Edward J. Huth

Structured Abstracts for Papers Reporting Clinical Trials

Excerpt No experienced editor believes that readers of his or her journal go through each issue article by article, word by word. Some readers probably scan tables of contents, decide what articles...

Needed: review articles with more scientific rigor.

Excerpt The paper by Mulrow in this issue ( 1 ) makes clear the frequent defects of review articles when they are judged by standards for adequate scientific evidence. The fault is not that of thei...

Needed: An Economics Approach to Systems for Medical Information

Excerpt Professions are defined in part by their expert knowledge and skills in applying it. Expert knowledge in medicine is its information and the conceptual machinery with which we use it. For a...

Style notes: bacterial vaginosis or vaginal bacteriosis?

Excerpt In the preceding editorial (1) Sobel discusses what for 5 years has been calledbacterial vaginosis. This term was proposed in 1984 (2) by Westrom, Evaldson, Holmes, van der Meijden, Rylande...

The American Shift to Medical SI Units

Excerpt For more than 2 decades, most of the medical community in the United States has stood by while the rest of the medical world, including our close neighbor Canada, moved from use of older co...

In the balance: weighing the evidence.

In their classic text on how to analyze and revise expository prose, The Reader Over Your Shoulder [1], Graves and Hodge describe the natural arrangement of ideas in critical argument: A question or problem is stated; evidence supporting, or conflicting with, a tentative answer or solution is presented; the relative strengths of all evidence are weighed; and the answer most strongly supported is delivered. They were writing about argument of any kinda debate on foreign policy, criticism of a governments fiscal management, literary criticismand not specifically about argument in science. Their notion of critical argument applies, however, just as well to resolving questions through the procedures of science and reporting the results of research [2]. The terms used for the elements of critical argument in science may differ from theirs, but the essence of their view is as correct for science as for other fields. The initial question or problem posed for a piece of research may be called hypothesis and the evidence may be called results and the cited literature. Regardless of the terms, the aim in science is to take all the available evidence possibly supporting or rejecting a hypothesis or potentially answering a question and to come to a conclusion. A physician facing the question of the best treatment for a particular patient cannot take even a tiny fraction of the time needed to weigh all the available evidence bearing on the decision. The physician needs an answer and quickly. Most of the time, physicians must carry the answers around in their heads. Much of this information typically represents judgments reached by experts who have taken the time to weigh evidence from reported research. Their judgments are set forth in textbooks, in postgraduate courses, and in consultations. But medical journals also have the responsibility for transmitting expert judgments. Many of these judgments are those reached by authors of papers reporting their clinical research. But these judgments may not be unanimous among experts. When controversy exists, journals can additionally help by presenting analytic critical judgments about particular treatments in the form of editorials, review articles, meta-analyses and letters-to-the-editor. In these formats, however, only the judgment of the author is presented, and the reader may not be aware of dissenting judgments that are worth consideration before a treatment is accepted or rejected. To help our readers develop their own conclusions on the advantages or disadvantages of a treatment about which experts differ, we are initiating a new section, In the Balance. The title is meant to represent the aspect of critical argument that Graves and Hodge call the weighing of conflicting evidence. The editors will select the topics to be discussed. Our plan is to present in this section, from time to time, dissenting views on questions of diagnosis and treatment, particularly questions arising in the care of patients with common, important problems. The proper, efficient treatment of acute myocardial infarction is a question of major importance in internal medicine. In the Balance debuts in this issue with a pair of papers [3, 4] that present differing views on the results in the GUSTO trial of thrombolytic agents reported last year in The New England Journal of Medicine [5]. To help our readers develop their own critical skills, we asked Dr. David Sackett to consider issues arising from the GUSTO trial report using an approach that illustrates how physicians can think for themselves about trial reports. The resulting analysis [6] is presented in the editorial preceding mine. We hope that the In the Balance papers and the editorial in this issue will help physicians reach their own conclusions about thrombolytic agents and will illustrate for them a method for judging critically the importance of conclusions reached in a clinical trial.

The Humanities, Science, and the Medical Curriculum

Excerpt Two major documents on American medical education have just been published. Both merit careful reading by everyone in medical education, from deans to residents, and perhaps even students, ...

Standards on Authors' Responsibilities

Excerpt The agreement among major journals on manuscript requirements (1) reached at a 1978 meeting in Vancouver, British Columbia, has greatly influenced medical publishing. The document issued fr...

The Academic Future of General Internal Medicine

Excerpt In the early 1970s concerns within the Federal and state governments that not enough physicians were available for primary care led to pressures on medical schools to respond. One consequen...

Research in General Internal Medicine

Excerpt This issue carries two articles (1, 2) from faculty of general medicine divisions. These articles were selected from 80 submitted in response to a call from the Society for Research and Edu...