Intensive Thoughts #1
Here are four features of bad science we can see in current critical care literature. Can you identify them in a research article?
Here are four features of bad science we can see in current critical care literature. Can you identify them in a research article?
Backwards reasoning
When the researcher pushes an association in a clinical study that makes no sense in real human biology and tries a post-hoc explanation of the spurious association without noticing it's spurious. The researcher’s confused mind will emerge as embarrassingly improvised statements of causality in the Discussion session of the article.
Instance: The half-baked proposition that higher severity scores impact the incidence of stress ulcers in critically ill patients. Link below.
Back to the past: REVISEing Stress Ulcer Prophylaxis
I was surprised and frustrated when I saw the recent pantoprazole RCT to prevent stress ulcers during mechanical ventilation. That was indeed a moment of mixed feelings.
Furor Metanalyticum
The practice of publishing a meta-analysis together with an RCT, taking advantage of your own unpublished data. It's quite common in critical care. Furor metanalyticum is a sign of psychological distress. People who derive self-value from their academic careers try to keep control of the narrative. Be aware!
Instances: The bullshit-cal discussion about chloride (linked below) and the unambitious Canadian SUP study (linked above under Backwards Reasoning).
The Chloride Case
Critical care is a specialty haunted by ghosts. We have created a safe home for them to grow and thrive in our ambivalent minds. On the one side, we are probably the most objective, precise, obsessive, controlling type of physicians. On the other side, our syndromes are vaguely described. The Chloride Case, as I dubbed the ghostly proposition that mild …
Bayesian spin
When a researcher is not satisfied with the results of frequentist analysis, the kind of analysis that tests for the association of exposition and outcome incidence, he tries to deceive you by offering a Bayesian analysis that proves his point. Of course, the audience is mostly unaware that everything is possible in the Magical Kingdom of Bayesian Analysis where the researchers manipulate the priors to prove anything right. The typical formula is “I found no association, but there is a high probability of existing an association that ultimately proves I am right“.
Instances: The Bayesian metanalysis of chloride studies (linked above under Furor Metanalyticum) and this terrifying perpetual sepsis study from France.
Sepsis research is scary
Some expressions trigger anxiety when I am reading research in our beautiful and bewildering specialty. One is sepsis. Another is Bayesian. I never found both words combined. Now you think about combining both words with PERPETUAL. You can imagine how terrified I was at the prospect of a
Terminal Bullshit Status
An advanced form of blindness to marginal utility where the critical care researcher's mind is completely detached from any previous knowledge of human physiology. When in TBS, Critical Care is indistinguishable from Integrative Medicine and other quackeries like prescribing ivermectin for a certain viral disease.
TBS is also the expected end stage of critical care research devoted to syndromes that don't have workable disease models like Sepsis, ARDS, Delirium, and Acute Renal Failure.
Instances: there are plenty of them, but my favorite is the Brazilian "dapagliflozin for everyone" study.
Irrelevant Yet Significant: The DEFENDER study (part 1/2)
I have recently acknowledged there is an ongoing clinical trial of dapagliflozin in patients with organic dysfunction in the ICU. The DEFENDER study rationale and design are here. As we are used to seeing in recent critical care research, the RCT meets the highest standards.
I can almost see a Critical Care Research Bingo Card emerging... :-)