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GidMK's profile
Health Nerd
Health Nerd
Health Nerd
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@GidMK

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Health NerdVerified account

@GidMK

Epidemiologist. Writer (Guardian, Observer etc). "Well known research trouble-maker". PhDing at @UoW Host of @senscipod Email gidmk.healthnerd@gmail.com he/him

Sydney, New South Wales
theguardian.com/profile/gideon…
Joined November 2015

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    1. Health Nerd‏Verified account @GidMK 20 Mar 2019

      Looking at the study, this is broadly correct. The hazard ratio comparing very hot to low temp tea was ~1.9, meaning a 90% increased riskpic.twitter.com/Q1PfGuXPsU

      1 reply 0 retweets 4 likes
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    2. Health Nerd‏Verified account @GidMK 20 Mar 2019

      But wait, let's think about this Total population included in study = ~50,000 Total number of cancers = 317 Why might the 90% risk increase be misleading?

      1 reply 0 retweets 4 likes
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    3. Health Nerd‏Verified account @GidMK 20 Mar 2019

      So the total number of cancers is 317, in a sample of 50,000 (or precisely, 49996) That means that the crude rate of cancer in this sample is 0.6%

      1 reply 0 retweets 8 likes
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    4. Health Nerd‏Verified account @GidMK 20 Mar 2019

      Now, we can't calculate the adjusted rates of cancer based on the info in the study. We'd have to run their regression model for that But the crude rates will give us some information here

      1 reply 0 retweets 5 likes
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    5. Health Nerd‏Verified account @GidMK 20 Mar 2019

      The crude rate in the cold tea group = 92/19,450 = 0.47% In the hot tea group = 87/10,799 = 0.81% The unadjusted relative risk ratio is ~1.70 But what about the ABSOLUTE risk difference?pic.twitter.com/S8Oa9volte

      1 reply 0 retweets 8 likes
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    6. Health Nerd‏Verified account @GidMK 20 Mar 2019

      Remember, relative risk ratio is p(1)/p(2) = 0.81/0.47 = 1.7 = 70% increased risk! Absolute risk difference is p(1)-p(2) = 0.81-0.47 = 0.34 = 0.34% increased risk THIS MAKES THE RESULTS MUCH LESS MEANINGFUL

      2 replies 2 retweets 18 likes
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    7. Health Nerd‏Verified account @GidMK 20 Mar 2019

      (Yes, the answer above was that they used relative risk which is not a great measure when the risk of an event is small)

      1 reply 0 retweets 11 likes
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    8. Health Nerd‏Verified account @GidMK 20 Mar 2019

      So, we've established that the increased risk of cancer was more like 0.34% from drinking very hot tea, every day, for 10 years But that's not the only issue here!pic.twitter.com/POedaTnAWP

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    9. Health Nerd‏Verified account @GidMK 20 Mar 2019

      Firstly, how did they collect tea heat preferences? It's not a variable you normally think about

      1 reply 0 retweets 9 likes
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    10. Health Nerd‏Verified account @GidMK 20 Mar 2019

      The researchers got their subject to sit in a room, and gave them a cup of tea prepared at 75 degrees They put another cup of tea in front of them with a thermometer in it, and at cooling intervals asked the participants to take a sip and see if it was their preferred temppic.twitter.com/dTcdO2NoTQ

      2 replies 0 retweets 6 likes
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      Health Nerd‏Verified account @GidMK 20 Mar 2019

      Now, I don't necessarily have a better way to do this - I mean, really, measuring how hot someone's tea is drunk? HARD - but this method has some clear elements of potential bias

      11:33 PM - 20 Mar 2019
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      1 reply 0 retweets 12 likes
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        2. Health Nerd‏Verified account @GidMK 20 Mar 2019

          However, this bias may not be that big an issue Why is that?

