Yes! This is good Stuff. Every new doc & nurse, especially working in a tertiary institution, should carry a copy of this in their little white lab coat pockets. So helpful in understanding WHY, these Covid studies are so confusing, oppositional & so darn “random” 😉.
Great job explaining the hierarchy or evidence! As a follow up it would be nice to hear your opinion on the benefits of each type i.e. Background info and case studies might be used to justify an RCT. It would also be helpful to address the risk vs benefit for when less than optimal evidence can justify the use of a therapeutic.
I had to look up the term 'confounders' for clarity. What comes to mind is correlation and causation are not one and the same. Aside: spellchecker doesn't like the term, it looks like a typo, but the medical community knows better. See 'confounding factor'.
That is exactly it! Correlation does not always equal causation. Even when it sometimes feels so clear it can simply be correlation rather than causation creating the outcome!
IMO for Covid 19, we should invert the pyramid to use theory, case studies, physician/patient (as a team) clincial judgement to NOW provide treatment during the first 3 days of infection as determined by physician/patient-team clinical judgement (if quick testing not available). This means using safe, off-label medicines as is legally permissable in other circumstnces, to prevent disease blow up.Time is of the essence.
The top of the pyramid takes significant time, money, and labor and is just not feasible in the short term. We saw that with COVID. With people sick, we have to make judgements based on limited data. I think one of the challenges with this though is that it has sowed confusion into both healthcare providers and the public as we have so many highly publicized studies with conflicting results on a spectrum of different COVID therapies. I don't have a better solution, but once this is all said and done it will probably be something worth revisiting so that in future epidemics/pandemics we have a better approach to accruing evidence to support/refute various therapies
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Well done, sir!
Thank you very much for the kind words!
Part of the problem why Ivermectin is not being taken seriously is it lacks RCTs
Hopefully the RCTs currently enrolling will give us some data soon!
Greatly enjoy your videos. Very important and interesting information, clearly explained.
Thanks for the kind words and for following along!
Thanks so much! This is exactly what I need
Our pleasure! Thanks for the kind words and sticking with the channel!
Yes! This is good Stuff. Every new doc & nurse, especially working in a tertiary institution, should carry a copy of this in their little white lab coat pockets. So helpful in understanding WHY, these Covid studies are so confusing, oppositional & so darn “random” 😉.
Thanks for the kind words! We felt this series was overdue! Sorry we didn’t come out with it sooner! More videos to come later this week
Great job explaining the hierarchy or evidence! As a follow up it would be nice to hear your opinion on the benefits of each type i.e. Background info and case studies might be used to justify an RCT. It would also be helpful to address the risk vs benefit for when less than optimal evidence can justify the use of a therapeutic.
Great idea! We will add that to the list of videos for this Understanding the Evidence series!
I had to look up the term 'confounders' for clarity. What comes to mind is correlation and causation are not one and the same. Aside: spellchecker doesn't like the term, it looks like a typo, but the medical community knows better. See 'confounding factor'.
That is exactly it! Correlation does not always equal causation. Even when it sometimes feels so clear it can simply be correlation rather than causation creating the outcome!
IMO for Covid 19, we should invert the pyramid to use theory, case studies, physician/patient (as a team) clincial judgement to NOW provide treatment during the first 3 days of infection as determined by physician/patient-team clinical judgement (if quick testing not available). This means using safe, off-label medicines as is legally permissable in other circumstnces, to prevent disease blow up.Time is of the essence.
The top of the pyramid takes significant time, money, and labor and is just not feasible in the short term. We saw that with COVID. With people sick, we have to make judgements based on limited data. I think one of the challenges with this though is that it has sowed confusion into both healthcare providers and the public as we have so many highly publicized studies with conflicting results on a spectrum of different COVID therapies. I don't have a better solution, but once this is all said and done it will probably be something worth revisiting so that in future epidemics/pandemics we have a better approach to accruing evidence to support/refute various therapies