1:1 Blood Resuscitation, Round 2.

[Ronald Gross]

Gotcha.  On that I do agree.

Take care,
Ron

>>> <htaed_rd at 123mail.org> 2/14/2008 1:44 PM >>>
On Thu, 14 Feb 2008 12:08:35 -0500, "Ronald Gross" <Rgross at harthosp.org>
said:
> Tim,
> 
> Sorry to ask, but what exactly is/was your point?

If Dr. Mattox was not just being polite when he wrote "YES, I agree.  
It will be a great session, and I don't really  know who will
will win.   It will all be in the  delivery," then the research
certainly needs to improve significantly. We have far too much that is
the result of persuasive researchers. In stead, we need persuasive
research, not charismatic people driving patient care decisions with
research that does not address what it claims to address. I am not
stating that there is any particular trauma study that this would
describe, but that if the delivery is the deciding factor, the research
is less than adequate.

Tim Noonan. 


> Ron
> 
> >>> <htaed_rd at 123mail.org> 2/14/2008 10:27 AM >>>
> We need to do research that will be large enough to produce enough
> subjects in the various treatment arms that differences in outcome will
> be clear.
> 
> As long as the research is small enough, or not well enough controlled,
> that readers can look at the study and state that it is flawed, we will
> be avoiding progress.
> 
> In 1989 in the cardiology community the question was which
> antiarrhythmic, when given to patients who had had heart attacks, would
> save the most lives (and make drug companies the most money).
> 
> All of the studies prior to that point had been on a surrogate end point
> - which drug did a better job of eliminating PVCs.
> 
> It was taken for granted that, since patients with PVCs die more
> frequently than those without PVCs, that eliminating PVCs saves lives.
> 
> The experts were in agreement on this theory.
> 
> The study was large enough to show survival differences and it was
> allowed to go long enough to produce statistically significant numbers.
> 
> Too many studies are stopped early because the results are "too good to
> justify withholding the study treatment from others," or vice versa.
> 
> How many of these treatments are found to be as beneficial/harmful in
> follow up research?
> 
> How much of this is self delusion by the study designers?
> 
> The result of the CAST (Cardiac Arrhythmia Suppression Trial) was a
> surprise to the cardiology world.
> 
> One of the drugs was leading to study participant deaths at 3 to 4 times
> the rate of placebo.
> 
> The best that could be said about any of the drugs was that it did not
> appear to be killing the patients at a greater rate than placebo.
> 
> All of these drugs are still used, just not very often.
> 
> Cardiologists no longer prescribe drugs to get rid of PVCs to everyone
> who has had a heart attack.
> 
> Antiarrhythmia therapy has become much more conservative (part of that
> is due to implantable defibrillators).
> 
> Had this study not been done, how long might it have taken before
> someone realized this treatment was harmful.
> 
> Almost 20 years later, would this still be the focus of care following a
> heart attack?
> 
> Diseased hearts have PVCs due to underlying disease.
> 
> Giving the patient a rhythm stabilizing drug does not change the disease
> process, at least not for the better.
> 
> This study should have been an example to researchers everywhere.
> 
> In stead, it is viewed as an oddity specific to the cardiology
> community.
> 
> It is not.
> 
> We need research that does an excellent job of controlling for as many
> variables as possible.
> 
> Too much research contains discussions of why variable A is not worth
> controlling for, even though it would have been relatively easy to
> control for it.
> 
> We need to keep these flawed researchers from continuing to do fatally
> flawed research.
> 
> How is it that experienced researchers, with doctorates in their fields,
> continue to engage in research that should not receive passing marks
> from a high school science teacher? 
> 
> The scientific method is one of the most important tools we have.
> 
> Its misuse kills.
> 
> Tim Noonan.
> 
> 
> On Thu, 14 Feb 2008 06:03:48 -0800, "Sise, Mike MD"
> <Sise.Mike at scrippshealth.org> said:
> > So there is controversy over 1:1. How do we answer the question? Is a
> > randomized trial justified or is it promising enough to just do it? On
> > the one hand, we spent over 40 years using the intellectually attractive
> > "balanced salt solution" lactated ringers without examining its impact.
> > And blood transfusion therapy during the same interval may have been
> > dictated by the technology that allowed fractionated blood banking - we
> > abandoned whole blood. On the other hand, the results of 1:1 appear
> > extremely promising. Pre-treatment Informed consent will be out of the
> > question. Soooo, how about it Ken, Karim, Ron, Tim, all you
> > trauma.org-istas.
> >  
> > Mike Sise
> > San Diego
> > 
> > "Scripps Information Security" 
> > ------------------------------------------------------------------------------
> > This e-mail and any files transmitted with it may contain privileged and
> > confidential information and are intended solely for the use of the
> > individual or entity to which they are addressed. If you are not the
> > intended recipient or the person responsible for delivering the e-mail to
> > the intended recipient, you are hereby notified that any dissemination or
> > copying of this e-mail or any of its attachment(s) is strictly
> > prohibited. If you have received this e-mail in error, please immediately
> > notify the sending individual or entity by e-mail and permanently delete
> > the original e-mail and attachment(s) from your computer system. Thank
> > you for your cooperation.
> > 
> > 
> > ==============================================================================
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/ 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/ 
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/ 
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/