Research Methods

Question 1

Definition of research

Answer 1

The systematic study of a subject in order to establish facts and reach new conclusions

Question 2

Definition of science

Answer 2

The systematic study of the structure and behaviour of the physical and natural world through observation and experiment

Question 3

Isolated research

Answer 3

Isolates specific aspects without reference to the whole picture/context. It doesn’t deal with the variables and therefore potentially drawing false conclusions

Question 4

Research on animals

Answer 4

Animal physiology is different from human.
Controlled clinical lab. The animals are stressed. Stress hormones cause: metabolism changes, functions of cells and organs are distorted.

Question 5

Weaknesses of the RCT

Answer 5

‘Gold standard’ clinical trial (RCT)
Randomised (double-blinded) placebo-Controlled Trial.

C Chap

• not concerned with Cause (just if suppresses symptom/s)
• Cherry picked data - result to support hypothesis
• Homogenisation - assumes identical pathologies; people have different diet, lifestyles, constitutions
• Abnormal environment - lab not real life
• Placebo-effect - well known to work

Question 6

Isolated research example

Answer 6

‘French get fewer heart attacks because they drink wine’ But fails to see whole picture:

• individual constituent of wine that may reduce heart attacks, what about negative effect of alcohol content
• other variables in French culture eg good food, less stress, garlic consumption

Question 7

Biomedical vs Natural medicine research

Answer 7

Biomed Natural

Single treatment Treatment strategy
intervention

Vested interests Cannot be patented
for profits - few profits to be made

Cuts out complexity Embraces complexity and
- variations merely variability
‘confounding factors’
to be ruled out of
investigation

Quantitative Looks at overall outcome
measurable qualitative

Homogenisation assumes patients are different
of patients

Biomed - one version of science - a narrow definition that is presented as the ‘truth’ or ‘evidence-based’ even if later discredited.

Question 8

Conventional Hierarchy of Evidence

Answer 8

Top of pyramid - systematic reviews and meta-analysis of RCTs

Bottom of pyramid - expert opinion, editorials

Question 9

The inverted pyramid

Answer 9

From top to bottom

1. Observations and experiences of practitioners and patients
2. Laws, principles and conclusions. Patients. Case studies.
3. Practitioner case studies in clinic. Patient questionnaires. Outcome research.

Question 10

Quantitative research

Answer 10

Accurately and precisely measured eg blood pressure
Most medical research

Question 11

Qualitative research

Answer 11

Something that cannot be accurately and precisely measured, such as the way people feel. More appropriate for complex investigations.

Question 12

Benefits of case studies in natural medicine

Answer 12

PIP’D

-Individual responses (looking at people in their complexity)
- Practical application - clinical reasoning - can share notes and experiences of what works
- Detail eg digestion, sleep (influencing factors on treatment)
- Plentiful and anonymous

Question 13

Questionnaires - MYMOP

Answer 13

Measure Your own Medical Outcome Profile (MYMOP)

Patient reports from visit to visit
Used in clinical audit to produce data about clinical effectiveness of the treatment

Question 14

Clinical audit

Answer 14

1. to determine whether best practice in being carried out in the clinic - health, safety, hygiene, positive patient experience.
2. Effectiveness of treatments delivered in clinic.

Question 15

Outcomes research

Answer 15

Greater focus on overall delivery of care eg cost, convenience, accessibility, patient preferences, levels of satisfaction etc.

Enables service providers to ensure best use of resources.

Question 16

The problem with ‘scientific truth’

Answer 16

Scientific truth changes with the next discovery eg drug Thalidomide passed all tests but then withdrawn. Real science does not changed - based on observable facts derived from observation and practice.

Question 17

Why learn about biomedical research

Answer 17

• contraindications and negative interactions
• toxicity/ safe upper limits of compounds
• communicate with other health professionals

Question 18

Definition of systematic review

Answer 18

Review of all available clinical studies on a drug to establish effectiveness.

Question 19

Definition of literature review

Answer 19

Same as systematic review but also taking into account evidence such as theory and pharmacology

Question 20

Definition of meta-analysis

Answer 20

Statistical procedure combining data from multiple studies. nb. flawed research can distort evidence.

Question 21

Definition of epidemiological research

Answer 21

How and why of disease in a particular population eg high prevalence of MS in Scotland

Question 22

Definition of retrospective study

Answer 22

Historical investigation, often in comparison to a non-affected group.

Question 23

Definition of prospective study

Answer 23

Follows a group of subjects over time eg ‘Child of our time’ study.

Question 24

Definition of narrative study

Answer 24

Narratives of patients in clinical practices. Paying attention to what they SAY.

Under development in WHO - counterbalance to RCT model.

Question 25

What organisation sets ethical codes and what are some of the common principles?

Answer 25

World Medical Association Declaration of Helsinki - act of doing good - do no harm - confidentiality of subjects - right to quit at any time

Question 26

What are the two perspectives in anthropology?

Answer 26

Emic approach - thoughts and beliefs of local people 'from the inside' Etic approach - thoughts and beliefs as observed 'from the outside' Combined, may achieve best results.

Question 27

Benefits of qualitative research?

Answer 27

VEMS - Variability and complexity - Experiences of patients and practitioners - Methodology - can be chosen according to what best serves the research as opposed to a narrow definition of science - Suited to areas with both social and clinical dimensions

Question 28

What to consider when reading research?

Answer 28

TIBIAS Transparency - conflicts of interest made clear? Who wrote it? published it? funded it? Isolated research? Bias - is the researcher setting out to a 'prove' something? Using own previous research as evidence? Interpretation of results justified? Animal/animal tissue? Symptom equated to the disease?

Question 29

Pharmaceutical bias in biomedical research

Answer 29

FUN GG Funds doctors training Unrepresentative samples Negative data can be withheld, or data massaged to 'prove' Ghost-written articles commissioned by the industry, without disclosure Gagging orders to prevent whistle blowing

Question 31

Bad science example - statins (1)

Answer 31

Introduced 1987. Theory - raised cholesterol = heart disease. Based on research undertaken on rabbits - feeding them red meat caused arterial plaques. Rabbits are natural vegetarians. Flawed premise - we can predict human physiological responses with reference to animal physiology. 2007 - 192 separate studies. Industry funded trials, 20 times more likely to deliver positive results than government funded. A lot of questionable data. Recent research suggests it is not a cause of coronary arterial disease, but sugar consumption is.

Question 32

Bad science - statins (2)

Answer 32

Only 15% of cholesterol comes from diet. 85% we make ourselves. Vital nutrient: - building block for hormones - cell membrane integrity - synthesis of vit D - high amount in brain

Question 33

Why is herbal medicine research often debased?

Answer 33

- isolated plant constituents - variables eg Passionflower tea study, to help with sleep. For some it will work, depending on what is keeping them awake. - assessed against narrow criteria, for instance doesn't look at outcomes over time

Question 34

Limitations of research

Answer 34

Symptoms Even in natural med, positive results don't always mean appropriate treatment plan eg cinnamon for lowering blood sugar, but doesn't address underlying cause - diet and lifestyle. Constitution Positive results with a substance doesn't mean always right for everyone, eg garlic in some constitutions can cause too much heat and GIT discomfort. Engage Professional literature in your field is usually the most relevant and appropriate. Apply Laws and principles of natural therapies. Patient more than the pathology.