Tamiflu not effective? Didn't we already know it....?

So Tamiflu is not effective for H1N1? At least not as effective as once was hyped? Ho-hum......

"Conclusion: Neuraminidase inhibitors have modest effectiveness against the symptoms of influenza in otherwise healthy adults. The drugs are effective postexposure against laboratory confirmed influenza, but this is a small component of influenza-like illness, so for this outcome neuraminidase inhibitors are not effective. Neuraminidase inhibitors might be regarded as optional for reducing the symptoms of seasonal influenza. Paucity of good data has undermined previous findings for oseltamivir’s prevention of complications from influenza. Independent randomised trials to resolve these uncertainties are needed." BMJ 2009;339:b5106

There never was any real data of true efficacy. I had posted on this before. Yes, it reduced the number of days of infection....by 1.3 days!! But we were repeatedly told that Tamiflu was the 'miracle drug' that was going to save the world from this vile and super-virulent H1N1 pandemic. Governments stockpiled tons of Tamiflu. And Roche was laughing all the way to the bank.

So now we are told that supporting detailed data has been concealed by Roche.

Hospital errors - more action needed

Salma Khalik of the Straits Times picks up the thread again today on hospital errors in a report entitled "Make hospital and docs more accountable". Well done.

I had posted a comment on this previously.

The restructured hospitals have generally done well in making their systems and procedures more accountable. But not necessarily more transparent. Much of the accountability, unfortunately, appear to have been put in place only for accreditation purposes.

The vogue at the moment is to seek accreditation with the US based Joint Commission International (JCI). In this accreditation exercise, reduction of hospital errors is one of the parameters assessed. It therefore became important that the hospitals have systems in place to deal with hospital errors. Or at least have the semblance of being able to deal with errors. But do the hospitals really want to know? If they really want to know they must have in place s system not just for reporting, but one also to audit the reporting, and not just expect to randomly uncover cases of non-reporting.

What do hospitals and the MOH do with these numbers? Do they really want to know the true incidences of errors? Just because there are reporting processes in place, and we can crank out statistics of some sort, shouldn't lull us into thinking that risks of hospital errors have been adequately mitigated.

Anecdotally, I know of cases of obvious practice errors, that go unreported. Recently, a wife of a friend of mine had to be wheeled back into theatre because of an error committed during surgery. I am quite certain the incident was not reported.

Reporting systems need to be audited, and the audit findings made public. Otherwise it will remain a sham. So should it be for hospital reporting - be it for surgical errors, medication errors or nocosomial infections.

Richard Feynman - What can we learn about the science in Climategate?

Richard Feynman was a bit of a hero to me when I was first getting into science. He was a great physicist and Nobel Prize laureate, and possibly one of the great scientist of our times. Although not a physicist I was drawn to his writings for that rare and genuine love for science he shared, and the honesty and integrity that he expressed in the science that he practiced.

The following are some of Feynman's quotations that are instructive to us:

"No government has the right to decide on the truth of scientific principles, nor to prescribe in any way the character of the questions investigated. Neither may a government determine the aesthetic value of artistic creations, nor limit the forms of literacy or artistic expression. Nor should it pronounce on the validity of economic, historic, religious, or philosophical doctrines. Instead it has a duty to its citizens to maintain the freedom, to let those citizens contribute to the further adventure and the development of the human race."

"The first ... has to do with whether a man knows what he is talking about, whether what he says has some basis or not. And my trick that I use is very easy. If you ask him intelligent questions — then he quickly gets stuck. It is like a child asking naive questions. If you ask naive but relevant questions, then almost immediately the person doesn't know the answer, if he is an honest man."

"The exception tests the rule. Or, put another way, "The exception proves that the rule is wrong." That is the principle of science. If there is an exception to any rule, and if it can be proved by observation, that rule is wrong."

"Religion is a culture of faith; science is a culture of doubt."

"Looking back at the worst times, it always seems that they were times in which there were people who believed with absolute faith and absolute dogmatism in something. And they were so serious in this matter that they insisted that the rest of the world agree with them. And then they would do things that were directly inconsistent with their own beliefs in order to maintain that what they said was true."

"Science is a way of trying not to fool yourself. The first principle is that you must not fool yourself, and you are the easiest person to fool."

"Learn from science that you must doubt the experts. As a matter of fact, I can also define science another way: Science is the belief in the ignorance of experts."

"The only way to have real success in science, the field I’m familiar with, is to describe the evidence very carefully without regard to the way you feel it should be. If you have a theory, you must try to explain what’s good and what’s bad about it equally. In science, you learn a kind of standard integrity and honesty. "

He also related an interesting account of the now infamous oil drop experiment which was also associated with 'tricks' that scientists use:

"We have learned a lot from experience about how to handle some of the ways we fool ourselves. One example: Millikan measured the charge on an electron by an experiment with falling oil drops, and got an answer which we now know not to be quite right. It's a little bit off because he had the incorrect value for the viscosity of air. It's interesting to look at the history of measurements of the charge of an electron, after Millikan. If you plot them as a function of time, you find that one is a little bit bigger than Millikan's, and the next one's a little bit bigger than that, and the next one's a little bit bigger than that, until finally they settle down to a number which is higher.