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        3. Health Nerd‏Verified account @GidMK 20 Mar 2019

          This one is pretty easy It's unlikely that the issues with tea heat measurement could've impacted group differences in cancer rates

          1 reply 0 retweets 5 likes
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        4. Health Nerd‏Verified account @GidMK 20 Mar 2019

          This means that errors in grouping would've (probably) occurred equally across groups, and if anything biased the results towards the null

          1 reply 0 retweets 5 likes
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        5. Health Nerd‏Verified account @GidMK 20 Mar 2019

          But there's another massive, glaring flaw that isn't touched on at all Reverse causality

          1 reply 0 retweets 7 likes
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        6. Health Nerd‏Verified account @GidMK 20 Mar 2019

          To think about this, let's rewind The hot tea/cancer hypothesis goes like this: hot tea = damage to throat = cancer

          1 reply 0 retweets 4 likes
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        7. Health Nerd‏Verified account @GidMK 20 Mar 2019

          But these people were measured at adulthood, and then followed over time The damage to their throat might have already happened So rather than the above sequence, we might see damage to throat = hot tea = cancer

          1 reply 1 retweet 11 likes
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        8. Health Nerd‏Verified account @GidMK 20 Mar 2019

          Is this likely? Well, the hot tea drinkers were also older, smoked more, used opium more often, less wealthy, and drank more at baselinepic.twitter.com/kZYIQGXxY4

          1 reply 1 retweet 12 likes
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        9. Health Nerd‏Verified account @GidMK 20 Mar 2019

          Given these confounders, is it likely that there was some reverse causality here?

          2 replies 0 retweets 4 likes
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        10. Health Nerd‏Verified account @GidMK 20 Mar 2019

          (Forgot to answer the question above btw, it was all of the above - the effect applies equally to groups, probably a minimal impact, and biases towards the null anyway)

          1 reply 0 retweets 2 likes
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        11. Health Nerd‏Verified account @GidMK 20 Mar 2019

          So, I'm just going to say it - yes, it's very hard in this situation to exclude reverse causality. There weren't any sensitivity analyses that really excluded it, so I think it's still pretty likely

          1 reply 0 retweets 4 likes
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        12. Health Nerd‏Verified account @GidMK 20 Mar 2019

          This raises the last massive issue - residual confounding Note how the authors describe their findings vs the Daily Mailpic.twitter.com/iCvBZCoW0N

          2 replies 0 retweets 2 likes
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        13. Health Nerd‏Verified account @GidMK 20 Mar 2019

          "Substantially strengthen the association" is NOT THE SAME AT ALL as "see their risk of gullet cancer rise by 90 percent" (Also, lol, gullet cancer is a great name)

          1 reply 0 retweets 11 likes
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        14. Health Nerd‏Verified account @GidMK 20 Mar 2019

          Why are the authors so cautious Maybe it's because TEA DRINKING IS SUPER SOCIAL AND HARD TO UNPICK FROM CONFOUNDERS It's in caps because GODDAM IT I SAY THIS EVERY WEEKpic.twitter.com/GUAQyTAYof

          1 reply 0 retweets 12 likes
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        15. Health Nerd‏Verified account @GidMK 20 Mar 2019

          We can't exclude residual confounding. Maybe people drink tea differently in different social situations. Maybe hot tea is more often served with alcohol. Maybe a single measure of how hot people drink their tea isn't that great a predictor 10 years later when they get cancer

          1 reply 0 retweets 5 likes
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        16. Health Nerd‏Verified account @GidMK 20 Mar 2019

          Maybe there are a million factors you can never measure, and never control for, and thus it's really hard to know if this is causal or not Maybe

          1 reply 1 retweet 10 likes
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        17. Health Nerd‏Verified account @GidMK 20 Mar 2019

          So the authors are cautious. They know that there's a decent chance that the heat of your tea has nothing to do with risk of esophageal cancer But the newspaper needs a story And so we get "hot tea causes cancer"pic.twitter.com/g6kancVrKs

          2 replies 3 retweets 9 likes
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        18. Health Nerd‏Verified account @GidMK 20 Mar 2019

          So, let's recap: Large epi study showed 0.34% absolute increase in risk of cancer associated with drinking the hottest tea compared to cold tea, in large amounts, every day for 10 years Reverse causality and residual confounding remain an issue

          1 reply 1 retweet 9 likes
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        19. Health Nerd‏Verified account @GidMK 20 Mar 2019

          Do we trust these results? Well, yes. The study was interesting, and well done Do we think hot tea = cancer?

          8 replies 0 retweets 8 likes
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        20. End of conversation

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