Venöse Multiple Sklerose Hypothese | CCSVI

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Über Forschung und andere generelle Themen

People interested in CCSVI follow research closely. This section lists books or articles which explain research. It's essential knowledge.

1. [evans10a] Evans I, Thornton H, Chalmers I: Testing Treatments: Better Research for Better Healthcare. Pinter & Martin; 2010. Website, ISBN 978-1-905177-35-6. PDF, PDF (es), amazon.com.
   Description

   How do we know whether a particular drug, therapy or operation really works, and how well? How reliable is the evidence? Are clinical trials truly unbiased? And is current research focused on the real needs of patients? Such timely and pressing questions are raised and addressed in this probing enquiry into modern clinical research, with far-reaching implications for daily medical pactice and patient care.

   Aimed at both patients and professionals, Testing Treatments builds a lively and thought provoking argument for better, more reliable, more relevant research, with unbiased or ‘fair’ trials, and explains how patients can work with doctors to achieve this vital goal.

   Reviews.

   Info

   This book explains how evidence in medicine for reliable decisions can be created as fast as possible. Relevant for CCSVI. A must-read!
2. [goldacre09a] Goldacre B: Bad science. Fourth Estate; 2009. ISBN 978-0007284870, amazon.com
   Description

   Guardian columnist Dr Ben Goldacre takes us on a hilarious, invigorating and informative journey through the bad science we're fed by the worst of the hacks and the quacks! When Dr Ben Goldacre saw someone on daytime TV dipping her feet in an 'Aqua Detox' footbath, releasing her toxins into the water and turning it brown, he thought he'd try the same at home. 'Like some kind of Johnny Ball cum Witchfinder General', using his girlfriend's Barbie doll, he gently passed an electrical current through the warm salt water. It turned brown. In his words: 'before my very eyes, the world's first Detox Barbie was sat, with her feet in a pool of brown sludge, purged of a weekend's immorality.' Dr Ben Goldacre is the author of the 'Bad Science' column in the Guardian and his book is about all the 'bad science' we are constantly bombarded with in the media and in advertising. At a time when science is used to prove everything and nothing, everyone has their own 'bad science' moments -- from the useless pie-chart on the back of cereal packets to the use of the word 'visibly' in cosmetics ads.This book will help people to quantify their instincts -- that a lot of the so-called 'science' which appears in the media and in advertising is just wrong or misleading. Satirical and amusing -- and unafraid to expose the ridiculous -- it provides the reader with the facts they need to differentiate the good from the bad. Full of spleen, this is a hilarious, invigorating and informative journey through the world of 'bad science'.
   Info

   This book explains research with bad examples. It's written in an entertaining way. Highly recommended!
3. [ioannidis05a] Ioannidis JP: Why most published research findings are false. PLoS Med. 2005 Aug;2(8):e124. Epub 2005 Aug 30. PMID 16060722, doi:10.1371/journal.pmed.0020124, PDF, comment, reply, general media article.
   Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
   Abstract

   There is increasing concern that most current published research findings are false. The probability that a research claim is true may depend on study power and bias, the number of other studies on the same question, and, importantly, the ratio of true to no relationships among the relationships probed in each scientific field. In this framework, a research finding is less likely to be true when the studies conducted in a field are smaller; when effect sizes are smaller; when there is a greater number and lesser preselection of tested relationships; where there is greater flexibility in designs, definitions, outcomes, and analytical modes; when there is greater financial and other interest and prejudice; and when more teams are involved in a scientific field in chase of statistical significance. Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true. Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias. In this essay, I discuss the implications of these problems for the conduct and interpretation of research.
4. [moerman02a] Moerman D: Meaning, medicine, and the "placebo effect". Cambridge University Press; 2002. ISBN 978-0521806305, amazon.com
   Description

   Traditionally, the effectiveness of medical treatments is attributed to specific elements, such as drugs or surgical procedures. However, many other factors can significantly effect the outcome. Drugs with nationally advertised names can work better than the same drug without the name. Inert drugs (placebos, dummies) often have dramatic effects on some patients and effects can vary greatly among different European countries where the "same" medical condition is understood differently. Daniel Moerman traverses a complex subject area in this detailed examination of medical variables. Since 1993, Cambridge Studies in Medical Anthropology has offered researchers and instructors monographs and edited collections of leading scholarship in one of the most lively and popular subfields of cultural and social anthropology. Beginning in 2002, the CSMA series presents theme booksworks that synthesize emerging scholarship from relatively new subfields or that reinterpret the literature of older ones. Designed as course material for advanced undergraduates, graduate students, and for professionals in related areas (physicians, nurses, public health workers, and medical sociologists), these theme books will demonstrate how work in medical anthropology is carried out and convey the importance of a given topic for a wide variety of readers. About 160 pages in length, the theme books are not simply staid reviews of the literature. They are, instead, new ways of conceptualizing topics in medical anthropology that take advantage of current research and the growing edges of the field.
   Info

