How to Read a Paper: The Basics of Evidence-Based Medicine

Now in its third edition, this respected book guides the reader through medical research and the jungle of jargon it comprises. The subject matter is divided into types of research, literature searches, presenting and analysing data, and publication and appraisal of research. Its definitions are superb, and it clearly delineates between commonly confused topics such as reliability and validity, systematic reviews and meta-analyses, and protocol and guidelines.

In the 12 years since the book’s inception evidence based medicine has evolved from illegitimacy to prodigy, thanks to champions such as David Sackett, Brian Haines, and Greenhalgh herself. They encourage clinicians to formulate the right question with three specific areas in mind. For example, Mr Smith is a 35 year old, normally fit and well professional golfer with acute medial epicondylitis (the “who”) who wishes to know whether rest, physiotherapy, or ultrasonography (the “which”) will most quickly get him playing competitive golf again without pain (the outcome). The doctor then uses resources such as the medical literature, the internet, and guidance from bodies such as the UK National Institute for Health and Clinical Excellence to ask, “What is the evidence?” which can be answered only, the book says, by “reading the right papers, at the right time.” It is no longer sufficient to accept the current practice as best just because good old boys sat around a table and deemed it so or because “that’s the way things have always been done,” as only perfect practice (not practice alone) makes perfect.

Each chapter is an elegant synthesis of years of toil and experience, evidenced by the references (400 in all) to papers (good, bad, and ugly), interesting articles, journals, books, and other resources. I recommend reading the book close to a computer with internet to follow up the references and complete the range of exercises on offer.

The author uses examples from her own practice to highlight the dangers of making decisions by anecdote, cost minimisation, expert consensus, or media report. For instance, she experienced a rare neurological reaction after taking an anti-sickness drug while pregnant and thus has not prescribed the drug since. This acknowledgement that even the best doctors are human and that humans are flawed beings demonstrates the role of evidence based medicine as a framework to help clinicians treat patients rationally and scientifically but with autonomy.

Among the book’s gems is a list of 11 common reasons why papers are rejected for publication (for example, they are badly written or lack originality), which should be read and revisited by all researchers to prevent their paper making up the “99% that belong in the bin,” says the author.

Greenhalgh is one of that rare breed, a teacher who can learn (and a doctor who can write), and as such is a role model for those of us who are still wet behind the ears. The book is essential reading for all healthcare professionals so they can understand the who, what, when, where, and why of biomedical research, and Greenhalgh succeeds in fulfilling a promise to an old friend to “demystify an important but often inaccessible subject.”