Choosing a Research Question: Focusing the Research Question Part 2

Once you have picked the general topic, you need to focus that question down. And what that entails, again we're back to the hard work piece, you need to evaluate the medical literature and other sources to evaluate the current knowledge in that research area. Maybe, the question you're interested in has already been answered by somebody else.

In many areas though, much of what we think we know is less than what is generally believed. And one of the places to start with this is review articles or treatment guidelines. But really, what this do is represent a synthesis of other's view on the data. And much in treatment guidelines is graded according to the strength of the evidence.

There is a recent study done about four years ago which actually looked at the recommendations in both cardiology and infectious disease treatment guidelines. Only 11% of what was in them had been generated from randomized controlled trials. And almost half of the recommendations were based on clinician opinion. So, that's bunch of nice guys sitting around the table

saying, "I think that should do this." But that's not evidence, and that's not science. So, many times, what you can actually get at guidelines is actually some of the questions that still need to be answered. Because even though they're in the treatment guideline based on best opinion, they haven't really been answered in a scientifically valid way.

So, John Ioannidis has actually brought this up in an essay that he wrote in 2005 saying that, "For many current scientific fields, claimed research findings may often be simply accurate measure of prevailing biases." And so what he meant by this too is that if you don't design a study properly, you may get an answer with P value around it, but a P value doesn't