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The value of identifiable research data

16 Dec

Joel Kallich of Big Health Data wrote me: Over the last 30 years, the government has been reluctant to release identifiable information, first on an

via The value of identifiable research data.

The neuroscience of meditation

16 Dec

Life is a permanent flow: one has to let go the past and present in order to authorize freely the next event of one’s life to happen. If not, a damp will interrupt the flow, which is not a good thing from a sound and balanced living perspective.

One has to live a life which is intrinsically ever changing, and thus which is anxiety provoking.

The only thing that is permanent is one’s awareness of being present in the present moment, which by itself is a blessing one should be grateful for .
At that point meditation, wether by focusing on an action like breathing or walking or by observing with detachment the course of our thoughts and feelings created by our mind or by exercising compassion and loving kindness towards other sentient beings can be of some help.

By the way it has been demonstrated by neuro-scientists that meditation modifies the way the brain functions and even the size of some brain regions.

I read an article on this subject in the November 2014 edition of the journal Scientific American entitled Mind of the Meditator, authored by Mathieux Ricard a Buddhist Monk, Antoine Lutz a research scientist at the Frenh National Institute of Health and Medical Research and Richard J Davidson from the University of Wisconsin-Madison.

They conclude that
even with the requisite cautions, research on meditation provides new insights into methods of mental training that have the potential to enhance human health and well-being”

Time series: what conclusions can we draw from ?

8 Nov

Here below is a link toward a time series published by the French Agency for pharmaceutical safety (aka ANSM). Although the method is well described and doesn’t raise any concern, nevertheless the interpretation that is done from the results in the discussion is subjected to caution.

My expression of concern is motivated by the fact that the authors of the study link the lowering of the incidence of pulmonary embolism to the lowering of sales of third and fourth generations of contraceptive pills.

Indeed a cofactor can explain the concomitant lowering of both time series:
the large warning campaign in the medias with messages about a) the risks attached to those third and fourth generations of contraceptive pills AND b) the risks of pulmonary embolism (ie blood clots in the lung) every woman faces under contraceptive pills, no matter the generation of the contraceptive pill.

Thus the practitioners could have been more attentive to the risk for all their patients and stopped the contraceptive pill, even for the first and second generation of pill, in case of any doubt (eg a phlebitis of the leg or a tobacco addiction).

One thing is for sure: the results of this study show that the campaign in the media had an impact in term of public health, but no causality can be formally drawn between the lowering of the sales of the third and fourth generations of contraceptive pills and the lowering of pulmonary embolism from the results of this study.

The study:

Etude de l’impact de la modification récente des méthodes de contraception sur la survenue d’embolies pulmonaires chez les femmes de 15 à 49 ans (07/11/2014) application/pdf (316 ko)

http://ansm.sante.fr/content/download/69461/886199/version/1/file/Etude-COC-Embolie-pulmonaire2014.pdf

Disability is a full time job

19 Oct

For persons enduring a severe disability, daily life is a full time job.
Two bloggers share courageously with us their daily struggles to show the amount of supplementary efforts they have to produce just to save an appearance of fluidity (not to say normality).
One blogger compares disability with an iceberg whose greater part is not visible:

http://atleastihaveabrain.wordpress.com/2014/09/22/invisible-disability/

An other blogger compares disability with an handful of a limited number of spoons. All seems normal to the surrounding peoples who examine her life as long as she has a sufficient number of spoons left in her hand. But each daily life efforts along the day takes one spoon away from her and when there is only one left in her hand she must stop for the rest of the day and all the activities she has still to do must wait for the next day:

http://www.butyoudontlooksick.com/articles/written-by-christine/the-spoon-theory/

