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Posts Tagged ‘lancet’

Trying to become a truly Professional Physician !

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

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Post-amble

Are you a professional physician doctor ?

Honestly I am struggling to become one , it is still a long way to go.

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Trust deficit in medical research and Journals : Need for an unprecedented transparency in declaring conflicts of Interest. 

Posted in Uncategorized, tagged , , , , , , on July 25, 2025|

An Awakening Call to the Guardians of Medical Science

Dr. Venkatesan Sangareddi MD, Former professor of cardiology, Madras medical college,Chennai .India

Medical science remains a cornerstone of human progress, and what we have achieved in the last 100 years is unprecedented. Every one of us is aware that the trust placed in medical research is sacred. Also, the medical profession is expected to remain noble as long as human beings exist. However, as in all walks of life, there must be trade-offs to any positives. Yes, this trust has increasingly become vulnerable, threatened by the pervasive and often subtle influence of conflicts of interest (COI). This is especially explicit in the current medical research landscape.

While the scientific community has made strides in acknowledging and requiring disclosure of COIs, particularly from authors , the measures are proving insufficient. There is a big irony sitting right across us. It is made to look, as if conflicts of Interest (COI) exist only with the authors.

The following article written by the author (Ref 1) calls for an  awakening to every medical journal publishers, regardless of their prestige or impact factor, to recognize their vulnerability . We are expected to adopt a new paradigm of transparency in declaring COI, that extends to every participant in the publication process, including the scientific or ethical committies that approve the study ,the peer reviewers, the publishers and finally to the industries that fund the research.

Reference

1,Click here to download the full paper: A caution: It is a fairly lengthy article. (15 minutes read) Hope the suggestions made in the article are not labeled as unrealistic and possibly crazy as well.

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Evidence based common sense, is rare entity in medical literature

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

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Early TAVR trial : Too early to call

Posted in Uncategorized, tagged , , , , , , , , , , , , , , , on January 18, 2025|

We know TAVI is in the striking distance , to literally take over most aortic valve interventions. From a humble beginning from very high surgical risk with prohibitive comorbidity, now it has almost touched the totally asymptomatic, relatively morbid-free patients. Thanks to the hardware, expertise, and motivation from multiple forces.

While the numbers increase, still the debate between SAVR and TAVR is riddled with speculation, skepticism, and absolute confidence. (Reason: TAVI is a passively fixed valve in a blind procedure at a self-selected annular plane, with no option to remove the crushed native leaflet debris and the resultant complications. Lastly, TAVI’s lifespan* is currently less than half of a mechanical valve. *Expected to improve with polymer valves)

The latest trial to join the litereture is EARLY TAVR in October 2024

Here is a brief, personal comment about the paper for non-academic consumption. Look carefully at the 15th second of the video. Pause it, look at the number over there on the bar of unplanned hospitalisation.

It is a staggering 41.7% in clinical surveillance group, twice more than TAVI group, pathologically tilting the conclusion of the study.

Video source and courtesy https://youtu.be/3wwQEEG4aWg

By the way, what is that unplanned hospital admission? Who is planning that admission in the asymptomatic control group? If 41% of people in the clinical surveillance group needed hospital admission, what does it mean? Does that mean clinical surveillance was so poor that they were rushed to the hospital despite being asymptomatic and stable in the surveillance period?

Why should totally asymptomatic patients get admitted in the control arm, in such huge numbers? You can presume what could be the reason. My guess is too sinister.

Another issue plaguing the RCTs for decades, is continuing even in 2025. That is putting together death, stroke, and unplanned hospital admission as a combined endpoint in the same basket. This is the familiar old cheat story i.e., used to intentionally torture the truth.

Final message

Any student with basic sense of statisitcs can interpret the result of this landmark trial from NEJM correctly. The question we need to ask is, what are the triggers for those unplanned hospital admissions?

Further, it is good for NEJM (and the medical community) not to accept any papers, if the studys’ endpoints are not appropriate or defined with the intention to manipulate, which happens in many sponsored trials.

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Journal club debates : Can “Aim of a study” be wrong ?

Posted in Uncategorized, tagged , , , , , , , , , , on December 18, 2024|

Absolutely yes. The number of studies with such wrong aims is staggeringly higher than we could imagine. “Wrong aim” is probably not the right word to describe them. Rather, we can call them obsolete, duplicate, illogical, unproductive, intentionally fraudulent studies, or studies with a prefixed conclusion.

There is an estimate, that says 95% of papers in nearly 5,000 medical journals, is either junk or written for the sake of publication related to mandatory academic positions or promotions as a budding scholar or faculty. Science has to survive on the shoulders of those rare & genuine 5% souls.

