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• How to Write a Strong Hypothesis | Steps & Examples

How to Write a Strong Hypothesis | Steps & Examples

Published on May 6, 2022 by Shona McCombes . Revised on November 20, 2023.

A hypothesis is a statement that can be tested by scientific research. If you want to test a relationship between two or more variables, you need to write hypotheses before you start your experiment or data collection .

Example: Hypothesis

Daily apple consumption leads to fewer doctor’s visits.

Table of contents

What is a hypothesis, developing a hypothesis (with example), hypothesis examples, other interesting articles, frequently asked questions about writing hypotheses.

A hypothesis states your predictions about what your research will find. It is a tentative answer to your research question that has not yet been tested. For some research projects, you might have to write several hypotheses that address different aspects of your research question.

A hypothesis is not just a guess – it should be based on existing theories and knowledge. It also has to be testable, which means you can support or refute it through scientific research methods (such as experiments, observations and statistical analysis of data).

Variables in hypotheses

Hypotheses propose a relationship between two or more types of variables .

• An independent variable is something the researcher changes or controls.
• A dependent variable is something the researcher observes and measures.

If there are any control variables , extraneous variables , or confounding variables , be sure to jot those down as you go to minimize the chances that research bias  will affect your results.

In this example, the independent variable is exposure to the sun – the assumed cause . The dependent variable is the level of happiness – the assumed effect .

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Step 1. ask a question.

Writing a hypothesis begins with a research question that you want to answer. The question should be focused, specific, and researchable within the constraints of your project.

Step 2. Do some preliminary research

Your initial answer to the question should be based on what is already known about the topic. Look for theories and previous studies to help you form educated assumptions about what your research will find.

At this stage, you might construct a conceptual framework to ensure that you’re embarking on a relevant topic . This can also help you identify which variables you will study and what you think the relationships are between them. Sometimes, you’ll have to operationalize more complex constructs.

Step 3. Formulate your hypothesis

Now you should have some idea of what you expect to find. Write your initial answer to the question in a clear, concise sentence.

4. Refine your hypothesis

You need to make sure your hypothesis is specific and testable. There are various ways of phrasing a hypothesis, but all the terms you use should have clear definitions, and the hypothesis should contain:

• The relevant variables
• The specific group being studied
• The predicted outcome of the experiment or analysis

5. Phrase your hypothesis in three ways

To identify the variables, you can write a simple prediction in  if…then form. The first part of the sentence states the independent variable and the second part states the dependent variable.

In academic research, hypotheses are more commonly phrased in terms of correlations or effects, where you directly state the predicted relationship between variables.

If you are comparing two groups, the hypothesis can state what difference you expect to find between them.

6. Write a null hypothesis

If your research involves statistical hypothesis testing , you will also have to write a null hypothesis . The null hypothesis is the default position that there is no association between the variables. The null hypothesis is written as H 0 , while the alternative hypothesis is H 1 or H a .

• H 0 : The number of lectures attended by first-year students has no effect on their final exam scores.
• H 1 : The number of lectures attended by first-year students has a positive effect on their final exam scores.

If you want to know more about the research process , methodology , research bias , or statistics , make sure to check out some of our other articles with explanations and examples.

• Sampling methods
• Simple random sampling
• Stratified sampling
• Cluster sampling
• Likert scales
• Reproducibility

 Statistics

• Null hypothesis
• Statistical power
• Probability distribution
• Effect size
• Poisson distribution

Research bias

• Optimism bias
• Cognitive bias
• Implicit bias
• Hawthorne effect
• Anchoring bias
• Explicit bias

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A hypothesis is not just a guess — it should be based on existing theories and knowledge. It also has to be testable, which means you can support or refute it through scientific research methods (such as experiments, observations and statistical analysis of data).

Null and alternative hypotheses are used in statistical hypothesis testing . The null hypothesis of a test always predicts no effect or no relationship between variables, while the alternative hypothesis states your research prediction of an effect or relationship.

Hypothesis testing is a formal procedure for investigating our ideas about the world using statistics. It is used by scientists to test specific predictions, called hypotheses , by calculating how likely it is that a pattern or relationship between variables could have arisen by chance.

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What Is A Research Hypothesis?

A Plain-Language Explainer + Practical Examples

Research Hypothesis 101

• What is a hypothesis ?
• What is a research hypothesis (scientific hypothesis)?
• Requirements for a research hypothesis
• Definition of a research hypothesis
• The null hypothesis

What is a hypothesis?

Let’s start with the general definition of a hypothesis (not a research hypothesis or scientific hypothesis), according to the Cambridge Dictionary:

Hypothesis: an idea or explanation for something that is based on known facts but has not yet been proved.

