The Internet gives us a free licence to find out information on every aspect of health. So, how can we find out the right information to help us make better health choices? First, we need to understand what clinical research is and how it affects us.
From the research on medicines and supplements you take to the studies on the development or prevention of disease, clinical research seeks to find out numerous facts such as how a drug or nutrient works in the body, its positive and adverse effects, prevalence of disease, statistical outcomes and safe practice.
Is clinical research important, relevant and applicable to our daily life?
What are the issues and controversy around clinical research?
Without taking a careful look at the research, interpretation can be difficult or misleading. This article will share some tips to help you find your way through the ever-increasing volume of research out there.
What is Clinical Research?
Clinical research involves human studies including clinical trials, epidemiology and physiology studies to assess treatments or methods by using consenting individuals (4). Once the study has been completed, one or many authors write an article, which can include the rationale for the study, the method, results and a discussion i.e. the author(s) interpretation of the results of the study.
Where is the research published?
There may be hundreds of research articles on the same product, food, medicine or disease. These articles may influence the way those in the medical profession carry out their work and serves as a bridge between science and practice (5).
According to the International Association of Scientific, Technical and Medical Publishers in 2015, there was an estimated 5,000 to 10,000 journal publisher globally (6). In 2014 there were almost 28,100 scholarly peer reviewed journals that were publishing 2.5million articles a year. And within this number of journals, the market revenue for medical journals alone in 2013 was $13.0 billion.
The issues of research
While it may seem reassuring to know there are so many research articles, Greenhalgh’s well known book on “How to read a paper” claims that over 99% of articles are ready for the bin due to methodological flaws (1). And states that research articles should really be assessed based on the method rather than the results or the discussions, which are usually easier to understand.
Types of flaws quoted by Greehalgh include the following:
- “Assumption that medical records are 100% accurate.”
- “Assumption that what doctors say they do reflects what they actually do.“
- “Failure to state dose of drug or nature of placebo.”
- “Failure to treat groups equally apart from the specific intervention.“
Then there are numerous types of biases to consider within the medical research field, which can influence the tone, outcome and conclusion of an article and therefore may influence the reader’s decision about the product discussed or researched.
Bias in sample: if a research is on a product and someone has an invested interest in the outcome, then that person may influence the outcome and create biases within the research, either intended or unintended. Check who was funding the research, how were the participants selected, and do they explain any drop out rates.
Bias in reviews: systematic reviews and meta-analyses are a collection of articles on similar researches, which are reviewed to help readers come to a conclusion. Even if each research presented has a good methodology, the reviewer, who may be an expert in their field may not be exempt from their own bias views (7). However, if systematic reviews follow a strict protocol then biases can be minimalized and a strong review provided.
An example of a research study path: Let’s take a study on turmeric as an example. Labelled as a super food, turmeric is now sold as a spice and a tea, is found in soups, dips, salad dressing as well as numerous supplement brands that line the health food shelves. There have been hundreds of studies on turmeric including its effects on inflammation, free radicals, Alzheimer’s, cancer and depression.
Writers in health magazines and newspapers are now using research articles to support what they are discussing. So how can you know if those research articles are biased or not or if they come from primary sources (see point 2 below)?
Here are a couple of points to give you a glimpse of an extensive checklist that those reading clinical research articles need to consider:
- Is the evidence from the study complete? Is it credible and can it be transferred to practice? (8)
- Was the article written by those conducting the research (primary article) or is it a review of the original research study (secondary article)?
- If it is a review, have the authors of the review interpreted the original article correctly?
But let’s get back to turmeric.
Most of the clinical studies on turmeric are on supplements given to subjects, which have a much higher dose than food grade turmeric (9) (10). So when we are sprinkling turmeric onto our food, this quantity may not have the same outcome as those in studies on supplement levels of turmeric. So are these studies relevant to the average person reading a health magazine blog on turmeric?
Research studies can be based on an average effect on a small group of people or up to thousands of people. Statistical calculation can be used to account for different variables and possibilities and larger groups can give better inferences for a wider population (11). However, Sprent’s article on statistics in medical research question the accuracy of statistics for transferring results of a study to a wider population.
