Comments on: Confounding Factors and Researcher Bias http://womantowomancbe.wordpress.com/2008/06/10/confounding-factors-and-researcher-bias/ Not just another WordPress.com weblog Sat, 02 Jan 2010 03:51:12 +0000 http://wordpress.com/ hourly 1 By: Jim Nicholson http://womantowomancbe.wordpress.com/2008/06/10/confounding-factors-and-researcher-bias/#comment-459 Jim Nicholson Mon, 23 Jun 2008 19:26:30 +0000 http://womantowomancbe.wordpress.com/?p=125#comment-459 As the main author of the study in question, I have a few comments. 1) You were on a role when you sounded like you might consider supporting AMOR-IPAT. Why the sudden pull back? Is there any other method of care that is trying to lower the US cesarean delivery rate? 2) Have you read the "editor's choice" article in the May 2008 edition of the American Journal of Ob/Gyn. This article reports with use of AMOR-IPAT in a randomized controlled setting. Although the study was not large enough to fully assess AMOR-IPAT's impact on C/S rates (c/s rates were numerically lower in the AMOR-IAPT group), the study did show lower NICU admission rates, higher uncomplicated vaginal delivery rates and a lower adverse outcomes index (AOI). 3) There is ample evidence that complications with delivery are fewest if labor starts spontaneously at around 39 weeks gestation. Therefore isn't it at least theoretically possible that induction of labor at that time might improve birth outcomes? 4) How much evidence would you need to see to be convinced that AMOR-IPAT improves birth outcomes? I ask that because there are now three studies that strongly support its use, and three others that will be published later this year. Throwing sticks and stones at AMOR-IPAT is ok, if you are sure that preventive labor induction is bad (mind you there is very little good evidence that this is the case in the medical literature), but for goodness sake get to work and do some research comparing the current standard of care to something that you think is better. As the main author of the study in question, I have a few comments.
1) You were on a role when you sounded like you might consider supporting AMOR-IPAT. Why the sudden pull back? Is there any other method of care that is trying to lower the US cesarean delivery rate?
2) Have you read the “editor’s choice” article in the May 2008 edition of the American Journal of Ob/Gyn. This article reports with use of AMOR-IPAT in a randomized controlled setting. Although the study was not large enough to fully assess AMOR-IPAT’s impact on C/S rates (c/s rates were numerically lower in the AMOR-IAPT group), the study did show lower NICU admission rates, higher uncomplicated vaginal delivery rates and a lower adverse outcomes index (AOI).
3) There is ample evidence that complications with delivery are fewest if labor starts spontaneously at around 39 weeks gestation. Therefore isn’t it at least theoretically possible that induction of labor at that time might improve birth outcomes?
4) How much evidence would you need to see to be convinced that AMOR-IPAT improves birth outcomes? I ask that because there are now three studies that strongly support its use, and three others that will be published later this year.

Throwing sticks and stones at AMOR-IPAT is ok, if you are sure that preventive labor induction is bad (mind you there is very little good evidence that this is the case in the medical literature), but for goodness sake get to work and do some research comparing the current standard of care to something that you think is better.

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