Critical Appraisal of Clinical Research – Free full-text /PMC5483707/ – J Clin Diagn Res. May 2017
This article is a primer on how to read research studies: what to look for and what to question.
Evidence-based practice is the integration of individual clinical expertise with the best available external clinical evidence from systematic research and patient’s values and expectations into the decision making process for patient care.
It is a fundamental skill to be able to identify and appraise the best available evidence in order to integrate it with your own clinical experience and patients values. Continue reading
Here is a whole page of some excellent charts from the National Institute of Drug Abuse (NIDA). – July 2019
NIDA has the most accurate, up to date, and pertinent information, since it’s the federal agency whose mission it is to deal with drug abuse, not the CDC or FDA.
Below is the chart showing that it’s illicit Fentanyl that’s increasingly involved. Note that in the numbers for prescriptions, the opioids are almost always not prescribed to the person overdosing.
Spurious Correlations – by Tyler Vigen
Hi, I’m Tyler Vigen! Spurious Correlations was a project I put together as a fun way to look at correlations and to think about data.
Empirical research is interesting, and I love to wonder about how variables work together.
The charts on this site aren’t meant to imply causation nor are they meant to create a distrust for research or even correlative data. Rather, I hope this project fosters interest in statistics and numerical research.
Above chart is just one example of bizarre correlations of unrelated data. (Click on chart to see full site with more of these.)
Pain Program Dropouts: Risk Factors Identified – Medscape.com – Fran Lowry – March 13, 2019
Cleveland Clinic’s low back pain program, called Back on TREK, is a 10- to 12-week program that includes psychological and physical therapy sessions.
“Typically, the patient requirement is about 3 to 4 hours a week in two to three sessions in both group and individual sessions. We try to make it easy for patients,” said Mijatovic.
Despite the team’s best efforts, the dropout rate for the 12-week program was 58% of about 200 participants.
Many patients with EDS have been abused by the Cleveland Clinic, which tends to discount invisible chronic pain, so I’m not at all surprised that more than half drop out. Continue reading
We Are Not A Dashboard: Contesting The Tyranny Of Metrics, Measurement, And Managerialism – by David Shaywitz – Dec 2018
The dashboard is the potent symbol of our age. It offers the elegant visualization of data, and is intended to capture and represent the performance of a system, revealing at a glance current status, and pointing out potential emerging concerns.
Dashboards are the physical manifestation of the ideology of big data, the idea that if you can measure it you can manage it.
I am increasingly concerned, however, that the ideology of big data has taken on a life of it’s own, assuming a sense of both inevitability and self-justification. Continue reading
Often Wrong, Never in Doubt – Six Ways Assumptions Mislead Us – By Chuck Dinerstein — December 19, 2018
Facts are far harder to obtain than assumptions; they may require long periods of observations or expensive, sensitive measurement devices.
Assumptions can be made more easily, in the comfort of the office, frequently papering over or shaping missing data.
One of the unintended results of this approach is that given a limited set of facts, the strength of our conclusions is based upon our certainty in the strength of our assumptions.
Assumptions are just not as sexy as conclusions and are frequently overlooked in our haste to know or do – it is a variation of often wrong, never in doubt. Continue reading
Performance of CMS’ opioid overutilization criteria for classifying OUD or overdose – Feb 2019
Researchers investigated whether the criteria underpinning CMS’ opioid Overutilization Monitoring System could effectively pinpoint Medicare subscribers with opioid use disorder (OUD) or at high risk for overdose.
The program, launched in 2013, asks that plan sponsors take action—such as utilization review, case management, and dose-dependent safety alerts or reimbursement denials—when they do identify high-risk beneficiaries.
Here CMS is finally looking at outcomes of their policy. Meanwhile, the CDC, which even included a requirement to evaluate outcomes in its own guideline, has refused to do so.
I’m almost certain they fear that any outcome measurements will show how ineffective their guideline has been at stemming overdoses and how perversely effective it has been in harming pain patients. Continue reading
As our healthcare system shifts to corporate ownership, the drive to generate profits is destroying healthcare (and all other social services).
When decisions are made on a financial basis instead of patient welfare, inappropriate standardization is applied where human variety is critically important: the fluctuating biochemistry of our individual bodies and how they react to interventions.
Here are 3 PubMed studies showing how research is corrupted by financial motives:
Frequency and reasons for outcome reporting bias in clinical trials: interviews with trialists – free full-text /PMC3016816/ – Jan 2011 Continue reading
California Doctors Alarmed As State Links Their Opioid Prescriptions to Deaths – Heard on All Things Considered – Jan 2019
Of all the hare-brained ideas states have implemented to clamp down on legal and medically appropriate opioids, California has come up with the worst:
Comb through the state’s PDMP for the last three years to find a link from someone who recently died from an overdose of illegal drugs to a doctor who prescribed them opioids up to three years ago, and threaten them with prosecution if the CA medical board doesn’t agree with some aspect of this long-ago prescription.
About a year ago, Dr. Ako Jacintho of San Francisco returned home from traveling to find a letter from the state medical board waiting for him. Continue reading
The trouble with Meta-Analyses – Thoughts About How They Should Contribute to Medical Science and Practice – by Milton Packer – Nov 2017
Many have critically examined the methodology of meta-analysis, and others have set standards for their execution. Despite such guidance, meta-analyses continue to proliferate, but we should ask: do they really contribute?
Esteemed organizations regard the conclusions of a well-executed meta-analysis as a higher level of evidence than a single well-done clinical trial.
This commentary explains why this cannot possibly be true. Continue reading