Evidence, not anecdotes
By M. Victoria Marx, MD, FSIR Fall 2018
As medical professionals, we should want to improve not only our patients’ lives but health care in general. However, we also know that we can’t improve patient care without research. Historically, IR (and radiology in general) has taken an observational approach to research—retrospectively reviewing and drawing conclusions from a series of past cases—which probably makes sense because of our problem-solving nature. In recent years, however, research in IR has involved more prospective trials, with the genuine potential to impact how medicine is practiced.
I recently read an article on a trial that found equivalent results between thermal ablation and resection of renal cell cancer—demonstrating the effectiveness of our minimally invasive, image-guided treatment, especially for people who are older and may not tolerate surgery.
This kind of evidence not only meets today’s demands for increased accountability, it serves us well on many other fronts. Perhaps most notably, it was the key to our recent victory on mechanical thrombectomy (see details on page 9). SIR’s mantra has always been “evidence, not anecdotes” and that’s exactly what we brought to the table—hard evidence that the Joint Commission’s individual volume requirements were too stringent, inappropriately limiting IRs’ ability to help these patients.
By providing data, we instantly got the Joint Commission’s attention, inducing them to remove those requirements for a period of further evaluation. If we keep generating the right evidence, we will continue to “beat” those who try to challenge the efficacy of IR with anecdotes.
That said, as a small specialty it takes significant funding to support those who build the evidence base through research. SIR Foundation works tirelessly to get people started on important projects and to financially support their initial efforts. It works closely with the society to teach researchers to better write grants and to pursue additional support from extramural governmental agencies. The foundation also provides a critical strategic role, driving research priorities with its research consensus panels and facilitating conversations around topics that are important to improving patient care. That’s why it’s so important to support the foundation however you can.
Another critical new way to contribute to the evidence base is through participation in IR registries. The first step is to implement the SIR structured reports, automatically pulling data from your institutional or electronic medical record to the registry database. Although there are logistical challenges to implementation within an institution, I think it’s something we should all work toward doing.
As much as SIR and SIR Foundation work to support the research community, data’s impact is limited if it isn’t published in the literature. Presenting your research at a meeting is certainly important, but it’s a promissory note of what’s to come—publication of final findings in a scholarly journal.
Publishing scientific investigation means a whole other logarithmic level of review establishing that it’s accurate and reliable. It’s understood that an article published in a scholarly journal has been reviewed, queried and extensively revised as needed. The community can confidently refer to it, reproducing the results and taking the value of that research data to another level. If a meeting presentation is like a performance art, a publication is a movie you can watch over and over again.
Publishing in your home journal, the Journal of Vascular and Interventional Radiology (JVIR), is critical. It’s a statement of the importance of interventional radiology as a primary specialty, and both authors and readers can be confident in the peer review of the content, because they know it was IRs who reviewed it.
Some may believe that publishing their work in another specialty’s journal will elevate the others’ awareness of IR, but that’s a vintage way of thinking. The digital evolution in publishing has transformed how we access and read peer-reviewed research. In the past, we’d read a single journal because that was in our area, and that’s all we’d see. Today, you just go to PubMed or even Google any topic and you can find all that’s out there on it. The idea that you only have access to your own specialty journal is completely outdated. For example, an oncologist who’s trying to find out about locoregional treatments for hepatocellular cancer won’t go to their specialty journal. They will search PubMed and will find your JVIR article.
Interventional radiologists publishing in our interventional radiology journal elevate the field. Be one of them!