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#090 - Dr. Abdul Razaak MD

Abdul Razaak Incubator Podcast

Bio: Dr. Abdul Razak is an attending neonatologist at King Abdullah bin Abdulaziz University Hospital and an Associate Clinical Professor at Princess Norah bint Abdulrahman University in Saudi Arabia. He has earned his MD degree from Rajiv Gandhi University of Medical Sciences, India, and a fellowship in Neonatal-Perinatal Medicine from McMaster University, Canada. He is passionate about neonatal research, and his research interest focuses on improving respiratory and neurological outcomes of preterm infants. He has published several peer-reviewed articles and book chapters (60 peer-reviewed journal articles and 9 book chapters). In addition, he enjoys learning and teaching neonatal evidence-based medicine.



The transcript of today's episode can be found below 👇

Unknown Speaker 0:59

Hello, everybody. Welcome back to another episode of the incubator. It is interview Sunday Daphna. How are you? I'm doing great. We I love you. I love interview days I really do. So, um, yeah. Interview days are always interesting. And I think I am a little bit upset because I I tend to focus a lot on the production while we talk to our guests. Make sure that the audio is recording Okay, and stuff. But then I get to listen to the interview. And I'm like this. There's a lot of I listened to these things. Overall, like two three times and there's always like, one day oh my god, I hadn't cut cut that initial and, and it's really, really neat. All the pearls that our guests share with us.

Unknown Speaker 1:40

And today, it's fun because we're getting to do what the incubator was designed to do, which is to showcase some of the young talent in neonatology and I miss case I guess, in global neonatology, so we're very excited. Yeah. Which was always a goal for us really, is to say, you know, neonatology is not just being done in the United States. It's being done everywhere and good work is being done. And so it's, it's neat, and it's been so

Unknown Speaker 2:12

what's, what's the word? It's been, it's been so joyful, I think, for us to really communicate with colleagues like all over the world what what a neat opportunity. Yeah, and I think to to create passion and momentum, it's reassuring to see that the coming generation has so much talent. So if you have not listened to this just past week's episodes in the neonatology review podcast that we did.

Unknown Speaker 2:41

Lindsey Kinnick hosted the website, the podcast for the week, and she's so bright, she's phenomenal. And and it's and it's people like her people like Abdul that we're having on today that make you excited about the future.

Unknown Speaker 2:57

And make you excited about what these guys are going to come up with. They're so innovative and so smart, that it's just fun.

Unknown Speaker 3:06

All right, shall we get into it? Let's go. Can you for the people who I mean if people like

Unknown Speaker 3:13

Abdul is Twitter famous, but for the people who don't know, can you can you read this read his bio? Absolutely. So Dr. Abdul Razak is an attending Neonatologist at King Abdullah bin Abdulaziz University Hospital and an associate clinical professor at Princess Noura bint AbdulRahman University in Saudi Arabia. He's earned his MD degree from Rajiv Gandhi University of Medical Sciences is in India, and a fellowship in neonatal perinatal medicine from McMaster University in Canada. He's passionate about neonatal research and research interests focus on improving respiratory and neurologic outcomes of preterm infants. He's published several peer reviewed articles and book chapters, in fact, 60 peer reviewed journal articles and nine book chapters. In addition, he enjoys learning and teaching neonatal evidence based medicine and as you said, he's quite active on Twitter. Yeah. Without further ado, please join us in welcoming to the show Dr. Abdul Razak.

Unknown Speaker 4:14

Abdul, thank you so much for being on the podcast with us today.

Unknown Speaker 4:18

Thank you, Ben. Thank you. Definitely. Thanks for the invite. And it's lovely to be joining with you on the incubator podcast.

Unknown Speaker 4:26

That's right. Yeah. No, it's a pleasure to have you and then for the people who are friends of ours on Twitter, you are famous.

Unknown Speaker 4:35

And, and for the people who may not know who you are.

Unknown Speaker 4:40

You are a neonatologist, and you practice in Saudi Arabia. Is that correct? in Riyadh? Yeah, that's like I practice and in a university hospital, which is called as King Abdullah bin Abdulaziz University Hospital. It's a level three unit single, but we have 32 beds. So that's where the practice currently

Unknown Speaker 5:00

And is this and are you from Saudi Arabia originally? Or did you? Did you move there for work? Yeah, I'm from India. So I've been, I've been to various places.

Unknown Speaker 5:12

So I'm from India, and I did my training all from there. And then then I've moved to Canada really did monumental training at McMaster University Canada, and then I had some good friends who pulled me back here and Saudi Arabia, working here since 2018.

Unknown Speaker 5:30

I think there's so much value to working in different health care systems, I think it teaches you a lot about flexibility and seeing things from a different perspective. So I'm wondering if you can speak a little bit, you know, about your journey through?

Unknown Speaker 5:52

Yeah, I mean, it's, it's sort of a little challenging to say,

Unknown Speaker 5:57

you know, when I first moved from India, to to Canada,

Unknown Speaker 6:02

so that the, the, the, the way we approach to babies to patients is completely different. So you have a team team of doctors and a team of nurses and team of many allied professionals who take care of babies. But in India, you know, it's sort of a kind of a one man army.

Unknown Speaker 6:25

So that's something with this, with this culturally different and it debit have different nuances that you have to learn about.

Unknown Speaker 6:34

Of course, everybody has their own say

Unknown Speaker 6:40

that something was, which was new. And, and.

Unknown Speaker 6:44

And then I think it's all the time. Once once you start knowing how things work, you start to

Unknown Speaker 6:53

get adapted to the process and to the teamwork, how we do.

Unknown Speaker 6:57

And then I can,

Unknown Speaker 6:59

I want to move to Saudi Arabia, to somewhat similar system. So we have, I'd say, we are really lucky to have other consultants from McMaster University. So we have six consultants. So we have similar kind of

Unknown Speaker 7:15

cultural practice here. But the language that that that that that's been primarily used to talk to patients is different. So that's something you're against setback, because that's, that's your main main main forte of talking to you.

Unknown Speaker 7:31

And to the parents. So that's something that again, as little different

Unknown Speaker 7:37

but you know, I think working in different system, you'll you'll tend to get a different flavor of how things work in neonatology across different parts for what's what's normal might not be something normal, at different place. So

Unknown Speaker 7:52

so the way you talk you communicate with colleagues is little different. So and with families, I'm sure, yeah. Yeah.

Unknown Speaker 8:02

Yeah, true. Sorry. Good.

Unknown Speaker 8:05

And is there? I think it's, I think it's great for us to be able to talk to neonatologist and physician from around the globe, because I think, as we say, in research, right, I mean, the patient populations differ from one place to the next. And so I'm wondering if in Saudi Arabia, is there is there like

Unknown Speaker 8:24

a neonatal specialty that you guys see much more of whether they are referrals, or whether they're maybe just use just the regular pre terms like, like the rest of the world? Or is there something that's very specific to Saudi Arabia? Or sometimes, you know, actually, I'm going to make an assumption here. But sometimes, when you work in a big city like Riyadh, maybe sometimes you get a lot of transfer from surrounding areas. But do you see things that are a bit unusual? That would be unusual compared to what you've seen, for example, in Canada, and that's very specific to Saudi Arabia?

Unknown Speaker 8:54

Yeah, I think in cannabutter, practice, it was a level three perinatal unit. So you'd have everything under the except the cardiac surgery and ECMO, of course, we used to transfer our babies from McMaster to Toronto.

