I agree and this is often said about EBM in psychiatry. Yet, haven't we
seen quite an improvement in the reporting style and format of journal
articles in general medicine since critical appraisal has become a bit more
"bread and butter" in vocabulary (e.g., after the JAMA User's Guide series,
ACP Journal club in the US just as one example of influence)? We can now
identify points for critical appraisal screening (i.e., whether the study
specifically addressed the question suggested by key words or article
title, the type of trial, whether it was randomized and blinded, often even
the follow up rate and whether intention to treat analysis was true.) This
was less true (but sometimes true) 10 years ago.
I think that, in part, when psychiatrists demand more evidence based
research, the picture you describe will improve, at least somewhat. Only
part of the problem is the particular difficulties encountered in
psychiatric research. Another part has to do with standards for reporting
styles, i.e., information necessary to include in research reports.
What I think should follow after critical appraisal (and other aspects of
EBH practice) become more commonplace is ready "advertisement" of sound
research protocol in titles and abstracts for already-sound study
protocols, then, improvement of study protocols when and where needed. I
do think researchers want to do "good science". When we (clinicians,
researchers, teachers, the public) demand it in all areas including those
that seem to be lagging behind, demand for resources to do better studies
should follow as should improvements in study protocols.
Two of the factors standing in the way are economics and the need to do
research on problems not accessible to RCTs and other more familiar
protocols (a familiar problem in many clinical fields). As EBH (as a
generic term for all like efforts worldwide) becomes more
interdisciplinary, if we can continue to encourage efforts from people
learning EBH, clinical epi etc, to "study how to study" problems in
occupational therapy, health service delivery, psychotherapy and many other
"paramedical" disciplines, we should be able to find some approaches to
questions in general medicine that we haven't even begun to look at
critically but slow us down every step of the way.
Economically, it's quite a bit a modern day social problem, isn't it? I
think the public is slowly getting involved in this sort of thinking as
people realize evermore that our information for just about everything is
overwhelming in quantity, inevitably biased, contradictory, often of poor
quality and often very influential nevertheless. EBH as a culture within
the medical culture demands priority of clarity over hierarchial standards
and I hope it will add its influence on health care from the ground up as
the scope of interested and informed people widens.
Best wishes to all,
Ati
At 10:18 AM 12/14/98 -0600, you wrote:
>Isla Roberts writes:
>
>> has anyone carried out an epidemiology of RCT's on any
>>subject?
>
>I'm not sure what you mean by epidemiology of RCTs (randomized control
>trials) but a recent issue of the British Medical Journal (October 31) had a
>whole series of articles reviewing the RCT. One that I chose for
>presentation at a journal club is
>
>"Content and quality of 2000 controlled trials in schizophrenia over 50
>years" Ben Thornley and Clive Adams BMJ 1998; 317: 1181-1184.
>
>I think a good subtitle for it would be "You don't have to be crazy to
>publish research about schizophrenia, but it helps."
>
>The authors point out the grossly inadequate sample sizes in most of these
>studies. The average study had only 65 patients total, and only 3% of the
>trials had adequate power according to the authors' criteria.
>
>Even worse, there was absolutely no consistency in how the papers measured
>outcomes. There were 640 different instruments used, and 369 were used only
>once. I feel very sorry for anyone who has to do a meta-analysis on this
>mess.
>
>The quality of the reporting was terrible. Only 4% of the studies provided
>sufficient information about the methods of allocation, and only 22%
>provided explicit information about blinding.
>
>With these sorts of results, I wonder how successful Evidence Based Medicine
>can be.
>
>For what it's worth, this is not a surprising result. What these authors
>describe about their field is also true for many other research fields.
>Every review I have ever read about the quality of published research has
>been rather depressing.
>
>Steve Simon, [log in to unmask], Standard Disclaimer.
>Ask Professor Mean: http://www.cmh.edu/stats/profmean.htm
>
______________________
Ati Yates, M.D.
Internal Medicine and Psychiatry
Michigan State University
Mailing address: 6092 Beechwood Drive,
Haslett, MI 48840
Phone: W 517 353 4362
H 517 339 5037
Fax: 517 339 5569
2nd Fax: 517 432 3603
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