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Tuesday, May 18, 2010

How many times do we have to go throught this!!!!!

Sorry if you read this post John as I know this is day 1 medical school. Please feel free to skip this post. It's just that this issue drives me nuts as I continue to read these misleading media reports and am dumbfounded that readers still haven't woken up to basic issues concerning statistics. I already discussed the issue of study power here when I spoke about tPA in stroke- nuff said. Yet here we go again.

OK, with that in mind, I'm sure you have all read about the latest on cell phones and brain cancer. All I can ask is "was it P.T. Barnum that said 'there's a sucker born every minute and none of them ever die?'"

Just read the very first sentence of the entire article:

"A long-awaited study of cellphone use and brain health has finally been released, but the data are raising more questions than answers."

Long awaited??????

While it is possible that the people running the study were a bunch of bumbling idiots and simply could not execute on the data they had, "long awaited" is medical speak for "It took the researcher a long time to enroll enough patients to be able to even say that they had something to say".

Now this can only mean one of two things:
1. It was hard to find patients to enroll in the study because they are very rare, etc... and therefore hard to find.
2. They enrolled lots of patients in the study but whatever effect they noticed was so small and insignificant that they needed to enroll a very large number of patients before they could even say that they had something to say.

I'll let you decide whether cell phones are rather common and therefore whether it would likely be hard to find people who use them and enroll them in a study.


This leaves only scenario B. Whatever effect they found was small

Now is the effect real? That is another issue entirely. But whether it is real or not, it is not likely very meaningful.

So I'll let you decide for yourself whether it is real and/or whether meaningless to all might still be still meaningful to others, but in the mean time I will personally worry more about bigger problems like whether I'm going to get killed by a drive who is texting while driving, etc...

What do we need to do to get people to understand this relatively simple issue?


PS- lest you think this issue "unimportant", think again.


Thai said...

For comments

Dink said...

This Gibson book (with the bad ending) had a few interesting things to say about "viral" spread of information. Its breathtakingly fast, but it can extinguish pretty fast as well. The information may remain as a hazy memory, but its no longer "active".

I guess what I'm trying to say is that the rumor spread fast, the fact that it was disproved spread fast, and this study is just trying to get some attention based on the hazy memory. It will fail to get attention long.

About your Iron Man 2 experiences:

They best not screw up the Tron sequel! Ah, what am I talking about. Lots of great movies had terrible sequels that have been lost in time without harming the original (Blues Brothers, Caddyshack, Matrix, Jurassic Park). I take Tron personally, though. I'll go lie on the floor and breath into a paper bag now.

Dr John said...

Funny post Thai. I worked with a psychiatrist who was obsessed by the idea that Aspartame was poison. He actually managed to get some study published that followed 6 pts who used it one who had a retinal bleed that he reported may have been related to their use of the sugar substitute. The fact that millions of people were using it millions of times a day without obvious effect was of no importance to him.

His paper was actually sighted in an issue of Skeptic on what constitutes bad medical research.

Have you read this?

Dr John said...

By the way Thai, I know this is supposed to be first year medical school but I don't think most doctors really know how to or care to tease apart a research study. If they did they would not be giving most of the meds they are handing out.

Thai said...

If they didn't then they would not be getting 5s on those patient satisfaction surveys by Press Ganey and we all know it is all about customer experience. ;-)

Thai said...

And no I haven't but I do agree.

Of course, if we can't say we see an 80% improvement in mortality by treating septic shock in a 90 year old with dementia and metastatic cancer in the ICU vs. the floor so we can use all these central lines, telemetry monitors, consultants, etc... all at a cost of $300,000, then we have a problem.

80% improvement sounds so good.

Of course this just might mean the absolute benefit went from 0.1% probability of survival to 0.18%.

And I'm making these numbers up by the way to simply make my point.

But someone does needs to pay for the physician's/nurse's/administrator's/JCAHO's/Regulator's new cars.

Point stuff like this out very often however and you're likely to discover you need a new job.

Besides, its not like the 90 year old needed the money. And if (s)he decides the spending is low value and wants to give it to his/her kids/grand-kids so the kids get a better chance in life, someone else would just tax the money anyway thereby preventing him/her from giving it to their heirs anyway. The old man likes his neighbors but not that much. So what difference does it make to the patient/family?

Do everything!

... What a mess we've made.

I wonder if instead you pointed out to people that you could live a little less time on this planet (say 3-5 months) but have an extra week of vacations every single year of your life whether they would really do what they do.

Of course the 3-5 months you lost are not exactly the highest quality time you will ever spend on this planet.

The vacations on the other hand might just be.

Even when it comes to death, we have become so "specialized" we simply fail to look up and see the big picture.

Dr John said...

I have vowed I would die at home with a jug of morphine and a straw. Maybe I will get cold feet. I hope my wife does not as I have made my wishes clear to her since internship.

Do the Drs you work with really believe in putting forth those kinds of resources in such a case or are we all just on a train going to fast to get off?

We just had JACHO through. The recommendations they made have nothing to do with improving pt care just ensuring they will be back for another visit.

Thai said...

I think they think "80% improvement from current standard, that's a lot"

I think they genuinely want people better.

I think they do not want to be sued.

I think they don't think about spending someone else's money.

I think they think they serve the patient in front of them and no one else.

I think they don't realize that OTHER PEOPLE'S resources are finite

I think they think they'll loose their job if they don't think this way.

I think it is in JCAHO's interest that others continue to think this way.

... I once watched JCAHO fine a hospital for not having EXIT signs on its roof.

JCAHO is like any well paid physician in a fee for service model: they always fine something. They are not dummies. ;-)

Dr John said...

When they were in it was all about having Drs sign an order within 48hrs. Everyone had to do this or there would be big fines. If it is a seclusion order it is 24 hrs or we will pay. How does that improve the well being of the pt? Maybe it improves the well being of the chart and the well being of JCAHO.

You are right. If they stop finding things they will be out a job.

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