The Braist Study

[jrnyc]

Sharon...(off topic)...your private messages box is filled

jess...and Sparky

[Pooka1]

LOL! okay Jess. :-)

[hdugger]

Just one example, here is a post from in the middle of a string of journal articles on the purported efficacy of SURGERY, a subject you claim I support blindly, I posted in the thread cautioning about automatically believing these results

Scroll to the top of the thread. Your caution is not about the three surgical articles you post. It, along with the three articles you then post, are a refutation of Weiss's article about the dangers of surgery.

That's because your emotion and personal dislike for me . . .

Care to go back to the pyramid?

There are simple facts in play here. If you want to engage them, I'm game. If you want to, instead, leave the facts behind and take a short trip to the lower rungs of the pyramid, you'll have to find someone else to talk with.

[Pooka1]

Scroll to the top of the thread. Your caution is not about the three surgical articles you post. It, along with the three articles you then post, are a refutation of Weiss's article about the dangers of surgery.

I have no idea what your point is. I posted that caution because *I* was posting a bunch of articles. The caution related to the articles *I* posted. The ONLY reason I posted the caution is because *I* posted a string of articles. That's the ONLY reason.


The caution is about ALL the articles *I* posted in that thread, NOT just the first three. Please follow along.

You AGAIN are trying to speak for me and AGAIN got it completely wrong. And this is honest how?

[hdugger]

The caution is about ALL the articles *I* posted in that thread, NOT just the first three.

I read that thread a second time, and it reads in exactly the same way. You appear to be responding the first post and not the others. I'm not going to argue your motivations, I can only tell you how things appear when they are read.

Unfortunately, without access to your inner workings, your explanation of what you meant in the above reference is no more obvious to the casual reader then your explanation that when you say "smells of politics" you mean that the researcher is doing something innocuous and common. To the casual reader, "smells of politics" means, well "smells of politics." If you mean to imply something different about the researchers in the Braist study, you might want to rewrite those posts for clarity.

[Pooka1]

I read that thread a second time, and it reads in exactly the same way. You appear to be responding the first post and not the others. I'm not going to argue your motivations, I can only tell you how things appear when they are read.

Unfortunately, without access to your inner workings, your explanation of what you meant in the above reference is no more obvious to the casual reader then your explanation that when you say "smells of politics" you mean that the researcher is doing something innocuous and common. To the casual reader, "smells of politics" means, well "smells of politics." If you mean to imply something different about the researchers in the Braist study, you might want to rewrite those posts for clarity.

You're a menace. Stop putting words in my mouth and imputing imaginary motives to my posts. You are batting ZERO. You are NOWHERE on the same wavelength as I am so you are CONSTANTLY wrong.

[Pooka1]

You obviously don't understand what I post nor why I post it. In the interest of honesty you should stop claiming you know what I am posting and why.

That assumes you even care about honesty. I honestly doubt it.

[hdugger]

Not motives - I don't pretend to know motivations. Just simple meaning. I read one post, it looks like it's referring to a specific post. You say something about "smells of politics" and I understand it as meaning that it smells of politics. I don't pretend to know what's inside people's heads - I'm just trying to make sense of the words on the page in front of me based on what I understand those *words* to mean.

What I've told you is my straight reading of those words. Nothing more.

For the rest, I have no interest.

I'm interested in the study, I'm interested in the things in discussions that might cause it to be misunderstood. And I'm profoundly uninterested in the rest.

[hdugger]

Weekend's over and my pumpkin is turning back into a carriage. I'm way over quota and won't be checking in for awhile. So, picture the avatar turned around, and not nodding quietly to whatever transpires.

[Pooka1]

Everyone who present data makes political decisions about WHAT to show and HOW to show it. And they would admit it. I could give some examples from my own work.

If you don't work with data you won't know this.

Here are some general ideas that I have about how data should be shown...

1. for a highly variable result, unless and until you show the average is a good measure of central tendency then you should only show the median.

2. for a highly variable result, you have to account for the variability and how it might affect the result.

