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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?

#71

Post by chiefalchemist »

vkou wrote: post #55
sixo wrote: post #50

Earlier quoted context omitted.

Amazing. And shameful (for them.)

> And shameful (for them.) 1. A single positive outcome with N=1 should generally not be the basis for making a medical recommendation. 2. It takes a mountain of research work to go from that to a study that you can draw meaningful conclusions from. 3. The hospital is not in the business of doing research, it's in the business of treating patients.

It shameful in the sense we all know there are circadian rhythms. We know the human body is not uniform from waking to shut eye. With this in mind health care therapies should be intentionally administered at various times - as wide as possible; from that perhaps outcomes will vary. You don’t need a study to look for opportunities to optimize a process.

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

#73

Post by more_corn »

ch4s3 wrote: post #61
wyldfire wrote: post #59

Earlier quoted context omitted.

Though it could certainly inspire such a study.

Sure, but someone needs to fund, organize, and conduct the study. If you're not at a research hospital it's not as easy for a one off case to generate a study.

Or you could consider if there’s reason to believe there’s a causal relationship, if there is you could change your protocol (offer it in the evening as an option), measure the improvement, publish the result and simultaneously improve your patient outcomes and move science forward.

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

#74

Post by echelon »

ch4s3 wrote: post #54
sixo wrote: post #50

Earlier quoted context omitted.

Amazing. And shameful (for them.)

It’s not shameful, it’s how evidence based medicine works. One case is interesting but not a basis for changing a protocol by itself. Tons of things could have influenced the outcome and you need a proper study to know that.

> It’s not shameful, it’s how evidence based medicine works.

Yeah, but I'll bet nothing happened as an outcome of this. No study, no communication to anyone else. That information probably just withered on the vine.

I did a molecular bio undergrad and had classes with a bunch of pre-med students. They had zero interest in the science, just getting A's. They did care about appearance and money, driving cool cars, and dating hot partners. I know my experience is purely anecdotal and not indicative of all doctors, but I came away from my undergrad experience highly unimpressed with our medical feedstock. The only students in upper level electives that cared were the research-track students.

I talk to my doctors regularly about medicinal chemistry and biochem -- they don't know anything. It's embrassing how little they retain or care.

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

#75

Post by echelon »

_qua wrote: post #65
vlovich123 wrote: post #63

Earlier quoted context omitted.

This is a fairly innocuous change the doctor should be organizing on their own to publish a pilot study. In terms of funding very little would be required since you’re just making a small adjustment to when an existing drug regimen is happening which you already isn’t a controlled factor requiring FDA oversight or anything.

Even simple studies are expensive and difficult. You need IRB approval, data collection and organization, staff to do those things. It seems simple from the outside but making it happen takes time, effort, and money which then means also applying for grants which is a process in and of itself.

It's no wonder biology hasn't even entered into the punch-card phase.

When I did my bio undergrad I was keenly aware our bodies are just scaled up molecular machines. I was hoping for a future where we'd grow MHC-neutral clonal bodies for organ harvesting.

Nope. We're in the stone age.

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

#76

Post by daveguy »

ch4s3 wrote: post #61
wyldfire wrote: post #59

Earlier quoted context omitted.

Though it could certainly inspire such a study.

Sure, but someone needs to fund, organize, and conduct the study. If you're not at a research hospital it's not as easy for a one off case to generate a study.

That's why doctors publish case studies all the time -- to inspire larger scale and statistically sound studies.

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

#77

Post by _qua »

echelon wrote: post #75
_qua wrote: post #65

Earlier quoted context omitted.

Even simple studies are expensive and difficult. You need IRB approval, data collection and organization, staff to do those things. It seems simple from the outside but making it happen takes time, effort, and money which then means also applying for grants which is a process in and of itself.

It's no wonder biology hasn't even entered into the punch-card phase. When I did my bio undergrad I was keenly aware our bodies are just scaled up molecular machines. I was hoping for a future where we'd grow MHC-neutral clonal bodies for organ harvesting. Nope. We're in the stone age.

Move fast and break things in human medicine means unethical researchers maim and kill people, often marginalized people. Nazis, Japanese experimenting on prisoners, Tuskegee airmen syphilis experiments, Cincinnati radiation experiments and many others stand as testament to what ambitious unethical scientists will do to further their knowledge and career. Thus we have strict guardrails that slow down how we do things.

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

#78

Post by echelon »

_qua wrote: post #77
echelon wrote: post #75

Earlier quoted context omitted.

It's no wonder biology hasn't even entered into the punch-card phase. When I did my bio undergrad I was keenly aware our bodies are just scaled up molecular machines. I was hoping for a future where we'd grow MHC-neutral clonal bodies for organ harvesting. Nope. We're in the stone age.

Move fast and break things in human medicine means unethical researchers maim and kill people, often marginalized people. Nazis, Japanese experimenting on prisoners, Tuskegee airmen syphilis experiments, Cincinnati radiation experiments and many others stand as testament to what ambitious unethical scientists will do to further their knowledge and career. Thus we have strict guardrails that slow down how we do things…

We've been able to clone mammals for 30 years and haven't acted on it. We're still toying with molecular systems beyond the limit of detection.

Clone humans. Cut off their brain stem during development. Turn off cephalization signals for good measure. Scale it up to industrial scale.

Research problems solved.

We'd have every study at our fingertips. We'd have organs and tissue and blood for everyone.

We could possibly even do whole head transplants and cure all non-blood, non-brain cancers.

But we're playing in the sand.

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

#79

Post by bravesoul2 »

sixo wrote: post #50
raylad wrote: post #48

My father was on chemotherapy with fludarabine, a dna base analog. The way it functions is that it is used in DNA replication, but then doesn’t work, and the daughter cells die. Typically, patients who get this drug experience a lot of adverse effects, including a highly suppressed immune system and risk of serious infections. I researched whether there was a circadian rhythm in replication of either the cancer cells…

Amazing. And shameful (for them.)

What's the p value? 0.5?

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

#80

Post by bravesoul2 »

tines wrote: post #53
ajkjk wrote: post #51

Earlier quoted context omitted.

"more samples" is not what controls for confounders. Controlling for confounders is what controls for confounders, which you can only do with enough samples that you can randomize out the effect of the confounder. Whether or not they controlled for nurse-alertness is something you'd have to read the paper (or assume the researchers are intelligent) for.

I guess I'm asking, how do you randomize out the confounder in this case.

Have every dose be observed by another doctor?
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