ITT for beginners

Dear Heyerick et al.

Thank you for your lovely study regarding the use of hops extract in menopausal women. Please note, however, that when you claim to use an Intention To Treat analysis, it’s considered obligatory to actually use the data from all patients, including the ones who drop out mid study. You don’t get to eliminate their data then go on to claim that your response may have been due to them dropping out.

This omission particularly suprises me, since as far as I can tell, you would have obtained a statistically significant response for your trial if you had analysed according to the ITT you claim to be using. Gaining a greater response for your active arm compared to placebo is much easier if you include the almost 25% of your placebo group who dropped out due to lack of effect.

Yrs in perplexity,

Stealthflower

Reference: Heyerick, et al. A first prospective, randomized, double-blind, placebo-controlled study on the use of a standardised hop extract to alleviate menopausal discomforts. Maturitas 2006; 54:164-75.

Brief links from the coalmines

Random cool links, just in case you were missing me - I'm too busy even to mock, at the moment.

I don't care how improbable the Lancet thinks a tarantula farm is - I've visited ones in Malaysia already. Chillies and tarantulas - pain killers of the future?

And as an Australian, I take an unworthy satisfaction in knowing that bulky cane toads get arthritis.

Finally, if you've ever wanted to boast about your cutting edge scientific studies, you too can do particle physics.

And it's back to work for me.

EDIT: It's just been pointed out to me that you'll need to register to view the Lancet article on pain relief. It's a free signup, but I thought I should warn you just in case.

How not to gain credibility

It may come as a surprise, but when would-be suppliers send me information about a particular ingredient, I actually comply with our regulatory requirements and check up on it. Especially when, to the best of my knowledge, no peer reviewed evidence exists for the use you're suggesting.

So if you send me abstracts for studies in a journal I'm not familiar with, I'll look it up. And I'll notice that it doesn't have a print presence - it exists purely online. And that it isn't peer reviewed, it's 'refereed'. And that its articles don't seem to be listed on Medline.

Then I'll look a little closer, and find that all the articles I've been sent were written by someone who happens to be the 'Executive editor' of the journal. And that despite all the board being members of various universities, the positions they hold aren't listed anywhere (one of my co-workers suggests they may be the cleaners).

I'll also look at the editor's credentials, and find out that they actually have a very senior position in the company that's trying to sell me the ingredient in question, and that the website for the product lists testimonials from Australians using the product, despite neither its only ingredient nor the product itself being legal in Australia. And that the one piece of research listed apart from your own doesn't exist.

Then I'll see that of the 'over 300' technical and research papers the editor is supposed to have written, none of them have been listed on Medline. And that not only are they no longer with the university they claim to work for, they never held the position they claimed.

And my company won't be using your product.

Names omitted to protect my job; all details correct.

Part of what I do here is work as email network support. If there's an issue with the mail platform, and beyond a tier 1 support level, it comes up to me here. Issues with customer networks, mail clients, or software configuration, however, is not my problem.

But fucking try telling that to tier 1 support. Needless to say, whenever I get an escalation from the lower echelons here, I' naturally a bit suspicious. Not fair, maybe? But how I have learnt through hideous, hideous experience.

Today, was really no different. However, today had one of the worst escalations I've ever dealt with. Why the worst? Oh, I shall tell you.

So, this little old lady (I can tell these things, tell with my MIND!) gets put through to me - she hasn't received any email in over a week! Comes straight through to me, no introduction, no case referrence, no nother. Siiiiiiiiiiiiiigh. So I start asking the customer a few preliminary questions, what does she do to check her mail, does she get any kind of errors, that sort of thing. I'm also checking out the network on my side, for a better picture of what's happening, while we talk.

It takes me a grand total of about, ooooh, let's say, thirty seconds to work out what was "wrong".

"...The reason you haven't received any email in the last week is because no-one has sent you any."

...

Yes, I'm fucking serious. This person was sent through to me, (apparently) level 2 technical support, 'cause someone confused "no email" with "email issue".

Now do you begin to see why I hate my coworkers so much?

(fake edit: here, for your amusement, is the brief missive I fired off to the "colleague" who originally escalated the customer...

