I find ppl have difficulty understanding #evidencebasedmedicine (EBM) & how Science works.
EBM doesn't try to "prove" anything but is focused on REFUTATION. Let's say u have a new medicine which you believe works better than previous medicine/no medicine. Thats your theory...1/n
#EBM sets out to refute this theory. Hence all trials start with a null hypothesis: New Treatment A is no better than placebo/treatment B.
You then use statistics to find out whether the difference between the two was likely to happen by chance. P < 0.05 only means that...2/n
there is less than 5% chance that the difference (if any) between the 2 treatments was likely to be due to chance, & is a real difference.
In this case, you reject the a priori Null hypothesis ( that there is no difference between 2 treatments) You accept...3/n
your original hypothesis that Treatment A is better than Treatment B/placebo, because you are unable to REFUTE this hypothesis. Until another study comes along.
Purists: sorry if this sounds too simplistic. Meant for Joe Public.

If you are interested, do read Karl Popper..END.

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More from @netshrink

31 Oct
THREAD: for academics & researchers wanting to influence policy makers. Mostly India specific advice. Based on my reading & experience of doing this stuff for > decade now.
At the end, I have also given a link to a very useful Nature paper on this subject
So let's begin..1/n
Rule 1: Policy makers are smart people, smarter than researchers/academics/clinicians. In most countries, its harder to become a senior civil servant than get admission to medical college or a proffesorship. Don't be fooled by the dumb look. That's training. So respect them..2/n
Rule 2: Civil servants/policy makers are busy people. If you do not get their attention in the first 5 min, you are never going to make it. So have a very sharp & effective "elevator pitch" ready before you step into their office. I practice in front of the mirror...3/n
Read 11 tweets
2 Aug
THREAD on patient confidentiality bcoz I am asked questions repeatedly. Read this & please stop tagging me on your tweets. My mentions can't cope! These are my opinions so please feel free to ignore!
1. Does confidentiality apply to counsellors/psychologists?
Ans: Yes ...1/n
2. Does confidentiality apply after death?
Ans: I am not aware of any precedent in Indian case law, but see box below. MPS is a malpractice insurance provider to Drs. Last point in Box suggests it does apply after death too. See this link for details ..2/n
3. What about "public interest" in the box above? That can be grounds for breaking confidentiality?
Ans: Yes. Even the Mental Healthcare Act makes this an exception to break confidentiality. However what is public interest is open to interpretation...3/n
Read 7 tweets
12 Jul
THREAD on Medical Students #suicides
There are 78333 medical seats across India. Considering a 6 yr course & accounting for recent seat increases, there are ~450,000 students in medical schools at any given time. Dandona et al using GBD data estimated suicide rate...1/n
for Indian 20-24 & 25-29 yr olds btwn 27-33 per 100k. For ease of calculation let's take a middle rate of 30/100k. Most medical students in this age group. Assuming med students suicide rate is same as general population, India has ~ 135 medical students dying by suicide/yr..2/n
Remember India has 78,333 medical seats in 549 med schools which is an average of 142 seats/med school. So each year, we lose approximately 1 medical school's yearly intake to #Suicides
The human cost & suffering is unmeasurable. The financial cost we can estimate..3/n
Read 6 tweets
15 Jun
THREAD: Troubled by many media reports & SM conversations where depression + mental health issues are assumed to be only causes of #suicide
Of course, we need conversations on #Mentalhealth & depression is associated with suicide. Why am I then bothered by this? Read on..1/n
In the West, studies show that ~ 80% of suicides have depression as a predisposing cause. Also in West, suicides peak is mostly older ppl (>60 yrs) + male:ratio is ~ 4: 1.
However India's suicide epidemology is different. In India, only ~50% have some mental illness...2/n
Also our peak suicides are in age group of 18-39 yrs + male:female ratio is ~ 1.5:1. So a lot of young Indian women dying of suicides.1 out of 3 women dying of suicide 🌍 are Indian. For women in this age group, suicides is No 1 cause of death, ahead of maternal mortality..3/n
Read 11 tweets
3 Nov 19
THREAD: Confusion amongst MH professionals abt IPC 309 (attempt to suicide) & IPC 306 (Abetment of suicide). Ppl wonder how a person can be charged with abetment, if attempted suicide is not a crime, because "Mental Healthcare Act has decriminalised suicide"
Wrong!! Read on...1/n
MHCA 2017 has not 'decriminalised suicide attempt'. What it has done is create a PRESUMPTION that attempted suicide is due to stress. IPC 309 continues to remain active, but to use it, the onus is on Police to prove, a person attempting suicide did NOT have stress and...2/n
did it for other reasons. For example, going on a fast to death for political reasons, the Police could charge a person under 309, if they can prove so.
IPC 306 says "Abetment of suicide" and NOT 'Abetment of crime'. So even if 309 was removed as a crime, 306 could...3/n
Read 5 tweets
20 Sep 19
THREAD: #SuicidePrevention
I get annoyed when ppl think the solution to India's suicide crisis is having more suicide prevention helplines. Don't get me wrong, they are absolutely necessary, but not enough! Why? Helplines are crisis intervention. Essential, but...1/n
Are we doing anything to prevent the crisis occuring in the 1st place? Ah, I hear you say - it's bcoz of depression & we need better mental health services. True, but depression is a final common pathway, not the cause of the crisis. Bcoz...2/n
~40-50% of suicides in India, there is no diagnosable mental illness (unlike West). So what's causing the crisis? Let's begin with children! If school going children are dying of suicide, shouldn't we ask what is wrong with our education system? And do something about it?... 3/n
Read 9 tweets

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