“That's a nice way of seeing what's going on,” said Steve Simon, Ph.D., a research biostatistician at Children's Mercy Hospital, Kansas City, Mo. “I'm the sort of person who doesn't mind having 100 e-mails in my in-box as long as I don't have 100 sheets of paper on my desk. The other nice thing about e-mail is that you can put all of those tables of contents in a special folder that you can get to when you have time.”
Dilip V. Jeste, M.D., editor-in-chief of the American Journal of Geriatric Psychiatry, noted that while physicians might feel stretched for time to keep up with medical journals relevant to their field, it's important to devotesome time to the endeavor. “Patients are becoming increasingly sophisticated and increasingly knowledgeable because of the publications in the media,” said Dr. Jeste, chief of the division of geriatric psychiatry at the University of California, San Diego, School of Medicine.
“They are also going outside of psychiatry when they read that some study found that vitamin E is associated with increased mortality. A patient will say, 'I'm taking vitamin E because I know it's an antioxidant. Should I stop taking it because of the increased risk of mortality?' If the physician is not knowledgeable about the study, I think that will create a problem.”
Dr. Jeste added that medical journals could do a better job of making material less, well, boring. “There's definitely a lot of technical jargon in some of the journals,” he said. “Clinicians may not find something that is really appealing to them in an understandable language.”
He noted that some journal subscribers have asked to see more clinical reviews of a topic in the journal and fewer scholarly reviews that may contain 100 references.
“The idea is to have a clinical review [that] is shorter, more succinct, with fewer references, and yet authoritative,” he said. This kind of review would “talk about which treatment would be best in which patient,” he added.
Since 1971, Drs. Robert Katz, Richard J. Castiello, Stephen I. Katz, Robert J. Carnathan, and Gary W. Cage have been using camaraderie to make journal reading more pleasant. Courtesy Dr. Stephen I. Katz
Focus on Data Collection, Not Analysis, When Reviewing Articles
The devil may be in the details, but when it comes to reviewing medical literature, Steve Simon, Ph.D., advises physicians to not get hung up on how data in a study were analyzed by the author or authors.
For example, physicians may wonder, “did they do the right statistical analysis in this study? That may be important, but it takes a lot of background to really appreciate that,” said Dr. Simon, a biostatistician. “More important is how the data were collected, because if you collect the wrong data, it doesn't matter how fancy the analysis is.”
By focusing on data collection, you'll begin to ask yourself such questions as, was there an appropriate control group? Who was left out of the research? Did they measure the right outcome?
“Those are the sorts of things that you can actually judge without having to have an extensive background in statistics or mathematics,” he explained.
“You do need to understand a little bit about the statistics, like what a P-value is and what a confidence interval is, but don't get really worried about the particular type of data analysis done. For the most part, if there's a problem with the research that makes it difficult to generalize the results, it's a problem with data collection and not with data analysis,” said Dr. Simon.
He also cautioned against drawing conclusions about a study without reading both the abstract and full text of an article. “One reason is that the abstract will sometimes be inconsistent with the paper,” he said.
“There's also a tendency to report the most statistically significant results in the abstract as opposed to the ones that are of most clinical importance. Finally, sometimes the conclusions are drawn too strongly in the abstract and qualifiers appear only in the paper itself,” Dr. Simon added.
He recommended the following books for help with interpreting studies that appear in medical journals:
▸ Evidence-Based Medicine: How to Practice and Teach EBM,” 3rd ed., by Sharon E. Straus, M.D., et al. (Edinburgh: Churchill Livingstone, 2005).
▸ How to Read a Paper: The Basics of Evidence Based Medicine,” 2nd ed., by Trisha Greenhalgh (Oxford, England: BMJ Books, 2004).
▸ Medical Uses of Statistics,” 2nd ed., by John C. Bailar III and Frederick Mosteller, ed. (Waltham, Mass.: NEJM Books, 1992).