Research Methods Flashcards
Definition of research
The systematic study of a subject in order to establish facts and reach new conclusions
Definition of science
The systematic study of the structure and behaviour of the physical and natural world through observation and experiment
Isolated research
Isolates specific aspects without reference to the whole picture/context. It doesn’t deal with the variables and therefore potentially drawing false conclusions
Research on animals
Animal physiology is different from human.
Controlled clinical lab. The animals are stressed. Stress hormones cause: metabolism changes, functions of cells and organs are distorted.
Weaknesses of the RCT
‘Gold standard’ clinical trial (RCT)
Randomised (double-blinded) placebo-Controlled Trial.
C Chap
- not concerned with Cause (just if suppresses symptom/s)
- Cherry picked data - result to support hypothesis
- Homogenisation - assumes identical pathologies; people have different diet, lifestyles, constitutions
- Abnormal environment - lab not real life
- Placebo-effect - well known to work
Isolated research example
‘French get fewer heart attacks because they drink wine’ But fails to see whole picture:
- individual constituent of wine that may reduce heart attacks, what about negative effect of alcohol content
- other variables in French culture eg good food, less stress, garlic consumption
Biomedical vs Natural medicine research
Biomed Natural
Single treatment Treatment strategy
intervention
Vested interests Cannot be patented
for profits - few profits to be made
Cuts out complexity Embraces complexity and
- variations merely variability
‘confounding factors’
to be ruled out of
investigation
Quantitative Looks at overall outcome
measurable qualitative
Homogenisation assumes patients are different
of patients
Biomed - one version of science - a narrow definition that is presented as the ‘truth’ or ‘evidence-based’ even if later discredited.
Conventional Hierarchy of Evidence
Top of pyramid - systematic reviews and meta-analysis of RCTs
Bottom of pyramid - expert opinion, editorials
The inverted pyramid
From top to bottom
- Observations and experiences of practitioners and patients
- Laws, principles and conclusions. Patients. Case studies.
- Practitioner case studies in clinic. Patient questionnaires. Outcome research.
Quantitative research
Accurately and precisely measured eg blood pressure
Most medical research
Qualitative research
Something that cannot be accurately and precisely measured, such as the way people feel. More appropriate for complex investigations.
Benefits of case studies in natural medicine
PIP’D
-Individual responses (looking at people in their complexity)
- Practical application - clinical reasoning - can share notes and experiences of what works
- Detail eg digestion, sleep (influencing factors on treatment)
- Plentiful and anonymous
Questionnaires - MYMOP
Measure Your own Medical Outcome Profile (MYMOP)
Patient reports from visit to visit
Used in clinical audit to produce data about clinical effectiveness of the treatment
Clinical audit
- to determine whether best practice in being carried out in the clinic - health, safety, hygiene, positive patient experience.
- Effectiveness of treatments delivered in clinic.
Outcomes research
Greater focus on overall delivery of care eg cost, convenience, accessibility, patient preferences, levels of satisfaction etc.
Enables service providers to ensure best use of resources.
The problem with ‘scientific truth’
Scientific truth changes with the next discovery eg drug Thalidomide passed all tests but then withdrawn. Real science does not changed - based on observable facts derived from observation and practice.
Why learn about biomedical research
- contraindications and negative interactions
- toxicity/ safe upper limits of compounds
- communicate with other health professionals
Definition of systematic review
Review of all available clinical studies on a drug to establish effectiveness.
Definition of literature review
Same as systematic review but also taking into account evidence such as theory and pharmacology
Definition of meta-analysis
Statistical procedure combining data from multiple studies. nb. flawed research can distort evidence.
Definition of epidemiological research
How and why of disease in a particular population eg high prevalence of MS in Scotland
Definition of retrospective study
Historical investigation, often in comparison to a non-affected group.
Definition of prospective study
Follows a group of subjects over time eg ‘Child of our time’ study.
Definition of narrative study
Narratives of patients in clinical practices. Paying attention to what they SAY.
Under development in WHO - counterbalance to RCT model.
What organisation sets ethical codes and what are some of the common principles?
World Medical Association Declaration of Helsinki
- act of doing good
- do no harm
- confidentiality of subjects
- right to quit at any time
What are the two perspectives in anthropology?
Emic approach - thoughts and beliefs of local people ‘from the inside’
Etic approach - thoughts and beliefs as observed ‘from the outside’
Combined, may achieve best results.
Benefits of qualitative research?
VEMS
- Variability and complexity
- Experiences of patients and practitioners
- Methodology - can be chosen according to what best serves the research as opposed to a narrow definition of science
- Suited to areas with both social and clinical dimensions
What to consider when reading research?
TIBIAS
Transparency - conflicts of interest made clear?
Who wrote it? published it? funded it?
Isolated research?
Bias - is the researcher setting out to a ‘prove’ something? Using own previous research as evidence?
Interpretation of results justified?
Animal/animal tissue?
Symptom equated to the disease?
Pharmaceutical bias in biomedical research
FUN GG
Funds doctors training
Unrepresentative samples
Negative data can be withheld, or data massaged to ‘prove’
Ghost-written articles commissioned by the industry, without disclosure
Gagging orders to prevent whistle blowing
Bad science example - statins (1)
Introduced 1987. Theory - raised cholesterol = heart disease. Based on research undertaken on rabbits - feeding them red meat caused arterial plaques. Rabbits are natural vegetarians.
Flawed premise - we can predict human physiological responses with reference to animal physiology.
2007 - 192 separate studies. Industry funded trials, 20 times more likely to deliver positive results than government funded. A lot of questionable data. Recent research suggests it is not a cause of coronary arterial disease, but sugar consumption is.
Bad science - statins (2)
Only 15% of cholesterol comes from diet. 85% we make ourselves.
Vital nutrient:
- building block for hormones
- cell membrane integrity
- synthesis of vit D
- high amount in brain
Why is herbal medicine research often debased?
- isolated plant constituents
- variables eg Passionflower tea study, to help with sleep. For some it will work, depending on what is keeping them awake.
- assessed against narrow criteria, for instance doesn’t look at outcomes over time
Limitations of research
Symptoms
Even in natural med, positive results don’t always mean appropriate treatment plan eg cinnamon for lowering blood sugar, but doesn’t address underlying cause - diet and lifestyle.
Constitution
Positive results with a substance doesn’t mean always right for everyone, eg garlic in some constitutions can cause too much heat and GIT discomfort.
Engage
Professional literature in your field is usually the most relevant and appropriate.
Apply
Laws and principles of natural therapies. Patient more than the pathology.