Unknown Speaker 9:08

So it's somewhat similar here.

Unknown Speaker 9:11

But I guess, in big cities, so you get both reference and you also have huge unborn babies.

Unknown Speaker 9:22

Yeah, and what I would say is little bit different is how we approach

Unknown Speaker 9:30

families and what are their values.

Unknown Speaker 9:34

So here a lot of emphasis is given to to the outcome death. So and, and of course and everywhere. patients and parents have different values and perspectives. So they give different vantage to different outcomes. So, you know, I mean, somebody might be more bothered about lung disease and you know, ROP and cancer thing or brain disease. But here what matters is Are you alive or are you sure

Unknown Speaker 10:00

But are you? Are you dead? That's something very, very severe to talk to families, they just asked this question, man, I've come across so many families saying that they just are bothered about whether the baby's going to survive or not.

Unknown Speaker 10:15

So that's something that's completely different. When we when we speak to families about outcomes related to brain lung, and well, they don't give so much importance to that piece of aspect. But

Unknown Speaker 10:29

they they give a lot of importance to that. I guess that's that's relatively everywhere across. But here, it's very, very

Unknown Speaker 10:37

hard to say, like, a different than the other places. It's a very interesting point you're making, right? I mean, it's a very culturally, this, I think. Yeah, I mean, it could be that a family is not

Unknown Speaker 10:51

from an intellectual standpoint, it's too much information to process. So they just want to know, survival versus not. But also, I think it may reflect a cultural idea of living in the moment of let me first get to am I going to make it out of here, and then we will worry about the next step. And and that's something that,

Unknown Speaker 11:09

at least in the US, is losing slowly but surely, right. We always want to plan out the next 15 years, even though there's what what is it that we say that men plans, and

Unknown Speaker 11:20

there's no such thing as?

Unknown Speaker 11:23

So that's very interesting. Yeah. That's great.

Unknown Speaker 11:27

I wanted to ask you a little bit. Is it is it? Can you Is it true that like, I was reading some of your tweets that you you were set to become a doctor by like, your grandparents, like your grandparents had already envisioned that you were going to become like a cardiologist or a cardiothoracic surgeon?

Unknown Speaker 11:46

So Bentley, also facing me. I don't know how you remember that?

Unknown Speaker 11:51

Yeah, you know,

Unknown Speaker 11:54

my grandmother, my maternal grandmother, he was, he was one of doctors. So the moment I was born, he wanted me to be a doctor.

Unknown Speaker 12:04

And my, my dad was my dad, my dad sent me some different values. He wanted me to become something else. So something like innovative work, something like engineering kind of stuff. But my my grandmother was, you know, you have to be taught from the beginning.

Unknown Speaker 12:23

And, and it's funny that he wanted me to go into school, a similar school, which his treating physician was, did go to the school, so so he had that strong core values. He wanted me to study in the same school. He wanted me to become a cardiologist.

Unknown Speaker 12:45

But, you know, so unfortunately, he's no more and

Unknown Speaker 12:50

and I think the moment I stepped into the, into the med school,

Unknown Speaker 12:56

people in there with us, but then, you know,

Unknown Speaker 13:00

he did play a huge role in mark him and my life. So everywhere I used to go, there was a book I used to carry. He said, You have to read, and there are some some set of values. He's told me, I still remember that. So no matter where you are, he said that you have to spend at least two to three hours of your time in reading in kind of a learning something.

Unknown Speaker 13:27

I think that's what I still do. Yeah, I keep doing that. You know, that's something keeps you motivated.

Unknown Speaker 13:34

And that's, that's a great piece of advice he gave to me. Yeah. And it Prime's, you for this this lifelong learning, right? So that everything is is potentially interesting.

Unknown Speaker 13:44

Yeah, yeah, that's true. Yeah. And then,

Unknown Speaker 13:49

you know, when I did my med school, I thought, I'll be going into the

Unknown Speaker 13:54

cardiac cardiac cardiology surgery. But then you don't know what's happening after the after the med school. You're everywhere. So I chose first surgery thinking that I'll do cardiac cardiothoracic surgery later.

Unknown Speaker 14:09

Can you know I said when surgery is too long, and I don't know I'm going to make it.

Unknown Speaker 14:14

So people said differently. So the lots of biased

Unknown Speaker 14:19

that I came across. They said, Okay, thanks. So today is something we just look looks like falling off my bracket and let me let me do something else. So then I chose medicine.

Unknown Speaker 14:28

Okay, I said, Okay, medicine is good. I think this is good. I think I'll enjoy so this is not a surgery, I don't need to stress myself out. That takes medicine is great piece. Then again, people said You know, you have to do medicine and then you have to do something more than that. You have to you have to super specialized if you do medicine, and you're already adopted there's not it's not a it's not something different than ours. Okay. Why should I do?

Unknown Speaker 14:53

Pediatrics? I love children. So I said, Okay, let me do it. So that's when I when I came

Unknown Speaker 15:00

Across pediatrics.

Unknown Speaker 15:02

And I thought I'll move away. But then you know, I'm sticking

Unknown Speaker 15:08

something to the pediatrics

Unknown Speaker 15:11

for so long, yeah.

Unknown Speaker 15:13

And then what happened with unit ology, then?

Unknown Speaker 15:16

Well, after pediatrics, then you know, after pediatrics again, you have to do something more as.

Unknown Speaker 15:25

And I liked intensive care. So I was still when I was in intensive care, the lots of babies I saved when I was when I was a trainee. So I did a lot of intubations. And a lot of great thanks, which my mentors were fond of. And so that's kind of set me well that I am pressured by intensive care physician. That's okay. So let me let me go into Pete's intensive care on your Tality. But then in your 30s is more simpler. You've all protocols, you have all guidelines, sort of thing. And so I said, Okay, this is great thing to move on. And then I joined, but after neutrality at some point, and then and then and then you decided that these guidelines had

Unknown Speaker 16:06

reassessed and then started your work about questioning every single one of these guidelines?

Unknown Speaker 16:13


Unknown Speaker 16:15

You know, now I read more and more know what's happening.

Unknown Speaker 16:19

And why.

Unknown Speaker 16:22

You know, I mean, that from well, I mean, it's all the time, right? You know,

Unknown Speaker 16:28

when you move to this, and this, oh, wow, I notice. And then you you in the fellowship,

Unknown Speaker 16:34

you say, Okay, now I know everything.

Unknown Speaker 16:37

Now you become attending is okay, what's happened?

Unknown Speaker 16:41

And then, you know, like, then after you go more and more, and then start interacting with many different people that Okay, so who said, PD should be this? We find people, let me search web, how did the definition of PD came from? So what does the spirit and means? So it's you start questioning everything? I think we get more mature in the way we think. And we approach medicine as we work along. And that's something we realize,

Unknown Speaker 17:10

well, it's so obvious how that value instilled in you by your father, about being a learner and wanting to read in question, definitely set you up for kind of a career and research.

Unknown Speaker 17:25

It. Yes. So my father, particularly, he used to ask me a lot of questions. You know, when something okay, what's this medicine? I said, so just eat this?

Unknown Speaker 17:36

You know, no, no, tell me what does it do? How does it work?

