Research

I began another block of research time this month.  I will be honest, doing research has never really excited me.  In fact, it has generally elicited the opposite response.  During my career in academia, I have participated in a number of research ventures.   I will be the first to admit that none of my research has been particularly noteworthy.  This is likely due to the fact that my primary drive for participating in scientific research has generally not been to contribute to the general fund of knowledge, rather to check off the "Have you participated in research?" box on my medical school and residency applications.

As various research projects are a requirement of my residency training, I've given a lot of thought to the idea of "research" and what benefit my study (which investigates the effects of topical nasal anesthesia on swallowing studies) actually has for practicing physicians.  

Though the concept has supposedly been around for centuries, the term "evidence based medicine" didn't pop up until the 1990's and has since become the buzzword in medicine today. The aim of evidence based medicine (EBM), is to "apply the best available evidence gained from the scientific method to clinical decision making."¹  In other words, medical treatment should be based on proven facts not theories.  

EBM was conceived when the medical community realized that a lot of the medical treatments that have been administered over the years weren't really helping anybody.  Though grounded in the sound scientific principles of the day, things like blood letting, frontal lobotomies, X-ray treatments, and other nutty treatments aren't generally used any more because they've been proven to do more harm than good.

Though I firmly believe that EBM has improved the efficacy of medical treatment substantially, there are a few people who seem to take the concept a little far.  

I recently stumbled across an article in the British Medical Journal² which addressed this issue exactly. The article is titled "Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials."  In this article a couple of cheeky British scientists question the validity of questioning everything by suggesting that since no randomized, controlled, double blinded studies have been performed proving the efficacy of the use of parachutes in "gravitationally challenged" individuals, we cannot assertively state that they improve survival.  

In the words of the authors: 

"As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute."

The idea of handing somebody a backpack which may or may not contain a parachute and convincing them to jump in the name of science made me chuckle.  However, I can think of a couple people who I'd like to have volunteer for the study.  There's some research I can get behind.  
                                                            
1. Health Aff. 2005; 24(1): 18-28 
2. BMJ. 2003; 327: 1459-61