"Hey there. In future, please complete all email troubleshooting steps before escalating an email issue to CTS. Namely, in this case, making sure there is actually an error, rather than the customer simply not having been sent email."

Owned.)

Here. Allow me to "rap" at you.

Alright, listen up, nubshats. I'd like to say I'm only going to explain this the once, but we all know that it ain't going to happen. None-the-fucking-less, there are just a few little things I'd just like to clear up for the general audience.

One: when the fuck was the last time where "No" wasn't an absolute? And I'm not talking about the weak as piss mumbling your mother utters as you're climbing on top of her after shovelling an armful of methadone into her. Have I missed some crazy-person memo where "No" now means "Maybe"? Or "Soon"? I don't care how much "customer service" bullshit gets bandied about, when I say "No", it's not a fucking invitation to debate. I don't say what I say for a laugh. If I did, a lot of it would be along the lines of "You really want to know how little I care?" and accompanied with a lot of laughter. It generally means that I'm providing an answer to a query or request, generally in a negative matter. No amount of bargaining, cajoling or shouting is going to get me to change my mind/policy/situation/laws of physics. Learn to fucking deal with it.

Two: I don't know about others, but I go to work to work. I don't like it, but I do it. I've come to accept the fact that I show up to a place I don't want to be at, to perform tasks I'd rather not do, in order to receive the money I can use to do the things that I'd rather be doing, in the time I'm at some place I'd rather be. That's just how the world works. Sure, I may have once believed that one day I might end up in a job doing what I loved; then I turned eight, and discovered Dungeons and Dragons. Then I turned eleven, and discovered breasts. But that's beside the point. The point is, however, is that there is no obligation or implied responsibility that owes you a profession of copious funds and limitless enjoyment. On the other hand, I've no commitment to enjoy the role I've found myself in. Which, I guess, is a very round-about way of saying: I'm sick and fucking tired of "team building" and "moral improving" bullshit! I'm here to work. I don't particularly want to be here, I don't particularly want to be friends with any of you. I don't need to participate in a survey that cost the department thousands of dollars to run to find out that most people here "arn't engaged". I could've fucking told you that beforehand, and that money could've been spent instead fucking engaging people. I also don't want to spend my personal time, or even fucking time I'm being penalised for, sitting and working out grade-school puzzle-book mazes for chocolate prizes. Fuck your "team building". There's this area, this zone, which is known as "The Mood". But "The Mood" is not around here. In fact, it's quite far, far away. And you know what? "The Mood" isn't a very big area, either. In fact, you might even say, I am not currently, nor will I ever be, in "The Mood".

And finally: I am your coworker, your superior, even your god. I am not, however, your friend. Fuck, I'm not even your associate, your colleague, your peer. If you manage to interact with me without pissing me off or making my life harder, I'll treat you with respect. But continually calling my line because you don't know how to do your job and want me to do it for you is going to fuck me right off. I know that we've been "asked" to help when asked, but the day I find someone to do my work for me is the day I entertain the notion of easing the ineptitude of something which happened 'cause a pizza delivery boy forgot to pull out fast enough. And if you decide to get petulant because I have the audacity to tell you how to do your fucking job in a condescending manner, well, that just means that the next time you annoy me with your added fucking trouble, then I am going to start making up answers. To amuse myself. Have fun with that, shitkick.

I guess, what I'm really trying to say, in the end, is that: I'm bored, angry, and arrogant. But fuck fuck it makes for some interesting times.

How not to establish credibility

Quick word to the wise - if you're the sales representative of a major supply company, and you're trying to sell a nutrient to a manufacturer, putting together a customised presentation brochure is a lovely touch. I appreciate it.

However, do realise that I'll also read it, and therefore trying to show that your product has been widely reported in international news by including an article on how laughter helps your stomach muscles may not win my respect. Even if you do go through and use a dodgy Powerpoint red circle to emphasis it, I'm still likely to notice that it has nothing at all to do with the product you're trying to sell me - or any other natural supplement, for that matter!

It doesn't matter how many printouts of my company's website you include and splatter with comments on how well the ingredient matches our identity. And including a screendump of a pubmed search with a few animal studies does not prove your ingredient is well researched. Sorry.

