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An open letter to British Medical Journal: giving again space and dignity to qualitative studies in scientific journals

The Waterhouse Paul Bond

The Waterhouse – Paul Bond

Last month, seventy six academics – among them, Trisha Greenhalgh – from eleven countries wrote to the editors of BMJ, expressing concern for the fact that qualitative or mixed-methods articles are often rejected on the base of presumed “low priority” and “lack of practical value”.

This comment is well known by who tries to publish qualitative articles on scientific journals. We know it too: we remind the experience of the publication of the article “Narrative Medicine to highlight values of Italian pain therapists in changing health system”, regarding pain therapists and integrating quantitative methods with narrative tools.

The answer to the first submission to a prestigious European journal, was “We will not forward your article to any referees, because we publish only quantitative results”: an answer that reflects the way in which many scientific journals still reason, leaving to narrative only the presentation of some sporadic clinical case.

But we did not want to publish our Narrative Medicine work on a specialized journal for Social Science or Medical Humanities: doing so, we would have continue to hide the humanistic part to pain therapists and operators in this field. And we did it, thanks to the open mind and the courage of the editor-in-chief of Pain Management.

Certainly, some qualitative articles can be low quality, bad written or inaccessible, or not relevant for the journal: but we also know this is not caused by the employed methodology, and it is true also for non-qualitative articles and researches.

But the aim of scientific journals is to lead the debate on health, and to involve, inform, and stimulate all professional figures in the healthcare field, in order to make them able to better address their choices, and to have positive results for patients. In this, quantitative methods answer to some clinical questions, while other dimensions are identified better by qualitative research methods. As highlighted in the letter to BMJ, qualitative studies help us to better understand the experience of patients facing therapies and of professionals, and why some clinical interventions not always work. Furthermore, these studies explore the complex relationships between healthcare system and social, cultural, and political context.

As Trisha Greenhalgh notes, traditionally doctors give a great importance to numerical data, that however – respect to some themes – can be misleading, reductionist, and irrelevant. The popularity of qualitative research in biomedical sciences has improved properly because quantitative methods have not succeed in some aspects of care, or have given wrong answers. Citing Nick Black, professor at the London School of Hygiene and Tropical Medicine, devaluing qualitative research we run the risk of research only what is measurable, and not what is relevant.

Give again a dignity to qualitative studies in scientific journals, and the same priority of quantitative studies, can only bring benefits for all the actors involved in the context of care, opening at the same time new methodological, philosophical and ethical questions.

Here the open letter to BMJ.

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