Detecting the effects of thromboprophylaxis: the case of the rogue reviews

Introduction

“Watson, Dr Watson!” I looked up at the muffled sound of Sherlock Holmes's voice as he stood at the window, gesticulating with his Stradivarius. Two hours of relentless arpeggios had finally ceased, and I gratefully removed the plugs of cotton wool from my ears. “A distinguished visitor is about to request admittance,” he observed. “Would you kindly ask Mrs Cochrane to show him up?”

A few moments later a tall, bewhiskered gentleman, with an enormous portmanteau and a general air of exasperation, entered Holmes's study. He introduced himself as Professor Legge, an orthopaedic surgeon.

“Mr Holmes, only you can end this madness!” he moaned, sinking into the nearest armchair. Holmes's hawk-like eye ranged over his visitor, and I knew that the great detective was about to presage the discussion with a display of his deductive skills. “Well, Professor Legge,” he began authoritatively, “I trust your search for systematic reviews on Medline this afternoon was productive?” Legge looked startled.

“Good Lord, Mr Holmes, how could you possibly know that I have just spent hours … searching for …?” He began to swab his face with an extravagantly large handkerchief.

“Simple, my dear Legge. The light coating of dust on your face would indicate that you have attracted an electrical charge, caused, I suspect, through hours of vigilant study at a computer monitor. That, and your rather glassy stare.” Legge nodded silently, while I enquired: “But how on earth did you deduce the reason for his search?”

“Are you unaware that the use of meta-analyses in the pursuit of effective health care is well established in your profession, Dr Watson?” he retorted. I was abashed. Holmes continued: “Well, I too am an exponent of evidence based methods. Naturally I am aware of their value in medical practice.” Professor Legge grunted sceptically and …