We would like to sound a caution about relying on abstracts;
One
writer to this list recently wrote, “…often we just rely on abstracts of
peer-reviewed journals…” as a way to quickly obtain (and advise other
clinicians) about the medical literature."
It
might be worthwhile to point out that there is danger in using abstracts to
solve the time crunch problem all clinicians run into when needing valid,
relevant information during the work day.
We often shock physicians into reading differently when we
tell them about the Pitkin study (Pitkin et al., JAMA, 1999) which reported that 18-68% of
abstracts in top journals (Ann Intern Med, BMJ, JAMA, Lancet and NEJM) contained
information inconsistent with data in the article or not found at all in the
body of the article. Abstracts may
be useful in helping to decide whether or not to discard a study, but
information in abstracts may be incorrect.
Worse, there is no way to tell if an article is relevant or valid
from looking at the abstract. During our programs, we shock physicians
even more by showing them powerful examples of harms caused by studies applied
without a critical reading to find the flaws.
We
have huge problems with healthcare quality and cost often as a result of doing
the wrong thing or not doing the right thing, not doing the right thing right,
etc. Respectfully, I submit that – while very
well intentioned – a service that suggests to people that they are getting valid
information from review of abstracts is
misleading.
Critical appraisal skills don’t have to come by agony. We have developed a powerful, yet fun,
method to teach people the needed skills to get them very far along the EBM
pathway in a very short period of time.
It doesn’t take doing an entire systematic review to understand
weaknesses in study types, frequently found biases, understanding confounding,
etc.
Another option is to subscribe to one of the ever-increasing
“formularies of evidence” such as Clinical Evidence, a collection of systematic
reviews with additional reviews of RCTs that is updated every 6 months and comes
with a CD, or the systematic reviews done by Cochrane.
President,
Delfini Group, LLC
Clinical
Assistant Professor, UW School
Medicine
206-854-3680
Sheri Strite, Associate
DirectorProgram Development,
Department of Family and Preventive
Medicine