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Posts Tagged ‘evidence based medicine’

Evidence based common sense, is rare entity in medical literature

Posted in Uncategorized, tagged , , , , , , , , , , , , on July 10, 2025|

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A forgotten job function of a Physician

Posted in Uncategorized, tagged , , , on December 11, 2024|

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False enemies in medical practice

Posted in Uncategorized, tagged , , , , , , on November 9, 2024|

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Will meta-analysis really come under an original scientific research ?

Posted in Uncategorized, tagged , , , , , , , , , , , , , , , , , on October 10, 2024|

“In one sense, meta-analysis would come closer to a milder form of ethical plagiarism”

Can meta-analysis really be called as original scientific research ?

No it is not, but some may say yes. It is very difficult to dispute either. But, the fact of the matter is, meta-analyses are not a true science of innovation. It is using some others’ work( sort of intellectual steal ?) done by a group of scientists interested in the same research topic, trying to squeeze more info from these studies. It is a glorified group journal club activity.

Image source & Courtesy http://www.inquasar.com

At best, meta-analysis can be referred to as knowledge and evidence aggregation. Surprisingly, mostof the academia seems to give more weight to meta-analysis, disproportionately more than the original researchers. This is because meta-analytic scientists backed by big journals claim, they can bring out more info out of the original. The assumed scientific superiority of meta-analysis is expected to be downgraded soon, as these sort of evidence aggregation can be done easily by any AI-powered engines. Network meta analysis, by dedicated medical scholastic AI networks can do this in a fraction of a second.

Meta analyses as of now is sitting proudly as crowning glory at the top of evidence pyramid. This is one of the reasons for the false glory surrounding anyone (or anything ) associated with meta-analyses. I doubt whether it really deserve the top slot. (An excellent debate between RCT vs metanalysis) Wish, the meta-analysis taste its own medicine at least once. We need to have a meta-analysis to show it is really superior to other forms of evidence. I cant find one as yet.

What about systematic review ? This looks better, as it has less statistical content , and the researcher is at least compelled to go deep and get enlightened on the topic as they spend months together on the topic.

How is meta analysis different from original research?

There is no new data collection ,no primary hypothesis testing . It primarily focus on summarizing existing evidence. To do it properly, there are certain standards.

  1. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)
  2. Cochrane Handbook for Systematic Reviews of Interventions
  3. MOOSE (Meta-analysis of Observational Studies in Epidemiology)

Ref :Finckh A, Tramèr MR. Primer: strengths and weaknesses of meta-analysis. Nat Clin Pract Rheumatol. 2008 Mar;4(3):146-52.

Positive side of metanalysis

While meta-analyses aren’t original research, it’s a crucial tool for evidence synthesis, research translation informed decision-making.

Flaws of metanalysis

It is a academic business with done studies. So it is 100% retrospective. It might come with irreversible errors. Unless every error in the past studies is accounted for and curated the result of meta-analysis, it can never be foolproof.

Should we get permission from all the authors who did their original studies before doing a meta-analysis?

As long as fair use criteria applies there is no need , but a moral obligation is definitely there . Other wise metanalyses will come closer to a milder form of academic plagiarism of others’ work. (Of course legally and scientifically approved)

Final message

In the world of true scientific research, meta-analyses can not be considered as great scientific work. It is just evidence aggregation, which of course could be meaningful if and only if the studies taken were done properly.

However, meta-analysis has undisputed value in aggregating rare cases, scenarios, diseases, and problems where there are very few published studies. Collecting them together in an organized fashion serves a real good purpose.

Reference

1.Pearson K. Report on certain enteric fever inoculation statistics. Br Med J. 1904;3:1243–6.

2 Smith, Mary L.; Glass, Gene V. (1977). “Meta-analysis of psychotherapy outcome studies”. American Psychologist. 32 (9): 752–760. doi:10.1037/0003-066X.32.9.752.

3. Eysenck, H. J. (1978). “An exercise in mega-silliness”. American Psychologist. 33 (5): 517. doi:10.1037/0003-066X.33.5.517.a.

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A forbidden quote in medical science

Posted in Uncategorized, tagged , , , , , , , , , , , , on September 14, 2024|

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When does a fact become an opinion & vice versa?

Posted in Uncategorized, tagged , , on October 11, 2023| 

When we realise, even class 1-A indication often blinks at the bed side,while class III -C appear to pour more sense, practicing cardiology becomes "Tough and exhilarating” .

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Testing times for EBM : NEJM gets ready & begins a new journey

Posted in Uncategorized, tagged , , , , , , , on January 19, 2022|

The New England Journal of Medicine (NEJM) the premier journal in medicine originated two centuries ago, in 1811, when  John Collins Warren, a Boston physician, along with James Jackson, submitted a formal prospectus to establish the New England Journal of Medicine and Surgery and Collateral Branches of Science as a medical and philosophical journal. 

Subsequently, the Massachusetts Medical Society (MMS) purchased the Journal for US$1 and, in 1928, renamed it to The New England Journal of Medicine.

