A minor example of how to properly read and interpret medical literature

© 2023 Peter Free


26 August 2023



A friend asked me about the wisdom of shoulder replacement surgery


I told him that it should be a last resort.


He responded by sending me a review of shoulder replacement complications, evidently still being somewhat hopeful that the risks were not as daunting as I had made them out to be.


His focus was on Table 1 of his provided review.


That table narrowly categorizes each negative effect. The resulting percentages of individual 'badnesses' are, therefore, moderately low.


What he inadvertently glossed over, was the review author's Abstract. An overview which more appropriately clumped these negative effects into larger, and therefore more statistically indicative, groups of 'bad' outcomes.



Below is what I told my friend, in response


The article you cited is a good example of medicine lipsticking a pig


The numbers cited for complications of shoulder implant-surgery would make any rational evaluator of interventional Benefit-versus-Risk run — except in last-resort cases.


The Abstract gives a more realistic summation of the situation, than Table 1's too-fragmented, and therefore numerically minimizing, layout of the purported facts does:



The most common causes of revision surgery after reverse total shoulder arthroplasty (RTSA) are, in decreasing order: prosthetic instability (38%), infection (22%), humeral problems (21%) including loosening, unscrewing and fracture, and, lastly, problems of glenoid loosening (13%).


Complications leading to reoperation are often multiple and their association is underestimated.


It is not uncommon for patients to be reoperated several times due to the persistence of the same complication, failure to diagnose associated complications, or onset of an additional complication.


[And even here, comes the inevitable lipstick:]


Although it may require a number of procedures in the same patient, it is very often possible (in 90% of cases, in our experience) to conserve or replace the RTSA, allowing patients to recover a functional shoulder.


However, the functional results of revised RTSA are inferior than for primary prostheses, and depend on the surgeon's experience and the number of RTSAs performed, suggesting that patients should be referred to a tertiary center.


© 2016 P. Boileau, Complications and revision of reverse total shoulder arthroplasty, Orthopaedics & Traumatology: Surgery & Research, Volume 102, Issue 1, Supplement, Pages S33-S43 (February 2016)



Translated (into my words)


Shoulder replacement is very likely to painfully screw you up big-time — require multiple surgeries — (as you get older and older) — those interventions making you both miserable and flirting with death — but eventually, we Medical Folk will be able to profitably (for us) make something work well enough to allow you to (half-assed tolerably) weakly flap your arms — while stumbling to your traumatized and pain-punctuated Ending's sweetly restful casket.



It is an art to read medical literature with a discerning eye


It takes experience to be able to detect the deliberately (or moronically) intruded lies, cover-ups, distortions of fact, interventions of conflicted interest, scientifically indefensible screwups in methodology and/or statistical interpretation— and so on — in medical literature.


I remain your humble flashlight.


End quote.



The moral? — Absent having an independently and objectively minded medical and scientific background . . .


. . . most people will benefit from access to scientifically skeptical personal guides to for-profit medical research and practice.


'For profit' basically characterizes the whole of medicine these days, as the COVID-19 tyranny-based fiasco so thoroughly continues to demonstrate.


Keep in mind, also, that American medical practice operates inside a bubble of constraints. Including the curious paradigm that one is protected from legal and medical (license) liability by having done what every other medical provider and researcher has been Establishment-directed to do.


In other words, whatever the Medical Establishment says is real, is unquestioningly assumed to be so.


And anything actually scientifically valid, or probably valid, that is not approved — will get a practitioner or researcher into deep trouble.


Like losing his, her (or its) occupational livelihood.


We can reasonably conclude that tyranny, whether instilled by avarice or autocrats, is medical science and practice's mortal enemy.


Pertinent to this, observe — just for instance — how the medical Establishment continues to ignore, by refusing to research, the surprising volume of excess deaths that continue, post-COVID, to occur.


Why are these excess deaths ignored?



There is a clear temporal association with COVID-19's mRNA vaccinations that is tentatively implied by the accumulating data.



Big Pharma's money machine shies away from the possibility of becoming more clearly causally implicated in these deaths, via actually researching their cause(s).


There are many things that the Medical Money Machine does not want anyone to discover.


Skeptical investigation is your friend.