Silversea Water Cooler: Part 3, Welcome!

[Tothesunset]

My main objective was to provide some solidarity to Lois rather than provoke anyone, but yes I do have some observations. They fall into several main areas, but I suggest five to start.

 

Firstly, to much research is provided by those financing research and have vested interests and this is now more wider than appreciated. There has to be a more robust process before stuff becomes NICE and more widely accepted. This also produces too much research that is willfully dramatised so that researchers can become "famous" and they seek publicity and paid for research.

 

Secondly a fair amount of research findings have a logical reasoning that seems to need to be more closely questioned. Two examples I give to illustrate are (1) it is a fact that a third of all serious road accidents are caused by people under the influence of alcohol. This therefore proves that it is the sober drivers that should be banned and drinking encouraged as that would cause less serious accidents and (b) that the average person in the UK has 1.99999999 legs but there is not a single person with that exact number. Anyone can argue their way out of these two examples because it relies on common sense. Medical research requires knowledge that most do not have and much therefore goes unquestioned. Where this most applies in what I see when I read data of medical research is where more questioning about other factors should be included mostly when profiling data groups of participants where one group (for example) is much more likely to be leading healthier lifestyles and diets as well as the use of the medication. For example when people look at how exercise bebfits people they overlook that people that exercise are more likely to eat well and people that do not exercise are more likely to eat badly. So the conclusion is that exercise is the fdactor and not the healthy lifestyle of those that exercise. I wish I could remember some specifics I have read through but I'm afraid my memory ........ :D

 

Thirdly very often the research uses extrmely small number of participants and the use compound percentages. So for example a piece of reasearch might take a group of say 100 people that have a 10% chance of suffering from some outcome and a medication reduces that by say 20%. They will focuys on the 20% reduction (20 people) and not the 2% overall ie 2 people. So they will suggest that more people ie 100 medicate for an issue that might potentially benefit 2% of a population. Super surveys compound flakey base research.

 

Forthly many GP's are incentivised to almost treat pateints like crops to be harvested. So they earn more if someone is treated with a chronic desease such as diabetes or hypertension. This is simply outrageous.

 

Finally, too many conclusions are not contexturalised. Doctors should be prepared to tell patients more that "something is going to kill you and it will probably not be this - so the decision to medicate must be seen against that background".

 

The essential thing is that it isn't just one of these factors that makes much of research and it's application stink, it is the compound effect of all these factors and many more.

 

Forgive the hurried response but the final lunch prep beckons .....:)

Those factors you've highlighted, and more besides, are well-recognised as factors which influence the validity of medical studies. Undergraduates are well-schooled at recognisiing factors within a study design that can influence outcome. While such studies are too often published, the modern practitioner will have no difficulty in dismissing something that is inherently skewed. Also, reputable medical journals - BMJ, BDJ etc - have rigourous review processes in place to weed out the weak or unstructured papers presented for publication. The press, however, are less discriminating which may go soome way to explaining why people feel they receive conflicting advice.

 

The real problem lies in ''confirmation bias''; that is, scouring the published evidence to find validation for extant methods while ignoring anything that opposes them. It's not just a problem in medicine but in life. For this reason practitioners are expected to make their decisions based on evidence rather than accepting, unquestioningly, current practices.

 

If I may I shall give an example from my own field where properly structured review changed, almost overnight, the established method. When removing a lower wisdom tooth it was usual practice in the UK to use an instrument to reflect the lingual (tongue-side) mucosa (gums, if you like) in order to protect an adjacent nerve (the lingual nerve) which is prone to damage during surgical extraction. Now, about 20 years or so ago, a very elegant study compared this measure with similar routines in other European countries (where the lingual flap protection measure was not routinely used. It was found that the incidence of nerve damage was lower where the lingual protection was not used (with complex statistical analysis reducing the possibility of confounding factors influencing the results - don't ask me how they do this but medical statisticians are highly evolved [if socially-challenged!!] beyond simple averages etc). Clearly the instruments used to protect the nerve were causing more damage than not using them. It changed UK practice in this area overnight.

