The Braist Study

[Pooka1]

As the non significant for you uneven distribution of the "succesful" (as you call them) cases in braced group. Suppose the raw data you want as I said you before. Maybe the fun seeing your asbsurd concepts in action not finished yet.

I notice you didn't respond to Leahdragonfly's direct question to you.

[flerc]

Stop to using Leahdragonfly's post to hide your Statistics ignorance!
Worldwide Science Organizations should to know what you are saying here.

[mariaf]

Flerc,

You keep flogging the point that Braist proves bracing is effective--we get that. What you don't seem to get is that many children are being braced when they do not need it AT ALL. So I just must know, how many kids is it ok to brace unnecessarily to save one surgery? Two? Five? How about 10? Or 20? At what point is it unethical to treat many kids unnecessarily to save one surgery?

What if the treatment we were discussing were chemotherapy? Or some type of surgical procedure? Would it be just as ok then to treat many kids unnecessarily just to save one from fusion or some other outcome? At some point there must be a value judgement about the treatment. The editorial that accompanied the Braist article concluded that approx 9 kids are treated unnecessarily to save one surgery. I am so curious what you consider ok in terms of unnecessary treatment percentages?

Flerc,

It's a valid question and one that deserves consideration. The medical field uses 'risk vs. benefit' analyses all the time to weigh treatment options. We are simply asking how many kids do you think it would be OK to brace unnecessarily to save one surgery? You are entitled to feel however you want - I'm not trying to attack you - but again it's a very valid question in terms of the current discussion. In fact, it's almost impossible to weigh the entire issue WITHOUT addressing this question.

[Pooka1]

Flerc,

It's a valid question and one that deserves consideration. The medical field uses 'risk vs. benefit' analyses all the time to weigh treatment options. We are simply asking how many kids do you think it would be OK to brace unnecessarily to save one surgery? You are entitled to feel however you want - I'm not trying to attack you - but again it's a very valid question in terms of the current discussion. In fact, it's almost impossible to weigh the entire issue WITHOUT addressing this question.

Flerc, maybe you could just say whether the number is more or less than one million.

I am coming to realize that there are probably parents who would accept even the remotest chance that some non-surgical treatment might work if it could avoid surgery. That's fine for easy treatments. It is NOT fine for difficult ones.

[flerc]

I still believe you are enough intelligent to understand how serious is what you said and (of course) you were unable to prove.
Worldwide Science Organizations MUST know about it.

[Pooka1]

I still believe you are enough intelligent to understand how serious is what you said and (of course) you were unable to prove.
Worldwide Science Organizations MUST know about it.

I noticed you didn't answer either Leahdragonfly or Maria. I think there is a reason you won't answer.

[flerc]

Even although I would agree with them, it would not clean in anyway what you said and (of course) not proved. There is already no way even deleting the entire thread or banning me.

I noticed you continue without finish your demonstrating. I know why.

Worldwide Science Organizations should to take actions!.

[hdugger]

I'm not particularly pro-brace or particularly anti-surgery - my son likely would have tried either one, if offered and I have no idea how he would have fared with either one. I'm the sissy in the family - he's pretty tough.

The Braist study is all about odds, but making sense of those odds is purely personal.

The odds are - given what we know now, the odds are 50/50 that a "high risk" case will progress to surgery by maturity. Wear a brace for less than 6 hours a day and you leave those odds unchanged. Wear it for 6 to 12 and you cut the risk by half. Wear it for more than 12 hours and you reduce the risk to < 10%. (I don't know where the 'brace 9 for 1 numbers come from - I don't see them in the article or in the editorial. The worst odds I see are 3 for 1)

What do you do with that information? Well, it really depends on your personal circumstances. For one child, that 50% chance of progressing to surgery may seem completely awful, and they'll be willing to brace. For another, the brace is too awful, and they'll take the chance on surgery. No one other than the patient can decide. That surgery freaks me out doesn't mean someone else's kid has to brace - it's all personal. But this study at least tells you pretty clearly what the odds are, and you can work it out yourself from there.

One thing I would say - if the curve is in your lumbar spine, I'd err on the side of bracing. Once a lumbar curve hits a certain size in a teen NOTHING you do is going to keep you from a very significant chance of needing surgery as an adult. Fusing the curve as a teen isn't a fix for the lumbar spine - you're still very likely to need surgery later on to extend the fusion. I'd certainly throw that into the calculation if you're dealing with a lumbar curve. Likewise, surgery for kyphosis is pretty gnarly. If a brace will hold that curve and keep you off the operating table, then I'd try that. But, for those kids with curves just in the thoracic spine - it's a totally personal decision. Now they know the odds.

[Pooka1]

Worldwide Science Organizations should to take actions!.

If you tell me who they are I will personally inform them of this thread. Do they ride in black helicopters?

[flerc]

Of course you don't know that kind of Organizations as nothing having to do with science.
Laugh all what you want. Typical in a perfect fraud as you.
If I would be responsible of this forum I would not be very quit.

[Pooka1]

I still believe you are enough intelligent to understand how serious is what you said and (of course) you were unable to prove.

What did I say and why is it so serious?

[flerc]

It seems I should not continue believing that (first phrase)

[Pooka1]

Pass.

.

.

[leahdragonfly]

<snip>(I don't know where the 'brace 9 for 1 numbers come from - I don't see them in the article or in the editorial. The worst odds I see are 3 for 1)<snip>

Hi hdugger,

The 9 for 1 figure I quoted was from the full-test of the editorial when it was first published. Unfortunately it has now been changed to a 100-word free preview and you can not view the full-text editorial unless you want to pay $15.

A curious comment in the original Braist article that most people seem to miss is that 42% of the children in the brace group who never wore their brace were successful. These non-compliant kids were nontheless counted as bracing successes, since they counted all children in the brace group based on intent to treat, rather than focusing on those who actually wore the brace. So those 42% of the braced kids whose brace was under the bed or in the back of the closet were counted as bracing successes! How is that possible?

[hdugger]

The 9 for 1 figure I quoted was from the full-test of the editorial when it was first published. Unfortunately it has now been changed to a 100-word free preview and you can not view the full-text editorial unless you want to pay $15.

Ah thanks. that explains it. I thought I was going blind. Can you recall what they based that number on? Is it that most kids who are braced are less high risk than this group? I just couldn't quite put it in context, since this study was coming up with a brace 3 to save one 1 ratio (or brace 2 to save 1 for more than 12 hours bracing a day)

A curious comment in the original Braist article that most people seem to miss is that 42% of the children in the brace group who never wore their brace were successful. These non-compliant kids were nontheless counted as bracing successes, since they counted all children in the brace group based on intent to treat, rather than focusing on those who actually wore the brace. So those 42% of the braced kids whose brace was under the bed or in the back of the closet were counted as bracing successes! How is that possible?

Yeah, I saw that too. But I think that would have the opposite effect - it would dilute the bracing group with people who weren't actually using the treatment making it seem *less* effective than it actually was in comparison to the control group. I think the overall effectiveness is slightly higher if you just focus on the kids who are actually wearing their brace, so tossing those kids out would have raised the success percentage.

So, I just ignored the overall numbers they reported, since it included all those kids who basically weren't wearing their brace, and focused only on the kids who were wearing it for 6 or more hours a day.