Re: The Faults Of Expert Reviews

Discussion in 'Health and medical' started by Peter Moran, Aug 22, 2003.

  1. Peter Moran

    Peter Moran Guest

    "Jan" <[email protected]> wrote in message
    news:[email protected]
    > http://bmj.com/cgi/content/full/bmj;327/7409/269
    >
    >
    > BMJ 2003;327:269 (2 August)
    >
    >
    > Collections under which this article appears:
    > Other Journalology
    > Information in Practice (journal section)
    >
    > Commentary
    > The faults of expert reviews are already well known
    > D A Fitzmaurice, clinical reader in general practice1
    > 1 Department of Primary Care and General Practice, Medical School,

    University
    > of Birmingham, Birmingham B15 2TT [email protected]
    >
    >
    > The authors are well known proponents of evidence based medicine and

    introduced
    > the concept of patient oriented evidence that matters (POEMs) and disease
    > oriented evidence in the early 1990s. The current study claims that the

    two
    > main POEMS from the United Kingdom prospective diabetes study (UKPDS),

    namely
    > that for patients with type 2 diabetes blood pressure control is more

    important
    > than glycaemic control and that metformin should be first line therapy,

    are not
    > well presented in review articles. It is odd, therefore, that they choose

    a
    > "convenience sample" of review articles rather than undertaking a

    systematic
    > review. Thus the search strategy is broad, and it is hard to claim that

    using
    > the authors as reviewers is an independent process.
    >
    > Having said this, the point is well made that review articles,

    particularly
    > those written by specialists, tend to be of dubious value, with authors
    > selectively choosing evidence to support their own prejudices. I would

    argue,
    > however, that most practising clinicians know this already, and my

    experience
    > is that most UK primary care physicians are aware of the key messages, or
    > POEMs, as described above. My perception, albeit limited, is that the
    > experience of a patient with type 2 diabetes is much more likely to

    include
    > metformin treatment, intensive blood pressure monitoring and control, and
    > intensive management of dyslipidaemia than the historical reliance on
    > haemoglobin A1c. This has happened despite the apparent dissemination of
    > misleading information described by the authors.
    >
    > The paradox of using non-evidence based methods to discredit non-evidence

    based
    > reviews is striking, and is similar to using a lecture method to impart

    the
    > information that lectures are not the best method for disseminating
    > information. If one were to apply information mastery to the current paper

    one
    > would not get past the abstract (some would suggest the title). The

    message is
    > important, however, that expert reviews cannot be trusted. Sackett has

    always
    > been wary of experts and has recommended that once a person has become an
    > expert he or she should change jobs. This information has obviously

    filtered
    > through to the "coal face" as clinicians are acting much more on primary

    data
    > than filtered expert opinion.
    >
    > The goal of the authors, to effect change through clinical research using
    > clinically important end points rather than intermediate or "proxy"

    measures,
    > seems to me to have been achieved despite rather than because of the
    > dissemination of poor information described. We should perhaps question

    why
    > these expert reviews continue to be published, given both their lack of

    rigour
    > and their apparent lack of influence.


    Perhaps, Jan, you would like to give us a brief, simple account of what
    this author is saying, and also what your opinion is of it after you have
    read the detailed rebuttal by the authors of the paper that is being
    criticised.

    Nevertheless, reading the BMJ is huge step up from your usual sources.
    Congratulations.

    Peter Moran
    >
     
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