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Medical Forum / General / Vision / September 2007

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Randomized-controlled trials necessary to prove causation

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RT - 16 Sep 2007 15:59 GMT
Another interesting article from the New York Times from today's
Magazine Section.

The article looks into the fallibility of scientific "discoveries"
related to health, for example how hormone replacement therapy went from
having such health benefits for women to the discovery that it actually
may elevate the risk of breast cancer.

This article, although about prevention of disease through medication
and diet, is pertinent to this group because it goes into a discussion
about causation, randomized-controlled trials etc.--when and how to take
assertions about preventative methods seriously and when to seriously
question them.

For example, this quote from the article may be helpful to Andrew to
understand why his hypothesis is not being taken seriously on a medical
science-based newsgroup. And for the Bates supporters and Otis, why
everyone is so insistent on proof:

> ...[Researchers] can distinguish associations between two events...[ ]...But they
> cannot inherently determine causation ‹ the conclusion that one event causes
> the other[ ]...As a result, observational studies can only provide what researchers call
> hypothesis-generating evidence ‹ what a defense attorney would call
> circumstantial evidence. Testing these hypotheses in any definitive way
> requires a randomized-controlled trial ‹ an experiment, not an observational
> study ‹ and these clinical trials typically provide the flop to the flip-flop
> rhythm of medical wisdom.

Jumping to the conclusion of article--why it is important to remain
skeptical until a randomized trial proves decisively that results are
consistently reached on a large population--not just observational
studies or anecdotes based on a few cases.

> All of this suggests that the best advice is to keep in mind the law of
> unintended consequences. The reason clinicians test drugs with randomized
> trials is to establish whether the hoped-for benefits are real and, if so,
> whether there are unforeseen side effects that may outweigh the benefits. If
> the implication of an epidemiologist¹s study is that some drug or diet will
> bring us improved prosperity and health, then wonder about the unforeseen
> consequences. In these cases, it¹s never a bad idea to remain skeptical until
> somebody spends the time and the money to do a randomized trial and, contrary
> to much of the history of the endeavor to date, fails to refute it.

Anyway, I think some people on this NG may find this article interesting
and pertinent to discussions about "prevention" and "cure."

"Do We Really Know What Makes us Healthy?"
New York Times Magazine 9/16/2007
<http://www.nytimes.com/2007/09/16/magazine/16epidemiology-t.html?pagewan
ted=1&ref=magazine>

Signature

~RT

Zetsu - 16 Sep 2007 18:11 GMT
Hi,

Cool, thx RT.
I'll check that out.

But randomized controlled trials take a lot of money....
I dont know how to do it....?
otisbrown@pa.net - 16 Sep 2007 18:33 GMT
Dear RT,

Subject:  Correct words.

I would separate the word "cure" from the word
"prevention".

For instance, HIV is preventable, but AIDS may
have no cure.

So when I suggest that PREVENTION is possible,
in no sense do I ever mean "cure".

Best,

Otis

> Hi,
>
[quoted text clipped - 3 lines]
> But randomized controlled trials take a lot of money....
> I dont know how to do it....?
Zetsu - 16 Sep 2007 18:49 GMT
Hi Otis,

I agree, prevention is better than cure.

But many of the poor and gullible patients are given the bad and wrong
treatments by the doctors, and when the glasses are put onto the
patients, instead of curing the poor child it locks their misery and
their nightmares inside themselves, instead of the doctors teaching
them how to prevent it before they ever needed any correction in the
first place. (They could have prevented it by reading the snellen
chart everyday).

So many people is need to be cured, unfortunately, instead of
prevented. But Otis I the plus lens is not the way to prevent the
imperfect sight, the best way is via the rest methods of cure without
glasses.

Plus lenses confuse the eyemind System and can sometimes even be
harmful. For example, it might induce diplopia in some of the
patients. So its risky and also ineffective.