NEJM’s New Journey

It is 2022, after 200 years of providing explosive knowledge in medical science, MMS  starts a new journal, fresh and bold. It is called NEJM Evidence. Can you guess, what is the need for such a journal now? I think the most battered word in science in current times is probably “ evidence”.  It has a unique character of appearing most sacred as well as scandalous at the same time.

NEJM has remained the torchbearer of almost all advances in the medical field seen in the last two centuries.  It is heartening to note the newborn is named as NEJM evidence. It has come at a critical juncture. I am sure, everyone will acknowledge that we are at difficult crossroads. Overwhelmed with unregulated scientific discoveries and publications, struggling to deal with self-inflicted knowledge pandemic. In the process, we have lost “not only” the ability to ignore trivial health issues “but also” failed to provide simple, cost-effective care to the real patients who desperately need it.

Let us hope, (& wish,) NEJM’s new prodigy will guide medical science towards a successful, meaningful, and ethically fulfilling journey for mankind. Meanwhile, let us pray for every medical scientist to be blessed with the required strength and courage to steer in the right direction, weeding off both academic and non-academic contaminants.

 

 

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FAME 3 fails to defame CABG, cardiologists need not worry though !

Posted in Cardiology -Therapeutic dilemma, Cardiology -unresolved questions, Ethics in Medicine, fame study ffr, Fracional flow reserve, tagged , , , , on November 5, 2021|

News: Series of clinical trials fail to clear the ongoing confusion in the business of cardiac revascularization.FAME 3 is the new addition. 

Caution: A non-academic journal review

There is no secret, about this cold war happening in an incognito mode for territorial rights between cardiologists and cardiac surgeons in glamorous cardiac suits for the past two decades. Of course, we keep believing this is a friendly fight in the overall interest of CAD patients. The ultimate winner should be the patient, not anyone else. Will that happen? Will anyone will allow that to happen? I am not sure.

The FAME3 is a stunning large study from 50 centers FFR guided multivessel PCI, that failed to dethrone CABG (or at least it wanted to sit along with it) I am not a seasoned statistician but definitely can’t understand the logic behind the methodology* and the choice of words in the conclusion from a paper published from a renowned journal.

 

 

(*I can recall an article about Non-inferiority trial  from Lancet (Ref 1) )

FAME 3 aftermaths: A dizzy Interpretation

Before accepting the fact that, FFR guided PCI wasn’t able to show its superiority or to unable to prove its non-Inferiority, while CABG was clearly found to be non-inferior, (rather superior) to PCI, we should take into account an important caveat in the concept of FFR itself, which has at least half a dozen serious hyperemic and non-hyperemic flaws that demanded a more superior,non-hyperemic indices like iFR, RFR, qFR, etc.

Those of you who still believe PCI would be an undisputed modality in multivessel CAD  should take up the challenge and disprove the superiority of CABG by doing the same FAME 3 subset with iFR and other stuff. (Eagerly waiting for the hypothetical iFAME 4 trial)

One more way to Interpret FAME 3: How can we accept FFR guided multivessel PCI as inferior, unless we have an FFR guided CABG (FAME 3 didn’t do this) to compare? Can you guess if only pre-CABG FFR was mandatory criteria, that would have excluded or included important grafts, what would have been the impact of CABG? This is a more dramatic suggestion, that will say sorry to FFR,( the old physiological friend,) and label it as a new villain.

Final message 

Multivessel PCI still has a long way to go before trying to dethrone CABG.  But, strictly scientific cardiologists need not worry much and they can continue to indulge multivessel PCI without FFR, which is no longer unscientific ! Thanks to FAME 3. I think one of the Important indirect consequences (?purpose) of FAME 3 would be, playing the end game for FFR.

Reference

https://doi.org/10.1016/S0140-6736(07)61604-3

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“Unconquered” enemy of scientific research in medicine

Posted in bio ethics, Ethics in Medicine, evidence based cardiology, Medcal research, Medical education, Medical ethics, medical quotes, medical satistics, Two line sermons in cardiology, tagged , , , , , on October 3, 2021|

Is there a solution?

As I understand, we don’t have any. Maybe, we can try this.  No way, I can prevent it from appearing ridiculous for the mainstream scientists.

Truths often lie silently  buried deep (many times intentionally). They definitely deserve an intellectual resuscitation beyond the dirty world of data and evidence. Further, why should experience be considered as enemy of evidence ?

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Which is most important component in any medical research paper ?

Posted in Ethics in Medicine, evidence based cardiology, Medcal research, tagged , , , , , , , , , , , on September 11, 2021|

There are about 30000 scientific journals and two million papers every year. Of which 5000 are in medicine (Ref : World university news) 

Now, take a deep breath and answer this query. What do you think is the most important aspect of any scientific or medical research in the current era ?

Final message

With due respect to all researchers, What do you think is the most important aspect of any scientific or medical research?  This query is very much relevant today. All components are equally important is an easy way out. But, that’s not the pathway that will take us to the truth.

Postamble  

Having answered the above question, no way, we can escape from this question –“Which could be the least important component “?

I guess you got it right. In the current scenario, my choice is striking and is sandwiched in the middle of the 7 responses..

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