Academic journal article Defense Counsel Journal

All Journal Articles Are Not Created Equal: Guidelines for Evaluating Medical Literature

Academic journal article Defense Counsel Journal

All Journal Articles Are Not Created Equal: Guidelines for Evaluating Medical Literature

Article excerpt

Discovering junk science, "honorary" authors, and just plain ghosts may be difficult, but defense counsel can learn to do so with the right questions

DEFENSE counsel are concerned with the periodical medical and health science literature, which consists primarily of journal articles. Between 3,000 and 4,000 journals in the medical and health sciences fields are indexed in the Index Medicus of the National Library of Medicine and in Medline, a biomedical electronic database. These journals are regarded by the medical and scientific communities as a primary channel for both communicating knowledge and as arbitrators of the authenticity or legitimacy of that knowledge. They represent the principal means of formal communication among scientists through which research is made public and through which it is evaluated and authenticated by other experts.(1)

As a consequence, most of the medical and health science literature defense counsel advance or confront as proof of premises for an expert opinion, pursuant to Rules 703 and 803(18) of the Federal Rules of Evidence or similar state court rules, comes in the form of a journal article. Evaluation of medical journal articles is not taught in law school. But, especially since the U.S. Supreme Court decision in Daubert v. Merrell Dow Pharmaceuticals Inc.,(2) it has become a necessary, fundamental skill. This article concerns the interpretation and critical evaluation of the medical and health science periodical literature.(3)

PERIODICAL MEDICAL AND HEALTH SCIENCE LITERATURE

A. Kinds of Medical Journal Articles

The following kinds of medical articles are of interest to defense counsel:

1. Epidemiologic studies in human beings offer statistical analysis of data, gathered from samples of human populations, permitting inferences and conclusions about the relationship between various characteristics of the study subjects and disease or other health effect.

2. Laboratory studies involving living organisms, either human or animal (in vivo studies).

3. Laboratory studies involving human or animal tissue (in vitro studies).

4. Anecdotal articles, which may consist of case reports, case series, or reviews of clinical experience, often provide the basis for more sophisticated research. In a case report or case series, authors describe their experience with a case or series of cases thought to exhibit unusual features, which may be useful to practitioners. The review of clinical experience is a more expansive and sophisticated case series in which authors may review all cases of a particular type or exhibiting common features over a period of months or years. The experiences of a group of patients are organized and summarized according to specific characteristics of interest, with relevant commentary by the author.

5. Review articles, in which authors summarize and review other articles devoted to a common subject.

6. Editorials and letters to the editor comment on matters of controversy or interest and often contain helpful critiques of original research. Occasionally a letter to the editor is used as a vehicle for providing information that supplements previously published original research. Letters and editorials are not necessarily peer reviewed. It is worth checking to see if an upcoming expert witness has published either an editorial or letter to the editor that contains information that can be utilized in cross-examination.

B. Format and Style

1. Format

The format of a medical journal article is described in the following table.(4)

Section:                  Look for the Following:

Abstract/Summary          Overview or summary of the work.
                          Highlights of results.
                          General statement of significance.

Introduction              Background information: history,
                          pathophysiology, clinical presentation. … 
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