Showing posts with label EBM. Show all posts
Showing posts with label EBM. Show all posts

Tuesday, April 2, 2013

Science at Work - Number Of Early Childhood Vaccines Not Linked To Autism

A new study from the Centers for Disease Control and Prevention finds no link between the number of vaccinations a young child receives and the risk of developing autism spectrum disorders.

A new study from the Centers for Disease Control and Prevention finds no link between the number of vaccinations a young child receives and the risk of developing autism spectrum disorders.

Jeff J. Mitchell/Getty Images

A large new government study should reassure parents who are afraid that kids are getting autism because they receive too many vaccines too early in life.

The study, by researchers at the Center for Disease Control and Prevention, found no connection between the number of vaccines a child received and his or her risk of autism spectrum disorder. It also found that even though kids are getting more vaccines these days, those vaccines contain many fewer of the substances that provoke an immune response.

The study offers a response to vaccine skeptics who have suggested that getting too many vaccines on one day or in the first two years of life may lead to autism, says Frank DeStefano, director of the Immunization Safety Office of the CDC.

To find out if that was happening, DeStefano led a team that compared the vaccine histories of about 250 children who had autism spectrum disorder with those of 750 typical kids. Specifically, the researchers looked at what scientists call antigens. An antigen is a substance in a vaccine that causes the body to produce antibodies, proteins that help fight off infections.

The team looked at medical records to see how many antigens each child received and whether that affected the risk of autism. The results, published in The Journal of Pediatrics, were unequivocal.

"The amount of antigens from vaccines received on one day of vaccination or in total during the first two years of life is not related to the development of autism spectrum disorder in children," DeStefano says.

The finding came as no surprise to researchers who study the immune system, DeStefano says. After all, he says, kids are exposed to antigens all the time in the form of bacteria and viruses. "It's not really clear why a few more antigens from vaccines would be something that the immune system could not handle," he says.

The study also found that even though the number of vaccines has gone up, the number of antigens in vaccines has gone down markedly. In the late-1990s, the vaccination schedule exposed children to several thousand antigens, the study says. But by 2012, that number had fallen to 315.

That dramatic reduction occurred because vaccines have become much more precise in the way they stimulate the immune system, DeStefano says.

The sad part is, by focusing on the question of whether vaccines cause autism spectrum disorders, [researchers are] missing the opportunity to look at what the real causes are. It's not vaccines.

- Ellen Wright Clayton, professor of pediatrics, Vanderbilt University

Hardcore vaccine skeptics are unlikely to be swayed by the new research. But many worried parents should be, says Ellen Wright Clayton, a professor at Vanderbilt University who helped write a report on vaccine safety for the Institute of Medicine.

"I certainly hope that a carefully conducted study like this will get a lot of play, and that some people will find this convincing," Clayton says. That would let researchers pursue more important questions, she says.

"The sad part is, by focusing on the question of whether vaccines cause autism spectrum disorders, they're missing the opportunity to look at what the real causes are," she says. "It's not vaccines."

Autism Speaks, a major advocacy and research group, seems ready to move beyond the vaccine issue. Geraldine Dawson, the group's top scientist, praised the new study and says the result should clear the way for research on other potential causes of autism.

These include factors like nutrition, which can affect a baby's brain development in the womb, Dawson says. Other factors could include medications and infections during pregnancy, she says, or an infant's exposure to pesticides or pollution.

"As we home in on what is causing autism, I think we are going to have fewer and fewer questions about some of these things that don't appear to be causing autism," Dawson says.

More coverage and science referring to a recent study showing no link between vaccines and autism. This was covered in the SBM Site
The Final Nail in the Coffin - sorry if some of yo have trouble getting to the site as it appears to be having problems

As one commentator articulated


"The sad part is, by focusing on the question of whether vaccines cause autism spectrum disorders, they're missing the opportunity to look at what the real causes are, It's not vaccines."

If you are interested in a detailed analysis of the science and statistical analysis the SBM article is excellent. The analysis


They sliced and diced the data in a variety of ways looking for correlations and didn’t find any

And does an in depth debunking of the lack of science in the broadside from antivaccinationists who's fear mongering seems to date back to the widely and roundly debunked falsification of data by Andrew Wakefield that was described as the most damaging medical hoax of the last 100 years. He was struck of the GMC register and barred from ever practicing medicine in the UK.

