Abstract
This month’s papers span social care, hospital medicine, and mental health 1 – 3 – we even have humble practitioners challenging the authority of the Royal College of Surgeons. 4 We also continue our must read series on the interpretation of research findings. 5 The two issues – better care and better understanding of science – are related.
Many of the recommendations that you find in commentaries and research papers that we publish depend first on the quality of the underlying studies, and second on the interpretation of the findings of those studies. The devil is in the detail of the interpretation.
Understanding and interpreting evidence was not taught when I was at medical school or preparing for postgraduate exams. The word of a major medical journal was God. In one particular placement, every Friday we’d switch patients over to the latest treatment that had won a head to head trial reported in that week’s NEJM or Lancet. As house officers and senior house officers we never questioned the apparent brilliance of our registrars and consultants who were unstintingly up to date in their clinical practice.
Only later did I begin to understand the folly of such practice. The spin surrounding new treatments invariably emerges first in the form of press releases, meeting presentations, and journal articles. Harms are mostly ignored. It’s only later that the less positive research is published and discussed. The marginal gains upsold as formidable breakthroughs in the early marketing end up being mere marginal gains or worrying harms.
Our initial enthusiasm is understandable. We want to believe that there’s something better to offer our patients. Confirmation bias affects us all, and nowhere is it more evident than on social media where papers are misunderstood and misrepresented to suit our personal narrative. That misinformation is then amplified. Once the authority of major medical journals ruled – and it still does to a large extent – individuals, qualified or otherwise, now also speak and inform with authority and influence that is unchecked by colleagues, peer reviewers, or editors.
Opening up access to information is good and important. The world has changed for the better – but it has also attracted many complexities, not least a confusion in scientific discourse that allows confirmation bias to be magnified and to dominate. One way of protecting ourselves is to understand research methods and critical appraisal, and, most importantly, to better appreciate how to interpret research findings and the strength of evidence. This is something that our series from the James Lind Library has done magnificently. If there is a must read, then this is it. Now we just need the Tik-Tok version.