What is the relevance?
In the age of technology, information is at our fingertips. The National Statistics Database report 51% of adults use the internet for health related information (12).
In 2009, David Cameron launched a campaign called, ‘Big Society’ to encourage the public to take more responsibility for their health in an attempt to work towards prevention of disease, reduce costs and help an over saturated medical work force (13). Most complimentary and Alternative Medicine (CAM) therapists advocate working along side the medical profession and clients in a bid to share the responsibility for the individual’s health.
So… can I use the internet to read articles and make my own choices?
What you can do
Evidence based medicine (EBM) and clinical expertise go hand in hand and neither one alone is sufficient (3). Clinical expertise ensures individual patients receive the appropriate individual care based on EBM and the experience of practical applications can become out of date without recent EBM.
No one wants to check every research paper cited in a blog or an article so finding a good blogger who does all that work for you may be the answer. Look for qualified professionals with an accredited diploma or a degree qualification who should be trained in using good quality research articles.
For those who are just starting to look at research articles, the World Health Organisation (WHO) and the National Institute for Health and Care Excellence (NICE) are two well-established organisations used by many people within the medical field.
- Greenhalgh T. How to read a paper: the basics of evidence-based medicine. Fourth. London: Wiley-Blackwell; 2010.
- World Health Organisation. HANDBOOK FOR GOOD CLINICAL RESEARCH PRACTICE (GCP) [Internet]. World Health Organisation; [cited 2018 May 20]. Available from: http://apps.who.int/medicinedocs/documents/s14084e/s14084e.pdf
- Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ [Internet]. 1996 Jan 13 [cited 2018 May 17];312(7023):71–2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8555924
- National Health Service. What is clinical research? [Internet]. [cited 2018 May 24]. Available from: http://www.uhs.nhs.uk/Research/For-public-and-patients/What-is-clinical-research.aspx
- Smith R. The trouble with medical journals. J R Soc Med [Internet]. 2006 Mar [cited 2018 May 20];99(3):115–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16508048
- Ware M, Mabe M, Consulting MW. The STM Report An overview of scientific and scholarly journal publishing [Internet]. 2015 [cited 2018 May 20]. Available from: https://www.stm-assoc.org/2015_02_20_STM_Report_2015.pdf
- Mulrow CD, Dewar F, European E, Collab G, European W, Gissi-Olson I, et al. Systematic Reviews Rationale for systematic reviews. BMJ [Internet]. 1994 [cited 2018 May 22];309:597–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2541393/pdf/bmj00455-0051.pdf
- Rychetnik L, Frommer M, Hawe P, Shiell A. Criteria for evaluating evidence on public health interventions. J Epidemiol Community Heal [Internet]. 2002 [cited 2018 May 24];56:119–27. Available from: http://jech.bmj.com/content/jech/56/2/119.full.pdf
- Chattopadhyay I, Biswas K, Bandyopadhyay U, Banerjee RK. Turmeric and curcumin: Biological actions and medicinal applications [Internet]. Vol. 87, Current Science. Current Science Association; [cited 2018 May 24]. p. 44–53. Available from:https://www.jstor.org/stable/24107978 https://www.jstor.org/stable/24107978
- Gupta SC, Patchva S, Aggarwal BB. Therapeutic roles of curcumin: lessons learned from clinical trials. AAPS J [Internet]. 2013 Jan [cited 2018 Jun 16];15(1):195–218. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23143785
- Sprent P. Statistics in medical research. Swiss Med Wkly [Internet]. 2003 Oct 11 [cited 2018 May 24];133(39–40):522–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14655052
- Office for National Statistics. Internet access – households and individuals - [Internet]. 2016. [cited 2018 Jun 3]. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/householdcharacteristics/homeinternetandsocialmediausage/bulletins/internetaccesshouseholdsandindividuals/2016
- Ashton B. Big Society: Political philosophy and implications for health policy. [cited 2018 Apr 28]; Available from: https://www.kingsfund.org.uk/sites/default/files/field/field_document/big-society-health-care-beccy-ashton-oct2010.pdf