Healthy Skepticism Library item: 7083

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Publication type: Journal Article

Greenhalgh T.
How to formulate research recommendations: the pie or the slice?
BMJ 2006 Oct 28; 333:(7574):917
http://www.bmj.com/cgi/content/full/333/7574/917-a

Abstract:

EDITOR-Brown et al set out a useful framework for guiding future research in clinical trials, but the title of their paper (“How to formulate research recommendations”) contains the inherent assumption that all research can be reduced to the EPICOT acronym.1 In many areas of health services research (diabetes, obesity, mental health, or sexual health, for example), and particularly for complex interventions aimed at behaviour change or incorporating new service models, the most pressing unanswered research questions are qualitative. There is another paper to be written about how to formulate these qualitative questions, which are likely to include

What are the priorities of patients, clinicians, and policy makers for further research in this field?

What is the mechanism by which particular complex interventions work, and how might existing interventions be modified to optimise impact?

What factors explain the gap between the effect size typically shown in research trials and that demonstrated in real practice?

Although the evidence based medicine movement has many strengths, and the systematic review of randomised trials with a clear definition of population, intervention, comparison, and outcome is rightly seen as the gold standard in the evaluation of simple interventions, there is a danger that the research agenda will be impoverished rather than enriched if we sign up to a “framework for future research” that focuses exclusively on this slice of the pie.

Keywords:
Biomedical Research* Diffusion of Innovation* Evidence-Based Medicine*