 

While that may be seen as barely relevant to medicine in general, the principles are important, in fact the principles are fundamental to understanding the effects of treaments. Nowhere is this more clearly seen than in the world of the snake-oil salesman. Yes, homeopathy. There exists not one single, properly-structured study that shows homeopathic therapies to bee effective other than as a placebo (in itself an important effect but in the case of therapy must be isolated as a confounding factor). Yet homeotherapy is popular. People want to believe it works (ie is therapeutic beyond the placebo effect) and is even available as a recognised therapy in France!

 

It's a complicated picture because, in the main, most people get their medical info from the media, websites, friends, the back of a cereal package or whatever. It would be wrong to conflate the confusion that the man on the Clapham omnibus feels to include the medical profession - indeed there are areas that are not understood but we have the benefit of knowing what we don't know and having sound evidence for those things that we know (or think we know!).

 

Or put it this way. If you ask for medical opinion from a Dr you will get such an opinion based on best current evidence, I suggest this is probably more reliable than Auntie Mabel or the bloke down the street who had the same thing last week. Just sayin'../

[UKCruiseJeff]

TTS,

 

Lovely post if you don't mind me saying so .......

 

I think the "big thing" in your post is the focus on the lack of appetite for "contrary evidence" and the lack of reporting and weight given to rebuttals and contrary opinions to so much research. Because the original research is presented in such a plausible and authoritative way and in such respected publications too much weight is placed on it as though it were definitive. On the other hand rebuttal opinion often "appears" less authoritative simply because of it's presentation and appearance of simply arguing.

 

In management there is a similar problem with institutionalised lack of respect for the pursuit of contrary evidence something I became quite interested in with particular respect for different ways of employing and identifying talent and promoting people through the use of profiling and interviewing techniques. But even in day to day management as a great believer in the harnessing of intuitive management decision making I am equally interested in adding to it the evaluation of contrary evidence. The problem is that it takes quite a lot of self-discipline to question your own judgement and seek contrary evidence and then pronounce yourself as previously wrong.

 

I had been unaware that I was routinelyand regularly following such a process until a much loved boss of mine bought it to my attention. What he noticed was that when I had a strongly held opinion about something and someone disagreed, I would quite aggressively soak test the opposing argument but extremely regularly when the person I was interrogating felt enormous pressure I would announce that I preferred their view and had changed my mind. He valued that ability to self-question and not be shy of admitting a change of opinion. Sadly too great a weight is placed on consistency of opinion in politics and management - and I'd say medicine and science - and too few people are admired for changing their mind when either situations change or new information emerges, or simply because they were simply originally wrong. Changing one's mind is seen as a weakness whereas it is an extremely valuable ability and behaviour to be admired. As long as it is used sparingly otherwise it proves you are wrong too often! ;)

 

This is also important when interviewing people for jobs. I'm a great believer in employing people as a result of how they behave rather than just their experience or qualifications so spent a lot of time developing behavioural interviewing skills as the main component of people selection. Once I started developing my skills in this area it was a path of tremendous enlightenment and value. I would often employ more junior people because the probing showed talents that I was looking for, and they therefore were given the opportunity to develop much more quickly than if I had employed someone with greater qualifications and as a reward they were offered accelerated growth opportunities they might not have been offered if their behaviour and latent untapped personality not discovered and released.

 

You might ask someone for example "Tell me about a time in your career that you had a really strong character as a boss .... perhaps a bit of a bully ... and you felt he had made a decision that he was about to act on that was completely wrong – how did you handle it". You then probe until they recall one. All of us have been in these situations. You then probe to find out how they handled it and try to establish how brave they were and how tenacious they were. You then ask for a similar situation when they lost the argument and how they handled that. Contrary evidence. Not a great example but it gives the flavour. When employing senior managers you might wish to establish about times they have changed important decisions they have made.

