Evidence-based medicine

By Brad Roberts, MD
Emergency medicine physician
PCMS representative on the CMS Board of Directors

Recently I was asked to speak as a panelist during a Colorado Medical Society webinar on smoking and COVID-19. As part of the preparation I read lay news articles from outlets such as Yahoo News, VICE, CNN, and other online sources found through a Google search. I also read multiple articles from peer reviewed journals from a PubMed search. 

My biggest takeaway surprised me: It became very clear that as physicians we need to make sure we are looking at true peer reviewed research and look at it with the critical eye we were taught to use at journal clubs during residency. While physicians must understand what the public is seeing, we need to be able to see through much of the popular press and be able to have an understanding of what is true evidence-based medicine compared with what is written as a quick article to entice readership. 

Ultimately the peer reviewed studies suggested that more research was needed to further look into why there were possibly fewer smokers admitted to certain hospitals than would have been expected. The researchers acknowledged small sample sizes and confounders that may be present, suggesting only an interesting finding that may benefit from further research. They were careful to state that patients should still be encouraged to stop smoking. The popular press, however, took this to state smoking was protective from COVID-19, which was not what the researchers had even implied. 

It also was clear from my reading of the peer reviewed research that smokers with COVID-19 were 2.4 times more likely to go to the ICU, be intubated, or die with complications from COVID-19 than non-smokers. Clearly, now more than ever, patients should be encouraged to make healthy lifestyle choices such as stopping smoking. Implying smoking was protective from COVID-19 was not only premature and likely incorrect but also harmful. Smoking is the leading cause of preventable death in the U.S. and the world and causes far more morbidity and mortality than COVID-19.  I have seen these same misleading popular press articles in the cannabis discussion as well.

It is imperative that we as physicians are able to understand and interpret scientific literature through the appropriate lens of the education we were able to receive. 


By Libby Stuyt
June 11, 2020
Good Job Dr. Roberts - absolutely everyone needs to read everything with great skepticism and rationale thought