Tuesday, January 15, 2013

Day 213 - a sad evening

Today would have been a perfectly lovely day except that when I got home from work, Emily mentioned that there was a snow storm coming and she had to be at her work tomorrow and did I think she should leave today to avoid having to drive two and a half hours in a snow storm? Wah! It is definitely the safer option for her to leave this evening, but I was looking forward to one more dinner and one more cup of coffee in the morning. Obviously, I want her to have a safe drive and she said she'd rather drive in darkness than snow so, it was the right choice for her to go, but I really don't have to like it. And I don't. There is still a part of me that thinks it is ridiculous for Emily to drive to Massachusetts--she's a newborn and newborns can't drive. She's not a newborn? You seem to be confused.
In other news, I haven't written about my port in a while. I'm still nervous to get it out because I don't want to jinx myself. (Everyone knows nothing causes leukemia to relapse like port removal--I read it in the New England Journal.) On the other hand, I would like it out because it is itchy and when I scratch it, I get weird little needles of neuropathy zinging around my upper chest wall sometimes. It would not be fair to call it neuropathic pain, and almost not fair to call it discomfort. Mostly it's just weird to scratch the top of it and feel an electrical sensation a couple of inches away. Sometimes if I press gently around the edges, the way one might if one wanted to make sure there was not swelling anywhere around it, it is a little tender. I would number it at way less than a 1, but as I have never  thought about my chest wall previously, it gets my attention. Also, the port is kind of unattractive and Ellie is weirded out by it.
The January 16, 2013 JAMA has several nice Perspective articles in it. One is a proposal for a mega-trial fund that makers of blockbuster meds could either contribute to voluntarily or by legal coercion. I thought it sounded like a great idea, because, as every doctor knows, the trials that are funded very seldom answer the questions we really need answered and often we are left putting information from two or three trials together to get a whisper of an answer. A funny thing about it is that I actually recognize the author's name as writing other pieces about statistics that I enjoyed reading. He's a very famous guy, but that's kind of geeky for me to recognize his name: Ioannidis.
The next perspective was also a little bit geeky and more specifically about statistics. The author was addressing how if you have access to a large data base and know how to mine it, you can put forward hundreds of hypotheses and ignore the ones that do not show an association--the observational study version of the "prespecified end point" problem. (Remember if the P value is <0.05, this means that one in twenty associations will be positive by chance and if you check twenty associations and only publish the positive ones, you are probably getting fooled? If you don't let people know that you have done this, your audience is getting fooled.) Anyway, this guy suggests that there be pre-specified falsification end points, basically a statement that you believe to be false related to the database. If there were an association in the database, you would know that the database was suspect. For example, if you were testing the "PPIs are associated with pneumonia" hypothesis, you could also see if PPIs were associated with something biologically implausible like urinary tract infections.
The final Perspective was also pretty nice; a systems researcher who ended up getting a heart transplant talked about his experience as a patient. The best part: "Patients don't care how much you know until they know how much you care." Not much left to say.
There is also a nice Grand Rounds about "Bacterial Co-infection in the Flu." I really like articles that go from molecular mechanisms to the organism to medications (which are other molecules).
If you had asked me this afternoon, what I was doing tomorrow, I would have cheerfully said, "Coffee with Emily and then seeing her off." Now, I'm not sure what I'll do. Perhaps solo coffee and sopping my tears with the NYT crossword puzzle. The good news is that I bought my hotel and airplane tickets tonight so at least I don't have to dread doing that tomorrow.
For me, for tomorrow, I will hope to be able to remember that Emily is very happy at school and that growing up is what children are supposed to do. For you for tomorrow, I will hope you are comfortable with whatever change is brewing in your life as well.


  1. I wish for Emily a safe trip back to school. For you I wish a restful sleep, a quiet day tommorow with lot of relaxation. Looking forward to a visit soon.

  2. Thank you. A visit sounds nice!