As David Gorski in his title the study had not intended to disprove the relationship between the "toxins" used as part of vaccine make up. This study came as close as one can to disproving that relationship:


Which brings us to “too many too soon.” It appeared to be a “hypothesis” that was impossible to falsify, but DeStefano et al came about as close as it’s ethically possible to do to falsifying the hypothesis. No wonder that all that antivaccinationists are left with are calls for “vaxed versus unvaxed” studies and pharma shill ranting.

Science at work!

Posted via email from drnic's posterous

Tuesday, September 4, 2012

Five Technologies that will Change the Practice of Medicine

Speech Technology

Speech recognition offers efficiencies today but recent innovations and new technologies will expand the horizon of opportunity with speech technologies that will change the human computer interface, simplifying the interaction and offering new and innovative tools that increase efficiency and safety of healthcare delivery and reduce the administrative burden and decrease costs.

Medical Intelligence in the Cloud

We’re facing a tsunami of patient data. The ability to process and leverage this data at the point of care is gone. Cloud based intelligence, analyzing data content and delivering contextually relevant information in real-time will become essential.


Continuous Mobile Monitoring

Our current perspective of a patient’s healthcare record is comprised of snippets of our total healthcare record (imagine a piece of string as the record – all we get is a very short piece when we visit a doctor/facility). Continuous monitoring (wireless, cloud based and automatically monitored and tracked) changes this and offers more complete view of our health record and more important data that is not just single data points but trends and changes.

Personal Health Management

This is becoming essential as we move from a system that disconnects the purchaser from the payer. It’s as if we were buying a car but someone else was paying with no personal financial consequence – we would all buy Ferrari’s, Porsche etc. As we move away from this model, personal responsibility, personal health management tools and PHR's will become essential, not just for capturing and holding the data, but for helping people interpret and manage their own care. We will all become our own care coordinators for ourselves and our extended family, but will need the tools and solutions to help – these will come in form of PHP and health management tools.

Social Media in Healthcare

If World of Warcraft can engage a generation of young adults and teens to stay online, engaged and spending enormous sums of money, the gaming industry is doing something "right". Applying this to health and getting folks engaged is the next frontier. We have already seen that just giving a patient access to their medical record and putting a definitive Diagnosis of obesity has a positive impact on their behavior and general health. Imagine what else you could do with social media and gaming engagement.


But as always - don't forget the patient. As I have noted before Doctor Please Look at Me not Your EMR

This was amplified in a recent article in JAMA: A Piece Of My Mind (JAMA. 2012;307(23):2497-2498. doi:10.1001/jama.2012.4946) that included this drawing from a 7year old girl:



Wednesday, March 14, 2012

Brain imaging, behavior research reveals physicians learn more by paying attention to failure

ScienceDaily (Nov. 24, 2011) — Research on physicians' decision-making processes has revealed that those who pay attention to failures as well as successes become more adept at selecting the correct treatment. The researchers also found that all the physicians in the study included irrelevant criteria in their decisions about treatment.

When seeking a physician, you should look for one with experience. Right? Maybe not. Research on physicians' decision-making processes has revealed that those who pay attention to failures as well as successes become more adept at selecting the correct treatment.

"We found that all the physicians in the study included irrelevant criteria in their decisions," said Read Montague, Ph.D., director of the Human Neuroimaging Laboratory at the Virginia Tech Carilion Research Institute, who led the study. "Notably, however, the most experienced doctors were the poorest learners."

The research is published in the Nov. 23 issue of PLoS One, the Public Library of Science open-access journal, in the article, "Neural correlates of effective learning in experienced medical decision-makers," by Jonathan Downar, M.D., Ph.D., assistant professor of psychiatry at the University of Toronto and Toronto Western Hospital; Meghana Bhatt, Ph.D., assistant research professor at Beckman Research Institute, the City of Hope Hospital, Duarte, Calif.; and Montague, who is also a professor of physics in the College of Science at Virginia Tech.

