“Medical information is derived from three principal sources:
– personal experience and apprenticeship
– planned research on groups of patients
– synthesis of individual research studies: this is the sphere of meta-analysis in medicine
How can one know whether a medical article is good or bad?
How should one judge whether a presentation made at scientific meeting should be trusted?
How should one choose the clinical, therapeutic and preventive information necessary for making medical decisions, and how should one use it in practice?
How should one evaluate data, with a view to applying them at the level of health policies and administration?
How should one proceed when different studies on the same topic yield conflicting results?”
“TABLE OF CONTENTS
Foreword. What is the purpose of this book, and who is it for?
Chapter 1. Gathering information and facts in medicine
* Sources of data in medicine
* Variety of motives for and information in health research
* Classifying analyses of research data
* Current medical information and its practical implications
Chapter 2. Evaluating an individual original research study, a medical article, or an essay
* Objectives and structure of the chapter
* Basic elements of an original study
* Quality criteria for a study of diagnosis
* Quality criteria for a descriptive study
* Quality criteria for a study of a causal relationship
* General criteria for assessing the acceptability of medical information in an article or an essay
Chapter 3. Synthesis and integration of medical information
* History, definitions, classification
* Narrative reviews
* Analysis by vote counts and by consensus
* Replicated secondary data analysis
* Qualitative meta-analysis
* Quantitative meta-analysis
* Problems specific to meta-analysis in the health sciences
* The ‘mosaic’ of medical information
* Conclusions: Importance, limitations and perspectives of meta-analysis in medicine
“All my life when I did not know how, I have looked for a book that told me how. …
A book is not enough, of course. It is what you bring to the book; your ability to
absorb the information it contains and make those facts, those insights, yours. If you
know how to absorb information, you can do just about everything – start your own
business, build a happy marriage, even shingle a roof.”
Joyce Brothers, How to Get Whatever
You Want Out of Life, 1978.
We have learned the theory and practice of medicine. We have mastered the rules of valid research and we know how to do scientific studies designed to address concrete, clearly defined problems.
Our teachers, our predecessors and our colleagues have inculcated in us some idea of the art and the science of medicine, without always specifying, however, the limitations of each (Table 0-0).
It remains to be known whether we have succeeded in confronting the great challenges of medicine today. Although there have been many mistakes and many blind alleys, the success of modern medicine is undeniable: reasonable control of diabetes, emergency medicine, organ transplantation, immunisations against viral illnesses, etc.
The results of such efforts and accomplishments is tangible. Over 200 biomedical journals are currently being published. The number of original articles, syntheses and other papers is increasing by 6 to 7% a year. Thus the volume of new medical information doubles every 10 to 15 years and increases tenfold in 23 to 50 years.1
All medical information is not of the same quality. The reader must make an assessment and choose which information is most likely to be useful to him.
– Which summary information is the most valid and objective, among a multitude of individual observations (studies) on the same topic? For example, if several studies aim to evaluate the preventive role of physical activity on the aetiology of myocardial infarction, what is its quantitative importance across the hundreds of studies on the topic? Are there contradictory results?
– If one constructs a summary table of multiple pieces of medical information on the same topic, do other data in this body of evidence enable one to pose new questions, to discover unrecognised and important problems, to formulate new hypotheses, to direct further research?
These questions illustrate clearly the importance of obtaining good primary medical information, whether in an article or a study. An analysis of medical information, as structured and as complete as possible, ought to achieve this.
Aside from the analysis of primary information, one needs a kind of “research on research”, an analysis, critique and synthesis of multiple pieces of information. A kind of meta-analysis in medicine emerges. The quantitative and qualitative aspects of meta-analysis of research have been developed and applied in a variety of biological and human sciences. Medicine needs this more than most because the flood of medical information shows no signs of abating.”
Translation by Iain Chalmers