I'm still going to conclude that either you're a moron, or you think I am. Neither are likely to inspire me with an overwhelming belief in you or your product.

It does give my stomach muscles a good workout, though.

Truth in advertising

Quote of the morning was waiting for me in my inbox today - it's always nice to start your work week with a giggle at some unlooked-for honesty from a manufacturer.

NutraIngredients, a daily newletter for the complementary medicines industry, has a quote from Dr Miquel Mir, product applications manager for Croda Health Care, who are launching a new fish oil supplement. This supplement contains measured levels of the normal EPA and DHA, as you'd expect, but it also touts the benefits of the intermediary omega-3 fatty acid DPA (docosopentanoeic acid, for the curious).

Dr Mir leads off the article talking about his shiny new product. His take on it?

DPA has been "wholly overrated".

I'm finding it refreshing to see such honesty in a product manufacturer. It's very nice when they're willing to state up front that an ingredient is unlikely to live up to the (usually excessive) hype. Of course, there'll probably be a correction in tomorrow's email, but until then, I'm somewhat sardonically basking in the heady glow of realistic claims.

For the curious, or the disbelieving, you can read the article here. And in case anyone is suddenly convinced about the benefits of DPA, it does actually look quite interesting. Bear in mind that it's going to be in just about every fish oil supplement you can buy (in Australia, anyway - America is a little different in that they can sell the isolated EPA and DHA on their own); these guys are just the first to bother talking about it.

Truth in marketing

Another raised eyebrow at marketing today. Yes, yes, it's not research. Unfortunately, I've been too busy actually reading and trying to apply it for work to have time to properly sit down and share the juicier bits with y'all.

Instead, I'd like to share my utter disbelief.

I've been looking vaguely around for a wheelchair, lately, since my therapists have started looking shifty and avoiding questions when I ask about them. And I came across the Karma Transit. That's right, there's a brand of wheelchair called the 'Karma Transit'.

I've been amusing myself by making up slogans for them - my favourite is still:


"Karma Transit... because it's all your fault."

Then I found their website. That's right, there's a whole range of karma wheels! They give their slogan as "Nurturing outstanding partners, manufacturing excellent products, providing superior services, and creating the brightest future".

I like mine better. It seems somehow more honest.

If I do end up in one, I'm attaching prayer flags to each wheel.

I've been both busy and unusually crippled lately - you'd think the crippled part at least would lead to more blog posts, wouldn't you!

But no, it actually leads to me lying on the sofa and occasionally whimpering pathetically to Mr Flower to get me something out of reach, usually while playing far too much Final Fantasy.

Now that I'm comparatively back on my feet, though, we're back to blogging!

Or at least to pointing out other people's blogs.

Today's entry is actually a link to the fabulous Cognitive Daily, who are discussing How Not to Write a Science Book. They've come up with a very handy numbered list of all the things you really shouldn't do if you want anyone to take you seriously. In my job, I don't usually have to read pop-sci for anything other than general information, but I've still come across my share of biased, poorly researched, and sensational pieces of crap. It's nice to see someone else pointing out the things that irritate the living crap out of me as well!

One thing I'd add to their list of pet hates is 'Plummet writing'. I'm sure you know the type - my descriptor comes from watching too many aeroplane disastershows where the plane 'plummets from the sky in a spiralling shower of death!'. Too often, in the alternative medicine field, I end up reading 'scientific' books about how X nutrient is NECESSARY FOR ALL LIFE, or will CURE ALL DISEASES, or worse, MEDICINE IS KILLING YOUR CHILD.

I'm not fond of sensationalism at the best of times, and I despise fear-mongering, so you can well imagine my opinion of these.

*grins* Anyone who can't, comment, and I'll treat you to the extended rant sometime.

Marketing. Making mountains out of molehills, and 'eating solutions' out of food

Quote of the day comes from an online 'magazine' I read this morning. It's not research, per se, just a particularly egregrious example of marketing-speak. It made me wave my hands incoherently, though, before emailing a couple of friends with some choice descriptors and ranting, so I'll share with y'all as well.

