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RE: Science in Anarchy! Participate in the world's first science experiment on steemit and get paid! by thecryptofiend

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· @thecryptofiend ·
This is a great idea but it might be a good idea to get someone with actual medical research experience onboard if you don't already.
Here are some problems I foresee with what you propose apologies if I missed something but I'm trying to do this quickly:

1) No blinding for the use of anti-inflammatories and also no placebo to act as a control.

2) Potential ethical concerns with encouraging people to take NSAID agents - certain people should not take these.  I know you have asked people to check the rules themselves but in a normal study people would be screened for contraindications and risk factors and it would need to pass an ethics review.  

3) The recording of people's information on the blockchain may also be an ethical issue even if people give consent - would be best to just double check this.  Obviously if people have registered under a pseudonym this may be less of a problem.

4) Relying on self selection and self reporting.  Self selection opens you up to certain forms of bias.  Self-reporting creates questions of reliability and the potential for false reporting. 

5)  The ability to self-swap groups could also be considered problematic as you may end up with incomplete numbers to give statistical significance to each group.
6) Further people switching between groups may experience a combined effect of multiple variables which would pollute your results.

These are not complete deal breakers though and I think getting some more advice before going ahead may be useful in order to optimise your study design to get the most out of it.

Might also be useful to see if there are any medical statisticians in the community - it is a very useful skill to have when designing a study  as well as when interpreting the results.  Medical stats are not easy!

Either way you have obviously thought about this a lot and this would be at the very least a good test and learning experience.

I'm a doctor and would love to get involved in this but unfortunately I'm having surgery on my left eye in a few days so will be out of action for a while - certainly will not be able to read.

This would have been ideal revision for me as I really need to relearn my critical appraisal skills as I have been off work for a while due to health issues and am due to return soon. 

I really need to revise some of this as critical appraisal is one of those "use it or lose it" skills which all physicians need to do but nobody likes doing!  Also the microbiome is one of my personal interests too.  

I would love to get a published paper on it at some point.
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@williambanks ·
@thecryptofiend

This information is awesome and going forward perhaps we should formalize the methods a bit more.
But your information while great is already addressed by the study's construction assuming we can get a large enough group.  It all comes down to the central hypothesis which is this...

Does interrupting the inflammatory cascade reduce the length of a depressive episode?

We aren't asking if NSAIDs can treat depression.  I'm not even sure that would be a valid question since each NSAID has a different method of action.  On the other hand, if we see a correlation in the data, then that poses a seed for further research.

The other thing is that we are only recommending people use OTC anti-inflammatories if they are in group 1 or group 3 and the first one of the drugs listed is not an NSAID and yet is one of the most common OTC anti-inflammatories.  OTC anti-inflammatories are GRAS at this point especially Tylenol.  However no one should be rushing out to buy and take something they've never heard of before.  This should be "whatever you normally take for aches and pains".

The control group gives us a baseline, and is protection against selection bias because we can safely assume that the control group will be the least likely to be depressed to the point that any of these actually sound like great ideas.  But will also have a goodly selection of people who would be any of the other groups except for time and life issues.

Group 2 are likely to be the ones most likely to see benefit if it turns out that the inflammatory response interrupt is actually a placebo effect.  The diet is one that will force the body to burn it's own fat and raise it's own metabolism and this has been shown to also reduce the body's ability tendency to enter the inflammatory cascade. Thus the group 2 and group 3 people are forcing their body to not go into the hibernation state that I believe may be central to the issue.

Group 3 are likely to see the most benefit if it turns out that the inflammatory response interrupt is not placebo effect, because they are doing everything that Group 2 are doing, plus they are tossing in an anti-inflammatory if they feel symptoms of malaise.

So yeah it's not a perfect study and it is relying on the assumption that thousands upon thousands will participate, thus drowining out issues such as self reporting biases.  However rigorous collection and rigorous analysis can let us know in no uncertain terms if the immune cascade is doing it or if it's the inflammation portion specifically, or if it's placebo effect.  At a minimum it will allow us to start the inquiry process and decide which avenues of study look the most promising.

As for someone to do the work that nobody likes doing, consider yourself hired and you can certainly author the paper and I know several places that would gladly publish.  
I'm more interested in the rigor of the data collection aspects here and making sure the dataset itself is open and the methods and procedures are well document. :D

p.s.  Please take care of yourself, that eye surgery sounds painful, just wanted to wish you well.
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@thecryptofiend · (edited)
Yes no study is perfect and what you have is fine as a starting point but I definitely think it will need refinement for further work particularly if you want to get published.  The people in peer reviewed journals can be really strict when it comes to protocols as they should be I suppose.

Depending on my work schedule at a later date I may  be able to help with that.  

Thanks for your concern.  Not looking forward to the surgery to be honest.  Just want to get it out of the way really now.  They said to expect it to be quite painful for at least a week and plus I'm an insulin dependent diabetic which slows things down.

All the best:)
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