In other words, it’s a statement that provides an explanation for why or how something works, based on facts (or some reasonable assumptions), but that has not yet been specifically tested . For example, a hypothesis might look something like this:

Hypothesis: sleep impacts academic performance.

This statement predicts that academic performance will be influenced by the amount and/or quality of sleep a student engages in – sounds reasonable, right? It’s based on reasonable assumptions , underpinned by what we currently know about sleep and health (from the existing literature). So, loosely speaking, we could call it a hypothesis, at least by the dictionary definition.

But that’s not good enough…

Unfortunately, that’s not quite sophisticated enough to describe a research hypothesis (also sometimes called a scientific hypothesis), and it wouldn’t be acceptable in a dissertation, thesis or research paper . In the world of academic research, a statement needs a few more criteria to constitute a true research hypothesis .

What is a research hypothesis?

A research hypothesis (also called a scientific hypothesis) is a statement about the expected outcome of a study (for example, a dissertation or thesis). To constitute a quality hypothesis, the statement needs to have three attributes – specificity , clarity and testability .

Let’s take a look at these more closely.

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Hypothesis Essential #1: Specificity & Clarity

A good research hypothesis needs to be extremely clear and articulate about both what’ s being assessed (who or what variables are involved ) and the expected outcome (for example, a difference between groups, a relationship between variables, etc.).

Let’s stick with our sleepy students example and look at how this statement could be more specific and clear.

Hypothesis: Students who sleep at least 8 hours per night will, on average, achieve higher grades in standardised tests than students who sleep less than 8 hours a night.

As you can see, the statement is very specific as it identifies the variables involved (sleep hours and test grades), the parties involved (two groups of students), as well as the predicted relationship type (a positive relationship). There’s no ambiguity or uncertainty about who or what is involved in the statement, and the expected outcome is clear.

Contrast that to the original hypothesis we looked at – “Sleep impacts academic performance” – and you can see the difference. “Sleep” and “academic performance” are both comparatively vague , and there’s no indication of what the expected relationship direction is (more sleep or less sleep). As you can see, specificity and clarity are key.

Hypothesis Essential #2: Testability (Provability)

A statement must be testable to qualify as a research hypothesis. In other words, there needs to be a way to prove (or disprove) the statement. If it’s not testable, it’s not a hypothesis – simple as that.

For example, consider the hypothesis we mentioned earlier:

We could test this statement by undertaking a quantitative study involving two groups of students, one that gets 8 or more hours of sleep per night for a fixed period, and one that gets less. We could then compare the standardised test results for both groups to see if there’s a statistically significant difference.

Again, if you compare this to the original hypothesis we looked at – “Sleep impacts academic performance” – you can see that it would be quite difficult to test that statement, primarily because it isn’t specific enough. How much sleep? By who? What type of academic performance?

So, remember the mantra – if you can’t test it, it’s not a hypothesis 🙂

Defining A Research Hypothesis

You’re still with us? Great! Let’s recap and pin down a clear definition of a hypothesis.

A research hypothesis (or scientific hypothesis) is a statement about an expected relationship between variables, or explanation of an occurrence, that is clear, specific and testable.

So, when you write up hypotheses for your dissertation or thesis, make sure that they meet all these criteria. If you do, you’ll not only have rock-solid hypotheses but you’ll also ensure a clear focus for your entire research project.

What about the null hypothesis?

You may have also heard the terms null hypothesis , alternative hypothesis, or H-zero thrown around. At a simple level, the null hypothesis is the counter-proposal to the original hypothesis.

For example, if the hypothesis predicts that there is a relationship between two variables (for example, sleep and academic performance), the null hypothesis would predict that there is no relationship between those variables.

At a more technical level, the null hypothesis proposes that no statistical significance exists in a set of given observations and that any differences are due to chance alone.

And there you have it – hypotheses in a nutshell. 

If you have any questions, be sure to leave a comment below and we’ll do our best to help you. If you need hands-on help developing and testing your hypotheses, consider our private coaching service , where we hold your hand through the research journey.

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17 Comments

Very useful information. I benefit more from getting more information in this regard.

Very great insight,educative and informative. Please give meet deep critics on many research data of public international Law like human rights, environment, natural resources, law of the sea etc

In a book I read a distinction is made between null, research, and alternative hypothesis. As far as I understand, alternative and research hypotheses are the same. Can you please elaborate? Best Afshin

This is a self explanatory, easy going site. I will recommend this to my friends and colleagues.

Very good definition. How can I cite your definition in my thesis? Thank you. Is nul hypothesis compulsory in a research?

