Can you believe the study you’re looking at? “It’s about asking yourself, How well is this study being done?” Dr. Burton said.
Explore This IssueNovember 2015
What are the results? Dr. Burton suggested looking at the effect size to determine how confident you can be about the results.
Will these results help me in my practice? “Only you know the answer to that question,” Dr. Burton said.
He continued, “You also need to know something about the harms and the costs of the treatment that’s being evaluated in the paper. Sometimes you get that from the paper, and sometimes you have to dig a little deeper.”
Dr. Burton gave one answer to those questions: systematic reviews. These are studies that use “a particular disciplined, transparent, scientific process for locating, appraising, and synthesizing the evidence.”
He added, “You might go to systematic reviews at the top of the evidence tree if you’re short of time.”
Don’t Be Afraid to Tromp Over to the Library
Robert Ferris, MD, PhD, chief of head and neck surgery at the University of Pittsburgh, cautioned that, when you are reading the literature, it’s important to do so skeptically and to keep up with the issues even after they seem to have been fairly settled.
If you don’t keep up, you do so at your own peril, he said. In 2003, a study in the New England Journal of Medicine seemed to establish that concurrent radiation therapy and chemotherapy were best in laryngeal cancer, but what was missed at the time was that the endpoint of the study—laryngeal preservation—was not the most important endpoint; rather, laryngectomy-free survival was. When the same authors reexamined the data 10 years later, looking at the more appropriate endpoint, they determined that radiation therapy before chemotherapy actually produced better results.
“You had to monitor that data were shifting,” Dr. Ferris said. “The field had already switched. We were treating people with one regimen, and this got reversed and a different conclusion arose. And I think it’s important for people to realize that that occasionally happens.”
He suggested that physicians read and know the data, be critical, and talk to colleagues and hear presentations on how others apply the data and the results. “With PubMed, it’s almost too easy,” he said. “You can just look at the abstract and move on. In the old days, we had to tromp over to the library and get the whole paper. So go to the methods, look at the data, look at the figures.”