Wednesday, December 14, 2011

When available studies are limited, expert opinions count

As a strong believer in evidence-based medicine, the lack of the highest quality of studies and sometimes of sound scientific interpretation in articles about Asherman’s syndrome is disappointing. It can be difficult to accurately assess information on AS from different sources when primary studies may be deficient in study design, use outdated techniques of diagnosis or treatment,  have small sample sizes, are carried out retrospectively, randomization/allocation concealment are absent and when comparisons between primary studies is impossible due to differences in methods of treatment. Unfortunately some of these limitations are difficult, if not impossible to overcome. However, there is still room for improvement in studies about AS. There is also a lot we can learn about AS by correctly interpreting data that is already available, and by taking note of the knowledge acquired from specialists with extensive expertise on the topic. To be knowledgible about AS requires more than having the letters MD behind your name, learning about AS through a 10 minute lecture at University and skimming through a few papers on it. To be an expert requires decades of experience with diagnosing and treating it and the ability to think scientifically (objectively), something doctors are not actually taught routinely which is only really pertinent to doctors that are involved in research.

Dr Charles March of California Fertility Partners is a respected authority on Asherman’s syndrome. He is board certified in Obstetrics and Gynecology and fellowship trained in Reproductive Endocrinology and Infertility and was a Professor at University of Southern California. Not only is he a great surgeon who is popular with patients, but I believe he is currently the doctor with the most knowledge about Asherman’s syndrome. This is probably due to the fact that he has over 30 years of experience in dealing with patients that have Asherman’s syndrome and that he is additionally a fertility specialist and obstetrician which enables him to clearly see the causes and repercussions of the condition. He also has a particular interest in the condition and clearly enjoys talking and educating others about it.

His most recent review article,‘Management of Asherman’s syndrome’, appeared in Reproductive Biomedicine Online this year. His articles show that he is a wealth of information on all aspects of AS. Anyone can write a narrative review by consolidating previous data and supporting their arguments with cherry-picked information they have read, sometimes from old or inaccurate sources, but only those who have strong critical appraisal skills and the know-how that comes from decades of experience can offer so much valuable insight and advice on a topic. My next blog will focus on the relevant discussions and kernels of wisdom found in Dr March’s review on Asherman’s syndrome.