WHAT IS THIS TELLING ME?

1. WHAT IS THIS TELLING ME? Robert J. Munk, PhD AIDS InfoNet / ATAC http://www.aidsinfonet.org A project of the New Mexico AIDS Education and Training Center at the University of New Mexico Health Sciences Center

2. Too Much Information! Google search results 4/7/2010: AIDS: 95 million results HIV: 50 million results

3. Too Many Sources! • Health web sites • AIDS web sites • Ads on search pages • Facebook • Twitter

4. Conflicting Information • Antioxidants and the Heart: good or bad? • Start treatment early! Or - delay for reasons of side effects, cost? • d4T: “least” toxic nuke? Or the worst?

5. Research Papers • Less hype • Better info • Author affiliations, contact info • Financial support • Conflicts of Interest • Journal reputation / peer review

6. Abstract • Background • Methods • Results • Conclusions Abstract: a “teaser” for full article or study. Do you want to read it all?

7. Abstract 124, CROI 2010 Rates of Cardiovascular Disease following Smoking Cessation in Patients with HIV Infection: Results from the D:A:D Study • Author list (10 people, “and the D:A:D Study Group”) • Author affiliations

8. Background • Why should I care? “Smoking rates are high in many populations. Most smokers can’t stop. In HIV negative people, substantial drops in heart disease within 1 to 2 years of stopping smoking. This study estimated CVD event rates after HIV+ stopped smoking.”

9. Methods • How was the study done? Who was studied? “Pts. included if in D:A:D study, no CVD before enrollment. Noted current smoking, how long since stopping, and heart disease events. Calculated rates for never smoked, stopped before study, stopped during study, or still smoke.”

10. Methods (Continued) • How was the study done? Who was studied? “Incidence rates calculated. Adjusted for age, sex, cohort, calendar year, ARV treatment, diabetes, family history of CVD, lipids, blood pressure.”

11. Results • Findings of the study “27,586 patients had smoking status reported. There were 432 MI (myocardial infarctions = heart attacks), 600 CHD (coronary heart disease), 746 CVD (cardiovascular disease) and 1902 deaths.”

12. Results (Continued) • More findings “After adjustment for other covariates, the IRR (incidence rate ratios) of CVD in patients who stopped decreased from 2.32 within 1st yr of stopping to 1.49 after 3+ years.”

13. Results (Continued) • More findings “Similar trends were observed for the MI and CHD endpoints, but reductions in risk were less pronounced for all cause mortality.”

14. Do I Care? You should have enough information from the abstract to know if you want to read the whole article!

15. Consider the Source • University researcher • National Institutes of Health • Drug company staff • Who would pay to study this question? • Alternative therapies?

16. Who Was Studied? “Inclusion Criteria” • Age • Gender • Ethnicity • Geographic location

17. Who Was Studied? • Drug approval: pharma wants “clean” population, good adherence • HIV/Hepatitis C coinfection can be difficult for docs to deal with – confuses the data! Generalizability? Is the study population “real world”?

18. Who Wasn’t Studied? “Exclusion criteria” • Who would be harmed by study? • If drug has liver side effects? • If drug is injected? • Has psych side effects? • Causes birth defects?

19. Statistics • Lots of jargon! (p values, two-tailed, IRR, statistical significance) • The bottom line: Could the results be just by chance? Skills Building Workshops II: 2:45pm ~ 4:00pm Statistics: The Basics: Tim Horn, AIDSMeds.com

20. Design Issues How confident are we in the results? • How many were studied? The “N”? • Control group? • Randomization? • Blinding? Skills Building Workshops III: 4:15pm ~ 5:30pm From SMART to START: Understanding Randomized Controlled Trials: Paul Dalton, AIDS Treatment Activist Coalition (ATAC)

21. Data Analysis Was analysis “pre-specified”? “Torture the data until it confesses”

22. What’s the Trial Design? “People who switched to Geico Insurance saved an average of $350.”

23. What’s the Trial Design? “85% of people who used our herbal ointment had their herpes lesions clear up within 4 weeks.”

24. http://www.aidsmeds.com • Patient oriented • “Lesson” format • Expert interviews from key conferences

25. http://www.natap.org • Comprehensive information organized by topic • Many original articles • Expert articles on key issues, conferences • Fairly technical content

26. http://clinicaloptions.com • “Professional” orientation • Extensive conference coverage • Many CME offerings for MD, RN, RPH and others • Expert “discussion” of key studies and conferences

27. You Be the Judge Authors are trying to prove something! Are you convinced? Researchers want a solid answer. Will they get one with this study?

28. Correlation is not Causation! Ice cream causes drowning!!!

29. Customers Who Switched to GEICO Saved an Average of $350 • Inclusion criteria? • Control group? • Who DIDN’T Save?

30. Herbs Effective Against Herpes We gave an herbal supplement to 86 people with genital herpes outbreaks. After 4 weeks, 86% of them had no pain, itching, or visible herpes sores.