• sherlock_holmes

     

    A woman taking a new prescription of Lisinopril for routine hypertension reports back to her doctor in a month with severe lower abdominal pain.  A workup for gynecological and gastrointestinal disorders comes back negative.  The doctor is asked whether the abdominal pain could be caused by the Lisinopril and the answer is “Well, I prescribe this all the time, and I have never heard of that.”  The patient happens to be a medical librarian and she checks the Micromedex drug database and abdominal pain is not listed under common or serious side effects.  A MEDLINE literature search, however, does discover several compelling “case reports” of similar problems from the drug.

    This is the value of “case reports” – to build the evidence on a topic – one case at a time. Once we know that there may be a trend through multiple reports, then perhaps larger studies and trials can be conducted.  But it is the initial case report that waves the flag and says – “Hey, notice me, something is going on!”

    Ten years ago, several residents came to me asking if the Library could pay for a license to a new journal from the British Medical Publishing Group called BMJ Case Reports, so that they could publish in it.  It seems that there had been a serious decline in scholarly medical journals accepting case reports in favor of large multi-center trials and reviews – often what publishers call more “Scholarly Communication.”  Case Reports have been the mainstay for residents and junior clinicians to enter the world of medical publishing for the first time.  They are relatively short and easy to write and for a long time almost every journal published them. So imagine my chagrin to discover that there was a trend away from them.

    BMJ was one of the first that I knew about to take a new approach – not adding them back into their main journal but starting a new journal dedicated to case reports.  But their publishing model was different – you or your Department had to pay THEM to get published!  This trend has caught on and now there is a flourishing marketplace of medical journals that publish only case reports: BMJ Case Reports, Journal of Medical Case Reports, Case Reports in Surgery – just to name a few.

    We could long discuss the merits of who should pay for content – the reader or the author?  But the important thing is to welcome back the lowly case report with open arms for they clearly enable the creation of new medical knowledge.

    The observations and thoughts in this piece are my own – in a sense – a case report based upon my limited experience and observations.  I have not conducted a formal study on the demise and revival of the case report – but perhaps someday maybe someone will!

    Now, back to our patient – she stopped taking the drug with more confidence because of the existence of reports showing a few other similar cases – and luckily all her pain went away. The main article – “ACE-inhibitor-induced intestinal angioedema: rare adverse effect of a common drug” was published in our old friend – BMJ Case Reports!

     

     

    Posted by kkg8n @ 1:13 pm