Wednesday, September 10, 2008

Can good science really be half full?

One reason I probably gravitated into science is that I am a very logical thinker. I enjoy following topics such as politics but I don't enjoy debating them because I'm usually thinking, "Why don't these people do outcome measurements with their legislation and report on that when they run for re-election?" Politics simply isn't an evidence-based discipline.

I admit, I can be overly-evidence-based, as evidenced by my prolific referencing in this blog. But that is what I am trained to do as a scientist--come to conclusions based on evidence.

So when a study like this one comes up, I just shake my head. At Cornell, I would have been handed back a paper like this with a big, fat, red "D" on the top. I would have been asked to rewrite my conclusions based on the evidence. These guys got published!

Based on the observation that mirtazapine (Remeron) helped to improve respiratory measurements in stroke patients, a group of scientists decided to try giving Remeron to ten patients, without depression, who had sleep apnea but refused to use a continuous positive airway pressure (CPAP) machine. Editorial note: Those contraptions you blame them?

Here is how they reported their results.

"After 51.9 +/- 8.4 days, the RDI was either reduced (51.9% in "responders" who were identified arbitrarily by a reduction in RDI >/= 25% at any time point of the investigation) or increased (154.4% in "non-responders"). Mirtazapine administration was stopped in the four patients with increased RDI. "

Translation: After an average of 52 days, patients either got better or worse. If you read the fine print where we said we only had 10 subjects in this study, almost half of them got worse.

Mirtazapine may be a probably effective treatment in stroke survivors with obstructive sleep apnea who refuse nasal CPAP treatment. As it may worsen central and mixed sleep apnea, patients who receive mirtazapine to alleviate sleep apnea or to control post-stroke depression with sleep disturbances should be monitored for changes in breathing parameters during sleep.

There is more waffling in that first sentence than I heard in the Democratic and Republican Convention broadcasts combined. Maybe a "probably effective" treatment? If you had cancer and you went in to your doctor and he suggested major surgery, would you be ok with him telling you that maybe this surgery was a "probably effective" strategy? If you were paying $20,000 for an in-vitro fertilization, would you fork that money over if all your doctor had to tell you was that maybe what you were paying him to do was "probably effective"

Translation: We really need to say something good about this medication so we can get published and keep our grant, but it looks like the only way we're going to be able to do that is fill this abstract with long sentences that go in circles and hope readers are in too much of a hurry to do the math.

I used to curse under my breath at those "D"'s my scientific writing professor used to scrawl across the top of my hard-labored assignments. Now I'm grateful he did. Not because it helps me to write this blog, but because when I need to ask for help for any of my own personal medical conditions, I can be much more assertive and judicious about negotiating the course (I'm talking safety as well as effectiveness)of my treatment.

Brunner H. Success and failure of mirtazapine as alternative treatment in elderly stroke patients with sleep apnea-a preliminary open trial. Sleep Breath. 2008 Aug;12(3):281-5. Epub 2008 Mar 28

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