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James Hooper has just pointed out that "none of the people .. were me" in my postscript should have read "none of the people ... was me" He is quite right, and I apologise sincerely. Mike And thanks to Richard M-B for making the same point as I type. Pedants rule OK (or, at least, exhibit many of the traditional signs of leadership....) ________________________________ From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Hallworth Mike (RLZ) Sent: 20 May 2011 16:49 To: [log in to unmask] Subject: Re: Berlin Blog Jonathan It's irritating and a bit patronising to put the question as "Is bad science ever good for patients". We aren't talking about bad science. We are talking about something that works and has practical clinical value, though it isn't ideal. So of course it can be good for patients, as those of us in the real world recognise every working day. Indeed, it's questionable whether we can ever achieve ideal levels of standardization in a distributed testing system where biological analytes are involved. But I fully agree that shouldn't stop us trying to do the best we possibly can, although the resource question has to be balanced against the potential clinical benefit. Science has never been absolute - it is always about the best available hypothesis/description that fits the data until something new turns up and causes us to rethink and do better. So put the high horse back in the stable - and have a good weekend! Cheers Mike (and none of the people at the party were me!!) ________________________________ From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Jonathan Middle Sent: 20 May 2011 15:29 To: [log in to unmask] Subject: Berlin Blog 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. -- Use [log in to unmask] for all professional email Use [log in to unmask] for personal email Go to www.jgmqc.co.uk for JGM Quality Consulting Go to www.aqmlm.org.uk for AQMLM Call / text on 07976 357 907 ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/ ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/ ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/