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• W2051280945 abstract "The terrorist attack on the World Trade Center a year ago on September 11th, 2001 demonstrated the chilling reality that there can be no safe havens in a world riven by environmental stresses, social and political instability, and improvised weapons of mass terror and destruction.1 Whilst the immediate responses in New York were swift, orderly and heroic, resulting counter-terrorist activities have broadened future responsibility across many agencies. Thus, stricter airport security, wider use of video face-recognition cameras, new building codes for reinforced construction techniques, secured ventilation systems, public health surveillance programs, clear channels of communication between police, health and security agencies, and education and training in the medical aspects of bioterrorism have all since been highlighted as priorities to prevent the likelihood of a recurrence.2,3 The series of three papers on terrorism in this issue of the Journal4–6 and the Commentary by Brennan illustrate the depth and scope of knowledge that physicians and others now need to have concerning these hitherto rare events, and the learning and cooperative planning opportunities they offer.7 In the information age, such knowledge may well come from a variety of sources. The traditional gold standard for reliable, peer-reviewed medical information has been biomedical journals, of which around one-quarter or some 3400 are rigorously selected for listing in Index Medicus. These in turn are accessible through the electronic database MEDLINE, a compendium of published research available for instance on the Internet through the PubMed website of the National Library of Medicine, Washington, USA. The sheer volume of papers now published and the move towards sifting through the different levels of data cited to concentrate on analysing only the highest quality levels of research evidence has led to dedicated sites available on the Web such as the Cochrane Library, a compendium of systematic reviews and randomized controlled trials and Clinical Evidence, a compendium of research evidence of interventions for common medical conditions. Their aim is to provide distilled, highest quality evidence from primary research in a valid, relevant, and user-friendly format.8 But should doctors concentrate exclusively on these small but focused repositories of medical data, or should we be reviewing information on more broad platforms to remain informed and up to date? Almost one in five of the references cited in the three terrorism papers in this issue of the Journal are taken from non-biomedical journals, ranging from scientific or military Internet sites and newspaper quotes to the Economist.4–6 Before physicians bemoan the apparent obfuscation of traditional medical sources of information, it is worth noting that the sanctity of biomedical journals has always had its challengers. The true worth of the peer review process itself has been questioned. There is little evidence how well it shields busy readers from wasting their time reading inferior papers, protects patients from the damaging effects of unreliable research or keeps egg off authors’ (or editors’) faces!9 Whether peer review should be open or blinded is also uncertain, with some journals such as the Medical Journal of Australia abandoning open peer review, currently utilized by our journal Emergency Medicine.10 The science on which to base such decisions is far from rigorous. Moreover, peer review does not necessarily recognize scientific error, nor misconduct in study reporting, nor outright fraud. In these areas, we are still reliant on the honesty and integrity of our researchers, no matter how excellent the study design may appear. In addition, retrieval of biomedical data may be limited by the surprisingly high level of reference errors in published articles that range from 4 to 40%11 with a rate of 35% in Emergency Medicine.12 The sands on which MEDLINE and Cochrane are built may be shifting more than we openly acknowledge. Finally, organizations may simply decide not to accept published, peer-reviewed data at face value. Thus, in a move that may delight industry advocates, but more likely send a collective groan around research agencies, the Bush administration recently classified new guidelines governing the quality and objectivity of scientific information released by federal agencies, in an effort to prevent flawed scientific studies being used to justify regulatory actions.13 Whilst research published in peer-reviewed journals would normally be expected to meet the minimum criteria for quality, it was decided that additional quality checks would be appropriate for influential studies that will have a clear and substantial impact on important public policies, or private-sector decisions. So is there a sanctuary for medical information outside of peer-reviewed journals that we as physicians should recognize and respect? The Internet is increasingly being used to disseminate medical information, although it clearly lacks the rigour and organization of MEDLINE-listed biomedical journals. Pollster AC Nielsen found that 20% of regular Internet users look to the Internet for information about health and medical conditions.14 But even ‘credible’ websites based on objective scoring of their source, currency and evidence hierarchy of medical information quoted do not necessarily provide higher levels of accurate health information.15 A variety of methods and tools have been developed to try to evaluate and rate the quality of medical Internet sites although ultimately individual users determine their own subjective assessment of ‘quality’ based more on satisfaction with the result of what they read, not its source or validity.16 Indeed these rating systems themselves merely use surrogates for quality that will not identify sites that meet the needs of the users. Thus popular sites do not correlate with traditional standards of quality biomedical information despite the fact that they are frequently being accessed and are clearly being used to direct health choices.17 Is this a reflection of gullibility on the part of people in general or more an indictment of the rigidity of scientists and doctors in demanding only the most rigorous evidence base? As a prominent geologist investigating available treatments for his son's incurable neurological illness recently said: ‘If geologists determining whether to drill for oil accepted only the sort of evidence base that doctors do, we would all be sitting around in the dark, cold and hungry.’ It appears that well-informed doctors must now become aware and abreast of the variety of information of medical importance that lies outside traditional journals, particularly in current interest areas such as terrorism, that embrace multidisciplinary cooperation, and be prepared to broaden their search for knowledge into these other arenas described. Science is notoriously slow in catching up with issues of the day, and waiting for an evidence base to emerge from traditional sources can leave a lengthy information void. For events like September 11th, we need information on which to base policy decisions quickly. Whilst regulation is unlikely to improve the quality of health information on the Internet, the consumers’ satisfaction with what they read must not be denigrated by those of us more used to rigorous data analysis. In the end our aims are the same, which is to inform, empower and heal people seeking an opinion from those of us society has licensed to practise the art and science of medicine." @default.
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• W2051280945 title "Whither the sanctity and sanctuary of medical information?" @default.
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