May 12th, 2014

Selections from Richard Lehman’s Literature Review: May 12th

CardioExchange is pleased to reprint this selection from Dr. Richard Lehman’s weekly journal review blog at Selected summaries are relevant to our audience, but we encourage members to engage with the entire blog.

BMJ  10 May 2014  Vol 348

Influence of Healthy Candidate Bias in Assessing Clinical Effectiveness for ICDs: I was taught English in a northern British grammar school in the 1960s. This makes a me a bit curmudgeonly about much medical prose, especially from America. Consider this latest BMJ submission from Harvard: ” Lower risks of measured outcomes likely reflect unmeasured differences in comorbidity and frailty. The findings highlight potential pitfalls of observational comparative effectiveness research and support physician consideration of general health status in selecting patients for ICD therapy.” By spending a year in New England I’ve grown used to listening attentively to this kind of stuff and translating it as I go. “Likely” means “probably.”  “Measured outcomes” means “recorded adverse outcomes.” The second sentence jumbles unrelated concepts. “Findings highlight potential pitfalls” is the sort of phrase that would have led to corporal punishment in my day. We were taught that writing was the organization of thoughts and words so that they followed a logical order and rhythm that would make them understandable. I can’t find any connection between the first and second parts of this sentence. If the findings show that important data about comorbidity and frailty are (likely) missing or unrecorded, how does that help physicians take them into account when selecting patients for ICD? And what is this “when selecting patients” about: shouldn’t that read “when discussing ICD implantation with patients?” This is paternalistic shared decision making at its traditional worst: the physician makes the decision on the basis of lousy evidence and the patient shares it.

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