Newsgroups: sci.med.dentistry

Subject: Periostat - A question for golfers
Date: Fri, 20 Apr 2001 03:57:32 GMT
Organization: EarthLink Inc. -- http://www.***.com/
Reply-To: Honest, there is a question at the end of this post.

Then he said something that suprised me.  He said one very definite
measurable fact had not changed in all those years.  The winning scores of
all PGA and USGA sanctioned events, when averaged together has not changed
one stroke in over fifty years.  He said you could use that fact to argue
that all the training, technology, and popularity has not changed the game,
and will not change your game either.  The statistical averages in golf say
that no matter what you do, statistically speaking, you will not improve
your game at all.

*********

Including the standard deviation, or the measure of variance or deviation
from the mean would clearly show whether or not there is statistical
improvement. Alas, Periostat fails to do that!

Joel M. Eichen, D.D.S.

His point was that if you use statistical averages to determine the value of
any new therapy, you would probably decline anything new.  But when you are
looking at a specific patient, with a specific need, you need to use what
works for you and that patient.

Can't be. When the mean for N=99 is 0.25 millimeters, then you need a huge
outlier to alter the average! In fact, you also need negative numbers to
balance it!

To use the golf analogy, supposing that the par for 18 holes is 65. Now
plenty of golfers are taking 90 or 100 to play the same 18 holes. This means
that some are doing the 18 holes in 20 strokes.

  And when some therapy fails to get the
clinical results desired, it is imperative that the clinician look for other
methods to get the desired results.

He says Periostat gets him very good results when other methods have gotten
fair to poor results.

An individual practitioner can never judge efficacy ....... How does he do
the double-blind thing all by himself?

 He says he sees less bleeding, less pocket depths,
and less non-responding pockets when a patient is prescribed Periostat and
is compliant and faithful in taking the medication.

He is probably fooling himself .... or more likely, his patients!

He figures he will
probably treat several hundred patients with Periostat over the next decade,
which equates to several thousand pockets.  He expects to get about a dime's
thickness of improvement if he ever averages all those pockets together.

Hah! Do not mention treating several hundred patients and a dime in the same
paragraph. Do you know how expensive it is?

Question:  Should this dentist stop prescribing Periostat, knowing
statistically he will only get a dime's worth of improvement over the next
decade?

Nope. Patients like worthless treatment. I tell them about the dime, and
many still want it anyway!

OTC

--
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Joel, how do they deteremine the P value?  ie. (P>0.05) I was under the
impression that P values were of more value because the took into
consideration standard deviation.  This is what all the clinical trial
studies seem to use.  Is there something you know that the reviewers don't?

what if N=9999?

Really, is that the only way you could come up with that number? Had no
idea.
I assume the same way you would judge the efficacy of of a new cement or
impression material.

If you can't trust the research, and you can't trust you own observations,
what can you do?

Ah, so based on his observations, he is either incompetent or unethical?
Patients like worthless treatment. I tell them about the dime, and

And of course, I assume you send them away without the worthless treatment?