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Clinical trials
I just stumbled on this article
https://www.nature.com/articles/d41586-023-02299-w
which raises the question of the impact of flawed data on clinical trials…I think this also applies to the hernia field and something to be aware of when citing this or that paper as evidence in the decision making process…
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7 Replies
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My impression is that the medical/surgery field is not as scientifically rigorous as other fields are eg you cannot be a physicist without a deep knowledge of statistics.
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This Topic reminded me of a recent (2021) article in Hernia about the flaws in the EHS Guidelines. I am not an expert in data analysis so can’t add much to what is shown in the abstract. Hopefully the EHS is doing a better job before they release their update.
The title of the article is telling.
https://link.springer.com/article/10.1007/s10029-021-02423-7
Original Article
Published: 13 May 2021
Mesh repair for lateral inguinal hernias: a non-evidence-based practice
D. E. Tripoloni, M. I. Canaro García, F. Cassani, M. Zanni & A. Sosa Mercado
Hernia volume 25, pages1183–1187 (2021)“…
Conclusion
The idea that mesh techniques reduce the recurrence rate in all PIHs is not supported by high level of evidence. The NNT for pure lateral hernias was very high and should be interpreted taking into account chronic pain rates and costs.” -
GI – Going to a random surgeon certainly isn’t a good idea, and increases the risk of a bad result. However, the odds aren’t exactly great with research either. Even Dr. Kang is reporting chronic pain odds similar to a Russian Roulette with a 6-shooter.
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Alephy two other quotes come to mind. “No one ever went broke underestimating the intelligence of the American people,” attributed to H.L. Mencken. The other is “There’s a sucker born every minute,” attributed to P.T Barnum.
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Watchful is right for patients that give up and do not do any research. No research at all = the highest chance of a bad result.
alephy’s reference shows that not all publications can be trusted. But it does not show that all publications should be mistrusted. It just shows that people need to understand the sources of the information that they are seeing. The registry based studies seem most valuable. We need more of them.
Thanks for posting this alephy. It reminds of the reply to the “International Guidelines for Groin Hernia Management” by the EHS, from some experts in data analysis. They showed that the premise for reviewing the data used to create the Guidelines was flawed and that the recommendations were not valid. Maybe that’s why the updated Guidelines are so far behind schedule. Years behind.
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Alephy your post reminds me of a quote by Mark Twain. “There are lies, damn lies and statistics.”
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That’s a blow as it leaves little to go on.
Mind you I think it’s all a risk and chuck is right when he says make your choice then pray.
Watchful has it right to with Russia roulette.
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