It’s a counter-proposal to be proven as a rejection

Please what is the difference between alternate hypothesis and research hypothesis?

It is a very good explanation. However, it limits hypotheses to statistically tasteable ideas. What about for qualitative researches or other researches that involve quantitative data that don’t need statistical tests?

In qualitative research, one typically uses propositions, not hypotheses.

could you please elaborate it more

I’ve benefited greatly from these notes, thank you.

This is very helpful

well articulated ideas are presented here, thank you for being reliable sources of information

Excellent. Thanks for being clear and sound about the research methodology and hypothesis (quantitative research)

I have only a simple question regarding the null hypothesis. – Is the null hypothesis (Ho) known as the reversible hypothesis of the alternative hypothesis (H1? – How to test it in academic research?

this is very important note help me much more

Hi” best wishes to you and your very nice blog” 

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7.3: The Research Hypothesis and the Null Hypothesis

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• Page ID 18038

• Michelle Oja
• Taft College

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Hypotheses are predictions of expected findings.

The Research Hypothesis

A research hypothesis is a mathematical way of stating a research question.  A research hypothesis names the groups (we'll start with a sample and a population), what was measured, and which we think will have a higher mean.  The last one gives the research hypothesis a direction.  In other words, a research hypothesis should include:

• The name of the groups being compared.  This is sometimes considered the IV.
• What was measured.  This is the DV.
• Which group are we predicting will have the higher mean.  

There are two types of research hypotheses related to sample means and population means:  Directional Research Hypotheses and Non-Directional Research Hypotheses

Directional Research Hypothesis

If we expect our obtained sample mean to be above or below the other group's mean (the population mean, for example), we have a directional hypothesis. There are two options:

• Symbol:       \( \displaystyle \bar{X} > \mu \)
• (The mean of the sample is greater than than the mean of the population.)
• Symbol:     \( \displaystyle \bar{X} < \mu \)
• (The mean of the sample is less than than mean of the population.)

Example \(\PageIndex{1}\)

A study by Blackwell, Trzesniewski, and Dweck (2007) measured growth mindset and how long the junior high student participants spent on their math homework.  What’s a directional hypothesis for how scoring higher on growth mindset (compared to the population of junior high students) would be related to how long students spent on their homework?  Write this out in words and symbols.

Answer in Words:            Students who scored high on growth mindset would spend more time on their homework than the population of junior high students.

Answer in Symbols:         \( \displaystyle \bar{X} > \mu \) 

Non-Directional Research Hypothesis

A non-directional hypothesis states that the means will be different, but does not specify which will be higher.  In reality, there is rarely a situation in which we actually don't want one group to be higher than the other, so we will focus on directional research hypotheses.  There is only one option for a non-directional research hypothesis: "The sample mean differs from the population mean."  These types of research hypotheses don’t give a direction, the hypothesis doesn’t say which will be higher or lower.

A non-directional research hypothesis in symbols should look like this:    \( \displaystyle \bar{X} \neq \mu \) (The mean of the sample is not equal to the mean of the population).

Exercise \(\PageIndex{1}\)

What’s a non-directional hypothesis for how scoring higher on growth mindset higher on growth mindset (compared to the population of junior high students) would be related to how long students spent on their homework (Blackwell, Trzesniewski, & Dweck, 2007)?  Write this out in words and symbols.

Answer in Words:            Students who scored high on growth mindset would spend a different amount of time on their homework than the population of junior high students.

Answer in Symbols:        \( \displaystyle \bar{X} \neq \mu \) 

See how a non-directional research hypothesis doesn't really make sense?  The big issue is not if the two groups differ, but if one group seems to improve what was measured (if having a growth mindset leads to more time spent on math homework).  This textbook will only use directional research hypotheses because researchers almost always have a predicted direction (meaning that we almost always know which group we think will score higher).

The Null Hypothesis

The hypothesis that an apparent effect is due to chance is called the null hypothesis, written \(H_0\) (“H-naught”). We usually test this through comparing an experimental group to a comparison (control) group.  This null hypothesis can be written as:

\[\mathrm{H}_{0}: \bar{X} = \mu \nonumber \]

For most of this textbook, the null hypothesis is that the means of the two groups are similar.  Much later, the null hypothesis will be that there is no relationship between the two groups.  Either way, remember that a null hypothesis is always saying that nothing is different.  

This is where descriptive statistics diverge from inferential statistics.  We know what the value of \(\overline{\mathrm{X}}\) is – it’s not a mystery or a question, it is what we observed from the sample.  What we are using inferential statistics to do is infer whether this sample's descriptive statistics probably represents the population's descriptive statistics.  This is the null hypothesis, that the two groups are similar.  

