Study levels and randomized controlled trials. In the otolaryngology literature, Dr. Benninger believes not only are there not enough Level 1 studies, there are also not enough Level 3 studies, which can be valuable. There are “probably too many” Level 4 and 5 studies, he said, such as case series or low-quality case-control studies.
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He also said it was important to keep in mind that while randomized controlled trials are vital, the medical field might sometimes put too much emphasis on them, hindering medical progress. In transplantation, for example, the lack of data from randomized trials delayed the use of immunosuppressants such as cyclosporine and tacrolimus, which have become essential treatment tools since the start of their use, he noted.
The Cochrane Collaboration, an example of a database that includes only Level 1 evidence, is valuable because it’s a go-to resource where physicians know the evidence level is top grade, said Dr. Benninger. But there’s a catch: “The problem is that it’s not only prospective clinical trials that have value, and therefore we miss much of the important literature if we’re focusing only on Level 1 data,” he said.
More letters to the editor. Dr. Benninger encouraged physicians to put their thoughtful critiques on the record in journals. “We’re missing thoughtful letters to the editor,” he said. “How many times have we done a journal club and we’ve really torn through an article, and then we never write a letter to say, “Here are the issues with it’?” (When writing letters to the editor, however, it’s important to note any biases the authors might have, he added.)
Should researchers publish? On the basic question of whether a researcher should publish, the answer is yes more often than they might think, said Dr. Benninger. If a study adds to the literature, impacts care, could lead to further research, could lead to personal promotion, or could support the career developments of others, then your work should probably be published.
In general, he said, prospective studies should usually be published, case reports involving a special finding or circumstance should be published, and review articles that are particularly thoughtful should be published.
“Everything we do has a little effect someplace,” he said. “And so publishing your work is really important.”
Thomas R. Collins is a freelance medical writer based in Florida.