A problem with clinical chemists

The bridges of Portsmouth, NH

Clinical chemists are extremely knowledgeable on a wide variety of topics and provide a valuable service. So what is the problem?

They tend to live in their own world and are reluctant to consider ideas from outside of this bubble. Here are some examples.

Top-down measurement uncertainty – I sent a letter to the editor about a paper which talked about the top-down method for estimating measurement uncertainty. My letter was rejected rather strongly so it is on my blog here. Rejected perhaps because after all, the top-down method is part of an ISO standard (20914). To recall, their top-down method is to run some controls. Here is what a real top-down method entails.

Commutability – There were three articles in Clinical Chemistry, (and later a fourth article) produced by an IFCC committee. These articles explained how to estimate commutability and why it is important. I prepared a critique of these articles and did not get anywhere in trying to publish it. So, my critique is here.

Bland-Altman plots – Bland-Altman plots (difference plots) are well known to clinical chemists. I tried to publish a letter suggesting (with simulation examples) that when X is a reference method, the difference should be plotted against X, not (X+Y)/2. No clinical chemistry journal would accept it – it was accepted in Statistics in Medicine 2008;27:778-780.

Clinical Chemistry Journal – I published a letter in Clinical Chemistry in response to an expert panel’s discussion about glucose meter specifications: Wrong thinking about glucose standards. Clin Chem, 2010;56:874-875. I would like to think that this letter helped to change the next version of the ISO 15197 glucose standard. The problem is that these days Clinical Chemistry no longer will consider letters to anything in Clinical Chemistry other than a technical article. This means that about half of the journal’s content is off limits. The editor of Clinical Chemistry reasoned that their content is sufficiently vetted. IMHO, this is unscientific and elitist.

Why Ezekiel Emanuel should not be on Biden’s Covid-19 Advisory Board

Near Burlington, VT

Ezekiel Emanuel MD, oncologist, bioethicist, and a former advisor to President Obama wrote an article in 2009 in The Lancet about how to allocate scarce medical resources. The so-called complete lives system shows a graph where the Y axis is probability of receiving medical treatment and the X axis is age. The age scale is 0 to 70 with tick marks every 10 years. Sorry octogenarians, you didn’t even make it on the graph! The graph’s curve shows a maximum at age 20 dropping off gradually so that by age 70 the suggested probability of providing medical treatment is close to zero. (The other losers in this graph are babies and young children). Dr. Emanuel also wrote an article in The Atlantic with the title “Why I hope to die at 75.” He discusses how older people become incapacitated both mentally and physically. Covid-19 is a dangerous disease for people over 70. Do we really want someone like Dr. Emanuel on the Covid-19 Advisory Board?