Keep in mind that the null hypothesis is typically the opposite of the research hypothesis. A research hypothesis for the ESP example is that those in my sample who say that they have ESP would get more correct answers than the population would get correct, while the null hypothesis is that the average number correct for the two groups will be similar. 

In general, the null hypothesis is the idea that nothing is going on: there is no effect of our treatment, no relation between our variables, and no difference in our sample mean from what we expected about the population mean. This is always our baseline starting assumption, and it is what we seek to reject. If we are trying to treat depression, we want to find a difference in average symptoms between our treatment and control groups. If we are trying to predict job performance, we want to find a relation between conscientiousness and evaluation scores. However, until we have evidence against it, we must use the null hypothesis as our starting point.

In sum, the null hypothesis is always : There is no difference between the groups’ means OR There is no relationship between the variables .

In the next chapter, the null hypothesis is that there’s no difference between the sample mean   and population mean.  In other words:

• There is no mean difference between the sample and population.
• The mean of the sample is the same as the mean of a specific population.
• \(\mathrm{H}_{0}: \bar{X} = \mu \nonumber \)
• We expect our sample’s mean to be same as the population mean.

Exercise \(\PageIndex{2}\)

A study by Blackwell, Trzesniewski, and Dweck (2007) measured growth mindset and how long the junior high student participants spent on their math homework.  What’s the null hypothesis for scoring higher on growth mindset (compared to the population of junior high students) and how long students spent on their homework?  Write this out in words and symbols.

Answer in Words:            Students who scored high on growth mindset would spend a similar amount of time on their homework as the population of junior high students.

Answer in Symbols:    \( \bar{X} = \mu \)

Contributors and Attributions

Foster et al.  (University of Missouri-St. Louis, Rice University, & University of Houston, Downtown Campus)

Dr. MO ( Taft College )

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Statistics By Jim

Making statistics intuitive

Hypothesis Testing: Uses, Steps & Example

By Jim Frost 4 Comments

What is Hypothesis Testing?

Hypothesis testing in statistics uses sample data to infer the properties of a whole population . These tests determine whether a random sample provides sufficient evidence to conclude an effect or relationship exists in the population. Researchers use them to help separate genuine population-level effects from false effects that random chance can create in samples. These methods are also known as significance testing.

For example, researchers are testing a new medication to see if it lowers blood pressure. They compare a group taking the drug to a control group taking a placebo. If their hypothesis test results are statistically significant, the medication’s effect of lowering blood pressure likely exists in the broader population, not just the sample studied.

Using Hypothesis Tests

A hypothesis test evaluates two mutually exclusive statements about a population to determine which statement the sample data best supports. These two statements are called the null hypothesis and the alternative hypothesis . The following are typical examples:

• Null Hypothesis : The effect does not exist in the population.
• Alternative Hypothesis : The effect does exist in the population.

Hypothesis testing accounts for the inherent uncertainty of using a sample to draw conclusions about a population, which reduces the chances of false discoveries. These procedures determine whether the sample data are sufficiently inconsistent with the null hypothesis that you can reject it. If you can reject the null, your data favor the alternative statement that an effect exists in the population.

Statistical significance in hypothesis testing indicates that an effect you see in sample data also likely exists in the population after accounting for random sampling error , variability, and sample size. Your results are statistically significant when the p-value is less than your significance level or, equivalently, when your confidence interval excludes the null hypothesis value.

Conversely, non-significant results indicate that despite an apparent sample effect, you can’t be sure it exists in the population. It could be chance variation in the sample and not a genuine effect.

Learn more about Failing to Reject the Null .

5 Steps of Significance Testing

Hypothesis testing involves five key steps, each critical to validating a research hypothesis using statistical methods:

• Formulate the Hypotheses : Write your research hypotheses as a null hypothesis (H 0 ) and an alternative hypothesis (H A ).
• Data Collection : Gather data specifically aimed at testing the hypothesis.
• Conduct A Test : Use a suitable statistical test to analyze your data.
• Make a Decision : Based on the statistical test results, decide whether to reject the null hypothesis or fail to reject it.
• Report the Results : Summarize and present the outcomes in your report’s results and discussion sections.

While the specifics of these steps can vary depending on the research context and the data type, the fundamental process of hypothesis testing remains consistent across different studies.

Let’s work through these steps in an example!

Hypothesis Testing Example

Researchers want to determine if a new educational program improves student performance on standardized tests. They randomly assign 30 students to a control group , which follows the standard curriculum, and another 30 students to a treatment group, which participates in the new educational program. After a semester, they compare the test scores of both groups.

