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On observation

Sticking to the point

Readers will have to dig hard to find many systematic reviews or randomised trials in this issue. We concentrate instead on good observational studies. Observational studies are great for raising questions, but not for answering them, or as some clever folk once put it “observational studies propose, RCTs dispose” [1]. Observational studies can, however, get you into the papers if written with sufficient extrapolation, and fed to journalists gullible to the hyperbole of press releases.

Yet when good they can help us think. This time we think about anaemia, especially anaemia in older people, and of chronic disease. Bandolier has visited this before, but more and better information tells us how big the problem is, in human and monetary terms. No RCTs provide answers about treatment, at least not just yet, though extrapolation from other clinical areas shows that treating anaemia is a good thing. It is certainly expensive, even when treating US economic information for transatlantic inflation.

Learning from observations of others is how we progress, especially when they are systematic and detailed. So it is with cat-scratch disease in older people, where presentation can be quite different in older people than in children.

Sticking to the point

Some topics are important but difficult. Bandolier is frustrated that more clear evidence is not available concerning adherence, compliance, concordance, persistence, or whatever. There is little but a quick canter through some recent studies, but they shed only a little light. Most important is perhaps that presentation methods change patient perception of adverse events, and in an RCT too!


  1. 1 G Davey Smith, S Ebrahim. Data dredging, bias, or confounding. They can all get you into the BMJ and the Friday papers. BMJ 2002 325: 1437-1438.

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