JISCMail - EVIDENCE-BASED-HEALTH Archives

Science is meant to be challenged, research is built on probabilities. There are no perfect studies. We can find best evidence by critically appraising methodology and that will produce minimal bias and reduce avoidable error.

When we look at the work of Da Vinci for example we see how scientists have made incredible inroads with so little to work with. Freud did not have the money to be a scientist so went into the psyche where conclusions are quite messy given the complexity of human interaction and the great potential for bias. We see how some research is still valid today, and that is usually because of very clear outcomes. Trials are not meant to discover anything they are literally a test of treatments or interventions.

It can’t be ignored that papers that point to errors are highly cited because most of us are trying to attain best practice in whatever we do. I think it is important to be observant in appraisal and yet keep an open mind. There was an excellent paper written By Alper et al Thrombolysis in acute ischaemic stroke: time for a rethink? at the BMJ http://www.bmj.com/content/350/bmj.h1075 This was based on looking at available research not just focused on primary and it is an important paper.

I remember one paper we were given in Clinical Epidemiology about the H1N1 flu. This paper shaped policy on a possible pandemic that never materialized. Some of the classmates were critical because they looked in hindsight but I can say that with no infectious disease background and looking at the paper I considered it well written. I would have taken the same route as those that made the decision.

I guess this does’t help much but I take all the critical no paper is good enough hype with a grain of salt. I listen, I apply but I also remember we live in an imperfect world and it is so easy to judge a piece of research without knowing the blood, sweat and tears that went into it. I have also read terrible papers because I had to and then got an idea from them even with a pretty much closed mind.I have also read beautifully written papers or those by someone with a name and found terrible errors in them.

I was hoping someone with greater experience would answer this because it is an important question we all wonder about. All the highly critical papers with inflammatory headlines are a real problem when working with junk scientists and consumers too because the consumers are confused and the mercenaries use this as an opportunity to color Evidence based health care/medicine/practice as a reservoir of division and darkness. This mode of criticism where problems are presented that breed fear and intimidation but are presented without visible solutions prevent students and young researchers from publishing lest they face the wrath of producing a lss than perfect research project. I think we need to start standing up and saying what evidence does well and holding critics accountable to produce the kind of research they demand from others.