Download the CSV data file to perform the hypothesis testing yourself: Hypothesis_Testing .

The researchers write their hypotheses. These statements apply to the population, so they use the mu (μ) symbol for the population mean parameter .

• Null Hypothesis (H 0 ) : The population means of the test scores for the two groups are equal (μ 1 = μ 2 ).
• Alternative Hypothesis (H A ) : The population means of the test scores for the two groups are unequal (μ 1 ≠ μ 2 ).

Choosing the correct hypothesis test depends on attributes such as data type and number of groups. Because they’re using continuous data and comparing two means, the researchers use a 2-sample t-test .

Here are the results.

The treatment group’s mean is 58.70, compared to the control group’s mean of 48.12. The mean difference is 10.67 points. Use the test’s p-value and significance level to determine whether this difference is likely a product of random fluctuation in the sample or a genuine population effect.

Because the p-value (0.000) is less than the standard significance level of 0.05, the results are statistically significant, and we can reject the null hypothesis. The sample data provides sufficient evidence to conclude that the new program’s effect exists in the population.

Limitations

Hypothesis testing improves your effectiveness in making data-driven decisions. However, it is not 100% accurate because random samples occasionally produce fluky results. Hypothesis tests have two types of errors, both relating to drawing incorrect conclusions.

• Type I error: The test rejects a true null hypothesis—a false positive.
• Type II error: The test fails to reject a false null hypothesis—a false negative.

Learn more about Type I and Type II Errors .

Our exploration of hypothesis testing using a practical example of an educational program reveals its powerful ability to guide decisions based on statistical evidence. Whether you’re a student, researcher, or professional, understanding and applying these procedures can open new doors to discovering insights and making informed decisions. Let this tool empower your analytical endeavors as you navigate through the vast seas of data.

Learn more about the Hypothesis Tests for Various Data Types .

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Reader Interactions

June 10, 2024 at 10:51 am

Thank you, Jim, for another helpful article; timely too since I have started reading your new book on hypothesis testing and, now that we are at the end of the school year, my district is asking me to perform a number of evaluations on instructional programs. This is where my question/concern comes in. You mention that hypothesis testing is all about testing samples. However, I use all the students in my district when I make these comparisons. Since I am using the entire “population” in my evaluations (I don’t select a sample of third grade students, for example, but I use all 700 third graders), am I somehow misusing the tests? Or can I rest assured that my district’s student population is only a sample of the universal population of students?

June 10, 2024 at 1:50 pm

I hope you are finding the book helpful!

Yes, the purpose of hypothesis testing is to infer the properties of a population while accounting for random sampling error.

In your case, it comes down to how you want to use the results. Who do you want the results to apply to?

If you’re summarizing the sample, looking for trends and patterns, or evaluating those students and don’t plan to apply those results to other students, you don’t need hypothesis testing because there is no sampling error. They are the population and you can just use descriptive statistics. In this case, you’d only need to focus on the practical significance of the effect sizes.

On the other hand, if you want to apply the results from this group to other students, you’ll need hypothesis testing. However, there is the complicating issue of what population your sample of students represent. I’m sure your district has its own unique characteristics, demographics, etc. Your district’s students probably don’t adequately represent a universal population. At the very least, you’d need to recognize any special attributes of your district and how they could bias the results when trying to apply them outside the district. Or they might apply to similar districts in your region.

However, I’d imagine your 3rd graders probably adequately represent future classes of 3rd graders in your district. You need to be alert to changing demographics. At least in the short run I’d imagine they’d be representative of future classes.

Think about how these results will be used. Do they just apply to the students you measured? Then you don’t need hypothesis tests. However, if the results are being used to infer things about other students outside of the sample, you’ll need hypothesis testing along with considering how well your students represent the other students and how they differ.

I hope that helps!

June 10, 2024 at 3:21 pm

Thank you so much, Jim, for the suggestions in terms of what I need to think about and consider! You are always so clear in your explanations!!!!

June 10, 2024 at 3:22 pm

You’re very welcome! Best of luck with your evaluations!

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Formulating Hypotheses for Different Study Designs

Durga prasanna misra.

1 Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

Armen Yuri Gasparyan

2 Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, UK.

Olena Zimba

3 Department of Internal Medicine #2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.

Marlen Yessirkepov

4 Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan.

Vikas Agarwal

George d. kitas.