Alex Eulenberg told me he still required intensive use of the plus
lens, after all this time. So it means; even after about 10 years he
was unable to cure the imperfect sight. This is a good evidence to
their uselessness. He should have begun the Original System of
treatment with rest methods, as directed from the Perfect Sight books.

Also, your niece remains not completely cured. You should have taught
her how to cure herself with the rest methods, instead of putting the
stupid and ugly plus lens on her and forcing her to wear it all
through school. That is very bad for the vision, and definitely will
never cure her.

You yourself remain myopic, dont you? That means that you should begin
the rest methods of cure, also, instead of wasting time with the plus
lens et cetera et cetera.
otisbrown@pa.net - 16 Sep 2007 19:09 GMT
Dear Absolutely Bates,

Subject:  Objecting to the minus.

I suggested that we break the problem in to two parts.

1.  Recognizing there is a "problem" with the minus lens.
(The second-opinion people should understand that issue.)
But then the hard part:

2.  What method, or methods can you use to clear
your Snellen from 20/70 to normal.  In this category
there are only two:

a.  Bates, who suggested "relaxation" and "swinging"
and the like, and

b.  Dr. Prentice, who suggested using the plus -- before
the minus.

Both these methods REQUIRE that the person make
an intelligent commitment to the method.  And both
are "difficult" for that reason.  For these reasons,
I hold them separate from "medicine".

So we can agree on part 1, and disagree about part 2.

=================

Zet>  Alex Eulenberg told me he still required intensive use of the
plus
lens, after all this time. So it means; even after about 10 years he
was unable to cure the imperfect sight. This is a good evidence to
their uselessness. He should have begun the Original System of
treatment with rest methods, as directed from the Perfect Sight
books.

Otis> Alex knows what he is doing.  I consider that each
person will have to make up their own mind about it.

Otis> The real requirement is that he keep his
Snellen at better-than 20/40 (pass the DMV).  If long-term
use of the plus is required to meet that goal -- then
so be it.

Otis

> Hi Otis,
>
[quoted text clipped - 32 lines]
> the rest methods of cure, also, instead of wasting time with the plus
> lens et cetera et cetera.
Neil Brooks - 16 Sep 2007 19:36 GMT
Sorry.  Rishi Giovanni Gatti (Zetsu) and Otis Brown are
long-time trolls who haunt s.m.v.

You'd do well to ignore them and wait for
responses from the caring, compassionate eye doctors who
DO also participate in this site.
Zetsu - 16 Sep 2007 19:38 GMT
Hi Otis,

Alex should stop bothering with the plus lens, it isnt doing any good
for him, and just furthers his suffering. I told him in a email: you
should begin the rest methods.

Also, if you need to use something for long-term, its a bit silly
because its wasting your time. You should just use the rest methods
because if you keep at the practice dilligently, the cure becomes
permanent. I mean you dont need to do anything at all; just let the
eyes alone and they will continue to see as long as the eyemind is at
rest. When a person is completely cured, it is difficult to go back
into the imperfect sight, because the eyemind kind of becomes immune
to the strain. So Alex should cure himself completely, permanently,
with the rest methods, then he will not need anything 'long term',
because he will just have perfect sight and that is that, end of his
troubles.

You either come to know what perfect sight is; or you dont.
Dr Judy - 16 Sep 2007 22:54 GMT
> Hi Otis,
>
[quoted text clipped - 7 lines]
> first place. (They could have prevented it by reading the snellen
> chart everyday).

So, Zetsu, did you read the link to the article about clinical
trials?  If you did, you should have a better understanding about why
doctors don't "cure the poor child".

If you know of published, randomised, controlled clinical trials
showing a treatment to be safe and effective in preventing myopia,
please share them with me.  I would love to offer prevention to my
patients.  Unfortunately, I do not know of any proven safe and
effective methods.

Dr Judy
Zetsu - 16 Sep 2007 23:16 GMT
Hi,

>doctors don't "cure the poor child".

