How to Read a Research Study, Part 1 of 7
Why this guide exists
A clinic scene that repeats most weeks; the gap between the trial number and the lived experience; why reading evidence well is a survival skill, not an academic exercise.
Ask Grace
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The clinic scene
A drug company representative arrives at clinic with a glossy slide deck. The headline number is 78% time in range; the trial enrolled 312 adults with an HbA1c between 6.5 and 8.5 percent, all using a closed-loop pump-CGM combination at month six. The rep wants you to recommend the system. The parent in the appointment after the rep asks why her daughter, who has the same closed-loop system, sits at 51% time in range and feels exhausted from chasing the alarms.
Both things are true at once. The trial result is real. The lived experience is real. The job of this guide is to teach you how to live in the gap honestly.
“Drugs are tested by the people who manufacture them, in poorly designed trials, on hopelessly small numbers of weird, unrepresentative patients, and analysed using techniques which are flawed by design, in such a way that they exaggerate the benefits of treatments. Unsurprisingly, these trials tend to produce results that favour the manufacturer. When trials throw up results that companies don’t like, they are perfectly entitled to hide them from doctors and patients.”
Source: Goldacre, Bad Pharma (2012), Introduction. The gap the rep does not see is the gap the parent in the next appointment is living in.
The picture, in one graphic
Why this matters
Bad evidence reaches the clinic. Each instance is plausible. Each one can change what is recommended to a person who lives with diabetes. Each one is at risk of being wrong in ways the person carrying the consequence cannot detect.
The cost of a wrong recommendation in T1D is not symmetrical with the cost of a wrong news article. The person with T1D adjusts their basal insulin on the recommendation, mistimes a meal, drives the late-afternoon school run, picks up a child from the gate. The consequences of a small wrong number compound across thirty years.
The honesty is the whole product. Reading evidence well is the practice of saying what the evidence forces you to say, naming what the evidence cannot tell you, and living comfortably in the gap.
Part 1 of 7
Why this guide exists