“Expiration date for evidence” seems like a proxy for the ongoing review of a trial’s external validity. If the trial subjects don’t (or no longer) look like your patients, then the study results will probably not carry over either.
If there is medical reversal, these are good examples of medical revision. Part of continuous medical education is asking if a treatment is as relevant as it was when it was tested then compared to now. If we don’t know history, we might not ask ourselves such relevant questions.
Sadly, the device companies use pseudo-education very cleverly to lead CHF and other cardiac patients to feel that their imminent death is around the corner without an ICD. You don't have to say this directly; you can use innuendo. What is worse is that interventional cardiologists hand out these educational materials or post them on their websites.
As usual, great insight. It always boggles my mind how we got to know what we know or we think we know. And you reveal the roots of our beliefs as your day job.
I would like to point out two more studies that are running in the ICD sphere:
British - ICD vs no ICD in EF <35% with MRI scar and nonischaemic aetiology
CMR-GUIDE run by Joseph Selvanagayam at Flinders Unversity, looking at ICD in patients with CMR scar but EF >35%
There should be an expiration dates on research and the clinical situation may well have changed in this circumstance.
But I think once again from the beginning there were people being fooled by randomness and the desire to "do something".
SCD-He FT 2005 reframed: You have a barrel of red and white marbles. There are ~33.1% red ones. (All we know from the study.)
Able draws 706 marbles and gets 240 red or ~34.0%
Claire draws 676 marbles and gets 244 red or ~36.1%
Benjamin draws 630 and gets 182 red or ~28.9%
Should we be surprised and conclude that Benjamin is a great red ball avoider? NO! Look at the upper and lower control limits, essentially 99.7 CIs:
Able's UCL 38.4% and LCL 27.8%
Claire's UCL 38.5% and 27.7%
Benjamin's UCL 38.7% and 27.5%
Medicine hides its ignorance between 2 and 3 sigma.
At 65, there are ABOUT another 20 years of life expectancy. But the SD (standard deviation) of life expectancy at 65 is about 9. Do the math!
I want everyone to live forever (or at least as long as possible without extraordinary means, and medicine can and doeshelp) because to paraphrase the story of Mary talking to Jesus outside of her brother Lazarus' tomb: Death stinks.
But we should try to avoid being fooled by randomness.
I wish you guys would do an RCT on whether to continue indefinite anticoagulation post afib ablation. I was ablated 3 years ago and have had no arrhythmias at all since then. But I am told the standard is for a lifetime on apixaban. I know recurrence is possible, but I am quite sensitive to arrhythmia and think I would feel it if it happened.
“Expiration date for evidence” seems like a proxy for the ongoing review of a trial’s external validity. If the trial subjects don’t (or no longer) look like your patients, then the study results will probably not carry over either.
Aren’t you describing SCIENCE?
If there is medical reversal, these are good examples of medical revision. Part of continuous medical education is asking if a treatment is as relevant as it was when it was tested then compared to now. If we don’t know history, we might not ask ourselves such relevant questions.
Sadly, the device companies use pseudo-education very cleverly to lead CHF and other cardiac patients to feel that their imminent death is around the corner without an ICD. You don't have to say this directly; you can use innuendo. What is worse is that interventional cardiologists hand out these educational materials or post them on their websites.
https://www.sicdsystem.com/en-US/sudden-cardiac-arrest.html
Hi John,
As usual, great insight. It always boggles my mind how we got to know what we know or we think we know. And you reveal the roots of our beliefs as your day job.
I would like to point out two more studies that are running in the ICD sphere:
British - ICD vs no ICD in EF <35% with MRI scar and nonischaemic aetiology
CMR-GUIDE run by Joseph Selvanagayam at Flinders Unversity, looking at ICD in patients with CMR scar but EF >35%
Love to see EPIC SR here. I wonder if the results will ever be published in a journal. I won't hold my breath.
Unfortunately these newer studies are small comfort to those of us with ICD implants, AND taking beta-blocker propanolol for a few years, no less :-)
There should be an expiration dates on research and the clinical situation may well have changed in this circumstance.
But I think once again from the beginning there were people being fooled by randomness and the desire to "do something".
SCD-He FT 2005 reframed: You have a barrel of red and white marbles. There are ~33.1% red ones. (All we know from the study.)
Able draws 706 marbles and gets 240 red or ~34.0%
Claire draws 676 marbles and gets 244 red or ~36.1%
Benjamin draws 630 and gets 182 red or ~28.9%
Should we be surprised and conclude that Benjamin is a great red ball avoider? NO! Look at the upper and lower control limits, essentially 99.7 CIs:
Able's UCL 38.4% and LCL 27.8%
Claire's UCL 38.5% and 27.7%
Benjamin's UCL 38.7% and 27.5%
Medicine hides its ignorance between 2 and 3 sigma.
At 65, there are ABOUT another 20 years of life expectancy. But the SD (standard deviation) of life expectancy at 65 is about 9. Do the math!
I want everyone to live forever (or at least as long as possible without extraordinary means, and medicine can and doeshelp) because to paraphrase the story of Mary talking to Jesus outside of her brother Lazarus' tomb: Death stinks.
But we should try to avoid being fooled by randomness.
I wish you guys would do an RCT on whether to continue indefinite anticoagulation post afib ablation. I was ablated 3 years ago and have had no arrhythmias at all since then. But I am told the standard is for a lifetime on apixaban. I know recurrence is possible, but I am quite sensitive to arrhythmia and think I would feel it if it happened.