Textbook of Maritime Medicine

Science is a human activity that creates new knowledge in a comprehensive form. Precisely the requirement of order and hence a degree of universality determines the original idea, the hypothesis, as an exit point emerging from the descriptive data. This concept of science can be used across all scientific disciplines whether natural science such as medicine, or humanistic or social sciences such as anthropology all of which are applicable and necessary in a maritime context.

Research describes the thorough scientific study of an area, for example the etiology and pathophysiology of a disease such as seasickness. Anyone can in principle engage in independent research, which, however, is mostly associated with university recruited academic staff. The word "research" is often used in a sense that is virtually synonymous with science. However, the two words are also used differently. Much research has too low a level of ambition to be called science. In addition, the choice between the two words can be about the balance between collection and processing of data, so that research may often represent the primarily active outreach but without necessarily processing the collected data. In contrast, science deals more often with the organization, processing and interpretation of data than with collecting them.

Research is considered to be an important driver in the development of any part of society including the maritime settings, be it in terms of economic prosperity, sustainable development, or quality of life including health and safety - to mention the most important areas.

19.1.1   The research process. Basic research, applied research and development work

The research process will always aim to improve the understanding of a phenomenon or to make a difference (and hopefully a positive one). Maritime research and development is therefore creative work undertaken on a systematic basis in order to increase the scientific and technical knowledge, including the understanding of man in the maritime environment, and of the culture and society at sea. The ultimate aim would be to exploit the existing understanding to devise new practical applications to the benefit of seafarers and fishermen.

Basic research is original experimental or theoretical work with the main aim of obtaining new knowledge and understanding without any specific application in sight. Applied research is also original investigation to gain new knowledge but is primarily targeted to specific practical goals. In a maritime medicine context, researchers will mainly go for applied research, which may be based on the outcomes of basic research from other settings, e.g. knowledge of the effects on man of noise or vibration studied in a land-based industrial environment. Development work is systematic work, drawing on knowledge gained from research and/or practical experience in order to produce new or substantially improved materials, products, processes, systems or services. All these aspects of research are needed and requested from the maritime populations and industries, and they should all be appreciated.

19.1.2   Researchers and the maritime community

Research may well be conducted by persons sharing a particular interest in the studied subject and who is in possession of a high degree of enthusiasm about the results and consequences of their research. However, the recognition or refusing of research results should be independent of the personal or social characteristics of the researcher such as e.g. ethnicity, nationality, professional training or political stand. What is crucial is the quality and originality of the research rather than the researcher’s individuality. While the medical community in clinical work as well as in research should always aim to benefit the patient or the person in risk, an additional challenge, which is particularly important in occupational and maritime medicine, is to promote sustainable solutions that are also largely influenced by technical and economical potentials and therefore rely on the support and accept by the ship-owners, the seafarers and the maritime authorities.

For that reason, research in the context of community interventions such as in occupational and more specifically maritime health and safety should always be balanced. This may sound easy but practical constraints flourish. In developed countries, the technical and economical achievements and therefore also the practical circumstances for creating healthy and safe maritime workplaces are often excellent. In addition, there may be a high degree of mutual understanding and respect in between the individual seafarers and their employers. In spite of the widespread recognition that happy employees constitute an asset for any business, it is less likely that these positive circumstances are present in less favored and poorer countries in which the maritime agenda may be characterized by commercial exploitation and minimal empathy towards risk persons. Fortunately, even in developing countries, however, the mutual interests between employer and employee may often not differ too much or even be the same. The shipper in a fishing boat share similar risks as his crew and the ship-owner often realizes that a healthy and safeguarded crew is also a major asset for the shipping company’s economy. Therefore, one can see small communities, e.g. in fishing, where owners and crew feel like a family and aim for solutions that can benefit all. In general, however, it should be recognized that even in developed communities, the ambitions with regard to what one can achieve may still be reduced by practical or economic barriers.

19.1.3   The nature of research

Common to all research is an organized or systematic skepticism. The raised questions should be answered through the application of stringent methods and consistently logical and critical thinking with nothing taken for given in advance. This may easily cause conflicts. When work-related health and safety aspects are studied, one constant source of conflict is the potentials of the various interests that may exist between employers and employees, e.g. when the former has to pay for the health and safety of the latter. Such different perspectives may in effect prevent the mere launch of a study, but may also bias conclusions if the researchers are for sale or influenced by specific interests. Even with no resulting bias of this kind, the researcher may still be regarded as prejudiced with the potential consequence that the research results are less likely to make a difference in real life.

Research methodologies have undergone a significant evolution over years.  Deduction from personal experience as a source of generalized cognition has been previously the only way for generating knowledge. Together with narratives, this approach may still significantly determine decisions. In spite of this, the increasing focus on evidence based medicine remains important, e.g. in the clinical setting. The advent of the randomized clinical trial has opened new possibilities for decision-making although the meta-analysis has shown us that a single scientific study may not necessarily provide the only and correct solution. In addition, the quantitative methods cannot give all the answers and solutions that we need. Qualitative research methods are equally important, and because many in the medical profession rarely undertake these approaches to achieving knowledge, we are highly dependent of interdisciplinary collaboration. Characteristics of each of the two main types of research are described below.