Unknown Speaker 17:41

And what does it do to your body and cannot think so. So, you know, I mean, when you're around with people like that, you start to do the same way. So that's something I was interested in. That's why I was interested in doing research, and trying to find out what best we can do for babies.

Unknown Speaker 17:59


Unknown Speaker 18:02


Unknown Speaker 18:04

So it's funny that you say that, right. I mean, I remember this this quote by by Neil deGrasse Tyson, who was talking about like, knowledge as this as this bonfire, and that it lights the way of your trajectory. But as it grows bigger, you you go to see more of the things that you've never noticed before. And it just gets you more thirsty and hungry for more discoveries and more information. So I kind of relate to your idea about like reading through the evidence, and seeing where the data come from, how come we're doing it this way, when the evidence is not really great.

Unknown Speaker 18:39

I think I think this is, this is really interesting. You've talked a lot about your father, and I'm wondering, you didn't really tell us what what was what was your father doing in his life in his professional life. So he was kind of an engineer. So he used to work with

Unknown Speaker 18:55

him engineering. I mean, he was here in Saudi Arabia for quite a long time. And he wanted me to do something similar.

Unknown Speaker 19:03

You know, try to create something innovative, try to do something that that is going to help people that's going to make life easy. And he he kind of did things in a simpler way. And the way he analyzed was completely different. You wouldn't imagine, okay, this is the way you could analyze. Well, wow. So. So that's something he taught me and he said, so when you end the interview, he was he was he tried to explain something about his kind of a work was very simply, and they said, This is what you have to, let's say, you become an engineer, or a doctor or something like that.

Unknown Speaker 19:44

You know, you have to present information to people in such a way that so they're going to catch up easily and they're going to remember it long.

Unknown Speaker 19:52

So that's how that's how you will become a good teacher and that's, that's something I do in my tweets or on social

Unknown Speaker 20:00

Meet, I tried to make it more simpler and make it more easy to help people understand because the more harder is, you know, you lose, you lose, you lose, you lose the lowest interest and you might not remember and something that that's snappy and catchy and easy to understand. You tend to remember things.

Unknown Speaker 20:20

And that's

Unknown Speaker 20:21

a Yeah.

Unknown Speaker 20:23

And so I think this is like this dovetails really nicely with the work you're doing with EBD. Alright, so for the people who are, I mean, we're trying to get people to familiarize themselves with with social media, but for the people who are not familiar with all the tools that we have available on Twitter specifically, can you tell us a little bit about what EB Neo is and what it's supposed to do and and what is your role with EB Neo.

Unknown Speaker 20:49

So, EPO is as a as a nonprofit organization. So we have group of neonatologist all around the world. And and what we do mainly is there are many things that we do and but what we do mainly is to try to find out articles,

Unknown Speaker 21:05

which are of potential importance and try to summarize in a simpler way, or in a similar kind of format,

Unknown Speaker 21:14

which makes it easy for people to read and understand what's out there in a short span of time, and try to

Unknown Speaker 21:25

get people alerted that this is there. And this, this can be of potential importance. And that's something that we do. That's one of the main important things. I guess the the same way you're doing it incubator podcast, you're picking articles trying to explain what the what is it and the same way, but we are trying to

Unknown Speaker 21:45

do it in a snapshot. So we have a specific format that we we go with. And you know, it's a simpler way of explaining, study design, the patient intervention, controlling outcomes, and the main outcome. And if there's any specific outcomes that the authors have found,

Unknown Speaker 22:02

in a way, so our job as someone after the social media returns, so so we have different kinds of editors. So we have cool social media editor. And we have regular social media editors, and there's some something less less social media editors.

Unknown Speaker 22:17

So more or less, we do something similar. But

Unknown Speaker 22:22

in general, the social media editor is assigned to specific set of channels. So for example, I think, if you see a toll is assigned to any GM and pediatrics. So I'm assigned to

Unknown Speaker 22:34

a pediatric n plus one. So what we do is every week, we go through the set of journals, and then we have a day. So for me, let's say, my day is Monday. So I'll try to look on Saturday or Sunday, and try to find out from last Monday until Sunday, what are the journal articles that have come up? And try to find out a good research versus, you know, I mean, I wouldn't say bad research, I would say just the research, which which couldn't answer very well,

Unknown Speaker 23:07

that warrants a discussion. Yeah, so something like that. Yeah. And so really, we try to find out as editors, which are the relevant articles, that can impact clinical practice.

Unknown Speaker 23:20

That's something where people are interested about and where we think the discussion can be generated. So we in that short span of time, we look at all the articles and try to pick up one of the articles. But let's say there could be one or more articles, let's say, if you're working on JAMA, and there could be two or more articles, then we kind of ask other people if they have no, no post for that day. So we kind of work along together so that every editor has got each day, Monday is Monday, and I looked at active pediatric and plus one, but but my role is close social media editor, so have little strong tools to pick up articles from everywhere. So let's say if if, if if if a content comes in a different channel, which has not been assigned, for example, there's journal colors, translation biology or something like that, that's not that doesn't fall under under our umbrella of specific journals. So that kind of agendas I pick up I'm trying to say I have a larger general content. So I can pick up from any kind of

Unknown Speaker 24:26

so we summarize in a in a way that

Unknown Speaker 24:29

people understand easily. And we try to color it in a way that people know this is intervention, and this is a control and and the entire product, put it put the author's conclusion at the end. And if it's something which doesn't fall in the way the authors have done, we try not to put it

Unknown Speaker 24:49

so there's a bit difference, but more or less we have similar content. So we try to post out in three different platforms. So one is

Unknown Speaker 25:00

on the Twitter, and that's where the most of the discussion times, and the second one is the on Facebook. And then the third is Instagram.

Unknown Speaker 25:09

So we use pot to post all the contents and you know, just do that and post it.

Unknown Speaker 25:17

So it goes all along.

Unknown Speaker 25:19

So, so that's, that's one of the work, which we do at Ibnu. And, and there are many other things that we do.

Unknown Speaker 25:28

One other thing is covering the major conferences, such as peers are lifted hot topics or something like that.

Unknown Speaker 25:38

So we generally call PSN hot topics, again, in those

Unknown Speaker 25:43

in those conferences, we assign,

Unknown Speaker 25:47

you know, a day, so let's say specific hours, depending on how everyone is flexible with, then we cover the content live. And we tend to post

Unknown Speaker 26:00

things which are out there as soon as possible. Again, at the end, the motive is to try to bridge the gap between the article which has between the study that has been conducted, and time it is out, you know, it takes a long time to come out. We wanted to keep it to get it soon.

Unknown Speaker 26:20

That I think that's one of the core value that what ABB has got.

Unknown Speaker 26:26

Yeah, and so for the people who are I mean, EB Neo is one of the reasons why I started using Twitter for a more professional

Unknown Speaker 26:34

as a more of a professional function. And EB Neo is at Ibnu on Twitter, and you even have like a website up near that org. I'm wondering, having How long have you worked with EB Neo? Well, I joined Twitter only in 2019. I think. So in May 2019.