 

I have gone off subject a bit …. but I guess I'm saying that these problems are often across disciplines … including business and politics.

 

With respect to who to trust viz a vis the doctor or Aunt Mabel, I guess that is true except that a lot of Aunt Mabel's solutions are tried and tested remedies handed down through generations and seems to work - but a lot of stuff that is received wisdom iby docs is untested by the same testing of time. And Aunt Mabel doesn't earn an extra £6 each year my BP is recorded or £75 if I am reclassified as type 2 diabetic rather than borderline and given treatment.

 

I do however fully accept, that I am on to a losing whicket as you are a qualified doctor and I am just an inelegant and uncouth punter! :)

Edited October 4, 2017 by UKCruiseJeff

[Tothesunset]

TTS,

 

And Aunt Mabel doesn't earn an extra £6 each year my BP is recorded or £75 if I am reclassified as type 2 diabetic rather than borderline and given treatment.

I would posit, however, that Aunt Mabel could neither diagnose nor treat such a condition nor be able to give you a differential diagnosis for, say, vertigo or abdominal pain and while syrup of St John's Wort might well seem effective for your tummy ache, it might be less so if it were the first symptom of a tumour!

 

 

I do however fully accept, that I am on to a losing whicket as you are a qualified doctor and I am just an inelegant and uncouth punter! :)

 

I doubt whether anyone minds having their statements challenged except where the challenge is illogical or thoughtless. Neither of which are features of your post on this topic.

[mysty]

And now for something completely different (with no disrespect to the above posts or posters). :) This article appeared today on the CBC news website. I thought the UK Cooler gang might be interested.

 

http://www.cbc.ca/news/world/britain-united-states-relationship-football-1.4317167

[mysty]

And I should have added a teaser relative to the article link above....."A bit of American doesn't hurt anybody," said Amber Piper of Northern Ireland who was shopping for the day on Regent Street." - a quote from the article.

[Camillus112]

Hello Coolers,

Mysty, what a coincidence. Your experience with Fosamax was the same as mine. After the doctor recommended I should discontinue use, I opted for no more med and try more weight bearing exercise. I also take Vitamin D supplement. I will have another bone density scan this year so I'll know how all is working out and I'll share it with you.

[mysty]

Thanks Cam! I also take vitamin D supplement and have upped the Calcium in my diet. I mostly use walking as my exercise (along with housework Ha Ha ). I would be very interested to hear how your approach is working for you!

[UKCruiseJeff]

I was one of the enormous number of people that "imagined" side effects of statins, and beta blockers nearly bleedin' killed me! :)

[mysty]

We are all different and I think it is nonsensical to believe that all bodies will respond the same way to anything we ingest or apply. The meds probably work for many people thus the recommendations. I think we need to pay attention to what our own bodies are telling us. :)

[Tothesunset]

I think we need to be aware that while the basic building blocks of each human are similar, there is enough of a variation to make trying to keep the thing together complex and often frustrating. Why should it be, for example, that children of the same parents with the same upbringing, diet etc are often so different in appearance, temperament and physiology? It's very unsettling. 'Twould be much easier if we were like cars with standardised parts and construction so you could remove the broken bit and put a new bit in.

[mysty]

Indeed TTS! Well said! And if I could be a car I think I would be a Volkswagen Beetle - the old school version! :)

[spinnaker2]

I be a metal flake emerald green karmann ghia convertible

 

Or a Morgan

Edited October 4, 2017 by spinnaker2

[mysty]

OOOOH Spins...exotic! And rightfully so! I am more the "work horse" model. Built for comfort not for speed. :)

[spinnaker2]

Mysty

Now there's an expression I haven't heard in awhile.

[mysty]

Built For Comfort - Canned Heat

 

[jollyjones]

I feel more like my pedal bike, except it's tires are flatter than mine, but I've got a spare.

