Skip to main content

Main menu

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • BJGP LIFE
  • MORE
    • About BJGP
    • Conference
    • Advertising
    • eLetters
    • Alerts
    • Video
    • Audio
    • Librarian information
    • Resilience
    • COVID-19 Clinical Solutions
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers

User menu

  • Subscriptions
  • Alerts
  • Log in

Search

  • Advanced search
British Journal of General Practice
Intended for Healthcare Professionals
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
  • Subscriptions
  • Alerts
  • Log in
  • Follow bjgp on Twitter
  • Visit bjgp on Facebook
  • Blog
  • Listen to BJGP podcast
  • Subscribe BJGP on YouTube
Intended for Healthcare Professionals
British Journal of General Practice

Advanced Search

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • BJGP LIFE
  • MORE
    • About BJGP
    • Conference
    • Advertising
    • eLetters
    • Alerts
    • Video
    • Audio
    • Librarian information
    • Resilience
    • COVID-19 Clinical Solutions
Letters

Cochrane reviews: relevant more than ever

Tom Fahey, Susan M Smith, Floris van de Laar, Tim Kenealy and Bruce Arroll
British Journal of General Practice 2013; 63 (606): 10. DOI: https://doi.org/10.3399/bjgp13X660643
Tom Fahey
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Susan M Smith
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Floris van de Laar
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Tim Kenealy
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Bruce Arroll
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info
  • eLetters
  • PDF
Loading

In The Review Trish Greenhalgh1 refers back to the halcyon days of editorials and opinion pieces in medical journals that relied on an author’s bias, speculation, and conjecture that passed for academic debate in the mid-1980s. She decries Cochrane reviews as narrow, boring articles that seldom answer the ‘messy context’ of clinical practice. Sorry, but we don’t agree. Using narrative reviews that do not systematically identify, assess, and synthesise information produces evidence that is biased, misleading, and may harm patients.2

Surely informed clinical practice means telling our patients about what we know is effective, what we know is ineffective, and what we are uncertain about? The Cochrane Collaboration and other useful sources of synthesised evidence such as the BMJ publishing group’s Clinical Evidence demarcate uncertainty and allow us to use regularly updated evidence when helping our patients. What is wrong with this? Every doctor, irrespective of their clinical discipline, cannot possibly keep up with the burgeoning medical literature. In 2009 1.5 million articles were published in 25 400 medical journals. In narrower disciplines than general practice (diagnostic imaging in cardiology) it is estimated a doctor would have to read 95 articles every day to keep up to date.3 One of several solutions lies with clinical summaries that access and synthesise systematic reviews of evidence that address focused clinical problems. Indeed there is now an established hierarchy of pre-appraised synthesised evidence that enables more efficient access to clinically relevant information. The base of this information pyramid is the individual original studies. It then moves to ever-increasing synthesised evidence: synopses of studies, (evidence-based medicine, ACP journal club); synthesis (The Cochrane Library); synopses of synthesis (DynaMed); summaries (National Clinical Guidelines, Clinical Evidence), and ends up with point-of-care decision support, a final ‘systems’ layer.4

The Cochrane Collaboration, and the explicit, systematic, and transparent methods that are used, are prime movers in the information revolution that enables safer patient care. Let us not forget that it is Cochrane authors who have shown how the research agenda can be misled at the inception, funding, publication, and reporting stages.5 We do not have to look far for examples of drugs that had disastrous consequences for some patients (rosiglitazone and rofecoxib); and other drugs that have questionable clinical benefit (gabapentin and oseltamivir).5 While sometimes ‘boring’, Cochrane reviews are seldom irrelevant. A recent example of a Cochrane review that has important clinical and policy implications concerns the use of general health checks in adults, shown not to reduce morbidity and mortality, despite the fact that the UK government began a policy of health checks for adults in 2009.6

We urge readers to take a more critical view of the medical literature and its relevance to their clinical practice. Cochrane reviews remain key components for GPs who wish to remain safe and effective doctors.

Notes

Competing interests

All authors are active members of the Cochrane Primary Health Care Field and Cochrane Collaborative Review Groups.