Unknown Speaker 26:53

And I joined I can my queue I joined only

Unknown Speaker 26:57

looking at the content of the EP knew I know, you know, I use Facebook. And then I came across this post. And I thought this is interesting. And then people said there's much, much larger discussions happening on Twitter. And where EB NIA has a larger role. So that's, that's where, you know, I joined, I joined Twitter and the first follower of the EPO, and as amazed. I think it's our opinion is all group. It's all you it's all us, it's everyone. Everyone is contributing it, it's just that everyone has got their own role. Let's say I'm going to curate the content from various journals. So that's my role. And again, as a consumer, and also what you're trying to do is you try to comment on, on on the study or on the methodology or something, what you think is important, so, so it's it's all of us. So I think it'd be nice, like a big

Unknown Speaker 27:50

new tutor family. So everybody's contributing to everything. So that's, that's, that's why I joined. That's, that's why I joined Twitter.

Unknown Speaker 27:59

And so what has Can you can you share with us a little bit some of some, I guess, some stories or in you working with EB Neo. And I think the other thing that people don't know is that the committee or the editorial team at Ibnu, is a collection of top notch fascinating neonatologist and so I'm wondering,

Unknown Speaker 28:22

can you share with us a little bit what this experience has been like in terms of your growth as a neonatologist? I mean, because I'm sure that there's there's an abdulrazaq from pre Twitter and there's an abdulrazaq, post Twitter, and I'm curious as to what has what can you What have you been able to pull away from Twitter into your day to day clinical practice that has made you a better clinician?

Unknown Speaker 28:45

Yeah, I think that's a very interesting question. So

Unknown Speaker 28:51

the when I joined Twitter, I didn't know anything about APA, I just knew that it was kind of a society or a committee or an organization because famous neonatologist

Unknown Speaker 29:04


Unknown Speaker 29:06

and they kind of put out the content. And I was amazed to see how they could get on to the articles. So early that we could not

Unknown Speaker 29:16

and how could they access orally that we could not and and the way they generate discussion, the way they create ideas. So it was amazing.

Unknown Speaker 29:28

And I think, you know, I mean, before I joined I didn't know how whether I could be part of a video but at one point, EPA had had advertised that if people are interested, they're looking for editors. And I thought this is a great opportunity. But I don't know I was I was fit for that role

Unknown Speaker 29:49

that I reached out to Nick and I think at that time Brian was switching

Unknown Speaker 29:54

the roles and I asked him whether I could be part of the

Unknown Speaker 30:00

Know the team? And they said, why not? And it's just you need to know,

Unknown Speaker 30:06

some core values. And, of course, you need to know how to how to interpret and to read a paper, I think, yeah, how to interpret the evidence and how you put out is something that's important.

Unknown Speaker 30:18

I think that's something that they already saw, you know, while I was interacting with the group.

Unknown Speaker 30:25

Now, this is kind of a prime of faith. So they knew about me, and I thought

Unknown Speaker 30:31

I could bring up some, some nice content and nice discussion.

Unknown Speaker 30:35

And, you know, I didn't know I would be a great fit, but then I joined the team. So. So it's been, I joined, I think, in 2019 2019, and I think after the COVID, are sore after the COVID, one started. So that's when, after joining a tech, what I see is this much larger discussions happening every day, every day. You know, I mean, the discussions that happen on Twitter, I don't think it happens anywhere else. To be honest. You know, I would, I would think that Twitter is kind of a Live

Unknown Speaker 31:11

Live Journal Club, which runs 24 by seven.

Unknown Speaker 31:15

And it has some great people to be honest, I love everybody out there, and

Unknown Speaker 31:22

everybody has got their own views. And and if you look at what they're saying, it's true. And why not? You know, I mean, if you think back, what he's saying is right, and what he's saying is right, and why why not think that we want to think this way, and everybody has their opinions and views. And so I think,

Unknown Speaker 31:41

by involving in, in the discussions on Twitter and with EPO, so I, I kind of picked up a more better way on how how do we interpret evidence. So there's some major things that happened in my life. One is the joining the program at McMaster, which has a very strong foundation of ABM and, and how the program set out how to understand APM was something that that's really great. But then Twitter has played a huge role in in how we interpret medicine, and particularly in the EPO group.

Unknown Speaker 32:20

So it helped me how to easily understand research. And of course, I mean, everybody knew that, but how easily you can understand what to look for. What, what are the specific things that that you do?

Unknown Speaker 32:35

That something, it's an amazing journey.

Unknown Speaker 32:38

So now it looks like full fledged. But But when something new comes, oh, I don't know, this

Unknown Speaker 32:45

rollback. So what I used to do is

Unknown Speaker 32:50

see when I joined the the Ibnu group and the Twitter, I mean, how many new people I didn't know any of any of the few of

Unknown Speaker 33:00

people around but then when I started interacting, I knew who is good at what and who is interested in what and and started tagging people. And then that that creates more discussion, then you're like you're tagging pulling up leg and okay, hey, look, what is your opinion kind of thing? And then when somebody posts something

Unknown Speaker 33:22

I tend to look at carefully and I try to read if I don't know, I ask.

Unknown Speaker 33:27

So these are the things that helped me build,

Unknown Speaker 33:32

do interpret medicine and more better way. So I would say one thing that people should do is join Twitter and start interacting.

Unknown Speaker 33:43

I think one of the best one of the best examples of this collaboration and this work that happened on a digital platform is your is it was it an editorial in JAMA peds about Yeah, the studies on probiotics? Yeah. Because Can you tell us a little bit about it, because you collaborated with people from you know, Twitter, and you wrote this great editorial to basically say, we have all the evidence that we need regarding probiotics, and in order to to change what the current evidence is showing we're going to need, I forgot how many it was like 8000 premies, to have a different outcome for for the evidence to start stepping in a different direction. That was so cool. So I'm curious to hear your thoughts on that. Well,

Unknown Speaker 34:25

you know, when when Cochrane came out with that message saying that, you know, probiotics are good, but they they're still not confident in the evidence.

Unknown Speaker 34:35

And they said they need an as usual way. They said they need more trials and said, Come on, how many plants gonna need?

Unknown Speaker 34:44

I said, Okay, so let me let me look for babies. How many babies have been studied and it was amazing to see that close to 10 15,000 babies have been studied.

Unknown Speaker 34:54

So this is the largest

Unknown Speaker 34:56

area which has been explored. So then how many more

Unknown Speaker 35:00

We should study to say that we are going to be confident in the in the findings that we have on probiotics. And then when you look at closely the other data, which is much larger the observational data and the QA studies, I mean, though you don't have material confidence compared to what you have in randomized trials, but then still, that forms a larger group. So I think that was close to around 80,000 babies. So if you combine both randomized anonymous evidence, almost 87,000 Babies was study. So the question was, do we need another 3000? To study more? Or how many more we need to study? Because if you're saying we're not confident estimate, because we are worried about small trials, which are by us pulling away the estimate, so then,

Unknown Speaker 35:46

so then, how many trials we need more to pull the estimate on the other side, so then, you know, that that discussion came up. So it was not my idea, it came up? As we started talking, everybody started talking more and more. And then, you know,

Unknown Speaker 36:03

I said, this is great. This is a great topic, and I should work on it. And then what I did is I saw we had, I had one one more colleague, Gollum Suresh. So the article was written by me governance solution, Ravi Patel. So I, you know, I, I think I reached out to Gotham saying that, hey, look, this is something I'm trying to understand. And so, this is what I think and I think we should write up. So he was, he was,

Unknown Speaker 36:35

he was much happy. So we thought, okay, let me do it. So I drafted the article, I put it all my content, and then I did, I did the basic work, then I am very much interested in systematic review. So I said, Okay, let me see what happened. If I put one more file with this kind of a size? What will happen? So then, okay, then we're gonna put that estimate in the in the reference database manager, which we use for metaanalysis. Well, the, the, the confidence was still there, it was not going.

