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Thread: Scoliosis Specialists

  1. #16
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    Thanks for the info. I'll respond afer I've had a chance to look at it more this evening. In the mean time, any chance you could also point me in the direction of the analysis you mentioned below.


    Quote Originally Posted by Pooka1 View Post
    Last, there was an analysis recently that shows that most of the published results, even in top-shelf journals, are false forvarious reasons.

  2. #17
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    Why most published results are wrong

    http://www.pubmedcentral.nih.gov/art...?artid=1182327

    Why Most Published Research Findings Are False
    John P. A. Ioannidis
    John P. A. Ioannidis is in the Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece, and Institute for Clinical Research and Health Policy Studies, Department of Medicine, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, United States of America. E-mail: jioannid@cc.uoi.gr

    Abstract

    Summary

    There is increasing concern that most current published research findings are false. The probability that a research claim is true may depend on study power and bias, the number of other studies on the same question, and, importantly, the ratio of true to no relationships among the relationships probed in each scientific field. In this framework, a research finding is less likely to be true when the studies conducted in a field are smaller; when effect sizes are smaller; when there is a greater number and lesser preselection of tested relationships; where there is greater flexibility in designs, definitions, outcomes, and analytical modes; when there is greater financial and other interest and prejudice; and when more teams are involved in a scientific field in chase of statistical significance. Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true. Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias. In this essay, I discuss the implications of these problems for the conduct and interpretation of research.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

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  3. #18
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    @mbarnes

    Thanks for your reply and I am pleased to hear that SpineCor has been making a difference, I have members on my group that are pleased with the results also.

    I just had to question the spam I was getting as 3 different people have spammed my blog using their website address.

    All the best for the future

    Simone
    Scoliosis Support, News, Blog
    Twisted and Curved....I like that in a person
    Harrington rod T5 to L1 (1989)

  4. #19
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    Hola Everyone

    No problem for jumping in or hijacking, I found this all very interesting to read

    Thanks for replying and I will keep visiting this thread.

    Best of luck to all
    Scoliosis Support, News, Blog
    Twisted and Curved....I like that in a person
    Harrington rod T5 to L1 (1989)

  5. #20
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    Sharon, Wow, you certainly gave me a lot to mull over. Thank you for the links. You opened my eyes to even more of the controversy surrounding scoliosis bracing.

    I spent much of Saturday reading the 3 papers you linked and continued on to read many of the papers they referenced.

    In trying to get a handle on where we differ, I keep coming back to the issue of "garbage science" and "worthless". Clearly I was wrong about the current understanding of the effectiveness of bracing. Perhaps our differences though are a matter of semantics. When I think of garbage science, it conjures thoughts of Creation Science and Dianetics (I hope I am not opening a can of worms here). My point is, I don’t think that we can paint previous bracing research with a broad brush and say it is garbage science. Ionnadiis (the 3rd author you linked) made the following comment in a published correspondence related to his paper; “Scientific investigation is the noblest pursuit. I think we can improve the respect of the public for researchers by showing how difficult success is". The very fact that the first paper you referenced was a meta-analysis of the previous research shows that the previous research has some scientific merit. (The paper you cite on the recent thread is another meta-analysis, and I do have comments on it that I will post there.) A key part of these meta analysis's are the assignment of a quality score to the reviewed works. Part of that score relates to how the study is designed and reported, and that is within the control of the researcher. But, part of the quality score is related to the nature of the data. So, one research paper that, say, is examining the different results between two braces may get a lower score if the wearers of those braces are not randomly assigned. That doesn’t mean his research techniques are poor nor is it a bad reflection of his application of the scientific method. So long as the fact is disclosed, it is valid and helpful to report the study. The "Quality" is a statistical tool for the meta-analysis.
    Science is a pursuit of the truth. Those involved with the "pursuit", even though they may not personally find the "truth" deserve our respect.

    I made the point above that the lack of unbraced cohorts in previous studies was limited by ethical concerns. I still think that is a true observation. The recent research you cited may remove these ethical concerns for research going forward. I disagree with you when you say there is no evidence that bracing is effective. There is evidence to suggest that bracing is effective. There is also evidence to suggest that it is not effective (and I thank you again for pointing this out to me). What is lacking is strong or conclusive evidence one way or the other.

    I now agree with you that a randomized trial is both ethical and called for. (But I disagree that is it the "only" way forward). I was interested to read a paper by Dolan (I think) where she reported on a survey that asked patients (and parents) if they would (if offered) participate in a random trial. Very few would participate. Knowing what I know now, I would not let me daughter be randomly assigned to a braced or unbraced group. I can see making the choice for not bracing but, personally, I would not give the power to make that decision to others (so much for noble scientist in pursuit of the truth).