The body of work that economists have done on the field of relationship between happiness and disability shows that not only the disabled persons themselves are less happy but also are their spouses, although this must be tempered by the numerous adaptive strategies that the couple puts in place.
A resume of the scientific literature here:

http://theincidentaleconomist.com/wordpress/adaptation-to-disability/

Journal of Public Economics
June 2008, Vol.92(5):1061–1077, doi:10.1016/j.jpubeco.2008.01.002
Does happiness adapt? A longitudinal study of disability with implications for economists and judges
Andrew J. OswaldNattavudh Powdthavee

http://www.sciencedirect.com/science/article/pii/S004727270800008X#fig1

http://www.sciencedirect.com/science/article/pii/S004727270800008X

Social Science & Medicine
December 2009, Vol.69(12):1834–1844, doi:10.1016/j.socscimed.2009.09.023
Part Special Issue: New approaches to researching patient safety
What happens to people before and after disability? Focusing effects, lead effects, and adaptation in different areas of life
Nattavudh Powdthavee

http://www.sciencedirect.com/science/article/pii/S0277953609006145

Social Science & Medicine
April 2014, Vol.107:68–77, doi:10.1016/j.socscimed.2014.02.009
Is shared misery double misery?
Merehau Cindy MervinPaul Frijters

We find that the events befalling a partner on average have an effect about 15% as large as the effect of own events.

Quoted from :
http://www.sciencedirect.com/science/article/pii/S0277953614001063

Journal of Economic Psychology
August 2009, Vol.30(4):675–689, doi:10.1016/j.joep.2009.06.005
I can’t smile without you: Spousal correlation in life satisfaction
Nattavudh Powdthavee

http://www.sciencedirect.com/science/article/pii/S0167487009000634

Geography

18 Oct

Epidemiology and geography since long ago share common interests.
Epidemiologists have always searched the causes of contagious diseases by locating the very place where the outbreak began. Hence the necessity to develop sophisticated geographical statistical analysis methods in order to localize the point from where the disease originates and then spread across the country. But nowadays those methods are also implemented by searchers to highlight high concentrations of non epidemic, chronic, degenerative diseases in a given country. Here the causal agent is no more a bacteria nor a virus but indeed a spot of concentration of social inequality (or pollution, depending of the research question ). If a geographical concentration exist of lack of knowledge of what a healthy behavior is, or of low incomes restraining access to a healthy life, then the analysis should uncover a higher prevalence of the degenerative disease at less this is the hypothesis. Here below is a link toward a paper very accurate in demonstrating how different geographical statistical analysis methods can lead to a variation in the epidemiological results obtained. This point is crucial to consider because were it Ebola virus or social inequality or educational level context, causes of diseases will always have something to do with geography!
http://jech.bmj.com/content/59/6/517.full.pdf

Big data challenges

7 Oct

Frontiers in Massive Data Analysis, from the National Research Council, nails some of the challenges of big data. But the challenges for massive data go beyond

via Big data challenges.

Are lawyers and pharmacists addicts to tranquilizers ?

13 Sep

Two studies, whose material encompassed the Independent workers health plan data base, analyze the consumption of tranquilizers among various categories of professionals. Lawyers ranked high and pharmacists too.

Lawyers are confronted to conflictual situations by the nature of their work itself and pharmacists are tempted, being surrounded by the product itself; these are the two explanations that I could find for these intriguing results.

Here below are the links to the two studies (I contributed to the second paper).

1-Oxford JournalsMedicine & Health Occupational Medicine Volume 64, Issue 3Pp. 166-171.
Mental health and substance use among self-employed lawyers and pharmacists
S. Leignel1,2,3, J.-P. Schuster1,2,3, N. Hoertel1,2,3, X. Poulain1,2,3 and F. Limosin1,2,3

http://occmed.oxfordjournals.org/content/early/2014/02/09/occmed.kqt173.short

2-Presse Med. 2011 Apr;40(4 Pt 1):e173-80. doi: 10.1016/j.lpm.2010.10.026. Epub 2011 Jan 11.
[Psychotropic medication use by French active self-employed workers].
[Article in French]
Ha-Vinh P1, Régnard P, Sauze L.

http://www.ncbi.nlm.nih.gov/pubmed/21227628

New blood thinners: the French studies in real life.

14 Jul

One more time CNAMTS boys have crunched the numbers from the reimbursement data bases.
They previously had done this exercise in real life for the mediator and they had found cardiac side effects. This time they investigated a new category of blood thinner the NACOs (Nouveaux Anti Coagulants). Unlike the mediator they have concluded that in the short term (3 months) no evidence of any adverse side effects such as bleeding or thrombosis could be found.

