The Medical Review Article Revisited: Has the Science Improved?

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The summary below is from the full report titled "The Medical Review Article Revisited: Has the Science Improved?" It is in the 12 December 1999 issue of Annals of Internal Medicine (volume 131, pages 947-951). The authors are A. McAlister, H.D. Clark, C. van Walraven, S.E. Straus, F.M.E. Lawson, D. Moher, and C.D. Mulrow.

What is the problem and what is known about it so far?

Review articles in medical journals summarize large amounts of information on a particular topic; they are therefore a useful and popular source of information for doctors. However, some review articles reflect the personal opinions of the author more than the body of knowledge about a topic. Experts have proposed guidelines for how authors should write review articles in order to avoid personal bias. These guidelines recommend that authors should address a focused question, describe how they searched for and evaluated information, identify gaps in knowledge, and estimate risks and benefits of recommended treatments. Although studies have shown that the guidelines are reliable indicators of the quality of a review article, we do not know how widely authors of review articles actually follow those guidelines.

Why did the researchers do this particular study?

They wanted to learn about the quality of review articles published after the guidelines were released in the early 1990s.

What was studied?

The study examined 158 review articles published in six general medical journals in 1996.

How was the study done?

The researchers read each review article carefully and recorded whether each article met each of 10 criteria for high-quality review articles.

What did the researchers find?

Of the 158 articles, only 2 met all 10 criteria. Less than a quarter described how the authors identified and evaluated information, just over one third addressed a focused question, and less than 40% identified gaps in knowledge. When review articles offered treatment recommendations, less than half provided estimates of the potential benefits of the treatment and slightly more than one third provided estimates of potential risks of the treatment. Only 6% had any discussion of costs of the treatments they reviewed.

What were the limitations of the study?

The researchers focused on review articles published in 1996, only a few years after the guidelines were developed. More recent review articles could be of higher quality. They also focused on only six journals out of the many medical journals that exist.

What are the implications of the study?

The quality of medical review articles varies. Unfortunately, many do not meet guidelines for high-quality review articles. Doctors should not assume that all published review articles are of high quality.