5 Centre for Epidemiology versus Arthritis, University of Manchester, Manchester, UK.

Generating a testable working hypothesis is the first step towards conducting original research. Such research may prove or disprove the proposed hypothesis. Case reports, case series, online surveys and other observational studies, clinical trials, and narrative reviews help to generate hypotheses. Observational and interventional studies help to test hypotheses. A good hypothesis is usually based on previous evidence-based reports. Hypotheses without evidence-based justification and a priori ideas are not received favourably by the scientific community. Original research to test a hypothesis should be carefully planned to ensure appropriate methodology and adequate statistical power. While hypotheses can challenge conventional thinking and may be controversial, they should not be destructive. A hypothesis should be tested by ethically sound experiments with meaningful ethical and clinical implications. The coronavirus disease 2019 pandemic has brought into sharp focus numerous hypotheses, some of which were proven (e.g. effectiveness of corticosteroids in those with hypoxia) while others were disproven (e.g. ineffectiveness of hydroxychloroquine and ivermectin).

Graphical Abstract

DEFINING WORKING AND STANDALONE SCIENTIFIC HYPOTHESES

Science is the systematized description of natural truths and facts. Routine observations of existing life phenomena lead to the creative thinking and generation of ideas about mechanisms of such phenomena and related human interventions. Such ideas presented in a structured format can be viewed as hypotheses. After generating a hypothesis, it is necessary to test it to prove its validity. Thus, hypothesis can be defined as a proposed mechanism of a naturally occurring event or a proposed outcome of an intervention. 1 , 2

Hypothesis testing requires choosing the most appropriate methodology and adequately powering statistically the study to be able to “prove” or “disprove” it within predetermined and widely accepted levels of certainty. This entails sample size calculation that often takes into account previously published observations and pilot studies. 2 , 3 In the era of digitization, hypothesis generation and testing may benefit from the availability of numerous platforms for data dissemination, social networking, and expert validation. Related expert evaluations may reveal strengths and limitations of proposed ideas at early stages of post-publication promotion, preventing the implementation of unsupported controversial points. 4

Thus, hypothesis generation is an important initial step in the research workflow, reflecting accumulating evidence and experts' stance. In this article, we overview the genesis and importance of scientific hypotheses and their relevance in the era of the coronavirus disease 2019 (COVID-19) pandemic.

DO WE NEED HYPOTHESES FOR ALL STUDY DESIGNS?

Broadly, research can be categorized as primary or secondary. In the context of medicine, primary research may include real-life observations of disease presentations and outcomes. Single case descriptions, which often lead to new ideas and hypotheses, serve as important starting points or justifications for case series and cohort studies. The importance of case descriptions is particularly evident in the context of the COVID-19 pandemic when unique, educational case reports have heralded a new era in clinical medicine. 5

Case series serve similar purpose to single case reports, but are based on a slightly larger quantum of information. Observational studies, including online surveys, describe the existing phenomena at a larger scale, often involving various control groups. Observational studies include variable-scale epidemiological investigations at different time points. Interventional studies detail the results of therapeutic interventions.

Secondary research is based on already published literature and does not directly involve human or animal subjects. Review articles are generated by secondary research. These could be systematic reviews which follow methods akin to primary research but with the unit of study being published papers rather than humans or animals. Systematic reviews have a rigid structure with a mandatory search strategy encompassing multiple databases, systematic screening of search results against pre-defined inclusion and exclusion criteria, critical appraisal of study quality and an optional component of collating results across studies quantitatively to derive summary estimates (meta-analysis). 6 Narrative reviews, on the other hand, have a more flexible structure. Systematic literature searches to minimise bias in selection of articles are highly recommended but not mandatory. 7 Narrative reviews are influenced by the authors' viewpoint who may preferentially analyse selected sets of articles. 8

In relation to primary research, case studies and case series are generally not driven by a working hypothesis. Rather, they serve as a basis to generate a hypothesis. Observational or interventional studies should have a hypothesis for choosing research design and sample size. The results of observational and interventional studies further lead to the generation of new hypotheses, testing of which forms the basis of future studies. Review articles, on the other hand, may not be hypothesis-driven, but form fertile ground to generate future hypotheses for evaluation. Fig. 1 summarizes which type of studies are hypothesis-driven and which lead on to hypothesis generation.

STANDARDS OF WORKING AND SCIENTIFIC HYPOTHESES

A review of the published literature did not enable the identification of clearly defined standards for working and scientific hypotheses. It is essential to distinguish influential versus not influential hypotheses, evidence-based hypotheses versus a priori statements and ideas, ethical versus unethical, or potentially harmful ideas. The following points are proposed for consideration while generating working and scientific hypotheses. 1 , 2 Table 1 summarizes these points.

Evidence-based data

A scientific hypothesis should have a sound basis on previously published literature as well as the scientist's observations. Randomly generated (a priori) hypotheses are unlikely to be proven. A thorough literature search should form the basis of a hypothesis based on published evidence. 7

Unless a scientific hypothesis can be tested, it can neither be proven nor be disproven. Therefore, a scientific hypothesis should be amenable to testing with the available technologies and the present understanding of science.

