The winding road towards evidence based diagnoses

• diagnostic research

Why are quality standards for therapeutic research so high in comparison with diagnostic standards? This difference has negative effects on the quality of diagnostic research and on its application to medical care. Various reviews dealing with the quality of research on clinical diagnosis have repeatedly reported that a large number of studies have serious flaws, with just a small proportion of studies fulfilling a high number of methodological standards. Improvements have certainly been made in recent years, but they fall short of what has been achieved in other areas of clinicoepidemiological research.1–3 The results of therapeutic research seem to be more rapidly applied and to readily form the basis for new recommendations in clinical practice; whereas the findings of diagnostic research are incorporated to a much slower extent in clinical practice and in the formulation of clinical practice recommendations. While the body of evidence based medicine is rich in evaluations and recommendations concerning therapeutic interventions, the number of reviews or recommendations regarding diagnostic procedures is scant. Another striking, though not surprising, aspect is the dissociation between academic proposals concerning how clinical diagnoses should be made and what doctors actually do when weighting a diagnosis. In particular, the actual use of the indices and quantitative procedures proposed by academic circles is the exception rather than the rule.4

The great schism that exists between research and clinical practice, suggests that significant changes should be made in diagnostic research. The Journal of Epidemiology and Community Health decided it would be a good idea to publish an exchange of views on the future of diagnostic research, which might point to possible paths to be taken by colleagues conducting research into clinical epidemiology. With this aims in mind, Dr Alvan …