Medical Writing and Editing

On the importance of a concise, clearly stated hypothesis, question, or objective

Remarkably often, medical research papers lack a definitive statement of the purpose or rationale for conducting the research. This lack of clarity may reflect lack of a clear research design from the very start of a project, a defect that continues throughout the manuscript. The result often is an unfocused paper—leaving the reader groping for the relevance and message.

In order to avoid this pitfall, the authors should ask themselves some direct questions before embarking on the research:

• Is the project worth doing? Will it produce important, new information, or be just a repetition of already published and well-known knowledge?
• Do the investigators have sufficient resources (equipment, technical skills, study population, statistical/analytical capability, time) to carry the project through to completion?
• What audience (readership) will they try to reach?

If these questions are answered affirmatively, the investigators should outline in detail the steps they will take to execute the project from start to finish. Each experiment they plan to do should be clearly connected to the main objective of the study. They may even write a trial manuscript based on the possible outcomes (supportive of their objectives or not; positive or negative). Throughout the course of the project they should periodically check to be certain they are pursuing faithfully the goal(s) they set out. They may learn that their initial objectives are unrealistic, untenable, or unachievable. If so, they should at once abandon or re-direct their efforts. Changing course is not a failure.

Upon completing the project, or at some point along the way, when the authors begin writing the manuscript, they must keep clearly in mind the objectives they laid out initially and construct the paper accordingly. Once the authors have all the experimental results, they need to re-evaluate them and make sure each piece of result is still connected to the objective they are going to write down in the paper. The main objective of the paper may be supported by several different points, and each of these points may be supported by a few subpoints. For each piece of experimental result, the authors should ask, which subpoint does this result prove? Any piece of result that does not fall into any subpoint does not belong in the paper.

In a well-written research paper, not only is the hypothesis, question, or objective of the work clear, but the objective forms the basis of a coordinated flow through the paper, from the opening statement to concluding statements.

Here is a hypothetical, abbreviated paper, illustrating the above points.

Title.

Rhubarb eating does not protect against colorectal cancer

Abstract

Background/rationale: Numerous environmental factors influence the incidence of colorectal cancer. Whether rhubarb eating is one of these factors is not known.

Objective: to determine the incidence of colorectal cancer in persons who regularly eat rhubarb compared with the incidence in persons who never eat rhubarb.

Methods: One thousand persons who eat rhubarb at least three times per week and 1000 persons who never eat rhubarb were evaluated with colonoscopy.

Results: The incidence of colorectal cancer in the rhubarb eaters was XXX%. The incidence in the non-rhubarb eaters was YYY%. The difference is not statistically significant (p >1.0).

*Conclusions: The incidence of colorectal cancer detected by colonoscopy in persons who regularly eat rhubarb and those who do not eat rhubarb was not statistically different. In this study population, rhubarb eating did not protect against colorectal cancer.

Note: The abstract conclusions are linked to the study’s objective.

Introduction

*Concluding sentence: In order to help determine if rhubarb protects against colorectal cancer, we examined, by colonoscopy, persons who regularly eat rhubarb and those who do not eat rhubarb.

Discussion

*Opening sentence: In this study, designed to help determine whether rhubarb eating protects against colorectal cancer, we found a similar incidence of cancer, detected by colonoscopy, in persons who regularly eat rhubarb and those who do not eat rhubarb.

*Conclusion(s): The incidence of colorectal cancer, detected with colonoscopy, was similar in persons who regularly eat rhubarb and those who do not eat rhubarb. Thus, rhubarb eating did not protect against colorectal cancer in this study population.

Note: The conclusions are linked to the study’s objective.

*At each of these points the objective is re-stated or paraphrased. This reiteration brings continuity and focus to the study and aids the reader in following the flow of the research from objective to conclusion.