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The problem with Friday

How are you feeling?

Bandolier hates Friday, because Friday is the day when the newspapers and television get hold of some piece of research to headline. Typically it will be one of two types.

The first is some incredibly early piece of research. An example would be that some gene is found linked to baldness or moustache-growing in Welshmen, and we then get quotes telling us how this breakthrough will make a huge difference for bald Welshmen with moustaches and will change their lives. Even if the example were not absurd, the delay between a research discovery and clinical use is substantial, usually measured in decades, as with monoclonal antibodies and TNF.

More irritating is the observational study linking moustache growing to baldness. More bald men have moustaches than men with full heads of hair. Clearly, growing a moustache makes your hair fall out. And then, when numerous experts have pontificated at length, and we are stimulated enough to get a copy of the paper and read it, we find that both of the bald men in the study had moustaches, and neither of the men who had a full head of hair. The numbers are so small that any conclusion is fatuous, before even getting to confounding and issues about causation.

This month Bandolier examines this latter phenomenon with two studies looking at coxibs and upper gastrointestinal bleeding in the real world. Both are big, and both are well done. But in one most patients were on coxibs, and in the other most were on NSAIDs. Numbers of events was small or very small, making interpretation problematical.

How are you feeling?

When you are young, have no medical complaints, and you take no medicines, you should be on top of the world. You certainly shouldn't have much in the way of symptoms or adverse events, because there is nothing for you to have an adverse event to.

Ah, if life were only so simple. In response to a reader's query, Bandolier has been looking at the rather limited literature on adverse nondrug events. There may be little literature, but there are a lot of events. Four out of five members of a population like that described above had at least one symptom over three days. That some were medical students and that the major complaint was fatigue is only a partial explanation.

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