A very close friend of mine has breast cancer. It is a very small tumor, diagnosed on an annual mammogram, requiring confirmation with a breast MRI. She had a lumpectomy today, and I was with her at the hospital. This proved to be an enlightening experience.To put things in perspective, when I was in training and in practice (yes, in the dark ages when we were expected to stay awake AND care for patients for over 48 hours at a time every 3 days),...
Tuesday, 21 December 2010
Monday, 20 December 2010
Why we need collaborations across healthcare sectors
I want to digress from our recent focus on methods and talk a bit about conflict of interest (COI for short). There has been a lot in the press lately about doctors taking money from the biopharmaceutical manufacturers, and doctors inserting unnecessary hardware into patients' hearts and spines. All of this has been happening against the background of a low hum of an ongoing discussion of what constitutes a COI, how much is too much and for what...
Sunday, 19 December 2010
How e-patients can fix our healthcare system
We got a little into the weeds last week about significance testing and test characteristics. Because information is power, I realized that it may be prudent to back up a bit and do a very explicit primer on medical testing. I am hoping that this will provide some vocabulary for improved patient-clinician communication. But, alas, please do not be...
Top 5 this week
There has been significant interest in the p-value this week...Here are the top 5 posts for the week:#1: Why medical testing is never a simple decision#2: Of P values, power, tobacco and cell phones#3: P-values, Bayes and Ioannidis, oh my!#4: Can a "negative" p-value obscure a positive findin...#5: Getting beyond the p-va...
Thursday, 16 December 2010
P-values, Bayes and Ioannidis, oh my!
When I graduated from college in the early 1980s, much to my parents' chagrin, I was not sure what to do with my career. So, instead of following some of my more wizened classmates to Wall Street, I got a job in a very well regarded molecular endocrinology laboratory in Boston. When I look back on that time, almost 30 years ago, so much seems surreal. For example, in those days it took us well over a year to sequence a gene! How about that? Something...
Wednesday, 15 December 2010
Why medical testing is never a simple decision
A couple of days ago, Archives of Internal Medicine published a case report online. Now, it is rather unusual for a high impact journal to publish even a case series, let alone a case report. Yet this was done in the vein of highlighting their theme of "less is more" in medicine. This motif was announced by Rita Redberg many months ago, when she solicited papers to shed light on the potential harms that we perpetrate in healthcare with errors of...
Monday, 13 December 2010
Can a "negative" p-value obscure a positive finding?
I am still on my p-value kick, brilliantly fueled by Dr. Steve Goodman's correspondence with me and another paper by him aptly named "A Dirty Dozen: Twelve P-Value Misconceptions". It is definitely worth a read in toto, as I will only focus on some of its more salient parts.Perhaps the most important point that I have gleaned from my p-value quest...
Thursday, 9 December 2010
1,000 lives per day or 45 lives every hour
In the wake of the recent studies confirming our suspicions that we are no better off today than a decade ago as far as the safety of our healthcare system is concerned, I have been doing a lot of thinking and writing about this issue. The other day I blogged about the fact that there are no simple solutions, yet we must pursue change. Today, this e-mail from 350.org really stopped me in my tracks:Dear friends,Climate negotiations can seem quite...
Wednesday, 8 December 2010
Getting beyond the p-value
Update 12/8/10, 9:30 AM: I just got an e-mail from Steve Goodman, MD, MHS, PhD, from Johns Hopkins about this post. Firstly, my apologies for getting his role at the Annals wrong -- he is the Senior Statistical Editor for the journal, not merely a statistical reviewer. I am happy to report that he added more fuel to the p-value fire, and you are likely to see more posts on this (you are overjoyed, right?). So, thanks to Dr. Goodman for his input...
Tuesday, 7 December 2010
Of P values, power, tobacco and cell phones
Like everything else political, science, as written in the tobacco playbook, is being used for divisive purposes. A new study from Denmark, as reported by WebMD, indicates that exposure to cell phones in utero may influence the child's behavior. The authors are appropriately tempered in their conclusions and subsequent recommendations, responsibly acknowledging the obvious limitations of their research. Yet, to paraphrase one of the authors, what...
Monday, 6 December 2010
"Invisibility, inertia and income" and patient safety
Hat tip to @KentBottles for a link to this storyI spend a lot of time thinking about the quality and safety of our healthcare system, as well as our efforts to improve it. I have written a lot about it here in this blog and in some of my peer-reviewed publications. You, my reader, have surely sensed my frustration with the fact that we have been unable to put any kind of a dent in the killing that goes on within our hospitals and other healthcare...
"When evil walks into a room, it is not wearing horns and a tail"
I was listening to a podcast of Krista Tippett On Being this past weekend while hiking. She was having a conversation with Darius Rejali, an Iranian-born American scholar who studies and writes about torture. His most memorable line was: "When evil walks into a room, it is not wearing horns and a tail". He said that one does not have to read Hannah Arendt to understand the banality of evil.Yet for me, reading Eichmann in Jerusalem did produce...
Sunday, 5 December 2010
Top 5 this week
#5: Could our application of EBM be unethical?#4: Evidence of harm#3: Our nation's shocking Lady Macbeth moment#2: Why are we still paying tobacco executives to kill...And the #1 post this week is... Healthcare quality: 5 ways to stop the insanityThank you all for stopping by, commenting and broadening my thinking with your contributio...
