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Research Methods Rigor

Minas, Clive, et al

First of all, I’d like to congratulate Minas on finding an article I had published in Arch Ophth over 20 years ago, that I myself had forgotten about. It does speak to the point that I’ve both performed “real hard” research myself (eg as a PI for the FDA trial for the first solid-state excimer laser), had training that was heavily biased towards a career in academic medicine, and was in academics for a few years before I left because I couldn’t hack the “politics” involved (you may have noticed my abhorrence for “political correctness”) as well as the lack of support and unreasonable constraints (eg on advertising) on me creating a strong refractive practice–back in the days where refractive surgery was not considered a “real” subspecialty (sadly still the case to some extent today)

To be clear, I’m not “against” performing hard studies, as my background and publications should make clear. I just would like to speak out against the mindset (as I have several times on this forum) that controlled trials in peer-reviewed publications are “real” and everything else is anecdotal BS

This attitude is both wrong and unnecessarily restrictive. With this attitude, all scientific research until 1950 would have to be considered “fake”, and if this “rule” had existed back then, it would mean that nothing would be discoverable–not penicillin, not any advance in any surgical technique, nor any new medication. 

There are many ways to seek out truth besides a controlled clinical trial. Think about Einstein’s great “thought experiments.” He didn’t happen to have billions of dollars, plus a time machine that would enable him to build a cyclotron. What he did have was the intellectual capacity to build thought experiments, that when gone through, would yield results that were both insightful and valid in their own way (and show the path towards later “hard” research)

Think about all the problems our profession has had with the best drugs to use before, during, and after cataract surgery, and even the best way to prep before surgery. Since many of the adverse outcomes are very rare (eg endophthalmitis), we cannot enroll enough patients to have an n that is powerful enough to assess outcomes rigorously. So then we are left with secondary metrics, like measuring bacterial loads as a metric after x antibiotic schedule preop and/or y prepping schedule. Please recall that most of the antibiotics we use for surgical prophylaxis were never actually approved by FDA (or rigorously studied) for that purpose, but for some “easy/cheap to study purpose” like bacterial conjunctivitis.

Regarding some members telling other members to “stop this avenue of discussion” I think that is quite presumptuous of them. I had to tolerate about 30 emails over 10 days several months ago about what to do to prevent one’s fingertips from bleeding after guitar playing, which had zero to do with ophthalmology. I’m sure there are some people who thought there were too many joking emails about the use of sunglasses indoors (although I found that thread quite funny). Shouldn’t we agree that only the moderator (MM) has the right to tell others to cut it out (ie to end threads that seem to be useless or taking on a non-collegial tone?

While on that topic, I would like to point out that some members have occasionally resorted to ad hominem arguments to “win” their point, or to “silence” another member with whom they disagree. This is really one of the lowest common denominators of debate, and anti-intellectual. Having someone unfairly malign me by saying basically, “Now we all know whom to refer pregnant women to if they want LASIK so he can perform more procedures” combined with the basic message of “please shut up” is not in the spirit of “free discourse” that Keranet was founded, and should really not be tolerated.

Finally, I have been contacted by several knet readers (who wish to remain anonymous) that the reason they do not actively participate and reply to posts is that they are afraid of being attacked by a few frequent posters who they feel act like a kind of “Knet mafia” (their words, not mine). By this, they mean that a handful of posters seem to feel that, because of their seniority in ophthalmology or this group, that their views should not be “overly challenged.” I have felt this myself, which is really bad, because I, myself am one of those senior members (having joined within the first few years of Knet’s founding). So I am just putting this out there, as is my wont, to open up this avenue of discussion. Please understand that I am one of the least “politically correct” eye MDs you will meet, and remember that I sometimes wish to act as a provocateur to spur discussion/thought — so try not to get “offended” or become “defensive” (I was also born in Manhattan, so sometimes my natural language is blunt and challenging and profane;))

On a parting note, while it’s nice to celebrate 1,000 participants on Knet, let’s all acknowledge that of these 1k members, about 900 ONLY read and NEVER post, another 50 rarely post, another 25 sometimes post, and ONLY ABOUT 20 MDs and 5 ODs frequently post. If we can all name 10 doctors who post 80% of all content, certainly that tells you something. Not ALL of the 900 who NEVER post are only “too busy” or “not motivated enough.” Again, I know a handful who have told me that they are too intimidated to post–which is really a very bad thing.

So if we can all agree (which I think we can) that having more members actively participate and post instead of just reading is a good thing, as it adds more diversity of opinion, then the question becomes: “What can we do to improve the experience so more members participate?”

I would like to end by posting the following questions:

1. What can we do to make it easier/more inviting/less intimidating for members to participate?

2. What can we do to form a hard code of ethics to prevent uncivil exchanges? MM is a GREAT moderator, but I’m sure everyone would agree it would be even better if we could monitor ourselves better, which would seem to necessitate some actual rules (eg, no ad hominem attacks, only the real MM saying when to close off a topic, having a maximum number of replies to a thread (?10?) that has nothing to do with eye stuff)

To tell you the truth, I was going to go back into “silent” (read only) mode a few times over the past year, when I felt that it was not worth my time to “share” while feeling attacked, but a few other members contacted me privately to say they wanted me to stay, as they thought worthwhile my: a) contributions re ASA, b) function to “stir the pot” and c) ability to “stand up to the powers that be” (again their terms, not mine). Of course, I know of at least 2 others who would love to see me leave, and have told me privately where to go;)

In summary, I have learned a LOT on Knet, but could clearly have a more positive ROI on my time if I only read most of the time, and rarely posted. Everyone who frequently posts is really doing so not just to spout out, prove how smart they are, and burnish their reputation, but because they really care about education, and are trying to share their expertise. It would just be preferable if these people (myself included) could do so in a way that was slightly less “bossy” and intimidating, and slightly more civil, so as not to discourage others from posting, and certainly not trying to silence those who do choose to post.

Let’s see what your response to this thread is–I’m eagerly awaiting the replies:)

Yours respectfully,

Emil “Dr LASEK” (like on my vanity plate)  Chynn;)

Emil William Chynn, MD, FACS, MBA

Harvard/Columbia/Dartmouth/NYU/Emory-trained

1st eye surgeon in NY to get LASIK himself (1999)

Performed 5,000 LASIKs from 1996-2002

Switched to non-invasive LASEK in 2003

Have performed more LASEKs than any MD in US

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