The mediator study:

http://www.ncbi.nlm.nih.gov/pubmed/20945504#

The NACOS study of the risk associated with the initiation of treatment with the new blood thinner in anticoagulant treatment naive patients (3 months of follow up):

http://ansm.sante.fr/var/ansm_site/storage/original/application/6372793e0dfaf927308665a647ed0444.pdf

The NACOS study of the risk associated with the change in treatment consisting in replacing Warfarin by the new blood thinner in anticoagulant treatment experienced patients (4 months of follow up):

http://ansm.sante.fr/var/ansm_site/storage/original/application/5504a80da7d6ec6eab26798eebf64fb3.pdf

Pitfalls of retrospective database studies

30 Mar

As you know a part of my work consists to participate in studies based on the extraction from retrospective databases and the analysis of the informations thus retrieved. The eligibility of the beneficiaries to the provision that represents the study’s outcome is always a major concern. There is two explanations for a beneficiary not having access to a care according to the data retrieved from the reimbursement base: either a real lack of access or a non eligibility of the care for a record in the reimbursement data base (for example if the insured is covered by another insurance or has lost his coverage and has exited from the health plan)*. I have always to keep in mind that I work on secondary data which are only a reflection of the primary data the reality of which I try to apprehend.
The dilemma is pretty well addressed in this article:

http://onlinelibrary.wiley.com/doi/10.1046/j.1524-4733.2003.00242.x/full

*as always there is a third possibility: the data concerning the care has been erased from or not yet recorded in the base. The timeline of the refreshment of the base (ie the loading and the purifying of the data) must be precisely described in the methodology of the study.

Article cited:
1)- Motheral, B., Brooks, J., Clark, M. A., Crown, W. H., Davey, P., Hutchins, D., Martin, B. C. and Stang, P. (2003),

A Checklist for Retrospective Database Studies—Report of the ISPOR Task Force on Retrospective Databases.

Value in Health, 6: 90–97. doi: 10.1046/j.1524-4733.2003.00242.x

Two other articles address the pitfalls of inferring from secondary data extracted from a retrospective data base:

2)- Berger M, Mamdani M, Atkins D, Johnson M.

Good Research Practices for Comparative Effectiveness Research: Defining, Reporting and Interpreting Nonrandomized Studies of Treatment Effects Using Secondary Data Sources: The ISPOR Good Research Practices for Retrospective Database Analysis Task Force Report—Part I.

Value in Health 2009 ; 12(8) :1044-52
3)-

The use of claims databases for outcomes research : Rationale, challenges, and strategies. Annual international meeting of the Association for Pharmacoeconomics and Outcome Research.

Philadelphia, Pennsylvania (USA), 1996/05/12. CLINICAL THERAPEUTICS, vol. 19, n° 2, 1997, pages 346-366, 74 réf., ISSN 0149-2918, USA. MOTHERAL (B.R.) *, FAIRMAN (K.A.). Outcomes Research. Express Scripts. Inc. Maryland Heights. USA

Full text of the article here:

http://ehealthecon.hsinetwork.com/Motheral_ClinTher_1997.pdf

 

The Decrease of life expectancy.

18 Mar

For the first time in history life expectancy decreases in a industrialized country as shown in the study below:

content.healthaffairs.org/content/31/8/1803.abstract

The New York time reported one of the key result of the study in a article entitled “Life Spans Shrink for Least-Educated Whites in the U.S.”here:

http://www.nytimes.com/2012/09/21/us/life-expectancy-for-less-educated-whites-in-us-is-shrinking.html?pagewanted=all&_moc.semityn.www&_r=0

These data must be integrated to the social policies that are based on the assumption that the upcoming generations will live longer.

Paul Krugman, the Nobel prize of economy, explains this reversing trend by the increase of income inequalities at a macroeconomic level here:

http://www.healthypolicies.com/2012/09/paul-krugman-america’s-greatest-public-health-champion/

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