Where's the excitement?

[brocktoon]

The existence of a connection between MS and venous haemodynamics has been known for more than a century The paper in question is hardly earth-shattering, it just moves the debate on a tiny bit. Perhaps you should also try reading Lee et al, (2010), where you will find this stetement:
"If there is a relationship between CCSVI and MS it is expected to be a complex one."
and then tell us what the Sethi et al paper has really contributed to our knowledge of this complex problem.

Dr Geoff, I will sum it up for you if you are willing to listen: CCSVI has been a very contentious topic these days. The problem is there are few studies that have done a complete analysis of all elements of this problem, most of them have just done ultrasound which is very controversial or only anatomical studies without functional flow information. The work that is presented here helps to present a complete picture. The paper does not propose that CCSVI or flow abnormalities cause MS, it is simply noted that there is a preponderance of flow abnormalities in a fraction of MS patients that may eventually lead to some better understanding of what is happening to this subset of patients. A large degree of consistency exists with MR since it is not operator-dependent like ultrasound. Also offered are critiques to studies which have flawed analyses.

As an established researcher (which I do respect out of you), you must be aware that change is slow and incremental. Does every paper require to be earth-shattering?

To me, a statement like: "To me, you and Dr. Haacke deserve a Nobel prize for this." (taken from the thread in the CCSVI forum) sounds sort of like hype to me. So do a lot of other things you wrote on October 16.

One person's hype or excitement is far less damaging than the amount of flawed and incomplete research that exists (even papers with perfectly written abstracts). But I am not going to argue with someone who thinks I deserve a Nobel prize, in fact I wish it happened more often.

[1eye]

There have been huge amounts of money, time, press coverage (talk about hype!) and grief spent in making sure this debate either oscillates wildly, or has a singular lack of scientific consensus, and goes nowhere very slowly.

Moving it a tiny bit is big news. Moving it a lot is a great contribution.

The paper by Sethi et al moves it a long way, bringing correct and novel analysis to a complex relationship.

[DrGeoff]

OK, shall we try to bring some perspective to this?
- On October 15th, brocktoon posts a link to a paper (Sethy et al) detailing the latest work from his team. This is posted in the CCSVI sub-forum. It attracts a lot of posts from a limited number of posters.
- On October 23rd, 1eye posts in the general discussion forum asking: “Where's the excitement?”, and linking this question to the CCSVI sub-forum.
- This prompted a comment from me that the lack of excitement was due to the work being poorly presented as evidenced by the abstract.
- This produced a lengthy response from 1eye, extolling the virtues of the Sethy et al paper.

Lets take that response first. 1eye stated:
“The purpose, as stated, was not to determine whether "MS" patients or HC were or were not ST.”
and:
“The ST-non-ST status was not the question.”
and
“I am sure you will be enlightened if you read the whole paper, and not just the abstract.”

Actually, you do not have to read very far into the paper to find (Introduction, Para 3)
“… and to further identify differences related to stenosis.”

Which comes right back to my point about the numbers in the abstract suggesting that a Chi-square test was appropriate, and subsequently being told that such a test had been done and that the result was highly significant. A result which surely belonged in the abstract.

Now by linking to the thread in the CCSVI sub-forum, 1eye has opened up the posts in that forum to examination. So let’s look at some that he made, starting with the item that JeanDeEau pointed out:

- To me, you and Dr. Haacke deserve a Nobel prize for this.
- That is a signal piece of scientific thinking, normalizing to arterial blood flow. That was the stroke of genius that broke this controversy wide open.
- Your work corroborates and verifies the work of Dr. Paulo Zamboni in an in-controvertible way. Shouting can begin any time.
- Making these stenotic jugulars work better is necessary, and perhaps the very first treatment most "MS" patients should receive. It is a disease-modifying treatment of the very first order.

Let’s look at that very last one, and remember that the percentage of non-stenosed people with MS was almost equal to those who were stenosed. 52% to 48%.
Immediately after the post that provided those quote, 1eye decided to post the entire abstract. Maybe, thinking even then that no-one would be bothered to read it. It does seem that I was not the only one who was not excited by that abstract.

But, for me, the most hilarious of a number of 1eyed statements is:
“BTW, "χ2 = 12.01; P < .001" is significant. It means most "MS" patients had stenosis, healthy controls did not.”
Actually, it is not significant, it is highly significant – and for that very reason it should have been in the abstract. Further, it does not mean that “most "MS" patients had stenosis, healthy controls did not.” It does mean that the difference in the proportions of stenosed and non-stenosed is significantly different between those with MS and the healthy controls. And, in reality, if you go back to the work of Tucker et al (1948) you can see that the matter of reduced ex-cranial blood flow in people with MS was known then (yes 50 years before Zamboni). Maybe you should be asking why Tucker’s finding was never followed up, rather than trying to hype up an adfvancement which is an advance im methodology only.