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Is the new professionalism and ACP's new ethics really just about following guidelines?

The Charter ( Medical Professionalism in the New Millennium.A Physician's Charter) did not deal with just the important relationship of ...

Monday, December 16, 2019

Important changes happening(and happened) in Med School Education what is it about?

Drs. Accad and Koka  discuss  major changes in Medical school education with Dr. Stanley Goldfarb.See here for the podcast.

Are the changes in the medical school curriculum designed to develop social and political advocates rather than well trained physicians?Dr. Goldfarb argues that it is.

The changes are all about population medicine,some thing I have blogged about often before see here.

Courses about climate and medical conditions are already on the curriculum of several medical schools ( see here ).One school mentioned in the linked article actually giving instructions on how to write op-eds about climate change supply a concrete example of Goldfarb's argument.Classes on
environmental justice are also appearing on the schedule.

The degree to which a progressive view point is often part of primary,high school and college education should make it no surprise that med school students are actually requesting courses
in social and environmental justice.



Friday, December 13, 2019

Should journals always report fragility index on a clinical trial.

Interesting article in December 2019 Circulation.(See here.) that discusses the "robustness" of a number of cardiovascular disease trials.

A  purported measure of robustness is the Fragility Index (FI) which is the number needed to move from the non-event group to the event group to turn a statistically significant finding into a non-significant event. A FI of 1 would mean that if one subject was moved from the event to the non event group there would no longer be a significant  difference.

A related concept is  the comparison of the FI to the number of subjects lost to follow up. The trial's results would be considered less robust if the number lost is greater than the FI.

Ridgeon et published a review of 56 RCTs in critical care treatment topics.The median FI was 2 and slightly greater that 40% of trials had a FI of one or less.So does that suggest that clinical guidelines based entirely or in part on those low FI studies are built on shifting sands?


But wait, listen to this criticism of the concept of FI by Dr. F.Perry Wilson before rushing to trash a RCT simply because the FI is too low. Wilson shifts the problem to one of having too much reliance on the p value in the first place.



1)Ridgean EE et al Crit. Care Med 2016,vol 44 ,1278

Thursday, December 05, 2019

What could possibly go wrong when legislators think they know how to practice medicine

Here is another item from the file labelled "I'm so glad I don't practice medicine any longer"

A proposed bill from the Ohio legislature breaks new ground in the land of the  ignorant and absurd.

It would require a physician to transplant an embryo from the fallopian tubes to the uterus of the mother or face a charge of capital "abortion murder".See here