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Dear Ash, Thanks for using our SRs- it is always good that someone can find some use of the research one does. However, I am not an advocate of data mining of medical records- I am only pointing to the exponential growth of this type of research. Surely, we ought to understand its strenghts and weaknesses because it will only continue to be performed at ever accelerating pace. Perhaps, EBMers have already said what needs to be said (as implied in your message and summarized by Roy and Steve in their seperate messages- that this research should not be trusted and perhaps not even done?) best ben ________________________________ From: Ash Paul [[log in to unmask]] Sent: Wednesday, September 22, 2010 9:57 AM To: Djulbegovic, Benjamin; [log in to unmask] Subject: Re: Data mining in Medical Records? Dear Ben, While I agree with you about the limitations of medical records as they constitute observational data, surely if you accept that argument, then you also need to accept that argument as a clinician wanting to try on novel/innovative treatments. Here in the NHS, amongst the worst offenders who spend the NHS cancer monies as if there is no tomorrow, are your fellow clinicians in haemato-oncology, who insist on funding for third and fourth bone marrow transplants on the same patients as phenomally exhorbitant costs, but when I ask them for the evidence, all they can come up with is observational data and case series. In my opinion, what is sauce for the goose, should be sauce for the gander as well. This is not a personal dig at you because I have read all your systematic reviews on bone marrow transplants where you have clearly pointed out the weakness and limitations of these case series studies, and I have used your systematic reviews to refute these clinicans, who understandably, have not taken too kindly to me. Regards, Ash Dr Ash Paul Medical Director NHS Bedfordshire 21 Kimbolton Road Bedford MK40 2AW Tel no: 01234897224 Email: [log in to unmask]<mailto:[log in to unmask]> ________________________________ From: "Djulbegovic, Benjamin" <[log in to unmask]> To: [log in to unmask] Sent: Wed, 22 September, 2010 12:44:26 Subject: Re: Data mining in Medical Records? I hope this thread receives some further discussion as currently (in US at least) there is tremendous enthusiasm (and expected bonanza in funding) related to the projects based on data mining of electronic medical records (EMR) (mostly within new Comparative Effectiveness Research program). Steve wrote: "Remember that medical records constitute observational data, and suffer all the limitations of observational data." However, this argument has not diminished the enthusiasm (and marketing) for ever increasing number of data-mining projects (as, for example, witnessed by increasing number of the quality measurements/performance projects, demands for public reporting of health outcomes, studying all kind of associations such as the link between statins and dementia, etc, etc). So, the question is: can we define circumstances/types of the projects (design, "rules of evidence" etc) when data-mining is more or less acceptable? (Is there "user guide" how to design and critically appraise data-mining reports?) My second comments relates to the 6S model (pyramid of evidence) (Systems -- the computerized decision support that occurs automatically within the system being used and not requiring external searching is the most efficient): this is an aspirational goal. I am not aware that such systems have been developed (outside some specific, decision-support systems) and very much doubt that they can be developed to tackle the entire field of medicine (despite tremendous progress in artificial intelligence, computing etc) ben djulbegovic ________________________________________ From: Evidence based health (EBH) [[log in to unmask]<mailto:[log in to unmask]>] On Behalf Of Steve Simon, P.Mean Consulting [[log in to unmask]<mailto:[log in to unmask]>] Sent: Tuesday, September 21, 2010 11:48 PM To: [log in to unmask]<mailto:[log in to unmask]> Subject: Re: Data mining in Medical Records? On 9/21/2010 3:53 PM, Ernesto Barrera wrote: > I have known a data mining software that calculates predictive models > without much statistical knowledge. I wonder if the automatic > incorporation of predictive models to computerized medical records, > patient risk modeling based on regional or local data could be a future. > In that case, could we say that we move towards a model of 7S > (predictive Statistics) in the pyramid of evidence? > > I appreciate your views on this subject. I know a videotape that you can watch that will allow you to perform surgery without much knowledge of anatomy. How well do you think that would work? Predictive models based on computerized medical records are a laudable goal, but only if they incorporate the appropriate statistical expertise. Maybe it will change in a decade or two, but today's computers are not smart enough yet to dispense with expert knowledge. Even an intelligently built predictive model based on medical records, though, will have serious limitations. Remember that medical records constitute observational data, and suffer all the limitations of observational data. Full disclosure: I am a professional statistician who will be put out of work as soon as the computers get smart enough that they can build good predictive models without much statistical knowledge. -- Steve Simon, Standard Disclaimer Sign up for The Monthly Mean, the newsletter that dares to call itself "average" at www.pmean.com/news