Thursday, January 29, 2009

Trusting the medical literature

really nothing always... just take it with a grain of salt
Dr RW has an interesting post where he responds to Dr Marcia Angells JAMA commentary where she questions the ability to practice evidence based medicine noting that "Physicians can no longer rely on the medical literature for valid and reliable information".

Though, as pointed out by Dr RW, there are prescient challenges and significant problems reagrding industry and non-industry supported research, Dr Angells assertion -reminiscent of the "pharma is all evil" canard- indeed seems far too simplistic.

Unfortunately, her opinion -though important and worth measured consideration- may be taken as fact and used by the ideological or the less scientifically literate to distract from a more balanced approach to considering a litany of real problems. Indeed, the research landscape is far from the useless state Dr Angell seems to claim.

As Dr RW notes:
"What then are practicing doctors to do? Angell’s statement above suggests that in the current environment the practice of evidence based medicine and science based medicine are impossible. Nonsense. EBM is premised on the fact that all research reports have weaknesses and are to be viewed with skepticism. SBM, recognizing that EBM lacks the tools to examine all claims, goes a step further by evaluating reports in light of prior research and scientific plausibility. In short, doctors have the tools to critically appraise the medical literature. It’s hard to believe Dr. Angell wants to abandon EBM altogether."
(My bold)

Hopefully that is not her intent. Dr Angell does seem to favor an "independent body" to serve as overseer and provider of clinical option fraught with many of the same problems beguiling the present research environment.

In the end, as these issues are -hopefully- objectively and pragmatically addressed, Dr RWs' call to using evidence and science based approaches and tools when evaluating data will continue to serve practitioners and their patients well.

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