 

 

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[UKCruiseJeff]

Well all this talk of ill health struck Wifey's car Bridget ill and she required our new and untested defib!

 

I never expected such a small gadget to work but it did! Unbelievable!

 

 

 

 

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[mysty]

JJ...very witty! Giggles ensued! :)

 

J...are you licensed to use that piece of equipment? :) It looks very intriguing!

[MBP&O2/O]

Medical conditions ? I am a 67 year old male who has just had a letter from my practice saying that they suspect I am suffering from post gestational diabetes!

I wondered why I was getting fat!

The mind boggles!

[mysty]

Well, on the plus side, it seems gestational diabetes goes away after delivery. :) Perhaps they meant to send the letter to someone else? In any case...yes indeed the mind boggles!

[Lois R]

Hi friends, first chance I have had to check in today.......thank you all for the replies/opinions/feelings about things.

 

I am not going to start to stress over this anymore..........I will go to the lab tomorrow after work and have them take blood

again but I am just going to continue to try eat healthier and I still try to walk every day after work as well.

This may sound morbid but sometimes I just feel like saying ----- well, I can't post it on here but it all is....if it is my time

to go, then it is my time.

I will let you know how the test results come back though.

 

OH, I don't think I mentioned this before but while I was on my cruise I got a bill from Quest (the lab people) about the tests my cancer guy does every month........these are definitely necessary......well, for some reason the insurance company denied the claim for the month of APRIL:eek:...........we are now in OCTOBER........so anyway, I am not paying

that bill and am in the middle of an appeal:rolleyes:..........denying the claim is BS.......I have had this same test every month

since last summer (when I was originally diagnosed) and they NEVER denied it........so now the Dr's office (Hematologist)

is trying to advocate on my behalf.........these blood tests are to make sure my white count number is good........so far

so good in that area.........the lab wants almost 1300.00..........NO WAY I am paying that.......that is why I have insurance!

I have no idea why they decided to deny the claim:mad: Grrrrrrrrrrrr

Edited October 4, 2017 by Lois R

[MissSophia]

G'Day......

 

Not sure what car I'd choose to be....probably an old jalopy right now 😉

 

Lois...try not to get down, it's not easy being on your own as one does at times have morbid thoughts....I'm a true believer in what will be will be but keeping up beat l find better than feeling low.

 

I once knew of a lady who refused to fly until her family finally persuaded her....or thought they did as they told her when your number is up it's up.......on the day she was due to fly she still refused to go and told her family that whilst her number may or may not come up there were over a hundred people on the same flight who's number may come up....logical thinking?

 

Still in post cruise lazy mode....😊

[mysty]

Greetings Coolers! We tied the record for the number of thunderstorms in any year since 1953 (when record keeping started) yesterday. Number 42 roared through yesterday. Not a record we really were interested in matching though.

 

Lois...you are definitely running into many frustrating situations these days. Hope everything smooths out going forward.

 

Miss S......That is an very interesting story. Logic can be extremely helpful and also challenging! I have to admit I did not ever consider that side of the coin! HMMMMMM!

 

Have a great day all!

[Solo mi!]

karmann ghia or bug-eyed sprite.....

[UKCruiseJeff]

Good Afternoon Coolers!

 

A short walk this morning trying to push back the onslaught of cranky creaky knees! AND I know I mustn't build up my hopes but Ocado claim that they now have the first of this seasons chestnuts in stock.

 

Ludicrously expensive and not compatible with twitchy throat clearing ... but I have added four nets to tomorrows delivery. I know they won't deliver them but at this moment I have at least the hope that they might!

 

 

Number two son is coming for lunch on Saturday and has insisted on a roast meal ie a sort of Christmas meal ..... so a busy kitchen day.

 

Lois, you are on the right track, but now you must do it. Just try snd find distractions to take your mind off of things.

 

 

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