[HSF] More on the Traysylol saga

Sun Oct 8 12:27:40 EDT 2006

Publishing in the NEJM is done more for the "Impact Factor" that it 
holds. Every library will have NEJM as it deals with such a wide variety 
of subjects. The same holds true with Circulation - surgical articles 
are posted there too . A times it may be a good thing as it would draw 
attention and educate a wider audience but if not strictly regulated 
then hilarious and sometimes unwarranted conclusions may be drawn from 
an unsuspecting reader.
I think Carpentier's publications in Circulation did more to spread the 
possibility mitral valve repair than all the surgical papers that he 
published !!
Prasanna

Mark Levinson, MD wrote:
>
> On Oct 5, 2006, at 3:21 AM, Ben Bidstrup wrote:
>
>> The power that Journal  Editors have is such that they must be 
>> answerable for their actions. ........ Now if a statistician who has 
>> such an exalted post cannot indicate the weaknesses in this study, 
>> then he should withdraw his paper and offer an apology, to all 
>> readers of the journal, to the public and to patients who suffered as 
>> a result of the non use of aprotinin. He should also be joined in any 
>> action.
>
> Ben:
>
> I appreciate your comments.     We have discussed the role of 
> statistical consultation for each manuscript submitted to the HSF 
> journal during our Board meetings.    Although this seems like the 
> answer for  blocking papers with bad science, there are problems.    
> First of all, not all statisticians agree.    There are many tests 
> that can be applied to the same data, of which the conclusions of each 
> test may be different.    In some cases, one statistical consultant 
> will claim a test is not even valid for the data, while the other 
> insists it is the test of choice.    Who can arbitrate these differences?
>
> Then there is the consistent dilmena of what to do with a statistical 
> result.    Does a p value of 0.05 mean that the study has proved cause 
> and effect?
>
> I agree that statistical analysis is an improvement over the era where 
> there was no statistics.   However, there are misused as well.   One 
> of the problems is that now everyone intrinsically trusts the final 
> conclusions of the statistical analysis.     If a p value is found, 
> then readers believe it establishes truth, and even worse "cause and 
> effect".    Some things that could not be related are forced into a 
> relationship by the presence of a statistical result.
>
> For example, if you were to perform a study about the mortality rate 
> of intubation, you will find the hospital  mortality is higher for 
> intubated patients than non-intubated patients.       Does this mean 
> that intubation caused their deaths?    Even if multivariant analysis 
> shows that intubation is still associated with a higher mortality 
> rate, this does *not* establish cause and effect.   We all know that 
> the cause of death is the disease process which ends up with 
> intubation and the tube is not the cause.       Cause and efffect is 
> only established be eliminating each variable and repeating the 
> experiment until the observation goes away.     Since this is 
> impossible in patient care situations, we utilize less perfect methods 
> initially developed in the behavioral sciences and poorly adapted to 
> our needs in surgery.
>
> Recently there was a paper discussing the falacies of statistical 
> analysis and centering on the t-test (the most common test used in 
> reporting differences between groups).    I was amazed at how limited 
> the scope of the t-test actually is.     After reading this paper, I 
> realized that almost all of the t-tests we use are based on incorrect 
> methods or assumptions.       So, we are standing on soft ground with 
> even the most basic statistical analysis and we must understand this....
>
>
>> Readers of the HSF who feel so inclined, should express their dismay 
>> at this turn of events and send an open email to the editors of the 
>> Journal and to Mr David Armstrong, (David.Armstrong at wsj.com) the 
>> author of the article in the Wall Street Journal (Hal's favourite 
>> medical source). Furthermore, you should encourage your library to 
>> cancel their subscription to the NEJM. The Massachusetts Medical 
>> Society should also be contacted.
>>
>
> Personally, the main failure of the NEJM is that they published a 
> paper on a surgical subject when they are a medical journal.  They are 
> no experts in surgical sciences and should have referred the author to 
> another journal.    They are not set up to evaluate articles on 
> surgical subspecialties.      The results analyzed were surgical 
> endpoints.    I do not know who the reviewers were, but I doubt any 
> surgeon, and particularly any cardiac surgeon, reviewed this paper 
> prior to publication.    Also, whoever reviewed this paper exceeded 
> the normal tolerance for personal diatribes in the discussion 
> section.       Inflammatory statements made in the discussion section 
> of the Mangano paper should have raised a flag and caused a secondary 
> review, or be returned to the author for deletion.       It is my 
> opinion that if the same paper has been submitted to the HSF board, it 
> would have been severely criticized or rejected outright.    But the 
> HSF has cardiothoracic surgeons on its Board while the NEJM does 
> not.    And of course Mangano chose not to submit his paper to the 
> Annals, JTCVS or another respected cardiothoracic journal.   I suspect 
> he knew that such an audience would have no problem finding the 
> weaknesses and rejecting the paper apriori.
>
> Just my opinion....
>
>
> Mark Levinson, M.D.
> Founder, Editor-in-Chief
> The Heart Surgery Forum®
> URL:   http://www.hsforum.com
> Email:  mmlevinson at hsforum.com
>
>
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