This week's journal reviews on Doctors.net.uk
Journal Watch is a service provided to summarise some of the most popular medical journals.
Doctors.net.uk has a panel of specialist advisers responsible for reviewing a range of journals of general medical interest and some more specialised publications.
General Journal Watch is written by Dr Druin Burch, Consultant in Internal Medicine
This week's journals include....
The Lancet:
What's the point of philosophy?
Philosophy, it's easy to think, is a bad game played when you pursue complexity and obfuscation over clarity and meaning. This article by a philosopher on the value of randomised controlled trials is not going to win you into a better perception of the discipline. "Roughly, RCT logic assumes a general metaphysical premise (premise 1) that probabilistic dependence calls for causal explanation." You can see what she means, but it's hard to imagine her words are designed to do anything other than make it impressively difficult to do so. In essence, her argument boils down to saying that you're never certain if an intervention will have an impact on any one patient that it's been shown to have, overall, on a large number. She's telling us something we already knew in as complex and muddy a way as possible. "But an RCT supports only an “it-works-somewhere” claim. How can we put hard-won RCT results to use for predicting “it will work for us”?" She misses the point that we don't use RCTs to guide our decisions because they're wonderfully
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BMJ:
Does prostate screening save lives?
If you take an optimistic view of this interventional study, you'll conclude that a twenty year period of being screened via digital rectal examination and PSA for prostate cancer is entirely useless. If you want to take a pessimistic view, or merely to delight in the conclusions that well-meaning studies can occasionally throw up, you'll note that the age-adjusted hazard ratio here does not, in fact, show that screening for prostate cancer provides no benefits - it shows it kills people.
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NEJM:
Decompressive craniotomy for traumatic brain injury
Lift the lid on the swollen brain, as this trial of 155 Australian patients shows, and good things will follow - much of the raised intra-cranial pressure is abolished (as you'd expect) and length of stay in the intensive care unit is reduced (as you'd hope). Alas, these turn out to be surrogate markers upon which we cannot rely. It was a sensibly run study, and these were the secondary endpoints; the primary one was an overall assessment of damage measured six months after the injury and it was made worse by the craniotomy. Full marks for the triallists, none for their intervention
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