Supported by pilot studies

If a hypothesis is based purely on a novel observation by the scientist in question, it should be grounded on some preliminary studies to support it. For example, if a drug that targets a specific cell population is hypothesized to be useful in a particular disease setting, then there must be some preliminary evidence that the specific cell population plays a role in driving that disease process.

Testable by ethical studies

The hypothesis should be testable by experiments that are ethically acceptable. 9 For example, a hypothesis that parachutes reduce mortality from falls from an airplane cannot be tested using a randomized controlled trial. 10 This is because it is obvious that all those jumping from a flying plane without a parachute would likely die. Similarly, the hypothesis that smoking tobacco causes lung cancer cannot be tested by a clinical trial that makes people take up smoking (since there is considerable evidence for the health hazards associated with smoking). Instead, long-term observational studies comparing outcomes in those who smoke and those who do not, as was performed in the landmark epidemiological case control study by Doll and Hill, 11 are more ethical and practical.

Balance between scientific temper and controversy

Novel findings, including novel hypotheses, particularly those that challenge established norms, are bound to face resistance for their wider acceptance. Such resistance is inevitable until the time such findings are proven with appropriate scientific rigor. However, hypotheses that generate controversy are generally unwelcome. For example, at the time the pandemic of human immunodeficiency virus (HIV) and AIDS was taking foot, there were numerous deniers that refused to believe that HIV caused AIDS. 12 , 13 Similarly, at a time when climate change is causing catastrophic changes to weather patterns worldwide, denial that climate change is occurring and consequent attempts to block climate change are certainly unwelcome. 14 The denialism and misinformation during the COVID-19 pandemic, including unfortunate examples of vaccine hesitancy, are more recent examples of controversial hypotheses not backed by science. 15 , 16 An example of a controversial hypothesis that was a revolutionary scientific breakthrough was the hypothesis put forth by Warren and Marshall that Helicobacter pylori causes peptic ulcers. Initially, the hypothesis that a microorganism could cause gastritis and gastric ulcers faced immense resistance. When the scientists that proposed the hypothesis themselves ingested H. pylori to induce gastritis in themselves, only then could they convince the wider world about their hypothesis. Such was the impact of the hypothesis was that Barry Marshall and Robin Warren were awarded the Nobel Prize in Physiology or Medicine in 2005 for this discovery. 17 , 18

DISTINGUISHING THE MOST INFLUENTIAL HYPOTHESES

Influential hypotheses are those that have stood the test of time. An archetype of an influential hypothesis is that proposed by Edward Jenner in the eighteenth century that cowpox infection protects against smallpox. While this observation had been reported for nearly a century before this time, it had not been suitably tested and publicised until Jenner conducted his experiments on a young boy by demonstrating protection against smallpox after inoculation with cowpox. 19 These experiments were the basis for widespread smallpox immunization strategies worldwide in the 20th century which resulted in the elimination of smallpox as a human disease today. 20

Other influential hypotheses are those which have been read and cited widely. An example of this is the hygiene hypothesis proposing an inverse relationship between infections in early life and allergies or autoimmunity in adulthood. An analysis reported that this hypothesis had been cited more than 3,000 times on Scopus. 1

LESSONS LEARNED FROM HYPOTHESES AMIDST THE COVID-19 PANDEMIC

The COVID-19 pandemic devastated the world like no other in recent memory. During this period, various hypotheses emerged, understandably so considering the public health emergency situation with innumerable deaths and suffering for humanity. Within weeks of the first reports of COVID-19, aberrant immune system activation was identified as a key driver of organ dysfunction and mortality in this disease. 21 Consequently, numerous drugs that suppress the immune system or abrogate the activation of the immune system were hypothesized to have a role in COVID-19. 22 One of the earliest drugs hypothesized to have a benefit was hydroxychloroquine. Hydroxychloroquine was proposed to interfere with Toll-like receptor activation and consequently ameliorate the aberrant immune system activation leading to pathology in COVID-19. 22 The drug was also hypothesized to have a prophylactic role in preventing infection or disease severity in COVID-19. It was also touted as a wonder drug for the disease by many prominent international figures. However, later studies which were well-designed randomized controlled trials failed to demonstrate any benefit of hydroxychloroquine in COVID-19. 23 , 24 , 25 , 26 Subsequently, azithromycin 27 , 28 and ivermectin 29 were hypothesized as potential therapies for COVID-19, but were not supported by evidence from randomized controlled trials. The role of vitamin D in preventing disease severity was also proposed, but has not been proven definitively until now. 30 , 31 On the other hand, randomized controlled trials identified the evidence supporting dexamethasone 32 and interleukin-6 pathway blockade with tocilizumab as effective therapies for COVID-19 in specific situations such as at the onset of hypoxia. 33 , 34 Clues towards the apparent effectiveness of various drugs against severe acute respiratory syndrome coronavirus 2 in vitro but their ineffectiveness in vivo have recently been identified. Many of these drugs are weak, lipophilic bases and some others induce phospholipidosis which results in apparent in vitro effectiveness due to non-specific off-target effects that are not replicated inside living systems. 35 , 36

