to experienced researchers or experts in the field of the study. Reviewers’ comments inform the editors’ decision on how to deal with the paper. Articles may be a) accepted for publication, b) accepted for publication dependant upon amendments requested by the reviewers, or c) rejected. Authors may receive copies of the reviewers’ reports, but once again, identifiers will be removed.

It is extremely rare that original research articles will be accepted for publication without amendments, and authors who achieve this outcome should be delighted! It is a reflection of the high quality of their work.

Most commonly, articles are accepted with amendments. Many authors find it both difficult and confronting that the paper they sweated over, their “baby,” might be judged and found wanting. Sometimes authors hit the wall at this point, unable to face re-writing their paper. It gets placed in the “in tray,” never to see the light of day again. As a sub-editor, I am grieved by these losses. It is important to remember that reviewers’ comments are for the purposes of improving an already fine piece of work. Take the criticisms as they are intended – constructively.

Occasionally, a paper is rejected outright. Sometimes papers are refused because they are unsuited to the readership of the journal (ie: they would be better published elsewhere), but the most likely reason for rejection is poor science. Sometimes reviewers are scathing, ‘This research is unethical, not worth the paper it is written on!’

The science of a study should be thrashed out before the study is begun. The process of designing research is complex and the way fraught with potholes. To avoid pitfalls along the way, universities require that students submit their plans for research to critical scrutiny, usually in a proposal review and an ethics review. The process varies slightly between universities, but across Australia all universities require that research involving human participants be granted ethical clearance prior to any contact with participants.

Private practitioners are under considerable pressure to engage in research, and it is likely that research will involve human participants. Even when not linked to a university, researchers have a responsibility to ensure that their research is both of sound design and ethically conducted. As a guide to intending researchers, I offer these comments on ethical research design.

Researchers are required to design studies that conform to the Guidelines for Human Experimentation of the National Health and Medical Research Council (NHMRC). Under the terms of the World Medical Association Declaration of Helsinki, to which the Australian Government is a signatory. All projects involving human participants should conform to the National Statement on Ethical Conduct in Research Involving Humans (NHRMC, 1999), and relevant Commonwealth and State legislation. These guidelines have regard for the physical and mental well-being of participants, and matters of confidentiality, privacy and consent. The National Statement on Ethical Conduct in Research Involving Humans (NHMRC, 1999) is available free of charge from the NHMRC website, www.nhmrc.gov.au.

All Australian universities convene Human Research Ethics Committees to review the ethical aspects of procedures where humans participate as subjects in research. These committees report directly to Australian vice-chancellors. Before conducting any research investigation with human participants, university staff and students are required to submit a project proposal for approval. This process, although often tedious, is worth the wait because clearance from such a committee covers the researchers under that university’s indemnity insurance. Some universities, hospitals, and community health centres will review research planned by people outside of those institutions, to provide an “in principle” ethical clearance, but no indemnity.

Four general principles apply to ethical research designs: nonmaleficence, beneficience, utility, and autonomy (Domholdt, 2000). Put simply, nonmaleficence and beneficience mean that researchers should, a) not cause needless harm or injury to participants, and b) promote the welfare of participants. Utility means that research should be designed in a way that brings, simultaneously, the most benefit and the least harm. An experiment should be designed such that the anticipated results justify the performance of the experiment. If little benefit is expected to result from the study, it is unreasonable to expose participants to uncomfortable or potentially dangerous procedures. Autonomy means that research participants should be informed, freely consenting volunteers, who are free to leave the study at any stage without prejudice.

The Tuskegee Study of Untreated Syphilis (TSUS) is a well known case of ethical misconduct in healthcare research. The US Public Health Service conducted the study in which 400 black men with syphilis were left untreated for 40 years (1932-1972) so that the natural history of the disease might be studied. Participants were not informed that they were being studied or being tested for syphilis, and were not provided with the results of tests. They were completely unaware that appropriate treatment was being withheld. Some benefits were provided to participants, including free aspirin and tonics, burial funds and health care for their families. These benefits did not afford any therapy for syphilis and may have provided incentive for some participants to remain in the study.

Over 30 years after the conclusion of the TSUS, despite the subsequent development of clear guidelines for the ethical conduct of research, there remains a Tuskegee effect – an under-representation of African Americans in healthcare research, particularly in Alabama where the study was conducted (Alarcon, 2002). Unethical research is indeed not worth the paper it is written on and furthermore, it may deprive us all of future research participants.

References:

• Alarcon, GS. A reply to comments on sociocultural issues in clinical research: unravelling the Tuskegee syphilis study. Arthritis & Rheumatism (Arthritis Care & Research) 2002; 47:691.
• Domholdt, E. Physical therapy research, 2nd ed. Philadelphia: WB Saunders.2000.
• National Health and Medical Research Council. (1999) National statement on ethical conduct in research involving humans. Canberra: Commonwealth of Australia, AusInfo. http://www.health.gov.au/nhmrc