19.1.4   Research ideas and planning of research with special reference to maritime medicine

The idea leading to new research may come up in various ways but would in any case demand a prior acquaintance with the subject. In maritime medicine as well as in occupational medicine, typical examples of upcoming ideas leading to research include complaints or requests from the trade with regard to, e.g. a wish to control specific symptoms or disorders, to address known acknowledged risk factors, or to assess issues such as the safety culture on board or the efficacy of the available safety equipment or emergency back-up systems.

The researcher may be influenced by professional experiences and challenges such as may emanate from prior practical tasks or previous research, which means familiarity with the subject in question. Motivation may also grow after discussions with committed fellow researchers. Other important matters that may influence a decision with regard to launching a certain study would be the current resources in terms of the availability and experience of manpower, and the significance of the raised issue with regard to, e.g. the number of persons in risk and the seriousness of adverse health effects should the risk occur. One frequently quite decisive factor is the existing opportunities for financing a project. Potential limitations here may prevent important issues to be studied while less significant problems may be subjected to intensive research if abundant opportunities for financing are available.

Frequently, ideas are created at the same time in multiple centers. They may be influenced by trends occurring simultaneously among professionals following identical or related thinking. A critical approach is a key issue here because the absence of a critical approach infers a risk of professional stagnation. If all researchers tend to look in the same (and possibly wrong) direction, there is little chance that the research will bring forward the needed recognition and eventually improve the health and safety of the maritime population.

In any case, an important part of the preparation for a research project is to achieve familiarity with the relevant scientific literature in the field and to discuss and scrutinize ones ideas with colleagues. In case of occupational medicine and maritime medicine, however, it may be just as crucial to discuss the issue with the professionals in the trade. They tend to have a practical view of the problem and may also have valuable ideas with regard to the ways and possibilities for solving it.

Any intervention that is likely to provide benefit for the seafarers’ health, safety or social life is also prone to constitute a cost, which, depending of the character of the intervention may be of a considerable size. The balance between cost and benefit is always in the scope of the researcher who wants to make a difference. In case of an excess cost of an intervention compared to the benefit, the success of the implementation will be less likely. In addition, it is to be expected that it will reduce the trade’s future confidence in development reached through research.

When is an idea a good one? The point is to develop and formulate a problem, e.g. by hypothesizing a cause and effect relation. This hypothesis should be based on existing and new observations and arguments. For a research idea to be a good one, it should be possible to perform the required measurements or assessments. Quantitative research should entitle unambiguous answers to the questions raised, lead to key relationships and illuminate many aspects of the subject. However, the first of these ambitions does not always apply with qualitative research, which, however, may often better contribute to the understanding of relations.

It is not surprising but unfortunate that many research projects deal with issues that can be solved instead of issues that need to or should be solved. Frequently, however, the outcome of such research may found the basis for future research that can lead to better understanding and even constitute a basis for decisions.

The quantitative researcher should develop a working hypothesis that permits falsification trials, through which a hypothesis may become stronger and more convincing. This approach is less feasible in qualitative research in which the researcher is and should be open to any relevant issues that may come up during fieldwork.

It is crucial that the researcher does not let his research lead by a well-known working method rather than an assumption on the potential consequences of the research in terms of the resulting health and safety outcomes. In contrast, the problem one wishes to analyze should determine the choice of methods (such as study design and analysis, the data selected for the study, and the ways of collecting the data), not the other way round. With a limited number of applicable methods, one risks a keyhole view of the issue. The methods should be simple and rapid enough to permit a sufficient number of observations for reaching a significant conclusion. However, sometimes the problem requires in depth studies, which inevitably means that for practical reasons only a limited number of study persons can be involved. In any case, the researcher should aim for a balance between the number of observations and the number of study persons, so that an accurate estimate can be achieved.

The study protocol should be sufficiently detailed to enable somebody else to reproduce the study. It should include a description of the background for and the challenges leading to the project, the aims of the project, the study group and the applied methods, the data that are to be collected data and their management, the conclusions, and the application and potential impact of the study.

19.1.5   Who can do research?

Anybody involved in maritime health and safety at an academic level can do research. But being a good researcher involves more than brilliant ideas and implementing them. Most researchers spend the majority of their time reading papers, discussing ideas with colleagues, writing and revising papers, and intermittently staring blankly into space and thinking.

It is important, in particular for younger or inexperienced researchers, to become part of a larger research community. Being let to oneself is frustrating and counteracts keeping track of the direction of the process and the exit point in the research, staying motivated, and spending ones time wisely.

It is useful to keep a journal of the research activities and ideas and to write down speculations, interesting problems, possible solutions, random ideas, references to look up, notes on papers you've read, outlines of papers to write, and interesting quotes. Read back through it periodically. You'll notice that the initially random thoughts start to come together and form a pattern, and may even turn into a research project.

One will have to read a lot of technical papers to become familiar with any field, and to stay current once caught up. Often over half of one’s time is spent reading, especially at the beginning. This is normal. However, it is impossible to read everything that might be relevant and selective reading is necessary. It is wise to ask an experienced colleague about the most useful journals in the field, and to ask for a list of seminal or "classic" papers that are definitely important to read.

Keep the read papers filed away so you can find them again later, and set up a bibliography with fields for keywords, the location of the paper and a short summary of particularly interesting papers. This bibliography will be useful for later reference.