USP

USABILITY of SCIENTIFIC PUBLICATIONS

USP[1] – not only for medical students

 

 

 

What is the problem?

 

Too many scientific papers lack validity. Experts presume that internal validity can be confirmed in only 10%-30% of clinical trials. This does not mean that 70%-90% of all trials are wrong, but rather, that there is a lot of uncertainty. We cannot be sure in those studies that the provided information leads to the right individual or policy decision.

 

This uncertainty was one of the reasons David Sackett and colleagues started about 15 years ago to fight for more EVIDENCE in medical decision making (1-3). Today, almost 15 years after these pioneers started their initiative we recognize three effects.

 

- Almost everybody talks about evidence-based practice but only a minority knows the principles and rules.

- Almost everybody claims to make evidence-based decisions but only a few realize when they in fact don’t do.

- Almost everybody in health care suffers from economic pressure and takes actions to manage this problem but without analyzing the reasons.

 

Our Hypothesis

 

We only can speculate about the reasons for this movement either, but we follow the hypothesis that the loss of medical professionalism and the growing economization of medicine cause the imbalance of the system. It can be predicted that the same what happened to our economic systems will happen to our health care systems. The more members of a society abusing the system to take personal advantage the higher ist the risk of crash. There is no reason to assume that this simple rule will apply only to economic but not to health care systems.

       

 

What can we do?

 

We are academic teachers and medical students who agree about the above hypothesis and want to do something against it. What we can do, is to support interested students to acquire the necessary attitudes, skills, and the knowledge to develop critical facility and to generate transparency.

 

 

How we started

 

The same idea – to support interested students (but only the really interested once) – emerged almost simultaneously at the University of Niteroi/RJ in Brazil, at the Ospedale Pediatrico Bambino Gesú in Rome/Italy, and at Clinical Economics of the University of Ulm in Germany. At these places academic teachers and interested medical (undergraduate and postgraduate) students considered the validity of scientific papers an important issue and just started to teach, how to assess the validity of scientific papers especially of medical studies, which should support health care decisions.

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What we observed

 

We observed that incentives may indeed be necessary to get things working. Economists teach us since ever that success depends on incentives. In medicine incentives are sometimes misunderstood. Some of us think that honor or altruism or successful healing are sufficient incentives to work as health care professional and others are convinced that the “coined liberty” is the only incentive that keeps us doing our jobs. We observed that a mixture of both, enthusiasm and economic understanding, may be the optimal incentive to balance medical professionalism and the economization of medicine (4-6). Therefore, we ask the users of our services to pay for our services and we pay the students who support us to provide these services.

 

 

What we understood

 

We understood (because we asked them) that most decision makers will not really test the scientific evidence they use. Academic teachers need valid publications for their lectures and seminars. Industry managers need valid publications to support their applications for approval of their products. Health insurance managers want to be sure, that the reimbursed services are based on valid data. All of these decision makers do neither have the time nor the resources to read the clinical studies they use to achieve their goals. Figure 1 shows several steps of a “decision chain” that has to be completed to transfer the information derived from a successful experiment to the users e.g. to academic teachers, industry managers, and health insurance managers. First, the results of a successful experiment have to be published. The published

 

 

 

 

 

 

 

 

 

 

 

 

Fig. 1:”Decision chain” from an experiment via original publication, review and guideline to the individual or policy decision. Note that decision makers often quote on original publications instead of reviews and guidelines but rather read reviews and guidelines instead of original publications. 

results have to be quoted by colleagues and have to be included in reviews. The reviews have to be considered (but may not be mentioned) in guidelines. Reviews and guidelines rather than original publications will shape the decision makers’ convictions and opinions (although the decision makers will prefer to quote on original papers than on reviews or guidelines).

As a consequence of this “decision chain” we might primarily strive for the assessment of the validity of reviews and guidelines which influence the convictions of decision makers. However, the validity of reviews and guidelines cannot be assessed without confirmation of the validity of the original key papers which are the basis of reviews and guidelines. We therefore recommend first to select the important reviews and guidelines, identify the key papers of these reviews and guidelines and then check the validity of the used original papers to support reviews and guidelines.      

 

 

What we offer

 

We offer a critical analysis of scientific evidence to academic teachers, industry managers, and managers of health insurance companies. Medical students can acquire the mentioned attitudes, skills, and knowledge, and of course pocket money. This ideal combination of incentives offers the chance to select only the best of all students. Our first group completed a critical appraisal and a manuscript for submission to an international journal within for weeks (7).

Students who are interested to join us may contact florian.lautenschlager[at]uni-ulm.de. Following a 2-day introduction course they will be integrated in our working groups.

The service is free for academic teachers of our university. Other interested stakeholders will be charged for this service.

 

 

References

 

1 Sackett DL, Richardson WS, Rosenberg W, Haynes RB. Evidence-based Medicine. How to Practice and Teach EBM. Churchill Livingstone, 1997, New York, Edinburgh, London

 

2 Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB. Evidence-based Medicine. How to Practice and Teach EBM. Second edition. Churchill Livingstone, 2000, New York, Edinburgh, London

 

3 Straus SE, Richardson WS, Glasziou P, Haynes RB. Evidence-based Medicine. How to Practice and Teach EBM. Third edition. Churchill Livingstone, 2005, New York, Edinburgh, London

 

4 Porzsolt F. Managed Care Vision 2020. Die Entwicklung der Symbiose von Ökonomie und Medizin aus ärztlicher Sicht. Ärztepost 2008;4:5-10.

 

5 Porzsolt F. Managed Care Vision 2020. Teil 2. Ärztepost 2009;2:5-9

 

6 Porzsolt F. Managed Care Vision 2020. Teil 3. Ärztepost 2009; in press

 

7 Steinestel K, Correa Londono M, Brattinger F, Porzsolt F. Involving Medical Students in the Critical Appraisal of Clinical Trials: A Win-Win Situation for Learners, Lecturers and Health Care Managers. 2009 Submitted for publication

 

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