The public, the internet, and the media are the bridge between producers and users

Article type
Authors
Napoli M
Abstract
Background: Too often, systematic reviews do not change clinical practice, especially when conclusions are at odds with entrenched medical thinking. The gap between the publication of Cochrane Reviews and appropriate changes in medical practice could be bridged by improvements in media coverage of and Internet access to the Cochrane abstracts. A better-informed public may, in turn, have a positive impact on physician acceptance of evidence-based
medicine.

Objectives: Improve dissemination of Cochrane abstracts via the media and the Internet.

Case in Point: The automotive industry will issue recalls once one of its automobiles is found to be dangerously defective. Physicians, however, are unlikely to comb their records in order to recall each patient to whom they have prescribed a drug, newly discovered to be harmful. The media and the Internet are the consumers best hope. Postmenopausal hormones use in the USA, for example, decreased substantially after negative results from the Womens Health Initiative received extensive nationwide media coverage.

Current Methods of Dissemination: The abstracts of the Cochrane reviews are freely available to all Internet users, and, in many cases, the only section of the review that is read. (Many physicians may read only the summaries, as one survey showed they were the majority of visitors to the Cochrane Consumer Network Web site featuring synopses of Cochrane reviews.) John Wiley & Sons, Ltd, sends a press release announcing one new review each month. Choice appears to be based on topics likely to be of general interest, such as quitting smoking and infant formula. Internet users seeking health and medical information are likely to use search engines to state a specific topic of interest (e.g., drugs for hypertension), as opposed to scanning the list of abstracts on the Cochrane Web site.

Suggested Improvements: Reviewers are encouraged to make the Cochrane abstracts understandable to the general public. The peer reviewers checklists should emphasize the importance of an abstract that is as jargon free as possible. Instead of sending press releases featuring only new reviews, John Wily & Sons might consider calling attention to older reviews relevant to what is currently newsworthy. For example, in several countries there was a protracted media debate over the Atkins diet as critics claimed its high-fat content causes heart disease. Evidence-based medicine could have entered the coverage with a timely press release about the 2001 Cochrane review showing low-fat diets have little effect in preventing heart disease. Similarly, the 2001 review on Psychological Debriefing to Prevent Post-Traumatic Stress Disorder, which found that some people are harmed by this common practice, could be featured in a press release sent out in the wake of a major disaster, such as an earthquake or a terrorist attack. Future Cochrane reviews could be written with Internet search engines in mind.