Science, to be at its best, needs to be a social process. The collaboration between individuals fosters the development of research ideas, allows for checks and balances of published findings, improves the dissemination of research and allows for valuable peer review. With the proliferation of social media, this social aspect of science is more rapid and accessible, opening the doors to individuals from wide and varied backgrounds to engage in and contribute to this process. We are fortunate to now exist in an environment that allows research to be shared, discussed and critiqued across a wide variety of mediums. There are several podcasts, blogs, discussion forums and forward thinking publication platforms that provide content, often free of charge, that exemplify science as a social process.
Discussion of research, in particular, is one of the essential aspects of science as a social process. In today’s environment, science and research are rife with publication bias, perverse incentives, spin, p-hacking and conflicts of interest. This distorts the evidence base used to best inform clinical decision making and makes deciphering the estimated 2.5 million articles of published research published annually an arduous and insurmountable task for any individual.
Through discussion and debate, we are afforded different forms of peer review. More traditionally, academic peer review allows for the appraisal of research after submission to an academic journal to ensure it meets certain scientific and journalistic standards. This is often a slow, inefficient process due to the limited availability of reviewers and minimal incentive provided to reviewers. This can lead to an often glacial pace of submission, review, acceptance, and publication. Following peer review and publication, clinicians are usually limited in their access to the full text of articles due to paywalls and restrictions on access.
The pre-print format of publishing continues to grow in popularity as evidenced by the increase in the popularity of repositories like arXiv. These pre-prints allow for open access to publications prior to their submission to more traditional academic journals which has numerous benefits. Users are able to access research they may not otherwise be able to due to paywalls. Utilizing pre-prints also allows people to much more rapidly access research and provide feedback prior to academic peer review and publication. This early access to research can potentially allow for more refined manuscripts reaching academic journals, as issues can be discovered well before actual submission.
The review process, however, does not end once an article has been published and printed. Post-publication peer review allows for a crowdsourcing of knowledge from individuals across the world, with different backgrounds, expertise, and perspectives. This post-publication peer review can occur informally through discussions on Twitter, blogs, podcasts and other mediums. More formally, there have been structured platforms developed such as PubPeer which allows users to discuss and review research. During these discussions and peer review, methods are appraised, claims are examined, strengths and weakness are highlighted and research findings are translated and disseminated. The hope is that this form of discussion allows for increased clarity of research findings, easier translation of results to clinicians and a move towards being less wrong in our interpretation of the relatively imperfect information produced by trials. There are several examples of this post-publication peer review revealing fatal flaws, fraud, and other issues in published work after they had passed through academic peer review and publication. Take moment to peruse through RetractionWatch.org to see specific cases.
It is important to understand that discussions and peer review are not perfect. The problems with typical academic peer review are well documented. As pre-prints and post-publication peer review continue to grow, so does our understanding of its limitations. Much like in published research, there are questions regarding the quality of the reviewers, prevalence of bias and spin, perverse incentives and the relatively lower standard required of manuscripts to be published for pre-print.
The physical therapy community, anecdotally, seems to struggle with scientific discussion. Too often do debates on clinical practice, research, and reasoning devolve into vitriol. These poor examples of argument effectively eliminate any potential benefit to those both actively engaged in the discussion and those passively observing. Much of the benefits of argumentation, how to improve our professional communication and the difficulties of changing behavior have been written about by Kyle Ridgeway, Jason Eure (here and here), Erik Meira and myself.
Further, there appears a growing sentiment in physical therapy that such discussions, particularly in more informal formats such as Twitter, are unhelpful or potentially damaging. Discussion, debate and peer review is often unfairly mischaracterized as “bringing others down.” This is an antiquated and scientifically naive position to assume. To forego leveraging these tools out of nebulous fears of “tearing each other down” or “airing out the profession’s dirty laundry” would be to unnecessarily squander the potential benefits in an area that physical therapy struggles mightily: scientific literacy and understanding of evidence-based practice. The available mediums for discussion, debate and peer review available to us are simply tools that can be used and misused. It is ultimately up to the end user and community to properly vet and appraise the information being shared and consumed, like any other form of information.
If our professional discussions on these new mediums are not up to par, we need not throw out argument and debate. Instead, we should embrace science as a social process and work to improve our ability to effectively communicate and engage on both intra- and inter-professional levels. Academic debate is a foundational aspect of scientific progress. Argumentation is not inherently harmful. Poor communication is harmful. Blind optimism is harmful. Unrelenting negativity is harmful. Painting well-intentioned and sound critique as “bringing others down” is harmful. It is up to the physical therapy community to decide to either leverage science as a social process in these new mediums or to squander the potential benefits due to an inability to communicate effectively, unwillingness to separate ideas from the individual and dubious fears of potential harm.
Header photo is a screen capture from Stanley Kubrick's 1968 film, 2001: A Space Odyssey