'cause, after all, ranting at empty pontifications is one of the things stealthflowers do best. Or most frequently, anyway.

The magazine is a functional foods publication, and they interviewed the maker of a brand of 'raw food' bars. She says:

'The American consumer is always looking for the next solution in terms of eating'.

...

The last time I looked, the best 'solution' for eating was to chew.

Preferably on healthy food, in amounts that are good for your body.

Since when has the idea of something so basic as digestion been conceptualised to the point that we need 'eating solutions'?? Come on, people! There are no 'eating solutions'. There's food!

If you are disempowered enough that you think that someone else is going to have a solution for your life that comes in a food bar, well, welcome to disillusionment. Food manufacturers can't make your health choices for you. And they won't. What they will do is package things up as attractively as possible, no matter what the contents, and leave you to flounder in the morass of conflicting half-stated claims.

Note: I am not in the least suggesting that this particular manufacturer is doing anything even vaguely questionable. I've never seen, nor eaten the bars in question, as I don't think they're available here in Aus-land. Looking at the ingredients, they sound pretty good for you.

However, they aren't an 'eating solution'. They're a food. Get over it.

Now, I can see where you would get confused...

Picture this: Customer X calls up, wanting an additional domain authorised to service Y. Fair cop, easy job. All I need to do is to send an authorisation email to address Z on said domain, and all the customer needs to do is to reply back to the system from address Z. The authorisation will only be verified if the reply comes back from that address. Seems easy enough, right? I explained this pretty clearly to the customer and, to his credit, the customer seemed to follow. So I send the authorisation email off to address Z, and end the call.

...Three minutes later, I get a system generated email back, saying that authorisation was refused. Why, I ask?

Authorisation was rejected as the addresses are mismatched.

Sent to "Address Z"
Received From "Address A"

...

...Oh, for fuck's sake...

So I've just sent the customer an email (to address Z, A, and 17), explain that I had to resend the authorisation email, WHY I had to resend the email, and how to do it properly this time.

And a paraphrased "...this time, try listening the fuck up".

Violating the laws of possibility for both fun and profit.

So, I got back into work today from a five day weekend. Only missed three days of work, but as soon as I stepped in the door to my floor, a little part of my soul died.

Know anyone who's hiring at the moment?

I sat down, strapped myself in, and hoped for the best. I mean - how bad could the first issue be? Well...

I just had a customer given our internal number here, and prodded in our direction by an other department who don't have the skills or panache to solve the issue. This fucks me off to no end, 'cause it's the WRONG way to do it, but we're to do it ANYWAY. So, I grit my teeth, roll my eyes, and see just how bad it was.

"So you're saying you're being billed for cellular broadband access at these times?"
"Yes."
"...And you say that they are during times where the handset is not even physically connected to the laptop?"
"Yes."
"And you're absolutely positive of this?"
"Yes, certainly."

...

The way that cellular broadband works is that data traffic is registered against a handset's ESN - which is a unique identifier, much like a MAC address. It's possible to have two handsets with the same cellular number, but not the same ESN. Simply put - the data traffic showing on the account was applied to the customer's ESN - which cannot be hacked. It shows up on the bill, then those bits and bytes went through that handset. QED.

So this customer was assuring me that all these "strange" data charges were being registered by the system at times when the handset was not physically connected or interfaced with the laptop.

"...You know, the way that you've described the situation, and the information I'm seeing here are mutually exclusive. What you've just describe to me is physically impossible."
"I know!"

...

So what was I to do?

"Well then, if that's the case, I'd recommend having the handset serviced or replaced, because there is no way this could happen is everything is working as intend."

Then I sent him on his merry way.

Now, what was the point of all this? What was the moral of the story I just related to you? Well, it's a simple one, and universally constant;

The customer is always lying.

Don't doubt yourself, never second-guess the systems. The customer is just fucking lying. Remember this, and dealing with them is just a little bit easier.

Quick! Save yourself!

...

I read an abstract this morning for a study entitled 'Sparing effects of selenium and ascorbic acid on vitamin C and E in guinea pig tissues.'

