Friday, January 7, 2011

Series launch: Critical review of medical literature

Today I am launching a series of posts on how to read medical literature critically. The series should provide a solid foundation for this task and dove-tail nicely with some of the more dense methods themes that occur on this blog. Who should read the series? Everyone. Although the current model of dissemination of medical information relies on a layer of translators (journalists and clinicians), it is my belief that every educated patient must at the very least understand how these interpreters of medical knowledge (should) examine it to arrive at the information imparted to the public. At the same time, both journalists and clinicians may benefit from this refresher. Finally, my own pet project is to get to a better place with peer reviews -- you know how variable the quality of those can be from my previous posts. So, I particularly encourage new peer reviewers for clinical journals to read this series.  

First, a conflict of interest statement. What comes first -- the chicken or the egg? What comes first -- expertise in something or a company hiring you to develop a product? Well, in my case I would like to think that it was the expertise that came first and that Pfizer asked me to develop this content based on what I know, not on the fact that they funded the effort. At any rate, this is my disclaimer: I developed this presentation about three years ago with (modest) funding from Pfizer, and they had it on a web site intended for physician access. Does this mere fact invalidate what I have to say? I don't think so, but you be the judge.

Roughly, the series will examine how to evaluate the following components of any study:
1. Study question
2. Study design
3. Study analyses
4. Study results
5. Study reporting
6. Study conclusions
I am not trying to give you a comprehensive course on how all of this is done, but merely make the reader aware of what entails a critical review of a paper.

Look for the first installment of the series shortly.


  1. (Sorry if this is a duplicate. My last effort to send seems to have disappeared in the ether.)

    Your lay reader fan here…I’m so glad you are posting this series on reading medical literature. When I was at George Warren Brown School of Social Work at Washington University in St. Louis, we had an excellent course in evaluating research. Unfortunately, I and a lot of other eager social work types didn’t absorb it sufficiently. Coming from a liberal arts (history) background I literally panicked at the fairly introductory statistics section that was included, but I and a number of us retained sufficient information t o know when we should at least question an article.
    Although for most of my career I was a practicing psychiatric social worker, I worked as a research associate twice for a period totaling a bit over four years, the first at Washington University’s department of psychiatry in the early 1980s, the second in the late 1990s at University of Texas Health Science Center at San Antonio. I’m mentioning all of this because of your “disclaimer.”
    Most of The projects I was involved in had some funding from drug companies. Looking back, I don’t think anyone at the time thought it was a problem, though I think later we did wonder, for a variety of reasons. But the answer doesn’t lie in banning drug company money from research. Drug companies should share some of their enormous profits for research outside of their own walls. I just don’t think we’ve come up with enough of the right mechanisms. Perhaps there should be a large blind fund to which companies put in a certain percentage of their profits. This fund could be distributed in such a way that no one knew whose money was going where and would perhaps be useful in direct drug-related research.
    Work you produced is in and of itself not corrupted by drug money, yet it was clearly useful for Pfizer because it gave the company’s web page an appearance of supporting impartial research. This doesn’t mean you shouldn’t have done it, because theoretically it also served a valid educational objective. It does mean, in my cynical mind and in the cynical atmosphere in which we live, that Pfizer had its own ulterior motive in mind.
    The thing is, I don’t think more and more rules and regulations are the answer. I think a lot of thought needs to go into how we can possibly develop a more ethical society in light of the total dominance of corporations who are their own countries. Perhaps your work on the Pfizer web page could be regarded as deliciously subversive: if Pfizer produces studies that are not quite honest, they can be directed to their own web page to find the source of criticism.
    Complicated stuff. And thank you again for my continuing education.

  2. Could you hyperlink your outline to posts. That would help me find them. Thanks!