I
wonder whether the "badness" of science
is to be judged by the
mathematicians / physicists / statisticians for the cleverness
of it's complex theoretical underpinnings or by the clinicians for the observable practical benefits to patients?
Perhaps a pragmatist could harmonise these seemingly non standardised
approaches to the judgment of
"badness" someday......
Chris
Hi
I would like to share some conversations I
had at IFCC WorldLab in Berlin earlier this week. (I was there for an IFCC
Commiteee on Traceability in Laboratory Medicine meeting, of which I am
privileged to be a member.)
One reason why I particularly want to
do this, is because at the party after the opening ceremony, I was 'ticked off'
for my postings to this forum (presumably on HbA1c standardisation) by a senior
member of the ACB. They said I would 'get into trouble' and that 'no-one
agrees with me anyway'! Unfortunately, this kind of remark is red rag to a
bull to me, and has had the opposite effect, as another of my obsessions is that
scientists must have freedom of expression. Being
wrong/irritating/controversial is every scientist's duty, if, in being so, it
helps the right answer to emerge!
Two other conversations at the party
were relevant:
One was with a senior and well known member of the ACB,
whom I have known for many years. His comment on standardisation -
"... is unacheivable by the untraceable ..." had the desired
effect (it wound me up), but it seems to reflect a view present in some quarters
of our profession, that this fundamental process does not have the degree of
importance that it demands.
The second was with an professorial
colleague, who, in advance of a lecture he was giving at the conference, posed a
question to me on the essential difference between standardisation and
harmonisation. I thought for a second or two and gave the pithy reply:
"standardisation is scientific and harmonisation is pragmatic", which, a
bit to my surprise, was the right answer! His comment that he wouldn't
need to give his lecture if everyone understood this as deeply as I do - I took
to be a compliment!
So - discussion point
number 1: Where do we stand on the issue of establishing a metrological
traceability chain being fundamental to what we do as clinical scientists?
Is scientific standardisation just too difficult to achieve, so we shouldn't
waste resources striving for it and just settle for pragmatic harmonisation?
The next issue is related to the
second but goes deeper. I attended this session:
REPORTING HbA1c FOR MONITORING AND DIAGNOSIS: THE
DEVIL'S IN THE DETAIL
09:00 Estimated average glucose 2 years on.
E.S. Kilpatrick (United Kingdom)
09:30 Status of HbA1c measurement and goals for
improvement. R. Little (USA)
10:00 EQA: HbA1c fit for the diagnosis of diabetes?
C.W. Weykamp (The Netherlands)
The second talk troubled me a lot. It was
asserted that NGSP/DCCT numbers must remain in place indefinitely so that
results can always be linked back to the DCCT and UKPDS studies. In
questions, I made the point that " ... in science, if you know something is
wrong and have something better and more scientifically rigorous to replace it
with, this must be adopted ...", and I asked the $64,000 dollar question - " ...
when will the US let go of NGSP/DCCT and fully embrace the IFCC reference
measurement system and use the new units ...".
The reply I
received was actually quite disturbing - that the US would never let go of NGSP
or the DCCT numbers. It appears they have a "different definition of
traceability" than other countries, preferring clinical traceability to
metrological traceability, and that "this is for the benefit of
patients". I felt ever so slightly 'put down' by this. (Surely such
a view means that the US will basically isolate itself from the rest of the
world and forever 'fossilise' its technology and decision making on studies
which will eventually become out of date. Furthermore it will probably
inhibit the diagnostic industry from ever fully implementing IFCC traceable
standardisation.)
So - discussion point
number 2: Can bad science ever be good for patients?
Cheers
Jonathan
PS - It was also mentioned to me that
the '5 Whys' in my previous posting about educating GPs on HbA1c reporting, work
just as well in the reverse direction. So feel free to re-arrange if it
suits. J.
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