I'm currently reading the full article, somewhat incredulously. For anyone not familiar with their vitamins, you probably won't see at first glance the reason I spent a good five minutes reading the abstract and giggling. I even showed it to a colleague to make sure I wasn't missing some subtle hidden nuance. But apparently not.

Ascorbic acid is vitamin C.

The title and abstract so far suggest that 13 scientists spent a good deal of time and several dead guinea pigs to establish that there was less vitamin C in the tissues of guinea pigs fed less vitamin C. Wow. Giving animals an essential nutrient causes a raise in that nutrient's level in the animal? Rocket science!

I'm currently reading the full article to see if there's some pressing reason why this needed to be established. So there may well be a relieved post from me later - I'd hate to think that people really sit down and waste time, money, and small cute mammals with adorable squeaking noises on the blatantly stupid.

I recommend against holding your breath.

As a side note, I really hope they didn't use Ribena as their source of C.

There's been some changes 'round here...

A ninja template change from the stealthiest sunflower around. Let's see how long it takes the Nihilist to notice we're no longer black and angsty.

No, now we're just the angst without the colourscheme!

What do you think? Do you find this more readable?

Note: proper post coming up this afternoon, in between digging myself out from under the pile of paperwork that keeps getting strategically 'stored' on my desk, and heading out to a work function. At this rate, 'this afternoon' may well mean 'sometime tomorrow'.

Short but sardonic

"Medical statistician: one who will not accept that Columbus discovered America ... because he said he was looking for India in the trial plan."

- Stephen Senn, Statistical Issues in Drug Development. (1997) (lifted from the British Medical Journal)


Since it's Wednesday and I have hump-day-itis, as well as far too much to do, you'll just have to make do with the quote rather than a rant. Still, if you're looking for amusingly dismissive off-the-cuff summations, it's a pretty good one!

Have a good day, everyone, and stay tuned for 'Five things that will make Stealthflower point and laugh at your research'.

The grass isn't greener on the streets

Just a quickie today, for anyone who has ever wondered whether those kids living on the streets are eating better than you. You know, what with all those three course meals and nutritious fresh vegies you can forage out of garbage bins and all.

A group of researchers has established that homeless kids in Toronto are 'nutritionally vulnerable' - that is, not as well fed as kids with homes and regular meals. Well, there's more research money gone on establishing the blindingly obvious.

It's probably unfair of me, but wouldn't that money have been better spent on buying those poor kids a sandwich?


Study is Tarasuk V et al. Homeless youth in Toronto are nutritionally vulnerable. J Nutr 2005 Aug;135(8):1926-33. Full text is available from the Nutrition Journal here.

Weighty matters

Time for Stealthflower's award for pointing out the blindingly obvious.
Today's imaginary trophy goes to the Canadian researchers who compared the nutrient intake between obese and non-obese kids and teens. They carefully quantifying the differences between the two groups in their methods, then discovered in their results that there was a statistically significance between the two groups in both weight AND Body Mass Index!

No, really?

It actually is both interesting and useful to compare the nturitional and vitamin intakes of the two groups, but do you really need to experiment to find that fat kids are fatter than non-fat kids?

Someone I work with has been known to say that common sense has to step in at some point. I'm still waiting for that point to arrive, me.


For the curious or pedantic, the study is: Gillis L & Gillis A. Nutrient inadequacy in obese and non-obese youth. Can J Diet Prac Res 2005;66(4)237-42. Pubmed abstract can be found here.

You'll get what you asked for, and you'll bloody like it!

I just got a call from another department. A lot of what I do here involves helping out the front like staff by either dealing with escalated cases, or advising the reps directly. So, in this case, I got a call from a rep asking for some advice. In this situation, a customer had some issues with a PDA. Errors when they hooked it up to their computer and what-not. So, the customer got some instructions mailed to him, instructing him on what to do. According the the rep, he didn't follow the instructions, instead going off and doing something completely different, and then called back for more help.

...

"The fuck?" I say.

So this guy had asked for help, ignored what we sent him, and then had the audacity to call back for more help. I'll be honest, this kind of brutal illogic stalled me for a bit. I blinked for a second, audibly, before telling the rep that if this customer wished for our assistance, then he was required to actually attempt the solutions we provide before asking for additional help. Worded slightly more sardonically.