    Finally, I disagree when you say “It is unethical to put a kid in a brace without knowing it is better than no action.” Again, perhaps we are talking semantics here. If you substitute for “unethical” words like “a difficult decision” or “a troubling choice” then I could agree. Many parents here have chosen to brace their child. I don’t think they are unethical because they are not 100% certain it will help.

  6. #21
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    Quote Originally Posted by concerned dad View Post
    Linda, I would be very interested to hear of any early results regarding Chiropractors and the SpineCor. Is
    Perhaps you should ask Dr. Rivard whether he thinks chiropractors are getting the same results.

    --Linda

  7. #22
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    Quote Originally Posted by concerned dad View Post
    Sharon, Wow, you certainly gave me a lot to mull over. Thank you for the links. You opened my eyes to even more of the controversy surrounding scoliosis bracing.

    I spent much of Saturday reading the 3 papers you linked and continued on to read many of the papers they referenced.

    In trying to get a handle on where we differ, I keep coming back to the issue of "garbage science" and "worthless". Clearly I was wrong about the current understanding of the effectiveness of bracing. Perhaps our differences though are a matter of semantics. When I think of garbage science, it conjures thoughts of Creation Science and Dianetics (I hope I am not opening a can of worms here).


    That's only a can of worms to the ignorant and intellectually dishonest. "Creation Science" has been repeatedly adjudicated to be the religion it obviously is which is why it violates the separation of church and state. Now Intelligent Design Creationism has joined that rogue's gallery of nonsense, at least in part of Pennsylvania. Young earth creationism has been dispositively ruled out by myriad lines of scientific evidence for over a hundred years. And Dianetics is clearly a scam to anyone who is even half awake.

    In re semantics, no I think it goes much further. I suggest a widely accepted definition of "garbage science" is an uncontrolled study. That was the case for the brace literature before a certain time. There is no getting around that. I discard all those data. Then there is the general problem of most published results likely being being false anyway.

    (snip)

    Quote Originally Posted by concerned dad View Post
    Science is a pursuit of the truth. Those involved with the "pursuit", even though they may not personally find the "truth" deserve our respect.
    But the problem is that many of the bracing studies are done by the brace inventor who may not have the truth as their only objective or may think truth is their objective but not realize they are letting biases into their analysis. And another problem is the prevalence of folks who claim they are doing science but who are not like all the creationist crowd, most of the chiro crowd, and some of the PT crowd. They either don't understand the scientific method or don't want to understand it.

    (snip)

    Quote Originally Posted by concerned dad View Post
    I now agree with you that a randomized trial is both ethical and called for. (But I disagree that is it the "only" way forward). I was interested to read a paper by Dolan (I think) where she reported on a survey that asked patients (and parents) if they would (if offered) participate in a random trial. Very few would participate. Knowing what I know now, I would not let me daughter be randomly assigned to a braced or unbraced group. I can see making the choice for not bracing but, personally, I would not give the power to make that decision to others (so much for noble scientist in pursuit of the truth).
    I, also, would not participate in a randomized bracing trial involving a hard brace worn 23 hours a day. There is not enough evidence at this point to think bracing is likely to be efficacious.

    In re how to characterize the decision to brace a child, I suggest parents who choose that may be laboring under an incorrect sense of the literature on the efficacy. I think if you ask them, they would tell you bracing works much of the time whereas I don't believe that is at all supported by the literature. At some point I think you have to confront the issue of why many orthopedic types never brace and why they are not sued successfully for malpractice. Isn't that independent proof that the verdict on bracing is out? How do you explain that? How can lay parents possibly trump the knowledge base that results in those guys not bracing kids when their medical license itself is on the line?
    Last edited by Pooka1; 12-21-2008 at 03:03 PM.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  8. #23
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    Quote Originally Posted by LindaRacine View Post
    Perhaps you should ask Dr. Rivard whether he thinks chiropractors are getting the same results.

    --Linda
    Why not just query pubmed?
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  9. #24
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    Quote Originally Posted by LindaRacine View Post
    Perhaps you should ask Dr. Rivard whether he thinks chiropractors are getting the same results.

    --Linda
    excellent idea, I will do that.

  10. #25
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    While not randomized (I also wouldn't participate!), there is evidence that bracing works compared to observtion:


    From the Scoliosis Research Society website:

    Treatment for Those Detected from Scoliosis Screening

    In general, treatment must attempt to alleviate current problems and symptoms, and to ultimately alter long-term natural history. Brace treatment for scoliosis is the most effective primary non-operative method used over the past 40 years. In recent years, refinements have been made in identifying which patients with idiopathic scoliosis may benefit most with this treatment9.

