I was looking at the Corfu paper by Pitsavos and colleagues when it got me thinking about the bigger question of research goals. Research is about answering questions, learning more about the world and how things work. In healthcare research we expect research to produce an understanding of health and illness. We should also be able to apply this research to help improve lives.
So a very nice question to ask is ‘when is a research question settled?’. When is it unnecessary to do any more research in this area? Take the paper above for instance. The researchers looked at some of the variables related to coronary heart disease risk. The age of the participant at entry to the study was associated with a hazards ratio of 1.1 with a p value of less than 0.001 and a 95% confidence interval of 1.06-1.14. The hazards ratio for smoking was 1.79 (95% CI 1.15-2.77) with a p-value of 0.01. The hazards ratio for BMI was 1.05 with a p-value of 0.1 however. Since the arbitrary cut-off limit for significance is usually set at 5%, this would not be significant. Additionally the 95% confidence interval is 0.99-1.10 confirming that this association is less than straightforward.
For each of the questions above, we are talking about a population. Even when we talk very robustly about the results at a population level, we can then move to the individual level. Population level results become difficult to talk about at an individual level as there are many variables that predict outcome and which can vary considerably between people. So if we have extreme confidence in a research question at a population level, we can always move to a discussion of the individual to refine the questions we ask. This is one aspect of personalised medicine.
However my conclusion from reflecting on the paper and the question was that there must be a hierarchy of answers to research questions. When Kuhn talks about the end of scientific inquiry in one research area, this becomes a tool for other areas of science. For instance, we know that the first element of the periodic table is hydrogen. It doesn’t matter how much is invested into building research studies to investigate the identity of the first element of the periodic table – it’s already been done. The studies wouldn’t produce any new answers to that particular question.
So some questions have been answered. Do they pass into a realm of what we would describe as facts, axioms or theorems?
What prevents us from reaching the answers to other questions?
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