[HSF] More on the Traysylol saga

Tea Acuff tacuff at swbell.net
Sun Oct 8 18:09:15 EDT 2006 

I would just like to add one point to Mark's analysis. I think that it shows how vulnerable even very sophisticated observors can be. That is, statistics NEVER prove causation. It is an unfair question for number theory. At best they show association of specific degree and at worst they show false association. Theory or logic is how we explain the association that we call causation. This may seem trivial or a mute objection to common language, but time and its new insights make many of our causations look quite naive. This trivial misunderstanding blinds us to whole new worlds of possibility.
Tea 


----- Original Message ----
From: prasannasimha <prasannasimha at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Sunday, October 8, 2006 12:57:40 AM
Subject: Re: [HSF] More on the Traysylol saga


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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