Of course, I do not expect the doctors to cure the child.
Their level of idiocy is so great that they will perhaps never learn
such an ability, it is beyond their little pool of ignorance, they
cannot reach it.

I only hope that perhaps the poor child will stumble, by chance, upon
the great book of cures, which is the Perfect Sight trilogy. My
fortunate fate found me the same route.
Zetsu - 16 Sep 2007 23:19 GMT
Hi,

>I would love to offer prevention to my patients.
>Unfortunately, I do not know of any proven safe and

How can reading a snellen chart, once with each eye, possibly be not
safe? Why dont you tell them to try, if it doesnt work then very well,
but if it does then, perfect sight for the rest of their life. But I
will not oblige you to do anything, you can stick to your own
treatments and I will stick to mine. But you find that I persist in my
mockery of the eyecare profession, until a small amount of
intelligence is brought therein.
Neil Brooks - 17 Sep 2007 02:16 GMT
Sorry.  Rishi Giovanni Gatti (Zetsu) and Otis Brown are
long-time trolls who haunt s.m.v.

Lena102938 aspires to troll status based primarily upon her
constant use of anti-eye doctor rhetoric as a
substitute for any actual information.

You'd do well to ignore them and wait for
responses from the caring, compassionate eye doctors who
DO also participate in this site.
p.clarkii@gmail.com - 17 Sep 2007 05:31 GMT
> Of course, I do not expect the doctors to cure the child.
> Their level of idiocy is so great that they will perhaps never learn
> such an ability, it is beyond their little pool of ignorance, they
> cannot reach it.

in numerous posts you claim that you have come to this newsgroup to
learn.   you believe, without having any real proof whatsoever, that
relaxation is the cure for ammetropias.  I suggest that you definitely
read the article that RT alluded to when he started this thread-- you
desperately need to understand it.
Zetsu - 17 Sep 2007 07:57 GMT
I dont need proof, or to prove anything.
The people who need proof is you, because you keep asking for it. So
you should demonstrate the proof to yourself, as described in the
Perfect Sight books.
lena102938 - 17 Sep 2007 03:10 GMT
> > Hi Otis,
>
[quoted text clipped - 14 lines]
> If you know of published, randomised, controlled clinical trials
> showing a treatment to be safe and effective iI

I think they did it in case of HRT, before they started to staff women
with hormones, trying to cure
myth of hot flashes.
Neil Brooks - 17 Sep 2007 03:35 GMT
> I think they did it in case of HRT, before they started to staff women
> with hormones, trying to cure
> myth of hot flashes.

You may want to consider a visit to sci.med.hrt.

If one does not exist, you could always start one.
A.G.McDowell - 20 Sep 2007 05:50 GMT
(trimmed)

>So, Zetsu, did you read the link to the article about clinical
>trials?  If you did, you should have a better understanding about why
[quoted text clipped - 7 lines]
>
>Dr Judy

The COMET trials showed a small effect for one year, statistically
significant (i.e., not due to chance) but clinically negligible. For
that matter, the O'Leary trials of undercorrection showed an effect -
but in the wrong direction; they made things worse. These are
nevertheless interesting, because they establish a causal link between
optical intervention and the growth of the eye, defending the observed
link between widespread literacy and the prevalence of myopia from
explanations that point to changes (e.g. in diet) that occur at the same
time as the introduction of widespread literacy.

