Which is: A systematic review of parachute use to prevent death and major trauma
I agree with Sharen Begley’s assessment in Stat of this year’s BMJ Christmas issue as a loser.
Bah! … humbug. Is it just us, or is the highly anticipated Christmas issue of the BMJ (formerly the British Medical Journal) delivering more lumps of coal and fewer tinselly baubles lately?
Maybe it’s Noel nostalgia, but we find ourselves reminiscing about BMJ offerings from Yuletides past, which brought us studies reporting that 0.5 percent of U.S. births are to (self-reported) virgins, determining how long a box of chocolates lasts on a hospital ward, or investigating Nintendo injuries.
I agree with her stern:
Note to BMJ editors: Fatal motorcycle crashes, old people falling, and joint pain — three of this year’s Christmas issue studies — do not qualify as “lighthearted.”
My all-time favorite BMJ Christmas article
With its conclusions:
As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.
The brief article is actually a great way to start a serious discussion of randomized trials with a laugh.
We can all agree that we wouldn’t participate in a randomized trial of parachutes. Any effort to conduct a systematic review and meta-analysis of such studies would answer up , formally speaking, as a failed meta-analysis. We we could start with a rigorous systematic search, but still end up with no studies to provide effect sizes. That’s not a bad thing, especially one as an alternative to making recommendations on weak or nonexistent data.
I would like to see a lot more formally declared failed meta-analyses by the Cochrane collaboration. Clearly labeled failed meta-analyses much preferable to recommendations consumers and policymakers for treatments based on a small collection of methodologically weak and underpowered trials. It happens just too much.
If the discussion group were ripe for it, we could delve into when randomized trials are not needed or what to do when there aren’t randomized trials. I think one or more N = 1 trials not using a parachute or similar device would be compelling, without a nonspecific control group. On the other hand, many interventions that have been justified only by observational trials turn out not to be effective when RCT is finally done.
Keep a discussion going long enough of when RCTs can’t provide suitable evidence, and you end up in a predictable place. Someone will offer a critique of RCTs as the gold standard for evaluating interventions or maybe of systematic reviews meta-analyses of RCTs being a platinum standard. That can be very fruitful too, but sooner or later can get someone proposing alternatives to the RCT because their pet interventions don’t measure up in RCTs. Ah, yes, RCTs can capture the the magic going on long-term psychodynamic psychotherapy.
[For review of alternatives to RCTs that I co-authored, see Research to improve the quality of care for depression: alternatives to the simple randomized clinical trial ]
Ghosts of Christmases Past
Searching for past BMJ Christmas articles can be tedious. If someone can suggest an efficient search term, let me know. Fortunately the BMJ last year offered a review of all-time highlights
BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6679 (Published 15 December 2016)
Cite this as: BMJ 2016;355:i6679
For more than 30 years the festive issue of the journal has answered quirky research questions, waxed philosophical, and given us a good dose of humour and entertainment along the way.
A recent count found more than 1000 articles in The BMJ’s Christmas back catalogue. A look through these shows some common themes returning year after year. Professional concerns crop up often, and we seem to be endlessly fascinated by the differences between medical specialties. Past studies have looked at how specialties vary by the cars they drive,7 their ability to predict the future,8 and their coffee buying habits.9 Sometimes the research findings can challenge popular stereotypes. How many people, “orthopods” included, could have predicted that anaesthetists, with their regular diet of Sudoku and crosswords, would fare worse than orthopaedic surgeons in an intelligence test?1
It notes some of the recurring themes.
Beyond medical and academic matters, enduring Christmas themes also reflect the universal big issues that preoccupy us all: food, drink, religion, death, love, and sex.
This broad theme encompasses one of the most widely accessed BMJ Christmas articles of all times
In 2014 Ben Lendrem and colleagues explored differences between the sexes in idiotic risk taking behaviour, by studying past winners of the Darwin Awards.4 As the paper describes: winners of these awards must die in such an idiotic manner that “their action ensures the long-term survival of the species, by selectively allowing one less idiot to survive.”
There is also an interesting table of the four BMJ Christmas papers that won Ig Noble prizes:
Christmas BMJ papers awarded the Ig Nobel prize