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The Sciences

Do Health Care Providers Understand the Medical Literature?

The IntersectionBy Chris MooneyJune 12, 2007 11:50 PM

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I've done something a bit off the beaten path recently--teamed up with a scientist to write an editorial for a medical journal. My piece, with Beth Jordan, M.D., who is the scientific director of the Association of Reproductive Health Professionals, just appeared in Contraception. Here is the gist:

In the medical and especially the highly politicized reproductive health arena, one consequence of the frequent misappropriation of the mantle of science can be seen in a cacophony of news headlines, presenting bewildering and often conflicting information: "Rethinking Hormones, Again", "What? Condoms Can Prevent AIDS? No Way!", "Public Citizen Petitions FDA to Ban Birth Control Pills Containing Hormone Desogestrel", "FDA To Reconsider Standards for Reviewing Low-Dose Oral Contraceptives", "Contraceptive Patch May Raise Blood Clot Risk" and "Delinking Abortion and Breast Cancer". Surveying this turmoil is a weary public, unclear what to think as research conclusions seem to change and contradict one another with disconcerting frequency. In such an era of rivaling "scientific" claims and data sets, when special interests bend the ears of journalists who are all too inclined to give "equal time" to unequally substantiated viewpoints, it becomes more important than ever that health care providers have the skills to understand and interpret scientific studies, especially those with strong implications for patient health and public health policy. Providers are ideally positioned to make sense of the published literature, communicate its results to professional and lay audiences, and reaffirm the value of solid reproductive health research. But do they truly possess the requisite analytic skills -- including the ability to critically interpret complex study designs and results, and make sense of them independent of both the authors' and the media's conclusions? One of the best kept secrets among health care providers -- especially medical doctors -- is that many do not have the ability to understand and interpret the medical literature. Many clinicians view their critical analysis skills as being modest at best. Traditionally, clinical decision making has been largely based upon dogma and traditions culled from pathophysiology, personal observation and intuition. While evidence-based decision-making models continue to supplant more subjective approaches in medical education, many students receive little rigorous critical appraisal training and have few opportunities post-training to acquire these technically challenging skills. This leaves providers at an embarrassing disadvantage when it comes to interpreting research with strong implications for clinical practice (and for public health policy). As Lancet editor Richard Horton has put it, "without that skill, a doctor is barely fit to practice". Clinicians who accurately interpret studies can quickly apply their findings in their practices while, Horton notes, more "ambiguous results are given pause for thought". At the same time, analytically skilled providers will know how to respond to patients who have been confused by sensationalized news reports calling into question common treatments, or promoting new and relatively untried modalities. Alas, evidence suggests that such talented providers are far too rare. The Women's Health Initiative (WHI), a study looking at the effects of hormone replacement therapy in menopausal women, provides a case in point. In the wake of the WHI results, one survey of physicians found that less than 30% correctly answered questions about the study results, while 67% overestimated study findings. Most disconcertingly, respondents were most often wrong about the risk of coronary heart disease, the number one killer of women in the United States.

My additions to this piece were largely rhetorical, but it's an important point, and I'd be interested to hear any reactions. And sorry, incidentally, for not posting...things have been busy, and I've been trying to get ready to give this talk about Storm World in Grand Rapids, Michigan tomorrow. Come on out if you're local!

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