Why didn't they discover the new number was higher right away? It's a thing that scientists are ashamed of - this history - because it's apparent that people did things like this: When they got a number that was too high above Millikan's, they thought something must be wrong - and they would look for and find a reason why something might be wrong. When they got a number close to Millikan's value they didn't look so hard. And so they eliminated the numbers that were too far off, and did other things like that. We've learned those tricks nowadays, and now we don't have that kind of a disease."

As it is, the physicists of the American Physics Society are themselves embroiled in the Climategate controversy, with charges of interest conflicts. Quite obviously they do not consider the sciences as being settled in any way. See here and here. They physicists in the APS should learn from Feynman.

Flat earth

Third Medical School - Quo Vadis?

Things have been very quiet ever since the last announcement in September 09 about a possible tie up between NTU, TTSH and Imperial College (some people say Karolinska?) for a 3rd Medical School in Singapore.

Word has it that progress has been slow because of turf issues. Not surprising though, if that were true. There are a lot more turf issues here then there were with Duke-NUS. Who sits in the driver's seat is critically important. There are 3 players here, Imperial College (or KI?), NTU and Tan Tock Seng Hospital. Imperial College would want to have a big say if they are to be tempted to come in. But unlike Duke-NUS, where SGH provided an easy walkover, the TTSH would not be so pliant I think. And understandably so too. TTSH over the years have built an almost enviable iconic role in doctor training. Students love going to TTSH for their posting, and rank them highest among the hospitals. They would not (and should not) lie down so easily and give away their core mission to a foreign institution.

But I am only speculating here. I really have no idea what's happening here and what state of discussion the 3rd Medical School at. But I worry that there is some element of truth in my conjectures. I don't want to see TTSH lose their mission, and submit to an external agency. If I had my way, I would like to see TTSH firmly in the driver' seat. NUS/NUH had somehow disappointingly sold their soul, and seem to have lost their mission for medical education. I hope the mistake will not be repeated for TTSH.

Procrustes and the climate

In Greek mythology, Procrustes was a not so nice guy who prey on tourist passing through his territory. He had an iron bed (actually 2...) where he made his 'guests' lie in. He would essentially work on each guest to make them fit the bed. If the legs were too long, he would just amputate them...etc...

In science, this is called committing a Procrustean crime. Wikipedia explains a Procrustean solution as being:
"the undesirable practice of tailoring data to fit its container or some other preconceived stricture. A common example from the business world is embodied in the notion that no résumé should exceed one page in length.

In statistics, instead of finding the best fit line to a scatter plot of data, first choose the line you want, then select only the data that fits it, disregarding data that does not, so to "prove" some point you are making. Its a form of deception that rhetoricians make so to forward their own interests at the expense of others. The unique goal of the Procrustean solution is not win-win, but rather that Procrustes wins AND the other loses. In this case, the defeat of the opponent justifies the deceptive means."

Sound familiar? Seems to me that this was what the climate scientists were doing. They had a model of global that they knew had to be right. Just too bad that some of the data didn't quite fit in with the model. So they just did what Procrustes did.

Interestingly there is actually a Procrustes analysis of climate data. Even though the context is a little different. :)

There is a nice simple write up about theoretical thinking here.... something even I can understand; even though the climate scientists seem to have difficulty with these concepts.

"The second reason you can't prove a theory true is that there is never just one theory that fits the facts. A theory is really just a narrative. A tale that explains. But stories can be told very differently. In a sense, there are always an infinite number of theories that fit the facts."

But for climate science, we are told repeatedly that the science is settled. Theory proven.

Procrustes would have been proud.

Climate change and flat-earthers - the emergence of dogma.

Did anyone else notice the Straits Times editorial today about climate change? It was entitled "To climate control, add thought control".

The opinions expressed in the editorial was reasonable enough but what was really scary was the leader to the editorial, on the top left hand corner of Page 2, under the caption Viewpoints....

"The science of climate change and its conclusions are settled. The sceptics must be denied, or precious time will be lost in futile disputation."

Conclusions settled? Sceptics must be denied? Seems to me that AGW has indeed moved from a scientific hypothesis to become scientific dogma and orthodoxy. It is ironic that they label sceptics as flat-earthers.

Just to make things clear with regards to my position....I have no vested interest in taking sides in this debate. I am inclined to believe global warming is happening, but I remain unconvinced that it is entirely man-made.