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Administering immunotherapy in the morning seems to matter. Why?

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Re: Administering immunotherapy in the morning seems to matter. Why?

#31

Post by JumpCrisscross »

tines wrote: post #14
ajkjk wrote: post #10

Earlier quoted context omitted.

https://en.wikipedia.org/wiki/Randomized_controlled_trial The same thing it means in every context: that (with enough samples) you can control for confounders.

Supposing that patients did better in the morning because, say, the nurses were more alert, no matter how many samples you take you'll find the patients do better in the morning. How does "more samples" help control for confounders rather than just confirm a bias?

> How does "more samples" help control for confounders rather than just confirm a bias?

I think you're correct that randomising patient assignments doesn't control for provider-side confounders. Curious if the study also randomised nursing assignments.

Re: Administering immunotherapy in the morning seems to matter. Why?

#32

Post by JumpCrisscross »

majormajor wrote: post #8
zevets wrote: post #2

This is bad science. Patients schedule when they go to immunotherapy appointments. People who go in the morning are still working/doing things, where once you get _really_ sick, you end up scheduling mid-day, because its such a hassle to do anything at all.

I always have seen mid-day appointments as also a luxury for those doing well (at least professionally/financially). If you have to go first thing in the morning, it's often because your boss wants you in relatively early and won't let you take time mid-day. If you're in a position where you can go in at 2PM and not have to sacrifice sleep to do so, that feels healthier. Given the highly-evident strong circular natur…

> mid-day appointments as also a luxury for those doing well

Irrelevant to this study given randomization.

Re: Administering immunotherapy in the morning seems to matter. Why?

#33

Post by simmerup »

tines wrote: post #16
kelnos wrote: post #11

Earlier quoted context omitted.

Patients in the study are randomly assigned to the early group or the late group. They don't get to schedule their own appointments for whatever time of day they want.

How does this control for the "alert nurses" variable? In that case, patients would do better in the morning, regardless of the patient.

Why do you think you're going to poke holes in a research article when you've clearly only just heard of the concept and havent even read the article

Re: Administering immunotherapy in the morning seems to matter. Why?

#34

Post by pbhjpbhj »

tialaramex wrote: post #27
justsomehnguy wrote: post #17

Earlier quoted context omitted.

There is always an option what taking it in the evening is magnitudes better than not taking it in the morning at all because you skipped it because you need a shower. Always remember what you are just an another patient with your own quirks.

For the drug I take every day (Levothyroxine), research found that evening was worse, but the explanation was poor compliance - people forget to do it more often compared to the morning. Same reason the contraceptive pill is less effective than you'd expect in real populations, compliance is poor. If you're the sort of person who can actually take it on time, every day, without fail, it's extremely effective, if you…

What annoys me here is that these things are hidden - if the patient knows that compliance is better (ie their chance of staying with the medicine and so of getting better) does it really reduce said compliance?

Re: Administering immunotherapy in the morning seems to matter. Why?

#35

Post by d_tr »

tines wrote: post #16
kelnos wrote: post #11

Earlier quoted context omitted.

Patients in the study are randomly assigned to the early group or the late group. They don't get to schedule their own appointments for whatever time of day they want.

How does this control for the "alert nurses" variable? In that case, patients would do better in the morning, regardless of the patient.

Based on these graphs and the differences in outcomes they show, you are not talking about "alert vs less alert" nurses but about "nurses doing their job vs nurses basically slowly killing dozens of patients".

Re: Administering immunotherapy in the morning seems to matter. Why?

#36

Post by unaindz »

tomcam wrote: post #26
iamtheworstdev wrote: post #24

Earlier quoted context omitted.

a brand new study comes out and you're mad the doctors didn't know about it a year ago? do you carry any of the blame on yourself since you knew there were explicit instructions but apparently waiting to shower or exercise was too much of an inconvenience for you?

Where did they say they’re mad?

The last paragraph heavily implies it

Re: Administering immunotherapy in the morning seems to matter. Why?

#37

Post by bjornasm »

tomcam wrote: post #26
iamtheworstdev wrote: post #24

Earlier quoted context omitted.

a brand new study comes out and you're mad the doctors didn't know about it a year ago? do you carry any of the blame on yourself since you knew there were explicit instructions but apparently waiting to shower or exercise was too much of an inconvenience for you?

Where did they say they’re mad?

They explicitly fault the doctor for not acting on research that wasn't available.

Re: Administering immunotherapy in the morning seems to matter. Why?

#38

Post by pbhjpbhj »

majormajor wrote: post #8
zevets wrote: post #2

This is bad science. Patients schedule when they go to immunotherapy appointments. People who go in the morning are still working/doing things, where once you get _really_ sick, you end up scheduling mid-day, because its such a hassle to do anything at all.

I always have seen mid-day appointments as also a luxury for those doing well (at least professionally/financially). If you have to go first thing in the morning, it's often because your boss wants you in relatively early and won't let you take time mid-day. If you're in a position where you can go in at 2PM and not have to sacrifice sleep to do so, that feels healthier. Given the highly-evident strong circular natur…

Surely your boss legally has to let you attend a health appointment? Though they might not have to pay you. That seems like a very basic workers right, the sort of thing you'd have a general strike over if it didn't exist??

Re: Administering immunotherapy in the morning seems to matter. Why?

#39

Post by tines »

simmerup wrote: post #33
tines wrote: post #16

Earlier quoted context omitted.

How does this control for the "alert nurses" variable? In that case, patients would do better in the morning, regardless of the patient.

Why do you think you're going to poke holes in a research article when you've clearly only just heard of the concept and havent even read the article

If I thought I could poke holes in the research, I wouldn't be posting on HN. I'm asking questions to learn because obviously I don't understand :)

Re: Administering immunotherapy in the morning seems to matter. Why?

#40

Post by levocardia »

Hazard ratio of 0.45 seems implausibly high, especially when it's just the exact same treatment dichotomized to before/after 3pm. My money is on something other than a real circadian effect: either the result of a 'fishing expedition' in the data, or some other variable that incidentally varies by time of day. Maybe breaking randomization, leaving the drugs out for too long at room temp, etc. If you really believe this is an important and biologically plausible effect it should be a top candidate for a replication attempt.
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