The researchers used functional magnetic resonance imaging (fMRI) to look at the brain activity of 35 experienced physicians in a range of non-surgical specialties as they made decisions.

The doctors were instructed to select between two treatments for a series of simulated patients in an emergency room setting. "First they had a chance to learn by experience which of two medications worked better in a series of 64 simulated heart-attack patients, based on a simplified history with just six factors," said Bhatt.

Unknown to the test subjects, of the six factors, only one was actually relevant to the decision: diabetes status. One medication had a 75 percent success rate in patients with diabetes, but only a 25 percent success rate in patients without diabetes. The other had the opposite profile. The physicians had 10 seconds to select a treatment. Then they were briefly presented with an outcome of "SUCCESS: (heart attack) aborted" or "FAILURE: No response."

"After the training, we tested the physicians to see how often they were able to pick the better drug in a second series of 64 simulated patients," said Bhatt. "When we looked at their performance, the doctors separated into two distinct groups. One group learned very effectively from experience, and chose the better drug more than 75 percent of the time. The other group was terrible; they chose the better drug only at coin-flipping levels of accuracy, or half the time, and they also came up with inaccurate systems for deciding how to prescribe the medications, based on factors that didn't matter at all."

In fact, all the doctors reported including at least one of the five irrelevant factors, such as age or previous heart attack, in their decision process.

"The brain imaging showed us a clear difference in the mental processes of the two groups," said Montague. "The high performers activated their frontal lobes when things didn't go as expected and the treatments failed." Such activity showed that the doctors learned from their failures, he said. These physicians gradually improved their performance.

In contrast, the low performers activated their frontal lobes when things did go as expected, said Bhatt. "In other words, they succumbed to 'confirmation bias,' ignoring failures and learning only from the successful cases. Each success confirmed what the low performers falsely thought they already knew about which treatment was better." The researchers termed this counterproductive learning pattern "success-chasing."

"The problem with remembering successes and ignoring failures is that it doesn't leave us any way to abandon our faulty ideas. Instead, the ideas gain strength from each chance success, until they evolve into something like a superstition," said Downar.

The fMRI showed that a portion of the brain called the nucleus accumbens "showed significant anticipatory activation well before the outcome of the trial was revealed, and this anticipatory activation was significantly greater prior to successful outcomes," Montague said. "Based on the outcome of the training phase, we were actually able to predict results in the testing phase for each low-performing subject's final set of spurious treatment rules."

The authors state in the article that the formation of spurious beliefs is universal, such as an athlete's belief in a lucky hat. "But the good news is that physicians can probably be trained to think more like the high performers," said Downar. "I tell my students to remember three things: First, when you're trying to work out a diagnosis, remember to also ask the questions that would prove your hunches wrong. Second, when you think you have the answer, think again and go through the possible alternatives. Third, if the treatment isn't going as expected, don't just brush it off -- ask yourself what you could have missed."

"These findings underscore the dangers of disregarding past failures when making high-stakes decisions," said Montague. "'Success-chasing' not only can lead doctors to make flawed decisions in diagnosing and treating patients, but it can also distort the thinking of other high-stakes decision-makers, such as military and political strategists, stock market investors, and venture capitalists."

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Story Source:

The above story is reprinted from materials provided by Virginia Tech, via AlphaGalileo.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

Journal Reference:

  1. Jonathan Downar, Meghana Bhatt, P. Read Montague. Neural Correlates of Effective Learning in Experienced Medical Decision-Makers. PLoS ONE, 2011; 6 (11): e27768 DOI: 10.1371/journal.pone.0027768

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Selecting the right treatment is a tricky business and this paper reveals some interesting results on physicians' decision-making processes
>>>Clinicians who pay attention to failures as well as successes become more adept at selecting the correct treatment.

These findings underscore the dangers of disregarding past failures when making high-stakes decisions," said Montague. "'Success-chasing' not only can lead doctors to make flawed decisions in diagnosing and treating patients, but it can also distort the thinking of other high-stakes decision-makers, such as military and political strategists, stock market investors, and venture capitalists

So when looking for a physicians maybe looking for the more experienced one if not the main characteristic to focus on.

Interesting ideas and helpful in understanding the clinical decision making process

Posted via email from drnic's posterous