Understanding medical research Thomas Abraham

Health reporting is often about life and death Experts are often divided There are often commercial, political and personal interests at play The public depend on you for information on which they can act

Three areas of health and medical reporting Health policy Medicine Public health

Medical Reporting By the end of this class, you should Know the different sources of medical news Be familiar with the main medical journals Know the different categories of medical research studies Have an understanding of how to turn a study into news

Where does medical news come from? 1. Medical journals 2. Scientific conferences 3. Press conferences to announce findings 4. Reports from organizations like the WHO

Journal articles are regarded as the most reliable source, because the findings have been peer reviewed The most prestigious: The Lancet The New England Journal of MedicineThe New England Journal of Medicine (NEJM) British Medical JournalBritish Medical Journal (BMJ) Journal of the American Medical Association Journal of the American Medical Association (JAMA) Science Nature

How do journals work? Researchers write up their findings in a paper and submit to a journal, which then puts it through a process of peer review Peer review=other experts in the field review the paper and asses it Peer review is not perfect, but there is not a better system at present (the case of Hwang Woo-suk and the cloning of human stem cells)

The structure of a journal article-IMRAD Abstract: sums up study Introduction- Why is this study being done? Methods- How did you do it? Results- What did you find? Discussion- What is its importance?

What reporters need to ask Is this news? How solid is the study and the evidence? Will people be able to use, or benefit from this study? Who funded the research?

Types of studies 1. Observational (observe groups of people, gather data, but does not make any kind of intervention) 2. Experimental studies ( makes an intervention) 3. Meta studies: takes data from a large number of studies and compares them, providing results that are stronger than individual studies

Observational studies 1. Descriptive studies Typically cross sectional studies ( measures or surveys data at a point in time) Eg: Opinion survey of nurses in Hong Kong about H1N1 vaccination Eg: Prevalence of obesity among teenagers Describes a situation at a point of time, but does not analyse cause and effect

Observational studies 2) Analytical studies (seek to suggest possible reasons for occurrence of a disease or population) a) Case control studies-Patients with a particular disease or condition are matched with a similar group of people without the disease, and then data is collected from both groups about past exposure or behaviour

Doll and Bradford Hill’s 1950 study Two groups of patients admitted to London hospitals were studied 649 lung cancer patients( cases) 649 patients without cancer (controls) Cases and controls matched for age, sex Aim of the study: “whether patients with carcinoma of the lung differed materially from other persons in respect of their smoking habits”

649 lung cancer 649 lung cancer 649 no lung cancer 649 no lung cancer Question to be answered: is smoking the difference between these two groups? CasesControls

649 lung cancer 649 lung cancer 649 no lung cancer 649 no lung cancer 642 Smokers(99.7%) 642 Smokers(99.7%) 622 Smokers (95.8%) 622 Smokers (95.8%) Cases Controls

649 lung cancer 649 lung cancer 649 no lung cancer 649 no lung cancer 2 Non Smokers(0.3%) 27 Smokers (4.2%) 27 Smokers (4.2%) Cases Controls

Proportion of heavy smokers greater in cancer patients Proportion of lighter smokers less Conclusion: “it must be concluded that there is a real association between carcinoma of the lung and smoking”

Some weaknesses of case control studies Relies on past exposure – therefore often relies on memory, can lead to biases in data

Observational studies Analytical studies b) Cohort studies- Two or more groups of people are chosen on the basis of differences in their exposure to a particular agent and followed up over a period of time to see the differences in outcome between the groups

Doll and Bradford Hill’s study Studied 40,000 British doctors over 10, 20 and 40 years Divided them into 4 groups non smokers, light, moderate and heavy smokers Results showed substantial differences in lung cancer mortality between smokers and non smokers Showed heavier smokers had a greater chance of developing cancer than the other groups ( dose response relationship)

Some limitations of cohort studies Can take a long time People can drop out Not an absolute proof of causation

Experimental studies- Randomised controlled trial (RCT) Gold standard of causality Used to evaluate new treatments Subjects are randomly allocated to intervention (gets new treatment and control( does not get new treatment) groups Both groups should be as similar as possible Double blind= neither subject nor researchers know who is getting what

Meta Studies Looks the results of a wide range of published studies; regarded as high evidence value

Evaluating studies Is it still at the animal or laboratory stage, or human stage? Where published? peer reviewed journal, scientific meeting or press release/conference? How big were the numbers tested? How relevant are the findings-is it of immediate benefit for people What will it cost? Conflicts of interest

How big were the numbers tested? How relevant are the findings-is it of immediate benefit for people What will it cost? Conflicts of interest

Resources Press releases How to read a paper BMJ press releases JAMA press releases: Science Media Centre

Exercise Read the article - Is it newsworthy? - Is it a good study ( ie large numbers, well designed)? - Published in a peer reviewed journal? - Will this information benefit patients? - If it is a new treatment, what cost? - Conflicts of interest

Writing What’s the lead? What additional material do you need? What do you need to explain?

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Deadlines Feb 28: First Story March 15: Book Review March 28: Second Story April 17: Third Story Online courses to be completed by Feb 21 HIV/AIDS Feb 28: Malaria March 13: TB