Sunday, December 26, 2004

subject matter experts and methodologists

The American College of Chest Physician's most recent treatise on venous thrombosis (The seventh ACCP Conference on Antithrombotic and Thrombolytic therapy)mentions in its methods section that two kinds of experts are involved in their very labor intensive review.There are subject matter experts -these presumably include physicians who actually treat DVTs- and also individuals who are well versed in statistics and the methodology of various aspects of clinical epidemiology. I believe this is a good thing. Less of a good thing are a number of articles I have seen over the past few years where all of the authors seem to be or at least tacitly claim to be in the latter category. Typical is a review article (a "systematic review") by generalists of a topic traditionally in the purview of a specialist, for example Parkinson Disease. As likely as not the multiple authors are members of a general internal medicine department and several if not all have appended to the defining initials after their names the letters"MPH". Their methodological reviews may be good or not but what is often missing is the insight of a subject matter expert.For example, someone who has actually treated many patients with the disease of interest. Such a person can put the data analysis in some type of real life clinical perspective.
Thirty years ago journal editorialists needed only to be the subject expert.Now they also either need to be experts in or need the help of experts in statistics and epidemiology to put issues into a contextual mix blending an analysis of the data currently being published with the prior evidence,the biological plausibility concerns and the clinical relevance.
I believe that review articles should routinely include among the authors someone who is in fact a subject matter expert even if others do the methodological heavy lifting. There is plenty of room for both types of experts in the advancing of medical knowledge and both types are needed.Evidence based medicine is currently defined as the integration of the best evidence with clinical expertise and patient values. Liklihood ratios and "NNTs" are great-atleast some find them useful- but we also may benefit from the insight from someone who knows the trees as well as those who describe the forrest in aggregate data terms.

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