Unknown Speaker 37:05

Well, I said, Okay, what's going to happen, because, you know, the NEC has very low incidence, the law. So that's another problem, you need to study big, big. So they start pulling more and more and keep keep adding more and more infants, then I found out that, so to move the estimate from from one end to at least to the to the null, so what we are we are not saying the other side completely, we're saying that, to know, to move towards not saying that probiotics are not useful, because that's what you're blaming for. Sure. You'd need another 80,000 infants. 80,000. That's right. That's right. I said, 8000. Yeah, no, that's fine. Yeah. 80,000 infants, so that was amazing. You know, I just, I didn't know how I did it. But you know, I kept adding, you know, 1000 1000 initially, and then I said, Okay, this is going to be big numbers, let me as 555. So

Unknown Speaker 37:52

I said, please move to one. So why did why did why does it seem it is not going to one I guess that led me on and other times? So when I 80,000. So that's when,

Unknown Speaker 38:01

you know, the estimate moved to one. And then so after me and gotten drafted initially, then I've you know, Robbie, Robbie has great knowledge and robotics. And he said, why? Okay, so he's an expert, why don't we ask him to

Unknown Speaker 38:18

share his opinion, then we shared the article, kind of, for a review. But then Ravi put out some great content.

Unknown Speaker 38:26

He said he had, you know, you'd say much more flavor to it.

Unknown Speaker 38:31

You know, when when you prepare a dish, it should also look nice, right? So that's what we

Unknown Speaker 38:37

do. Yeah. He gets you from like a one star Michelin to a three star Michelin dish. Yeah. And they certainly allow. So this is looking very great. So that then we didn't know where to put it. And I said, Okay, why don't we start putting in some, and then it got accepted right away? Yeah, that was ambitious. That was ambitious. And I think this is, this is such a great story. The reason I didn't want to interrupt you throughout this story is because it exemplifies what Twitter can do for you, right? I think, if you had planned to coordinate this type of collaboration in real life,

Unknown Speaker 39:12

it would have most likely taken months, and it most likely would not have succeeded. But I think Twitter gives the opportunity to connect with people from around the globe. So you're like you were saying if you go into the comments section in the EB Neo posts, you will have people from

Unknown Speaker 39:28

the US you'll have people from the UK people from Australia, people like yourself from Saudi Arabia engaging and discussing a paper and and it's it's quite fascinating to be even privy to these types of discussions. And when you think about what it would take to get something like that done in real life, it would have to be at a conference where all these people show up where all these people meet up in a room and and it's almost impossible and and the fact that we're all online at this, this I forgot I was I had the opportunity to listen to the to the CEO of slack talk about this

Unknown Speaker 40:00

About this idea that asynchrony provides benefit where we're not all there at the same time. But yes, this asynchrony allows us to engage and still have a meaningful conversation is something that's, that's quite amazing. So like you said, if you if you haven't,

Unknown Speaker 40:15

if you haven't joined Twitter, this is the perfect story, the perfect example. And we will link that editorial because I think it was what like, I know how it'd be Neo has this cool, like 52 RCTs. And like, you guys, you guys rank the best randomized control trial in the year. That was, to me the best publication of the year, because it would just, it was just making a point, right, I made a point it made it well, and, and it was, and it was audacious because it went against some things that were published in Cochrane, and by the American Academy of Pediatrics, who I think, honestly, speaking, were having some issues committing to recommendation versus another. And you went in and be like, alright, it's like 80,000 babies, are you going to you seriously saying we need to enroll 80,000 More babies in order to figure out whether this intervention is working or not? So congratulations, and kudos to that? Well, I would say thanks to everyone out there. No, I what I was wanting to say is that for people who aren't on Twitter, who are still nervous to be on Twitter, actually, EB is a website where you can go and see the EB mio reviews, the major alerts, you can vote for the article, the month and article the year. So that's another way that people can get engaged and involved in, especially on the commentary around

Unknown Speaker 41:35

data. Because I think, especially for trainees or learners, you're going to hear some commentary in the, in your own unit, maybe, maybe not everybody agrees. And so it's nice to hear some of that or be prepared for some of that, from the community. And I wanted to ask you, specifically, when we're talking about trainees, or maybe people who don't have a strong background in statistics, but want to practice evidence based medicine, it's never too late. But what's a good way to kind of get your feet wet? And really start understanding

Unknown Speaker 42:11

some of the kind of research paradigms?

Unknown Speaker 42:19

I think

Unknown Speaker 42:21

the usually the start is to, is to

Unknown Speaker 42:26

get yourself engaged and in, in your, in your own community, I think. So very practice. I think that's where the start with, you know, you have to come out of that comfort zone.

Unknown Speaker 42:40

You know, I mean, I'm telling this now, but I was doing that same day, it's

Unknown Speaker 42:46

Mr. Social media, social media editor, it's easy to say no, but

Unknown Speaker 42:54

you know, I mean, when I was I was a trainee, to be honest, when somebody said Journal Club, it was all looking black and white to me.

Unknown Speaker 43:04

I said, I don't want to do this.

Unknown Speaker 43:08

But, you know, for me, it all started with, with a criticism, I wouldn't say criticism, I'd say, you know, a positive kind of feedback. You know, I'm, I'm a person who tends to adapt things faster. So. So, when generals used to come up with great content, I used to say to my mentors, Look, what a great article has come up, this is amazing. Look at the look at the data. Whilst the mortality so much, so much lower. I think we should do this, you know, the card milking that came up in 2012 2011. So Vietnamese, they said we should do it,

Unknown Speaker 43:39

then, you know, my mantra is, is to say, okay, hold on.

Unknown Speaker 43:43

So that trial is done somewhere else, you have to do a similar kind of thing here, you have to show that this is what

Unknown Speaker 43:50

and you have to have little bigger purpose. Okay. So why are thinking differently? Why I'm thinking differently, you know, that started with, you know, why why are the different will have the different views? Why can't we just take it so, so that kind of a thing. So and then.

Unknown Speaker 44:05

So, when I asked my mentor, they said, Well, I mean, this is my view, and this is somebody or somebody else we went so what we just need to do is we need to, to know more better way to interpret how, how the study is done. So and then you know, the best place to start is to get engaged in detail flops.

Unknown Speaker 44:28

So that you so why don't just do more and more so that that's where I started doing more and more than clubs. And then still, you know, at some point you feel okay, there's still lots lots of things to learn. So then I started

Unknown Speaker 44:43

not a skip journal clubs, even though you don't present it, you try to engage. And the discussion has been present with somebody else. And then, you know, that's the face that everybody doesn't and, you know, joining to any evidence based medicine workshops, that kind of a usual thing that everybody does.

Unknown Speaker 45:00

But I think for me a great success was

Unknown Speaker 45:04

was a unique program at McMaster that was designed by by one of our

Unknown Speaker 45:10


Unknown Speaker 45:13

And, and it was really great. So I'll tell you, I mean, how it was designed.

Unknown Speaker 45:19

So what we, what we, what we did is, we said, let's say okay, there'll be 10, journal clubs, that's going to happen.