  • © British Journal of General Practice 2013

REFERENCES

  1. 1.↵
    1. Greenhalgh T
    (2012) Outside the Box: Why are Cochrane reviews so boring? Br J Gen Pract 62(600):371.
    OpenUrlFREE Full Text
  2. 2.↵
    1. Mulrow CD
    (1987) The medical review article: state of the science. Ann Intern Med 106(3):485–488.
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Fraser AG,
    2. Dunstan FD
    (2010) On the impossibility of being expert. BMJ 341:c6815.
    OpenUrlFREE Full Text
  4. 4.↵
    1. Windish D
    (2012) Searching for the right evidence: how to answer your clinical questions using the 6S hierarchy. Evid Based Med, [Epub ahead of print].
  5. 5.↵
    1. Doshi P,
    2. Jefferson T,
    3. Del Mar C
    (2012) The imperative to share clinical study reports: recommendations from the Tamiflu experience. PLoS Med 9(4):e1001201.
    OpenUrlCrossRefPubMed
  6. 6.↵
    1. Krogsbøll LT,
    2. Jørgensen KJ,
    3. Grønhøj Larsen C,
    4. Gøtzsche PC
    (2012) General health checks in adults for reducing morbidity and mortality from disease. Cochrane Database Syst Rev 10:CD009009.
    OpenUrlPubMed
Back to top
Previous ArticleNext Article

In this issue

British Journal of General Practice: 63 (606)
British Journal of General Practice
Vol. 63, Issue 606
January 2013
  • Table of Contents
  • Index by author
Download PDF
Article Alerts
Or,
sign in or create an account with your email address
Email Article

Thank you for recommending British Journal of General Practice.

NOTE: We only request your email address so that the person to whom you are recommending the page knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Cochrane reviews: relevant more than ever
(Your Name) has forwarded a page to you from British Journal of General Practice
(Your Name) thought you would like to see this page from British Journal of General Practice.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Cochrane reviews: relevant more than ever
Tom Fahey, Susan M Smith, Floris van de Laar, Tim Kenealy, Bruce Arroll
British Journal of General Practice 2013; 63 (606): 10. DOI: 10.3399/bjgp13X660643

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
Cochrane reviews: relevant more than ever
Tom Fahey, Susan M Smith, Floris van de Laar, Tim Kenealy, Bruce Arroll
British Journal of General Practice 2013; 63 (606): 10. DOI: 10.3399/bjgp13X660643
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
  • Mendeley logo Mendeley

Jump to section

  • Top
  • Article
    • Notes
    • REFERENCES
  • Info
  • eLetters
  • PDF

More in this TOC Section

Letters

  • GPs’ understanding of the wider workforce in primary care
  • 2020 vision? A retrospective study of time-bound curative claims in British and Irish newspapers
  • Verschlimmbesserung
Show more Letters

Editor’s choice

  • Wellbeing and the lingo of mental ‘health’
  • So why should I go to the RCGP Annual Conference …?
  • Consultation length
Show more Editor’s choice

Related Articles

Cited By...

Intended for Healthcare Professionals

BJGP Life

BJGP Open

 

@BJGPjournal's Likes on Twitter

 
 

British Journal of General Practice

NAVIGATE

  • Home
  • Current Issue
  • All Issues
  • Online First
  • Authors & reviewers

RCGP

  • BJGP for RCGP members
  • BJGP Open
  • RCGP eLearning
  • InnovAiT Journal
  • Jobs and careers

MY ACCOUNT

  • RCGP members' login
  • Subscriber login
  • Activate subscription
  • Terms and conditions

NEWS AND UPDATES

  • About BJGP
  • Alerts
  • RSS feeds
  • Facebook
  • Twitter

AUTHORS & REVIEWERS

  • Submit an article
  • Writing for BJGP: research
  • Writing for BJGP: other sections
  • BJGP editorial process & policies
  • BJGP ethical guidelines
  • Peer review for BJGP

CUSTOMER SERVICES

  • Advertising
  • Contact subscription agent
  • Copyright
  • Librarian information

CONTRIBUTE

  • BJGP Life
  • eLetters
  • Feedback

CONTACT US

BJGP Journal Office
RCGP
30 Euston Square
London NW1 2FB
Tel: +44 (0)20 3188 7400
Email: journal@rcgp.org.uk

British Journal of General Practice is an editorially-independent publication of the Royal College of General Practitioners
© 2022 British Journal of General Practice

Print ISSN: 0960-1643
Online ISSN: 1478-5242