Another hypothesis proposed was the association of the routine policy of vaccination with Bacillus Calmette-Guerin (BCG) with lower deaths due to COVID-19. This hypothesis emerged in the middle of 2020 when COVID-19 was still taking foot in many parts of the world. 37 , 38 Subsequently, many countries which had lower deaths at that time point went on to have higher numbers of mortality, comparable to other areas of the world. Furthermore, the hypothesis that BCG vaccination reduced COVID-19 mortality was a classic example of ecological fallacy. Associations between population level events (ecological studies; in this case, BCG vaccination and COVID-19 mortality) cannot be directly extrapolated to the individual level. Furthermore, such associations cannot per se be attributed as causal in nature, and can only serve to generate hypotheses that need to be tested at the individual level. 39

IS TRADITIONAL PEER REVIEW EFFICIENT FOR EVALUATION OF WORKING AND SCIENTIFIC HYPOTHESES?

Traditionally, publication after peer review has been considered the gold standard before any new idea finds acceptability amongst the scientific community. Getting a work (including a working or scientific hypothesis) reviewed by experts in the field before experiments are conducted to prove or disprove it helps to refine the idea further as well as improve the experiments planned to test the hypothesis. 40 A route towards this has been the emergence of journals dedicated to publishing hypotheses such as the Central Asian Journal of Medical Hypotheses and Ethics. 41 Another means of publishing hypotheses is through registered research protocols detailing the background, hypothesis, and methodology of a particular study. If such protocols are published after peer review, then the journal commits to publishing the completed study irrespective of whether the study hypothesis is proven or disproven. 42 In the post-pandemic world, online research methods such as online surveys powered via social media channels such as Twitter and Instagram might serve as critical tools to generate as well as to preliminarily test the appropriateness of hypotheses for further evaluation. 43 , 44

Some radical hypotheses might be difficult to publish after traditional peer review. These hypotheses might only be acceptable by the scientific community after they are tested in research studies. Preprints might be a way to disseminate such controversial and ground-breaking hypotheses. 45 However, scientists might prefer to keep their hypotheses confidential for the fear of plagiarism of ideas, avoiding online posting and publishing until they have tested the hypotheses.

SUGGESTIONS ON GENERATING AND PUBLISHING HYPOTHESES

Publication of hypotheses is important, however, a balance is required between scientific temper and controversy. Journal editors and reviewers might keep in mind these specific points, summarized in Table 2 and detailed hereafter, while judging the merit of hypotheses for publication. Keeping in mind the ethical principle of primum non nocere, a hypothesis should be published only if it is testable in a manner that is ethically appropriate. 46 Such hypotheses should be grounded in reality and lend themselves to further testing to either prove or disprove them. It must be considered that subsequent experiments to prove or disprove a hypothesis have an equal chance of failing or succeeding, akin to tossing a coin. A pre-conceived belief that a hypothesis is unlikely to be proven correct should not form the basis of rejection of such a hypothesis for publication. In this context, hypotheses generated after a thorough literature search to identify knowledge gaps or based on concrete clinical observations on a considerable number of patients (as opposed to random observations on a few patients) are more likely to be acceptable for publication by peer-reviewed journals. Also, hypotheses should be considered for publication or rejection based on their implications for science at large rather than whether the subsequent experiments to test them end up with results in favour of or against the original hypothesis.

Hypotheses form an important part of the scientific literature. The COVID-19 pandemic has reiterated the importance and relevance of hypotheses for dealing with public health emergencies and highlighted the need for evidence-based and ethical hypotheses. A good hypothesis is testable in a relevant study design, backed by preliminary evidence, and has positive ethical and clinical implications. General medical journals might consider publishing hypotheses as a specific article type to enable more rapid advancement of science.

Disclosure: The authors have no potential conflicts of interest to disclose.

Author Contributions:

• Data curation: Gasparyan AY, Misra DP, Zimba O, Yessirkepov M, Agarwal V, Kitas GD.