Unknown Speaker 45:29

And this one is going presented by x, y, z and that kind of thing. And then E Journal Club, we came up with the, with the methodological aspects, okay, so the person who is presenting, the first dental club is going to talk on randomization is going to talk on blinding. So the next person is going to talk about allocation concealment. And then the various other kinds of biases that might come up. And then the next person who is going to talk about is intention to treat versus protocols. So we kind of clubbed it with articles,

Unknown Speaker 46:02

where we think that method is important.

Unknown Speaker 46:07

You know, particularly where there have been a lot of protocol violations, which was an article which has presented both intention to treat and protocol analysis. So we kind of switch sandwiched, I'd say,

Unknown Speaker 46:20

the methodology and the articles together in a way that we knew from top to bottom, okay, now we know how to interpret randomised trials. So how can we have confidence? How can we apply the medicine? So that kind of thing. So that was a unique program, that that we came up. And that was awesome. And I think that has that had a major role. And I think the second

Unknown Speaker 46:45

major role is is joining the treat, of course, and joining the EPO. I think everybody out there is listening today and who's not on Twitter, not not following the podcast or the the video, I think

Unknown Speaker 47:00

we strongly encourage you to do that. So there's lots of learning here. And it's free.

Unknown Speaker 47:08

And I think that's, that's, so I'd say Twitter APU and all the podcasts and all the discussions that happens on the new new to committee is great. So that kind of enhanced my further learning. And, and and the third major thing that I would say is my own personal effort, you know,

Unknown Speaker 47:28

you have to do a lot of writing and reading and also reviewing. So I make sure that every week, at least I read a couple of articles, good articles, I don't want to miss from a present, I have to go to all the methodology and try to find out what's happening. And can I really believe the evidence. So at least not to miss the major, the major topics, I'd say at least everybody out there, try to do at least once a week.

Unknown Speaker 47:54

And then of course,

Unknown Speaker 47:56

you have to start writing I mean, we're gonna start fighting, you will, you will understand, what are you seeing? So you know, I mean, my again, quoting my great grandmother used to say, you know, one time writing is better than 10 times reading so. So keep writing.

Unknown Speaker 48:13

Also, when you write you think a lot, okay, what should I write?

Unknown Speaker 48:17

When, again, when you write to say somebody, okay, this is not the way you have to live? So I think that's something Yes, that's, that's that I keep doing? I write a lot of articles. So I've have many publications. So.

Unknown Speaker 48:30

So, so. So the way I keep writing, it helps me also to interpret the way or the way I approach medicine. And I think, you start thinking, you start thinking a little bit like the author, right, you start and then when you read somebody else's paper, you're like, Oh, I see, I see what they're trying to do here trying to make sure that I understand that this type of patient was excluded. It helps it helps tremendously. I think you're absolutely right. Yeah, that's to restaurant. And then.

Unknown Speaker 48:57

And then the next thing is reviewing also.

Unknown Speaker 49:01

So of course, the way you review is you can also just do the simple turn flops or like, like just reading, but I also tend to remove many articles, you know, I'm a peer review for many journals. So I tend to take up at least two three articles a month, so tend to read them tend to try to find out what's happening, what's the flaw? So basically start doing all these things. I think you will be able to understand more better way how to

Unknown Speaker 49:30

how to approach or interpret medicine. I like that's my take on of course, I'd love to hear no, I love how you gave a kind of framework and you know, we're we're kind of working through our own framework. And I wonder when we talk about making change on a systemic level, like, can't we all just get together and decide on like, a, like a format to, to to you know, reviewing

Unknown Speaker 49:59

research and

Unknown Speaker 50:00

and writing research. So I know we have the abstract in the participants and methods, but it still seems like even within those sections, there's a lot of

Unknown Speaker 50:11

room for interpretation. And so I don't know if any thoughts on that. Yeah.

Unknown Speaker 50:20


Unknown Speaker 50:21

You know, I, I love doing systematic reviews. And I've done couple of them. And,

Unknown Speaker 50:28

and I think

Unknown Speaker 50:31

after reading many articles, I have kind of I have, I have got a systematic way to approach how we interpret an article. So I never read the introduction part.

Unknown Speaker 50:42

But it's great for journal clubs and, and building your knowledge. If you don't know about the subject, that's fine. But so I skip that, and it saves time. And then the moment you go on to the methodology, so you I mean, if it's anonymous silence, so you look at all the ways where the biases can be, from the way patients get selected, how the patients get analyzed, who's analyzing them, you know, all those sorts of things, and looking at all the baseline characteristics.

Unknown Speaker 51:10

So looking at every single possible way to see whether there's a bias or not, so they do a lot of systematic reviews. So we tend to go through the all the seven biases that are listed in Cochrane. So we have seven major versus randomization, allocation, concealment, blinding of participant blinding of outcomes, so who did the outcome assessment to? How was it done, and whether there were any patients that are missing, so if you go in that way, so when you start reading, of course, you have the main outcome, that's always there. But But I think the first thing looking before the outcome is most important to look at the validity of the study. And if the validity of the study is good, then only you go to the outcome, and there's no point in going to come when the validity is happened. And, and, and the way you can make sure the validity is fine, is just going through all the seven biases that Cochran has listed up, and now it's been little reorganized in this group by us too. But but they're still there, the selection, the follow up the attrition outcome assessment. So just look at all the places where the best can be. And once you're sure, okay, all the seven baskets are ticked off, there is no way that there was a bias, then, you know, okay, you're confident when the study was done, good, and I'm happy with the study, and then go, go, go go look into the outcomes. And that's, and then after looking at the outcomes, then see how much change is,

Unknown Speaker 52:38

is happened with that particular treatment or therapy, and that change is appreciable, and that it is meaningful, and that change is clinically relevant or important. And then you think, Okay, next is whether you can apply that that thing here and whether that's going to change something, what you're doing at your place. That's that's how I kind of look at. So first is validity. And then next is the effect size of efficacy or effectiveness, something, what we call next is the applicability. So these are the three major domains that I that I tend to look up. I think if you start reading more and more, you will tend to know a better way of doing it. And you know, I mean, I'll just say this, that.

Unknown Speaker 53:20

Don't think that if a study has come out in a great general, it's always good. And I think everybody

Unknown Speaker 53:29

Yeah, yeah, vice versa, and, and cite, look at each components, try to see if there was something wrong and try to find out.

Unknown Speaker 53:38

If there was something that was in I mean, the artists would not want to do it, or the study people do not want to do.

