Moving beyond floccinaucinihilipilification: Enhancing the utility of systematic reviews

Abstract

In a forthcoming chapter in the proceedings of a seminar on the extension of systematic reviews to diverse study designs, Petticrew and Egan comment that: "There is a widespread assumption that what systematic reviews are best at is assessing 'the evidence' and concluding that it is too little, and anyway what there is of it, isn't very good" [ [1] Petticrew M, Egan M. Relevance, rigour and systematic reviews. In Popay J, editor. Moving beyond effectiveness in evidence synthesis: methodological issues in the synthesis of diverse sources of evidence. London: NICE, in press. Google Scholar ]. They highlight a useful 19th century word for this activity—floccinaucinihilipilification—which, according to the Oxford English Dictionary means "The action or habit of estimating something as worthless." On the basis of decades of experience, this sounds to me like an activity that has frequently been directed at the product of sociologic enquiry in the health field, and particularly qualitative enquiry. Take, for example, the steady stream from the 1990s of articles, some in high-impact journals such as the BMJ, seeking to make a case for the relevance of qualitative research to health policy and practice in general and evidence synthesis in particular [ 2 Fitzpatrick R. Boulton M. Qualitative research in health care: 1. The scope and validity of methods. J Eval Clin Pract. 1996; 2: 123-130 Crossref PubMed Scopus (55) Google Scholar , 3 Mills E.J. Montori V.M. Ross C.P. Shae B. Wilson K. Guyatt G.H. Systematically reviewing qualitative studies complements survey design: An exploratory study of barriers to paediatric immunizations. J Clin Epidermiol. 2005; 58 (1101–1108 (this issue).) Google Scholar , 4 Boulton M. Fitzpatrick R. Swinburn C. Qualitative research in health care: 2. A structured review and evaluation of studies. J Eval Clin Pract. 1996; 2: 171-179 Crossref PubMed Scopus (74) Google Scholar , 5 Bury M, Davies P. Contributions from qualitative research. In Davies H, Nutley S, Smith P, editors. What works? Evidence-based policy and practice in public services. Bristol: The Policy Press. Google Scholar , 6 Popay J. Williams G. Qualitative research and evidence based healthcare. J R Soc Med. 1998; 91: 32-37 PubMed Google Scholar , 7 Dixon-Woods M. Fitzpatrick R. Qualitative research in systematic reviews: has established a place for itself. BMJ. 2001; 765: 765-766 Crossref Scopus (182) Google Scholar , 8 Murphy E. Dingwall R. Greatbach D. Parker S. Watson P. Qualitative research methods in health technology assessment: a review of the literature. Health Technol Assess. 1998; 2: 1-274 Google Scholar ]. I do not recall similar articles from epidemiology or survey research, for example. (Although one could argue that Archie Cochrane's famous call for greater attention to be paid to RCTs was equivalent, and no doubt some readers are even now searching through their bibliographic databases to prove me wrong on a wider front!). But that is to get off the point.