How do we know? This is an issue that comes up often in relationship to the information we have available to us on any number of issues. In medicine patients are educated and often times very savvy on various issues related to their health and wellbeing(Kothari & Moolani, 2015). While it is refreshing to see patients advocate for themselves, it can also be problematic in that sometimes the information they have trusted is incorrect or misleading. This is because on the internet anyone can say anything… no one is policing the internet to see if what someone writes is reliable or not. So I want to start this blog with a little information on evidence and resources, so you will understand what you will read here.
This blog will hopefully contain a vast expanse of information. Sometimes I will be writing very informally about myself, my experiences (even personal ones), or my feelings and thoughts. Other times I will present information to help you understand more complex health issues and treatment options. Understand that my informal writing will not be cited or backed up by any particular evidence because its personal to me and its opinion. I’m not making any claims about my opinions being evidence based or viable. They are just my informal thoughts. On the other hand, when I am presenting information on issues that relate to medicine, science, health, etc., I want it to be reliable evidence and not just my opinion.
So how will I vet my sources and what makes a good source and what sources are questionable? In medicine and research there is a system of classifying evidence (Murrad, Asi, Alsawas, & Alahdab, 2016). When using research, evidence is gathered from many sources. Published research in journals will include meta-analysis, random controlled trials, cohort or case control studies. These are sources of evidence that present unfiltered information. So while this sounds like a solid hierarchy, these articles have to be further examined to verify that the study design and methodology are rigorous… meaning is bias minimized and evidence strong and convincing because the study was conducted in such a way as to reveal findings that are solid and relevant.
Ok so in layman’s terms… here are some examples. A study that was conducted within the last five years is considered of higher and more reliable value than a study that was conducted 30 years ago; unless it is considered a seminal or landmark study (older sources that are still considered valid and pivotal) (Daramola & Rhee, 2011). A study that randomly selects participants, known as random sampling (each member of a population has an equal chance of being selected as a participant), is considered stronger evidence than a sample chosen based upon convenience, (called a convenience sample). A study that examines empirical evidence and then statistical data from a number of independent studies of the same subject, in order to determine overall trends (called a meta-analysis), is stronger evidence than a random controlled trial (RCT) which is a single study. However, a RCT is considered high quality evidence when compared to expert opinion. Yet, let me say that the opinion of a qualified professional with many years of experience in their field and a wealth of knowledge derived from clinical experience, cannot be discounted (Ehrich, Somekh, & Pettoello-Montovani, 2018). A providers experience of treating sometimes tens of thousands of patients is valuable and may sometimes prove to be different than what research involving a few hundred patients may reveal. Also, it is important to consider who conducted the research. If research on a new drug developed for diabetes was conducted by a pharmaceutical company, it may not be a reliable body of research because the researchers may be biased. Consider all of these things when you educate yourself.
Of course, this is a blog, and therefore still a narrative of the evidence. So, I encourage you to read the evidence yourself. I will always try to cite my sources and provide links to the articles. I hope that this will provide you with strong evidence and reliable sources to consider. On a final note, please do not believe everything you read on the internet. Dr. Google has yet to classify its evidence, much of it is opinion, and sometimes what we read is driven by the promotion of business rather than evidence.
Daramola, O., & Rhee, J. (2011, January). Rating Evidence in Medical Literature. American Medical Association Journal of Ethics, 13(1), 46-51. Retrieved from https://journalofethics.ama-assn.org/sites/journalofethics.ama-assn.org/files/2018-05/pfor2-1101_0.pdf
Ehrich, J., Somekh, E., & Pettoello-Montovani, M. (2018). The Importance of Expert Opinion–Based Data: Lessons from the European Paediatric Association/Union of National European Paediatric Societies and Associations (EPA/UNEPSA) Research on European Child Healthcare Services. The Journal of Pediatrics, 195, 310-312. http://dx.doi.org/10.1016/j.jpeds.2017.12.064
Kothari, M., & Moolani, S. (2015). Reliability of "Google" for obtaining medical information. Indian Journal of Ophthalmology, 63(3), 267-268. http://dx.doi.org/10.4103/0301-4738.156934
Murrad, H., Asi, N., Alsawas, M., & Alahdab, F. (2016, August 16). New evidence pyramid. BMJ Journals, 21(4), 125-127. http://dx.doi.org/10.1136/ebmed-2016-110401
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