   This book explores the placebo effect. Recommended.
   Example extract 'angina pectoris', p57ff

   The logic of this theory of rusty pipes has had a long history. Several indirect revascularization techniques which involved rerouting various arteries were developed in the 1930s by Beck and in the 1940s by Vineburg (Meade 1961:480:515). Although Beck's procedure attained modest popularity, the first widely used surgical approach to angina was the bilateral internal mammary artery ligation (BIMAL). The internal mammary (or thoracic) arteries arise from the subclavian artery high in the chest and descend just inside the front wall of the chest, ultimately supplying blood throughout the chest and viscera. Following anatomical research by Fieschi, an Italian surgeon, which indicated connections between various ramifications of these arteries and the coronary circulation, several other Italian surgeons developed a procedure in which the arteries were ligated (tied off) below the point where these branches presumably diverged to the heart in order to enhance this flow and supplement the blood supply. The operation was first performed in the United States by Robert Glover and J. Roderick Kitchell in the late 1950s (Glover 1957 PMID 13475193; Kitchell, Glover and Kyle 1958 PMID 13497954). It was quite simple, and since the arteries were not deep in the body, could be performed under local anesthesia. The physicians reported symptomatic improvement (ranging from slight to total) in 68% of their first sample of fifty patients, in a two- to six-month follow-up. The operation quickly gained some popularity.

   "The problem is that no one else believed that there was any real connection between these arteries and the heart! So, shortly after these reports appeared, two different surgical teams at two American medical centers - one from Kansas City under the direction of E. Grey Dimond (Dimond, Kittle, and Crockett 1960 PMID 13816818) and the other in Seattle under Leonard Cobb (Cobb et al. 1959 PMID 13657350) - did double blind trials of the procedure. In each case, the surgeon learned only while in the operating room which patients were to have the complete operation and which were to receive "sham surgery". Those patients receive the complete operation, but the arteries were not ligated. In both studies, the patients were followed for at least six month after the surgery by cardiologists who were unaware of which patients had received the ligations and which had not. In one of the studies (Seattle) the patients were told that the operation was experimental, but they were not informed that some of them would get the sham surgery. In the Kansas City study, it is not clear from the publication just what the patients were told; it does say that the patients did not know which procedure they had received (suggesting that they knew there were two possibilities). This seems not to have made any difference anyway. In both studies, most of the patients were much better after surgery regardless of whether they had the full operation or the sham surgery. Table 5.1 indicates the outcomes of the two studies and shows the combined outcome.

   In both cases, patients experienced significant subjective improvement; that is, they reported that they had substantially less pain than before the surgery. This was true regardless of whether or not they had the full procedure (67% substantial improvement) or the shame procedure (82% substantial improvement). In the Seattle study, "need for nitroglycerine was uniformly decreased". In the Kansas city study, the average number of nitroglycerine tablets taken per week dropped 34% in patients with the full operation and 42% in patients with the sham operation. In both studies, patients were, on average, able to exercise longer before an angina attack. In neither study were there substantial changes in electrocardiogram readings, although one Seattle patient with striking abnormalities before surgery had none afterwards. He received the sham surgery.

   It is hard to know how to account for substantial improvement in these patients. Whatever the truth may be about the alleged connection between the internal mammary arteries and the coronary arteries (it doesn't show up anywhere in my Gray's Anatomy!), it doesn't really matter; in these two studies, the patients with the sham procedure did as well (maybe even a bit better) than those with the complete procedure. But for people willing to trust their surgeons and doctors, this is a pretty compelling operation. The notion that your heart is starved for blood makes pretty good sense. And the notion that we can, by shutting off the flow of blood down one pipe, enhance the flow into another pipe - sort of like what happens in the bathroom sink when you turn off the sower - makes very good sense. One patient in Kansas City study, when asked if he felt better, said, "Yes. Practically immediately I felt better. I felt I could take a deep breath … I figure I'm about 95 percent better. I was taking five nitros a day before surgery. In the first five weeks following, I have taken a total of twelve." This patient's arteries were not ligated (Dimond, Kittle, and Crockett 1960:484 PMID 13816818). But he did have two scars on his chest, and he had an explanation that made sense (unless he was an aficionado of Gray's Anatomy). He had all the elements of meaning which he needed."

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