Badgett, R (Badgett, Robert) Why would physicians undervalue reviews by the Cochrane Collaboration? JOURNAL OF CLINICAL EPIDEMIOLOGY, 61 (5): 419-421 MAY 2008

[Eugene Garfield]

Email Address: BADGETT at UTHSCSA.EDU

Author(s): Badgett, R (Badgett, Robert) 

Title: Why would physicians undervalue reviews by the Cochrane 
Collaboration? 

Source: JOURNAL OF CLINICAL EPIDEMIOLOGY, 61 (5): 419-421 MAY 2008 

Language: English 

Document Type: Editorial Material 

Keywords Plus: SYSTEMATIC REVIEWS; CLINICAL QUESTIONS; PRIMARY-CARE; 
METAANALYSES; QUALITY 

Excerpt: Clinicians at the bedside want quick, prescriptive advice [13]. 
Cochrane is less likely to provide either. Studies show the expectation of 
finding an answer is a predictor of a clinician’s
searching for an answer [13,14], thus, I think the expectation of not 
finding a quick answer in a CSR deters the busy clinician at the bedside. 
It is tempting to recommend that The Cochrane Collaboration integrate 
clinical expertise with the results of Cochrane reviews to write more 
prescriptive
reviews. The Cochrane Collaboration has been urged to create reviews on 
clinical topics such as dizziness and syncope [11]. I would not suggest 
this just as I would not suggest that Clinical Evidence, Pier, or UpToDate 
do their own meta-analyses. Medical publishing is too complicated
for one group to excel at both the meta-analysis and clinical guidance 
without massive support. Blending clinical expertise with evidence is 
difficult, fallible, and not well
understood. Fallibility forces subjectivity as demonstrated in the 
mammography controversy [15,16].
Clinical knowledge, such as disseminated by the Cochrane Collaboration, 
can also reach the patient without reliance on the doctor’s reading. Maybe 
the Cochrane is
read by the local clinical expert who educates the doctor, the author of 
the doctor’s favorite knowledge resource, or the doctor’s institution that 
encodes a practice guideline
into their electronic health record. The PLUS Project found that 
specialists valued Cochrane reviews more than did generalists. Otherwise 
measurement of this indirect route to the
bedside is difficult. A key metric of how well does information travel 
between authors is Eugene Garfield’s Impact Factor [17]. Cochrane should 
study its Impact Factor, which will be available for the first time in 
summer of 2008. Cochrane should also work with Clinical Evidence, Pier,
and UpToDate to study citations by these resources. For now, searching for 
the word ‘‘Cochrane’’ at web sites such as Clinical Evidence, the New 
England Journal of Medicine
(pdfs only), and eMedicine whose full text is indexed by Google reveals 
numerous citations to the Cochrane. Personally, I think The Cochrane 
Collaboration is doing well and we will find it is a strong, though 
indirect, contributor to bedside knowledge. The results of the PLUS Project
urge innovation in readability. However, I would not suggest more drastic 
changes such as using clinical expertise to avoid inconclusive reviews 
unless evidence is found that Cochrane struggles in the indirect path to 
the bedside.

Addresses: Univ Texas Hlth Sci Ctr San Antonio, STVHCS, San Antonio, TX 
78229 USA 

Reprint Address: Badgett, R, Univ Texas Hlth Sci Ctr San Antonio, STVHCS, 
7400 Merton Minter, San Antonio, TX 78229 USA. 

Cited Reference Count: 17 

Times Cited: 0 

Publisher: PERGAMON-ELSEVIER SCIENCE LTD 

Publisher Address: THE BOULEVARD, LANGFORD LANE, KIDLINGTON, OXFORD OX5 
1GB, ENGLAND 

ISSN: 0895-4356 

29-char Source Abbrev.: J CLIN EPIDEMIOL 

ISO Source Abbrev.: J. Clin. Epidemiol. 

Source Item Page Count: 3 

Subject Category: Public, Environmental & Occupational Health 

ISI Document Delivery No.: 288HX 

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