It is unfortunate that there appear to be no randomised controlled
clinical trials of interventions which simply attempt to (for instance)
advise the treatment group to perform near work at the furthest
practical distance. Other suggestions can be found in "The Myopia
Manual": www.myopia-manual.de. These days this could include the
substitution of text on computer screens at medium distance for text on
paper at closer distances. Quite apart from the requirement for
statistical expertise in designing and running such a trial, the
declaration of Helsinki appears to require the involvement of medical
professionals, making it impractical for enthusiasts to run such trials
themselves (unlike e.g. Ornithology, where volunteer studies are
accepted and valued). I think I have noticed a degree of polarisation in
this newsgroup. It would be a shame if it was working to prevent or
delay such trials, lest they be seen as "giving in to cranks".
Signature

A.G.McDowell

Neil Brooks - 20 Sep 2007 06:16 GMT
On Sep 19, 9:50 pm, "A.G.McDowell" <mcdowe...@mcdowella.demon.co.uk>
wrote:

> The COMET trials showed a small effect for one year, statistically
> significant (i.e., not due to chance) but clinically negligible. For
[quoted text clipped - 22 lines]
> --
> A.G.McDowell

Au contraire.

For YEARS, I pressed Otis Brown (chief s.m.v. crank) to work with ANY
of the leading American Optometry schools to CONDUCT such a study, but
he seems unwilling to validate, verify, or actually do anything.

He'd rather rail, prevaricate, annoy, evade, obfuscate, harangue, and
hurt.

I don't really understand that, either.

If it were ME, I'd be having face-to-face meetings with the deans of
the optometry colleges asap, and trying to put the issues to the test
once and for all.
Robert Martellaro - 20 Sep 2007 17:47 GMT
>On Sep 19, 9:50 pm, "A.G.McDowell" <mcdowe...@mcdowella.demon.co.uk>
>wrote:
[quoted text clipped - 40 lines]
>the optometry colleges asap, and trying to put the issues to the test
>once and for all.

You'd think so.

Juvenile-onset myopia has not, and is not being ignored by the medical
community. There is research ongoing in this regard, even at the smaller,
slightly less prestigious locations like the Medical College of Wisconsin.
However as mentioned in previous posts, the majority of research dollars are
certainly targeted towards the more serious and debilitating diseases.  

It seems to me that the medical professors and research scientists would be
scrambling, and I mean crawling over each other, testing his hypothesis, if they
felt it had merit (it would help if it wasn't surrounded by dogma and
pseudoscience), and if such testing would not cause harm to the test subjects.

Robert Martellaro
~~~~~~~~~~~~~~~~~~
Optician/Owner
Roberts Optical
Wauwatosa Wi.
~~~~~~~~~~~~~~~~~~
"Science is a way of trying not to fool yourself."
- Richard Feynman
otisbrown@pa.net - 20 Sep 2007 18:54 GMT
Dear A.G.,

Subject:  Run an engineering-scientific study.

Re:  Over-view by second-opinion doctors.

Re:  Intelligent understanding of the person himself.

Re:  Study to be preceeded by an education about
these goals.

==========

AG> Quite apart from the requirement for
statistical expertise in designing and running such a trial, the
declaration of Helsinki appears to require the involvement of medical
professionals,

Otis> Agreed, but is strictly and "over-sight" capacity.

AG> making it impractical for enthusiasts to run such trials
themselves.

Otis>  You do raise a good point.  I personally believe
that a pilot (with the motivation) could be taught how
to measure their refractive STATE (with equipment -- and
under THEIR control).  By having the person himself use
a trial-lens kit, to establish his refractive STATE, the
results could be compiled as a student-project
in an engineering college.  Were the students
truly understood the SCIENCE supporting PREVENTION.

Just one man's opinion,

Otis

> In article <1189979666.537359.157...@n39g2000hsh.googlegroups.com>, Dr
> Judy <mpac...@rogers.com> writes
[quoted text clipped - 38 lines]
> --
> A.G.McDowell
lena102938 - 16 Sep 2007 21:16 GMT
> Another interesting article from the New York Times from today's
> Magazine Section.
[quoted text clipped - 4 lines]
>to the discovery that it actually
> may elevate the risk of breast cancer.

There is no health benefits. Hormones it is , excuse me please,
hormones it is "strong medicine"  not a mass-consumption food
additive
for particular gender..

Side effects of hormones were well known
in wild Eastern Europe for long time,
(30 more years )
 
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