Epidemiology for English speaking students / How to read a paper / Do patients need to read research

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Do patients need to read research?

Richard Smith

BMJ 2003;326;1307doi:10.1136/bmj.326.7402.1307

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RESEARCH

FOLIO/TOBIAS HICKEY

Do patients need to read research?

Most patients wouldn’t dream of reading	children who had developed autism (and a	same time is to “randomise” the patients to
medical research. They probably imagine it	strange bowel disorder) after being given	one treatment or another. To exclude “bias”
to be arcane, mystical material full of	the MMR vaccine. The problem is that	(which might, for example, lead a doctor to
numbers, formulas and Greek symbols.	virtually all children are given the vaccine—	put all the sicker patients into one arm of
They aren’t far wrong, but it is possible to	which means hundreds of thousands a	the trial) neither the doctor nor the patient
get to grips with medical research without	year—and all sorts of things will happen to	should know who has got the active
being as clever as Wittgenstein. If it’s any	them in the weeks after they have been	treatment, making the trial “double blind.”
comfort, most doctors don’t read or	given the vaccine. Some will break legs.	Because the benefit from most medical
understand medical research either—but	Some will start to talk. Some may show	treatments is small and so hard to detect,
they can be trained to do so without too	signs of autism. But this doesn’t mean that	you need very many patients in the trial.
much effort.	these events are caused by the vaccine.	Although “double blind randomised trials”
The main reason for reading medical	I can’t in a short piece convey everything	are the best way of working out whether a
research is that it underpins all of medicine.	you need to know to assess the validity of a	treatment works, many of them have not
Increasingly, doctors are reluctant to use	piece of research, but I can give some	been well done and have given misleading
diagnostic methods and treatments unless	guidance on one of medicine’s most	results.
they are based on good research. I belong	important—and simplest—questions: “Does a	A final reason why patients might want to
to a generation who had our tonsils	treatment work?” The simplest experiment	read medical research is because it’s a
removed for recurrent snotty noses. The	would be to give a patient a treatment and	satisfying intellectual experience—like
treatment was useless. Thirty years ago	see if it works—a case report. Such reports	reading Proust or trying to make sense of
patients who had heart attacks were kept in	used to be common in medical journals, but	the paintings of Titian.
bed for days. The treatment killed them.	we don’t know what would have happened
When my first son was born my wife was	to the patient without the treatment. The	Further reading
given an enema and had her pubic hair	same problem applies to a collection of	To learn more about how to work out
shaved. Both unnecessary. The history of	patients: a case series, the most common	whether a piece of medical research is
medicine is mostly a history of ineffective	type of study in many surgical journals.	reliable, read Trisha Greenhalgh’s book,
and often dangerous treatments. This is		How to Read a Paper, available from the BMJ
what is meant by “evidence-based medicine.”	Intellectual experience	Bookshop (www.bmjbookshop.com/) for
Unfortunately there is still no evidence to	The scientific answer to the problem is to	£16.95. The articles that made up the book
support most diagnostic methods and	have “control” patients who don’t get the	are available for free on bmj.com
treatments. Either the research hasn’t been	treatment. You might have a series of	Richard Smith has written a book, provisionally
done or it is of too poor a quality to be	patients from before the treatment was	entitled The Trouble with Medical Journals,
useful. Patients might want to read medical	available and compare what happened to	which will be published next year by Cambridge
research in order to understand if evidence	them with a series of new patients given the	University Press.
exists to support the treatments they are	treatment, known as a “before and after”	Competing interests: Richard Smith is editor of the
undergoing.	study. There are two major problems with	BMJ and chief executive of the BMJ Publishing
They might also want to read research in	this: firstly, we don’t know if the new	Group Ltd, which publishes a great deal of
response to particular controversies—like,	patients are the same as the old patients;	research, and Trisha Greenhalgh’s book. He is paid
for example, the argument over whether	secondly, other things—perhaps the weather	a fixed salary and will not benefit financially from
the MMR (measles, mumps, rubella)	or the medical staff—might have changed	more people reading either the research or the book.
vaccine causes autism. This idea arose from	and led to better results.
a scientifically weak study in the Lancet,	The best way to be sure that you are
		Richard Smith editor, BMJ, London WC1H 9JR,
which described a cluster of cases of	comparing the same sorts of patients at the	[e-mail]

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