Helpful pie-charting

So, as I said in my last post, one of the things I do for a living is read (and evaluate) clinical trials. Much of the math and statistics remains beyond the ability of my pea-sized math brain to understand. But I do often catch it when the authors are trying to pull a fast one on me. And that irks me.


Dear Scientist,


If you insist on including graphs as scientifically "meaningful" as the one below in your really, really important medical study, you will be laughed at. Then I will wield Janiece's Shovel of Doom (TM) and make you go away.




xoxoxo,
Neurondoc

Thank God for Biostatisticians!

I work in the medical field. That's a big "Duh!", I know. Part of my job as a physician is to keep up-to-date in my field (neurology). Most of the meaningful neurology articles published in reputable journals come in the form of clinical studies. And those clinical studies, whether prospective randomized placebo-controlled trials or retrospective observational case series studies, include statistics.

I hate statistics. Really, I do. Why, you ask? Well, that's because my stats course in medical school consisted of lectures from a biostats grad student on 8 or 10 successive Friday afternoons. This grad student did not want to be there, and neither did we. It was poorly taught, and (certainly in my case) poorly learned. I swear that I came out of med school with only one statistics "fact" in my head -- p values should be greater than 0.05 (P> .05) for the study results to be significant. Let's just say that this minimalistic view of biostatistics was not really adequate for a practicing physician.

I'm not here to teach or explain statistics (God, no!), but I have learned quite a bit more useful methods of evaluating the adequacy of statistical analyses over the past few years. I greatly appreciate the biostatisticians in my (professional) life (thank you! thank you!).

And so I present this video for your viewing pleasure (found on youtube, of course). If you aren't interested in statistics or scientific analyses, then feel free to move along. But it had me laughing out loud.

Bad patient

I've been a bad patient lately. I still haven't started physical therapy, a month after the neurosurgeon instructed me to. Work has been busy, and I never seem to remember to call during daylight hours. But I called today, and I'll be starting in about 10 days. I know that going back to work full-time in January set me back some -- I had no transition. I had been working 2 hours per day, then BLAM! I was working 8 hours. Given my current position, it has been hard to work a reduced schedule. Everyone wants something from me. And if they don't want it now, they want it tomorrow. It's nice to be popular, but there are limits.

But this isn't why I am a bad patient. I am about to willfully disregard the instructions from one of my doctors. If y'all remember, I had a deep vein thrombosis in my right leg, part of which migrated to my left lung (pulmonary embolus) as a bonus a week after the surgery. That blood clot bought me 6 months on rat poison ... er, I mean a blood thinner (Coumadin or warfarin). They want my level between 2.0 and 3.0. It's been 2.5 or 2.6 since early December, and I have forgotten my Coumadin dose only twice since I started taking the stuff. The hematologist put me on a crazy regimen -- 6 mg on Sun and Wed and 4 mg the rest of the days. But it clearly works, since my levels have been perfect. Today I had my blood checked, and the result was 2.8. I figured that he'd leave the dose alone. But I got a call from the nurse this afternoon instructing me to increase the dose to 6 mg alternating with 4 mg. I thought what the hell? but didn't say that out loud. I asked her if she was sure if that was correct, as my levels have been rock-solid on the other dose. She said that that is what she was instructed to tell me.

I have an appointment with the hematologist this upcoming Thursday, and I have decided to ignore his instruction. I am going to keep taking the Coumadin as I have been until I talk with him. I am not sure if I received instructions meant for a different patient, which would make sense. I have enough medical knowledge (duh) to make my own decisions, although I hate it when my own patients do that. We'll see what he says on Thursday.

Cover your mouth and nose when you sneeze

Your public health notice for the day. You're welcome.

What She Said

You know, I really can't add a thing to this article. I only wish that the morons of the world (ahem, Jenny McCarthy) would read it with an open mind and actually learn something. But then again, pigs'd fly first. Instead, credulous people choose to believe in crackpot theories and revile people who work hard to reduce sickness in the world. Oh, and make death threats against them. Why oh why, do people actually listen to Jenny instead of Amy?

Truly -- while people believe that they are exercising their rights to make their own medical decisions and appropriate medical decisions for their children, inadequate immunization brings a great deal of risk to the population as a whole, as well as to each individual person. Herd immunity is a function of a large enough percent of the population being vaccinated -- if that number too low, herd immunity disappears. You need quite a high percentage of population vaccinated to provide herd immunity for the community. For example, measles and pertussis are rather contagious and may require up to 94% of the population to be vaccinated for that vaccine to confer herd immunity.

Herd immunity confers protection to those who either can't receive a vaccine due to health reasons (immunocompromised, cancer, chemotherapy, infants) or people whose vaccines have failed (they don't "take" in everyone). Therefore, when these "concerned parents" choose not to vaccinate their children, they are actually endangering the health of other parents' kids, even if those kids are vaccinated. So while part of me says "fuck you, evil parents who don't vaccinate their kids, your kids'll pay for it", in reality, it is those who are sick and vulnerable that bear the brunt of these people's folly.

Swine flu!

ThePinkThing is finished with camp. We have an upcoming long weekend of fun and frolicking, then it's the nose to the grindstone in 1st grade. She's enjoyed her summer, splitting it between 2 camps. She has just finished camp at her aftercare program. I think it was a nice program, iwth just the right amount of structured activities and free play.

When I went to pick my daughter up from her last day of camp yesterday evening, I chatted with a friend, the mother of one of ThePinkThing's friends. The mom happened to mention to me that her daughter had just come back to camp after having had swine flu. I was shocked, because I hadn't heard anything about it. TPT's BFF was out all of last week with flu-like symptoms, and I had wondered if she had swine flu, but I hadn't heard anything for sure. TPT had a very brief flu-like illness last week, but she recovered quickly, other than a lingering cough. Now, of course, I am wondering if she had a mild case of swine (H1N1) flu. If so, I am glad, because she will likely be protected during the upcoming flu season. I am also glad because TPT's friend has recovered and looks like she is back to her usual wacky self.

What concerns me is that there was no information passed along to the parents that there had been a documented case of swine flu in one of the campers. Obviously, the director shouldn't mention names, but a general notification would have been appropriate. Fergoshsakes, these people post lice and strep notices all the time. The director said that she was expressly instructed by the main office of the childcare organization (they have multiple locations in the DC area) not to mention that a child in the program had swine flu. She was told not even to mention that one of the kids had a flu-like illness. I believe that this was a very poor decision on the part of the main office, and they will be receiving an irate phone call from a parent who is a physician today (namely me). I tried to find out if swine flu is a mandatory reporting disease to the Health Dept, but that isn't clear. Even if it isn't mandatory to report it to the health dept, it is only common sense and fairness to report a communicable illness to the parents whose children may be affected. Adequate notification is essential when dealing this type of highly communicable and potentially life-threatening (okay, mildly life-threatening) illness.

What acceptable reason could they possibly give me?