Unknown Speaker 53:45

Yeah, right. Go ahead, go. That's fine. Right, I was gonna say, I was gonna say, actually, it's not that like, even like a study may come out in the big journal. And it's not that it's not valid. But I think people tend to forget that sometimes, in order to answer a question, you have to make sacrifices. So like, for example, we've talked about this on the podcast many times, where if you do a big database review, then you are always going to have to sacrifice some of the granularity of the data, for example, and you're going to have to be working with more more partial information. But that yet again, your sample size is massive. And it's that's the, that's what you're sacrificing the details for. And then sometimes you have a very, very small data. And it's small numbers, but it's super well designed, because obviously, it's easy to design a study when you have only 30 patients. But obviously, you create some issues with generalizability. And so I think this is where all the biases that you're talking about that are very well outlined by the Cochrane Library are super useful in order to help you understand how to review data. We're coming to the end of the show. So I wanted to really ask you about the Cochrane Library because I know you are doing some work and you're working with the Cochrane Library about doing a review. And I don't want you to talk too much about the topic you're reviewing because I think you told us but I think if you say it on

Unknown Speaker 55:00

The people are gonna start hammering you with questions. But I'm wondering, how does it work? When How did it work? How does How do you approach the Cochrane Library to say, hey, I want to do a review on this topic? Do you just, obviously, do you have to get their approval first? Or do you submit a finished meta analysis? And then and then they approve it? How does that work? What is the process? Like? Yeah, yeah. So

Unknown Speaker 55:23

what we do with Cochrane is, first thing is to go into the library itself, and try to find out if that review which we want to do, or which you intend to do, still, is existing or not. So that's, that's the first thing you want to do. So let's say you have to do something on live now versus our live now versus an IPP or something like that. You go and look into the Cochrane Database itself, okay? Is somebody doing a review or not? If you find nobody is doing a review, then the next next thing is to draft a proposal. So there is a Cochrane proposal form, which is out there. And it's just, it's just,

Unknown Speaker 56:02

it doesn't contain too much of information, but it just asked you about

Unknown Speaker 56:06

what you want to do and what you're going to do in this review, and what are the outcomes basic things, the patient's intervention outcomes, and, and what kind of

Unknown Speaker 56:14

materials that you're going to do. And you you send it to the Corcoran Group,

Unknown Speaker 56:20

you know, in order to sell, and ask him whether

Unknown Speaker 56:24

this is something that you can you can go up with. And they might, or they might tell you that somebody's already doing it. So I think before writing the proposal itself, is you can ask them, whether somebody is working on it. And if the group if the Cochrane group says that nobody's working, and then you can propose them in a brief way, that in a brief way that this is what you want to do. And I said, Yes, I think this is great, then I think you can, you have to meet up with them.

Unknown Speaker 56:53

Just to make sure how you're going to work out and whom you're going to work out. Because you need in support, right? You need, you need some kind of supervision. So you have, you have to have some artists who have already done a Cochrane Review, who are going to support you in the in the so if you're doing some, some complex analysis, that's in Utrecht, metaanalysis, you need to have a statistician who is well versed with the network data analysts something something like that. So once the once they detect that your group is good to go, and your group can handle the review. So then they asked you to submit the protocol, which is then six months timeline, from the time you have submitted, I think it's six months or one year, I think it's six months. And once you submit it,

Unknown Speaker 57:35

so they will, they will send it to the peer review, and then it gets reviewed. And then it will send it back to you. You know, you go through some changes. And then finally it's approved. Once it's approved, you have two years timeline to complete the review.

Unknown Speaker 57:48

Two years. Yeah. So you know, I mean, the whole process from start to end honnestly. If you look at the timing, I assume it takes four to five years. So I'll tell you, I was always

Unknown Speaker 58:05

passionate to do something with Cochran and before leaving McMaster, I said to Ahmed Tom, I'm working at Thomas McCurdy, his was my mentor, a great friend. And I said to him that I have to do something with coke. And then we said, Okay, why don't we do this? And the idea started when I was leaving the program, so that was in 2018.

Unknown Speaker 58:24

So 2018, Feb. So that was, that's when I left McMaster University. And it's now 20. What is the date? 20?

Unknown Speaker 58:34

It's almost like four years. Now, where are we?

Unknown Speaker 58:41


Unknown Speaker 58:44

So now we are still extracting the data. So hopefully by next month or so we are going to analyze. So I think it's going to take one more year to complete the the whole whole review. So give it a take it takes

Unknown Speaker 58:57

the painful question is that it's such a slow process, you're doing this you're getting to the end of your analysis and then a paper one more paper comes out and you're like shit, do I have to add this to the analysis.

Unknown Speaker 59:11

But you have, you should do what we do and Cochrane

Unknown Speaker 59:16

so we look at everything. So we just don't look at published trials. We also look at trial registries we also look at conference abstract things which are not published and then we have list of those articles. And we then we tend to contact the authors and they will kind of give a timeline then we know that okay, so there's something which is going to come. And of course that's tedious process. I mean, you can just add a simple study to determine and you can just analyze data but you again you have gone to a game we let's say if your confidence interval moves, your interpretation is going to change.

Unknown Speaker 59:47

Stay familiar trial comfort and you're

Unknown Speaker 59:52

doing a complex analysis then forget it.

Unknown Speaker 59:55

You may not be so excited at the prospect of new evidence. When you're doing you're working on it.

Unknown Speaker 1:00:00


Unknown Speaker 1:00:02

this was really enlightening actually about how the process works. And I think it's a great opportunity for people who are newly interested in research to get some of that mentoring in a, in a topic that is of interest to them. I also hope that maybe after listening a little bit more about a trainees who are just starting to create their own research project, I think the Cochrane Library is a great place to go to see, you know, what's been done, like, what is the bulk of work, and start your lit review? I think it's a great place to start a light review.

Unknown Speaker 1:00:42


Unknown Speaker 1:00:43

And I think when, when looking at the evidence, particularly from the meta analysis,

Unknown Speaker 1:00:49

you know, I always say that look at the studies that are contributing to the metallics, look at the major golf studies. So what would they say? Because, you know, small studies tend to pull the estimates here and there, because the effect estimate that comes from them is large.

Unknown Speaker 1:01:06

So they tend to pull the estimate in a larger way.

Unknown Speaker 1:01:11

So I think we have to look at how many studies and which studies are contributing, and if you have big trials, and you have confidence in them, and then I think you have confidence in the meta analysis, but otherwise, then, you know, you don't know what's going to happen. So if you look at today's

Unknown Speaker 1:01:29

retraction that happened on antenatal steroids, so one of the major, major, major paper got attracted, which is published in European journal, on antenatal steroids and morbidities. In late preterm autumn babies. It's amazing to see how much how much number the the child has enrolled, it was close to 1300 patients and that contributed are weighed heavily on the Cochrane meta analysis. Now, if you take out that article, you don't know what's going to be. So you have to really look at the studies that are contributing and how good are the studies just don't tend to

Unknown Speaker 1:02:08

you know,

Unknown Speaker 1:02:10

look at the estimate and say, This is what Cochran said, you have to have your own impressions. Because conquer any when you tell us. Yeah, I was gonna say can you tell us a little bit you're so you're referring to which article on antenatal steroids late preterm infants, and you said it was it was retracted? From which journal?

Unknown Speaker 1:02:29

I think it was European Journal of Obstetrics and Gynecology and something.

Unknown Speaker 1:02:34

So it, I heard about it yesterday.

Unknown Speaker 1:02:38

Okay, and it was all over Twitter today, I think.

Unknown Speaker 1:02:42

It was a major, major, major trial. As I said, it was it was a trial of 1300 patients.

Unknown Speaker 1:02:50

And it was it was included in the in the Cochrane meta analysis. And I think it did, it did sway the confidence. And, and I think the brilliant people from Monash,

Unknown Speaker 1:03:05

they, they figured out that there was there was an issue with the evidence, and there was some issues with, you know, very tiny details, I think, just the way how, how the distribution of agenda was, and I think, this little bit on dates, and then then then they started to, you know, pull the leg saying, you know, where does the data show us the data and, and when you don't get an appropriate response from the team, then it's never good.