3. if variable X is known to affect a long-term outcome Y, leaving out data on variable X is overtly political which is NOT a crime if they leave it out for the purpose of publishing it in a subsequent paper. I expect researchers to get as many pubs as possible from studies so I would never criticize them for this. Nobody would.

With regard to #3 and BrAIST, I am guessing that the 25% "successfully" braced must all or mostly be under 40* because if there is a significant number of patients above 40*, it would call into question the meaning of the conclusions of the first paper. That is, using 50* is a number and you can measure it but what does it mean? They are not going hang themselves out to dry on this.

[Pooka1]

Dr. Hey writes:

While many children and adolescents will have curve that seem to stabilize with bracing or just follow-up without bracing at the end of growth, some curves continue to progress slowly during adulthood. Then, as the curves become larger, and the discs and facet joints in some cases start to give way, the curves can start to progress more rapidly often causing a "spike" in pain and trouble with activities of daily living, and possibly leg symptoms as well.

http://drlloydhey.blogspot.com/2013/...dolescent.html

------

In our natural history study that we are preparing for publication now, as many as 38-40% of patients with scoliosis as a teen continued to progress during adulthood. Lori did say that they are planning to do a 2 year follow-up on their cohort to see if there is any further progression. We both agreed that even long-term follow-up would be helpful -- even lifetime!! Certainly my hundreds and hundreds of adults over the years with progressive painful scoliosis would encourage us to consider such a long-term, full life approach.

http://drlloydhey.blogspot.com/2013/...dolescent.html

[flerc]

It would be really good to have access to a serious study about adult progression, where we may see something as ‘No potential conflict of interest relevant to this article was reported.’ as we may read at the end of this study http://www.nejm.org/doi/full/10.1056...icleDiscussion
Anyway as a summary we may say to parents reading this long thread, that if they see as something important to reach maturity under the surgical range (50°) instead of over it, this study is definitely proving that braces give them reasonable good chances to achieve that goal although their use may be unnecessary.
Certainly if there is a way to know if brace would be unnecessary or not in each case (because 'spontaneous' ending progression), parents should to know about it.

[flerc]

It also should to be taken into account in order to decide to brace or not, that of course scoliosis problem is much more than the curve itself, so there not exist a guaranteed surgical solution.. in fact it seems that in many cases, what only could be guaranteed are big problems.

[Pooka1]

More comments from Dr. Hey about BrAIST and bracing

Compare and contrast these with some of the comments in this thread.

http://drlloydhey.blogspot.com/2013/...-from-hey.html

Today in clinic we were busy as usual, but had plenty of time to spend with each of our guests, including guests from Columbia, SC, Virginia Beach, VA and West Virginia. I actually spent over an hour with the mom and dad of one of our scoliosis patients who has a thoracolumbar curve of 34 degrees, which has been progressive. We had a really good long talk about the possible long-term affect of this particular curve type, especially because this patient also has about a 5 cm trunk shift to the side due to the scoliosis. The dad was not there for the initial visit, and he had lots of questions, and both parents were so glad for this time to learn more before their daughter comes back for her next follow-up xray in a few months. We talked through the choice for scoliosis bracing again with the pro's and con's, and I shared with them the latest clinical research data including Weinstein's recent randomized control trial (RCT), which showed some effect from bracing in some patients at least in the short-term. However, longer term follow-up studies are needed and there is still a "cost" to bracing in terms of the potential psychological/emotional and social effects of wearing a brace for 18+ hours per day for possibly several years. It is sometimes a good idea to get a second opinion when considering bracing, and to take the whole patient and family situation into account.

[mariaf]

"However, longer term follow-up studies are needed and there is still a "cost" to bracing in terms of the potential psychological/emotional and social effects of wearing a brace for 18+ hours per day for possibly several years. It is sometimes a good idea to get a second opinion when considering bracing, and to take the whole patient and family situation into account."


This is possibly one of the most sensible statements I have read on this topic.

It also shows that Dr. Hey has great compassion and understanding towards his patients and their individuality.