The Rest of the Story: How to Read the Medical Literature

A recent Let’s end COVID! article (February 25th) talked about the process of medical research and how the results are communicated to the world at large via public and social media. Journalists who translate the mysterious pronouncements of medical researchers and other scientists provide a valuable public service by helping us non-scientists keep up with current developments. This is especially important in a public health crisis such as the current COVID-19 pandemic, where it is a matter of life and death.
   
Scientific research is supposed to be objective, impartial. Of course, scientists are human, and even the most careful scientist can unknowingly let bias affect their work and how they interpret and communicate their results. When scientific information is communicated by non-scientists to other non-scientists, it’s a little like the “telephone game” where one person whispers a word or phrase to the person beside them, that person whispers to the next one in line and so on, until the last person announces what they heard, which often is not what the first person said. Journalists reporting medical news may have their own biases that unintentionally color their communication.
   
Sometimes the people communicating research results deliberately misinterpret scientific findings that disagree with their own partisan agendas. We have seen this several times during the current pandemic including, for example, when some people continued to recommend using ivermectin to prevent or treat COVID-19 although no studies have shown that it works.
   
When reading a news article about COVID-19 (or any medical issue) I look for the source of the information. If the author hasn’t included a link to the study being discussed, or at least enough information (author and journal title) to find the study easily, I get suspicious. Does the author not want me to look at the original information for some reason? As the Russian proverb popularized by Ronald Reagan advises, I like to “trust but verify.” If I’m going to apply this new information to my own healthcare, I want to see—and decide—for myself.
   
Researchers strive for clarity, conciseness, and precision when reporting their results because they are communicating to other busy scientists who are coping with the same daily flood of information, and who need to determine quickly whether the article is relevant or provides new knowledge.
   
Fortunately, this helps the rest of us, too. Professional journals publish several kinds of articles, including editorials, case reports, and even letters to the editor, but when you are following up medical news you will be looking at primary research articles. These reports of studies and results follow a consistent outline:
• Abstract (Summary)
• Introduction (Context)
• Methods and Materials (The Experiment)
• Results (The Data)
• Discussion (Explanation)
• Conclusions (Interpretation)
   
The abstract reviews the article’s key points—the question being studied, why it’s important, how the research was conducted, and the study results and conclusions. Non-scientists should read the abstract first to get a sense of what information the article contains, but don’t stop there. Read the introduction next for context and background information, including previous studies on which the new research builds. It helps you understand where the new research “fits.” The introduction will clearly state the purpose of the research and the question (the hypothesis) it answers.
   
Some experts recommend reading the introduction first and the abstract last. That way you can draw your own conclusions and see whether they match the authors’.
   
It’s OK to skip the methods section, which explains in detail how the research was done so that other scientists can evaluate the study’s quality, repeat the research to confirm the results, or develop new studies based on its methods and findings. You may also—unless you are familiar with statistical concepts and vocabulary—skip the results section, which presents and analyzes the data the investigation produced.
   
Finally, read the discussion and conclusions (sometimes separate sections) to see how the authors interpret their findings. They should also tell you of any limitations in the study that might affect the results, the strength of their evidence, the implications for practice change and future research, and what additional studies may be needed.
   
More reading tips:
• Look for clues in the author information such as questionable institutional affiliations and potential conflicts-of-interest due to grant support or employment
• Look up unfamiliar words—medicine has its own vocabulary
• The introduction can point you to other articles of interest
• A quick author search in PubMed will tell you how often and on what subjects the author has published
• The number of articles citing the one you’re reading indicates its importance to other researchers (look up in PubMed or Google Scholar)

Various online guides for nonscientist readers exist. “Anatomy of a Scientific Journal Article” by Erica Mitchell (https://blog.eoscu.com/blog/anatomy-of-a-scientific-journal-article) and “How to read and understand a scientific article” by Jennifer Raff (https://cdn.ymaws.com/www.oandp.org/resource/resmgr/docs/skc/journalclub/How_to_Read_and_Understand.pdf) are good ones.

Michael Heyd, a retired medical librarian from Fairfield Township who spent more than forty years searching the literature for professional hospital staff, is a member of Let’s end COVID!
Published: 3/25/22

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