Unknown Speaker 1:03:35

You have to do the redo the meta analysis and see what's going what's going to happen. So how much

Unknown Speaker 1:03:40

you're going to believe. So that's why I said, you have to look at the articles, and how much they are actually weighing in that meta analysis. Because if you pull many, many research, which has been, which has been conducted in a in another good way, so then you're not really believing the evidence. So So then let me this is my last question for the interview. Because we're now over time, obviously, and, and for the people who may not realize definitely is POST call. Oh, I wanted to ask you, sometimes, sometimes you read, you read these meta analyses, and especially in the concrete, and like, the studies that are being used are very old, right, like 1982. And, and the methodology of the study is sound, meaning the study is included, and it's appropriate, but then you wonder you're like, man, 1982, like so much has changed. And no matter how well the study was designed, and how everything was well controlled for, isn't there? Do you think that there should be a parameter for for based on how fast our field of especially in neonatology how fast our field has changed, that we shouldn't say, Well, you know, we can't include data. That's, that's published before 1990 For example, how do you feel about that? Yeah, that's something which we do,

Unknown Speaker 1:04:51

which which we do and between, which I have done in fact, for one of the meta analysis, you know, we returned to exclude that from

Unknown Speaker 1:05:00

studies which were older than 2000, that's where antenatal STI rates were not that used, the rate of steroid use, it was very low. And now since the use it has gone up, things have significantly changed, survival has gone up and all the morbidity stuff can come down.

Unknown Speaker 1:05:18

So, you know, that's something that that you have to think about. But when you look at the totality of evidence, you have to really look into everything. So you can't just ignore studies. But if you ignore studies, saying that you have done you have to have a solid reason.

Unknown Speaker 1:05:35

And you know, people just don't buy it. If you exclude studies, if they're just old. They, they say that, why don't you just comment? And if there are many older studies and less newer studies, then yes, of course, when you when it comes to the applicability part, you say, okay, so all the evidence that we have is from older studies, which is not relevant and might not be applicable. So it might be good to do something like now try to find out, at least from the observational data, you know, what's happening. But, you know, of course, if you're doing an observational data analysis, you can, you can think of that option, and many meta analysts have seen that you have excluded older studies less than 2000, or even older than 9090, or something like that.

Unknown Speaker 1:06:19

That's interesting. I kind of like your approach, I kinda like what you said, mentioning, or explaining if you're going to keep the study that say why you're keeping the study and how you're accounting for the changing landscape. But don't just like dump it and saying, Well, just Yeah, I think I appreciate that. I have one more question. And my question is more around how two people can look at the same evidence and find and be still at odds with one another about what the evidence means. So for people who are going to get on to Twitter or talk in their own journal clubs and their own division meetings,

Unknown Speaker 1:07:00

what is the etiquette to just having cordial discussion about research?

Unknown Speaker 1:07:08


Unknown Speaker 1:07:11


Unknown Speaker 1:07:14

a very good job. Always clean, quite respectful.

Unknown Speaker 1:07:20

I think if everybody has got their own impressions, and how you approach the evidence, and I think at the end, what matters is what matters for the families and whether it's important for them. And you have to tell to them clearly. What is it out there? So the great example was

Unknown Speaker 1:07:38

the steroids when it came up. I think one of one of our EPO, colleagues had had tweeted that the great lifestyle on hydrocortisone showed no difference. So then people started talking. Everybody's like talking, okay, let's just dump it go to dexamethasone and things. You know, I mean, okay, that's great. But if you remember, how was the extra Medicine study, how many patients were included in the DAT trial, there had been 60 babies.

Unknown Speaker 1:08:08

And you're dumping the major trial, and he's taking evidence from the smaller trial, which is ever finished, I mean, which was not finished at all.

Unknown Speaker 1:08:17

So coming back to the point, I think everybody has their own impressions. And, and if if we think that that, that that impression that we have is important for the consumer, and I think that's what giving it to baby, so that what tiling, otherwise, just leave it to them. So let's say if, if, if I have a baby, I hope I don't, I'm going to have a food get.

Unknown Speaker 1:08:44

And let's say

Unknown Speaker 1:08:46

if I'm if my baby would have been sick and wanted to have on steroids, and you know, I mean, I know what what's the evidence out there? And I would say, Okay, I would love to have my baby out of the ventilators zone. Whatever it is, I know that the neurodevelopment hasn't changed is not going to change. But still, I like to see my baby though. It has been shown that things are better with hydrocortisone. Why don't you try it? So that's my perspective. Right? So it's up to the taste. If you like it, you just use it. So you're saying you're saying every baby should be on steroids, right?

Unknown Speaker 1:09:24

I'm not saying that.

Unknown Speaker 1:09:29

I'm just teasing you have done. I'm sorry. I couldn't find you.

Unknown Speaker 1:09:37

But it is interesting. And I think I think I think this is where what you were saying earlier that you were taught at McMaster University about learning how to interpret data and methodology becomes very important. What's the risk? What's the risk of benefit? What's the risk of harm? This is where it matters, and especially like Daphna saying, because I think definitely what you're mentioning dovetails into patient counseling, right? What when parents are asking you

Unknown Speaker 1:10:00

I mean, I do. You're the worst example I would dare I would, I would dread having you as a parent in the unit. But

Unknown Speaker 1:10:09

but you can imagine, you can imagine a parent saying like, aren't you want to give my baby steroid? Or so many of the things that we get?

Unknown Speaker 1:10:17

Yeah, yeah, yeah. And I think many times the parents are too stressed to even think sometimes rationally about asking those questions. But we've had these these parents who are very comfortable with numbers and saying, like, Alright, what's the what's the risk? What are the numbers? And then and then that's when you have to learn how to interpret your data. That's, so I think before every meeting, what I do is I tend to look up what I'm going to say, yeah, that's particularly when I'm going to talk to parents about steroids. I have to have some numbers, I'd say, Okay, let's say if you have 10 babies, you know, five babies might have five babies might not have, if you give this to babies might have two babies might not have something like that. I think it's important to just look at the local numbers, not the numbers from the trial. You should have your own numbers from your unit. So something that and then you can speak to them. Yeah. Meet Yeah. Yeah. Abdul, this is this was fantastic. I mean, we went over time, as usual. But this was very informative. I think you're doing fantastic work on your Twitter, I think people who are interested in social media, we were talking not too long ago with Alberto perennial, and we were talking about like the people to follow even if you're not going to engage on Twitter, and I think you're definitely one of these accounts. And we will link your account in the show notes and we will link to Eb Neo. And I think, again, you are a very approachable person if you're a trainee. If you want to get involved in education and in social media, reach out to Abdul and I'm sure that you'll be able to find connection points as to how you can contribute. So thank you for coming on the show today. Thank you for everything you do. This was this was tremendous. Thank you, Ben. Thank you.

Unknown Speaker 1:11:53

Thank you for listening to the incubator podcast. If you liked this episode, please leave us a review on Apple podcast or the Apple podcast website. You can find other episodes of the show on Apple podcasts, Spotify, Google podcasts, or the podcast app of your choice. We would love to hear from you. So feel free to send us questions, comments or suggestions to our email address NICU You can also message the show on Instagram or Twitter, at NICU podcast or through our website at WWW dot the dash

Unknown Speaker 1:12:27

This podcast is intended to be purely for entertainment and informational purposes and should not be construed as medical advice. If you have any medical concerns. Please see your primary care professional. Thank you

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