    With the information available in the literature today, it is difficult to speak with absolute certainty about the effectiveness of bracing. There are no level I evidence bracing studies currently in the literature. Though nearly all brace studies are level III or level IV evidence studies, many of them represent important and well-organized research and most conclude that brace treatment is effective in diminishing curve progression10-29. The most common parameter used to assess the effectiveness of brace treatment is the amount of curve progression that occurs, usually with success defined by curve progression of <=5 degrees at maturity. The other parameter used to assess the success of brace treatment is the prevention of surgery. A recent evidence-based review of the literature reported a 20 % to 24 % risk of needing surgery despite best efforts at bracing30. The risk of surgery without any brace treatment in the same patient population is currently unknown. This fact alone emphasizes the importance that a level I evidence study could have in clarifying the effectiveness of brace treatment in preventing the need for surgery. Such a study, a five-year multi-center randomized controlled trial of bracing sponsored by the NIH/NIAMS, is currently underway.

    And, from the NSF website:


    The best proof to me is that these studies were conducted by scoliosis surgeons. If they have any intentional bias, one would think it would be toward bracing not working, as that would be the most fruitful source of new surgical candidates.

    --Linda

  11. #26
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    Quote Originally Posted by LindaRacine View Post
    The best proof to me is that these studies were conducted by scoliosis surgeons. If they have any intentional bias, one would think it would be toward bracing not working, as that would be the most fruitful source of new surgical candidates.
    I reject that. The good ones have more work than they can handle. Try scheduling a kid's surgery over a school break or summer... you better do it way ahead of time or you're SOL.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  12. #27
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    Quote Originally Posted by Pooka1 View Post


    In re semantics, no I think it goes much further. I suggest a widely accepted definition of "garbage science" is an uncontrolled study. That was the case for the brace literature before a certain time. There is no getting around that. I discard all those data. Then there is the general problem of most published results likely being being false anyway.
    Many of the studies on Scoliosis braces are retrospective.
    Retrospective studies do not have control groups. They are uncontrolled studies.
    They are not as valuable as prospective studies however they are not "garbage science".

    By your "widely accepted definition" all retrospective studies are "garbage science".
    I suggest that it is indeed semantics and that your definition is wrong.

  13. #28
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    Quote Originally Posted by concerned dad View Post
    Many of the studies on Scoliosis braces are retrospective.
    Retrospective studies do not have control groups. They are uncontrolled studies.
    They are not as valuable as prospective studies however they are not "garbage science".

    By your "widely accepted definition" all retrospective studies are "garbage science".
    I suggest that it is indeed semantics and that your definition is wrong.
    I was unclear.

    I meant to say all uncontrolled studies are garbage science as far as I know.

    One of my doctoral committee advisers, early in his research for his doctorate, did a study, wrote it up, and gave it to his adviser. The adviser thumbed over to the methods section, saw it there weren't adequate experimental controls and tossed it in the garbage can right then and there without reading any further.

    That made an impression... that guy when on to be a very famous scientist in his field. And the story alone made a huge impression on me and hopefully improved my own research.

    And I'm not clear on whether the retrospective studies don't also have a retrospectively assembled control (natural history) group. If they don't then I discard them also for being uncontrolled.
    Last edited by Pooka1; 12-21-2008 at 03:22 PM.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  14. #29
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    Quote Originally Posted by Pooka1 View Post
    I was unclear.

    I meant to say all uncontrolled studies are garbage science as far as I know.
    "as far as I know" OK, I'll accept that.
    I would guess that your education/background/experience is in a field of science where controlled studies are the norm.
    That is not always the case in the biological sciences. Yes, if a control is possible, there is no excuse for not having one. However, I stated the "excuse" in the case of scoliosis braces (ethics). You opened my eyes that the excuse may not be valid. That doesnt mean that all those who labored believing that a concern for their patients (ethics) whould overide the significance of the scientific method only produced garbage.
    as I said before, Ethics trumps research 101 when live people are involved.

  15. #30
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    Quote Originally Posted by concerned dad View Post
    (snip)That doesn't mean that all those who labored believing that a concern for their patients (ethics) would overide the significance of the scientific method only produced garbage.
    as I said before, Ethics trumps research 101 when live people are involved.
    I don't understand why people would do uncontrolled studies and especially why the editors would allow it to be published.

    There is a clear sense now that it was wrong to do so then because the new guidelines call for controlled studies, no?

    The idea of controlled studies has been around a while including the period when these uncontrolled studies were published. I don't see an excuse here but I'm not a medical researcher... possibly I'm missing something but if so, it hasn't yet been pointed out. If there was some merit to uncontrolled studies, why would the newer studies go to a controlled format?

    Still, science is science and orthopods now throw out those early uncontrolled studies. We know they are discarding these data because many of those studies showed high efficacy rates and yet many orthopods still don't brace as I type.
    Last edited by Pooka1; 12-21-2008 at 05:59 PM.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

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