Science and Medicine

Question 1

Purpose of the NHS

Answer 1

‘… to secure, through resources available, the greatest possible improvement in the physical and mental health of the population’

Question 2

What is evidence based medicine ?

Answer 2

Using the best evidence in the scientific literature to provide the best care for an individual patient.

Question 3

What is scientific method ?

Answer 3

Observation/experiments
Explanation (Hypothesis) which can be tested
Prediction
Experimentation and data interpretation
Confirmation (or not) of hypothesis
Peer review
Publication (conference/academic journal)

Question 4

What is good science ?

Answer 4

Observation and experiments
Hypothesis (prediction and testing)
Peer review
Publication

Question 5

What is real science ?

Answer 5

Observation and experiments
Hypothesis (prediction and testing)
[Results not consistent with hypothesis]
[Back to beginning]
Peer review
Publication

Question 6

Where do the ideas for hypothesis come from ?

Answer 6

‘Standing on the shoulders of giants’
Invention of a new technique
Intuition/hunch/luck
Funding bodies which control research
[Pharmaceutical industry/ government/ charities]

Question 7

What is tamiflu ?

Answer 7

An antiviral drug (produced against Swine flu) marketed by Roche

Question 8

Types of bias

Answer 8

Selection bias
Attrition bias - patients drop out
Reporting bias
Performance bias - did patents know about the trial
Detection bias

Question 9

What were some bad science examples in the production of Tamiflu ?

Answer 9

The trials were too small

No published protocols

Placebo capsules contained dehydrocholic acid and dibasic calcium phosphate dihydrate.

Authors of clinical study reports cannot be identified.

Missing statistical analyses

Question 10

Pfizer Neurontin original license

Answer 10

The control of partial seizures in epilepsy - used in conjunction with other anti-epileptic drugs (anti-convulsants)

Question 11

What was wrong with the Pfizer Neurontin drug ?

Answer 11

It was sold as treatment for many other things as well as epilepsy, which was not what the original license was for.

e.g pain, bipolar disorder, restless leg syndrome, migraine

Question 12

Importance of evidence based medicine in the provision of care

Answer 12

EBM allows the integration of good quality published evidence with clinical expertise and the opinions and values of the patients and their families or carers.

Question 13

Effect of bias on scientific research

Answer 13

Bias can cause the results of a scientific study to be disproportionately weighted in favor of one result or group of subjects.

Question 14

What is a primary study ?

Answer 14

An experiment where a procedure is performed on a patient in artificial, controlled surroundings where the effects of varying one condition can be measured.

Question 15

Describe primary studies

Answer 15

Direct experimentation
[In vitro models / In vivo testing]
Clinical trials
Surveys

Question 16

In vitro models

Answer 16

Molecular biology, cell & tissue culture, isolated tissue and organs.

Question 17

In vivo testing

Answer 17

Animal models and volunteers (artificial control over biological variables)

Question 18

Clinical trials

Answer 18

Drug treatments and follow ups

Question 19

Describe secondary studies

Answer 19

Research overviews
- Review
- Systematic review
- Meta-analysis

Question 20

Review

Answer 20

Expert summary of a number of research studies

Question 21

Systematic review

Answer 21

Objective analysis of all qualifying primary research studies

Question 22

Meta-analysis

Answer 22

Integrated analysis of the numerical data from all qualifying studies.

Question 23

Difference between primary and secondary studies

Answer 23

Primary studies involve :

-Direct experimentation
-Clinical trials
-Surveys

whereas Secondary studies involve :

• Research overviews

Question 24

How can you asses the accuracy of information ?

Answer 24

Refereed paper
Group of old professors
Systematic review
Randomised control trial
Meet somebody in the Union
Read a textbook

Question 25

What is an evidence pyramid ?

Answer 25

It is like a hierarchy of quality from worthless up to the best.

Where possible you should try to get the best possible evidence from as high up the pyramid as possible.

Question 26

Describe the layers of the evidence pyramid from bottom to top

Answer 26

BOTTOM
‘I read it in a textbook’
‘Somebody told me’

Cohort studies
Case control studies
Cross sectional studies
Case studies, series or report

Systematic reviews and meta-analyses
Randomised controlled double blind studies
TOP

Question 27

What is a peer review ?

Answer 27

Process of subjecting an author’s scholarly work or ideas to the scrutiny of anonymous referees, who are experts in the field.

Question 28

Purpose of peer review

Answer 28

Ensures that authors meet the standards of their discipline and of science generally.

Leads to publication in an academic journal : Nature, Lancet, BMJ, JAMA etc.

Question 29

Name the infamous non-paper

Answer 29

Wakefield MMR
8/12 parents convinced the onset of problems coincided with the MMR jab.

Question 30

What is the MMR controversy ?

Answer 30

MMR vaccination was linked to the development of autism.

Early report published in the Lancet in February 1998 by Wakefield et al. from the Royal Free Hospital.

Question 31

What happened after the Wakefield paper was released ?

Answer 31

A review was published questioning the safety of the immunisation programme (Wakefield 2011)

The tabloid press suggested that medical opinion was divided on the safety of the MMR vaccination.

95% of children with the measles virus in the gut had MMR as their only documented exposure (Wakefield 2002)

Identification of a distinct group of children with autism resulting from MMR (Shattock 2002)

Question 32

Example that expert review is subjective

Answer 32

Tabloid press implied 50:50 split, but in fact 99% thought MMR OK only 1% did not. Shattock et al same group as Wakefield.

Question 33

Why is MMR delivered as a 3 in 1 vaccine ?

Answer 33

MMR is free on the NHS
Single doses are not
more chances if drop outs if vaccinate for each separately.

Single vaccines are less safe than MMR because they leave children vulnerable to dangerous diseases for longer

Question 34

What is more dangerous measles or MMR ?

Answer 34

Measles

Question 35

How to read a scientific study ?

Answer 35

Why was the study done ?
What clinical question were the authors addressing ?

What type of study was it ?
Was the design appropriate to the research ?

Are the conclusions justified ?