I mean for fuck's sake. How does it make sense to ask for assistance or a solution, and then to ignore what was provided? And worse - then call back for "more" assistance? This is what happens when you design devices and services to be used by idiots.

Oh, and I'll write a self-effacing introductory post in the near future. You lucky, lucky fucks.

Welcome! Greetings. Pull up a drink and sit down.

At some stage I should probably introduce myself, I suppose. I'll let the Nihilist speak for himself, even if that speaking is likely to consist of drunken ramblings interspersed with the occasional cuttingly articulate dummyspit.

I'm a researcher, among other things, for a natural supplement company. I've been working in the alternative therapies industry for the last seven years or so, in a whole variety of roles, and I've encountered an ever surprising range of fuzzy thinking, poor logic, and blind optimism in the face of all apparent fact - as I expected.

What I didn't expect, in my naivety, is to encounter exactly the same thing on the more 'scientific' side of the fence. In my current role, I'm wading through more research papers than I care to think about every work day. And while I knew that medicine was a developing field, I didn't realise just how poorly thought out some of the research contributions were.

I managed to dismiss the first trial I read, that concluded a particular herb wasn't more effective than a placebo, when they used a placebo that contained the herb in it as well, as an oversight.

Then I started reading trials that concluded supplements were ineffective for conditions they weren't clinically used for. Trials that went for too short a time to show a difference in long-term conditions. Placebo-controlled trials that didn't actually say what active ingredient they were testing. And my personal favourite - a study that 'proved' several herbs had potentially negative effects on male fertility... by washing extracted sperm in an alcohol extract of the herbs, and trying to use it to knock up an isolated hamster ovum.

(I'll be pulling that particular study apart later, so if you have a roadkill fascination with drunken sperm trying to get a hamster egg in a testube into the sack, stay tuned.)

It was at this point that my ever patient partner (who I'm tempted to call Mr Flower, but I'd probably better find another nickname for him), pointed out I really should be blogging this shit.

So here I am.

There is no such thing as "underestimation" in customer service.

You may work for a major ISP/Telco. You may be working with DNS, VoIP, and other fancy acronyms. You may associate with other technicians, both within and outside your corporation of employment. But there is one thing you just simply cannot achieve. Not in any way, shape, or form.

You just simply cannot underestimate your clients and coworkers.

IT: where you have to be nominally smarter to deal with the same stupid people.

The RDI of vitamins is good for you! Honest!

Ok, it's not strictly research, but have any other Aussies read the National Health and Medical Research Council's recommended daily intakes of vitamins and minerals?

I was reading the entry for magnesium the other day, and was rather suprised to read that while the recommended intake for kids (4 to eight year olds, to be precise) is 130mg, the upper level considered safe...

is 110mg.

So basically, it's suggested that kids need to eat more magnesium than the government is willing to say is safe for them. *amused*

I've read their justification - it's not a typo, and there's no erratum up on their site.

If anyone's curious enough to go see for themselves, you can download the pdf from here (it's quite large, I warn you!), or you can look at their site here.

Welcome, strangers

I'm a researcher in the alternative medicine field, among other things. And, in the many years I've been working in the industry, it seems that every ten minutes someone turns around with some new scientific study that 'proves' that a particular nutrient causes/cures cancer/aging/obesity/spontaneous human combustion/you name it.

You'd be surprised some of the things I've seen claimed for all manner of random foodstuffs or supplements. I really wish I still was. And often, there's some 'research' or other to back it up. Well, I've got news for you, oh gullible wunderkiddies. Scientific studies are just as prone to demonstrating random stupidities as the next person with a budget and a sloppy supervisor.

From the 2001 study I read yesterday that found that not only were children in a Romanian orphanage more neurotic than kids with families, they also had lower magnesium, which of course must be the cause, to the archetypical 'well, duh!' study in the 1990s that 'proved' that what you ate changed the makeup of your shit, I'm going to share with you just what our best and brightest medical minds do with their research dollars.

Well, maybe not the best and brightest. Possibly just the most entertaining. But isn't it more fun that way?