Final message

What is the true “Aim for your study” , I want a very honest answer ?

Yes sir, I agree ,the primary aim is to publish my damn paper and get that promotion !

A related post

There was a brief post about this in the year 2008, 15 years ago. Is it still relevant? Find out for yourself.

Journal club debates : Can a “Aim of a study” be wrong ?

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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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Its time WHO,may declare CVD as a “communicable disease” equivalent

Posted in Uncategorized, tagged , , , , , , , , , , , on August 5, 2024|

*Lifestyle definition

 A set of attitudes, habits, or possessions associated with a particular person or group. and such attitudes, etc, are regarded as fashionable or desirable.

Final message

Communicable disease need not be an Infectious disease like covid. The word “Communicable” shall soon convey a new meaning, to the enlightened. Adverse life styles ,disseminated into the community that vigorously propagate CVD, has every reason to be referred to as a ‘Neo non-infectious pandemic”

Postamble

In the strict sense, CVD is not a communicable disease ,rather the risk factors are …but technically it is.

Reference

1.Rippe JM. Lifestyle Strategies for Risk Factor Reduction, Prevention, and Treatment of Cardiovascular Disease. Am J Lifestyle Med. 2018 Dec 2;13(2):204-212. doi: 10.1177/1559827618812395. PMID: 30800027; PMCID: PMC6378495.

3.A comprehensive narrative review

Click to access ijerph-20-04427.pdf

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Major research papers from NEJM in 2023

Posted in Uncategorized, tagged , , , , , , , , , , on January 25, 2024|

Here is a pleasant surprise, a collectors issue of NEJM year book 2023, is made available free (even for non subscribers, in its website) .It is fascinating to know how fast the Internal medicine has grown. For the busy cardiologists, this will a be refreshing reminder, that there are other important organs and specialties do exist in medicine , with equal breakthroughs and Innovations.

It is indeed an amazing , whirlwind tour of medicine for all those who see medical science as single holistic specialty. It has articles, ranging from from simple clinical studies on postpartum hemorrhage (E-MOTIVE study) from deep inside Africa by Melinda Gate foundation, to Dupilumab for COPD, a stunning monoclonal antibody inhibitor of IL-4 for COPD exacerbations. Shortening tuberculosis treatment with a strategy involving initial treatment with an 8-week Bedaquiline-linezolid regimen (TRUNCATE-TB study) is also a revelation.

Of-course, the mandatory cardiac topics do find a prominent place including the currently omnipresent drug GLP agonist Semaglutide for HFpEF (STEP-HFpEF study). Baxdrostat, an Aldosterone synthase antagonist for treatment-resistant Hypertension, appears promising (BrigHTN).

Final message

However, the crowning glory among all articles appear towards the end of the document, titled Combating misinformation as a core Function of Public Health.

Let me share the link to this PDF document here. Hope it allows open access and there are no copyright issues. Notable articles of 2023 from NEJM .

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Lancet : A 200 year old Idea and a process towards righteousness

Posted in Medical ethics, Uncategorized, tagged , , , , on January 4, 2024|

It was 1823, a genesis of a new thought process in medical publication began. The man who started it all, Dr.Thomas Wakley the founder of the most famous medical journal (Ref 1)

One of his peers described him what sort of an Image he had. “Thomas Wakley the editor as we find him—a courageous challenger of the medical establishment who was usually right and whose language, however tasteless it might seem today, was well suited to the rough and tumble of the time in which he wrote and spoke”

Lancet celebrates 200 year anniversary

On this 200th anniversary Lancet , looks back ,introspects and redefine the agenda of medical profession. We need more and more people like Wakley in the current era.

The Lancet editorial team has come out with two clips one podcast and other a brief video for a total of 28 minutes . If you have enough patience to hear to this , you are probably in the right direction to understand what exactly is the purpose being a Doctor.

After going through the history of medicine through the lens of Lancet, and understanding its original motto, one thing is very clear. Science and research are vital for progression medical science . But, the least important enemy to handle for a healthy planet and mankind is not diseases and afflictions as such, but the unkind behaviour of biased power centres, skewed knowledge, and unhealthy & unequal practices of health care invention and delivery.

Final message

Doctors are primarily healers, all right; more importantly, they are guardians of goodness and justice in healthcare. For this, we need to “Wakleyse the medical education“, meaning, keep a watch always on the true aim and action of medical establishment under which you work . I know, this post might sound pessimistic for many of you, … but that’s where optimistic goals are hidden deep .

Reference

Thomas Wakley (1795–1862): a biographical sketch

sharp2012Download

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