Medical Forum / General / Vision / September 2007
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.
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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.
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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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