In an environment where blood and blood products may not always be available (usually not), such as where I work, and where TXA is more readily available for the massively haemorrhaging trauma patient, there is certainly a role for this and detractors for its use should actually come and work with me and provide me with alternate solutions.

I find it interesting to see this as some epic battle between the FOAMed enthusiasts and the ‘traditionalists’. I didn’t experience the same level of emotion that seems to have been engendered in others regarding this debate. After all, it was a good review of the current evidence and the various commentaries that have accompanied this important clinical question. The tone may irk some but it could be easily said that the impassioned pleas from other blog sites are no different. I view information either from the Internet or from peer-reviewed journals as both requiring critical review. Whatever the source of information, we need to filter out the rhetoric, opinions, egos, personality cults or even prodigious reputations, and focus on the evidence as it stands weighing it up with everything we already know and understand. There are many intellects and out there much greater than mine but it doesn’t mean that I blindly accept their conclusions without careful scrutiny and considering the relevance it has to my particular context. Perhaps the only lesson from this article is that we all have to be careful in any academic forum about indulging in ‘ad hominem’ arguments to support our viewpoints whilst discrediting… Read more »

And perhaps by doing so the authors undermined the inherent respect for an academic publication or…..revealed the flawed assumptions of how we attain knowledge. The artificial separation of fact and opinion. Author conclusions may not accurately reflect the demonstrated p-values and box plots (e.g. IST-3) and editorials may be just an alternative discussion of how the data should be interpreted. These authors by playing the same game as FOAMed, has shown that we need to turn a critical eye to anything we read.

Nonetheless, we are starting to see similar functionality of social media outlets with peer-revewed journals. BMJ rapid responses is an example.

As these boundaries become blurred, I wonder if we will improve the savviness of our readership or dumb them down? Do we need to put a disclaimer at the bottom so that people won’t get confused? I read the article as an editorial. I would hope the average reader would have realised this too.

Sorry for the long post but this has me fired up in large part because it provides a fascinating conflict between the “traditional” ways of knowledge translation and the “FOAMed” ways of knowledge translation. The level of resistance to the CRASH-2 trial findings is intriguing considering that far more expensive and potentially dangerous interventions out there don’t receive this level of passion and scrutiny. It’s healthy to debate articles in the medical literature but the criticisms of CRASH-2 seem to frequently revolve around concepts that are far from scientifically rigorous. There are recurring themes to the criticisms, here are a few of them: -Just half of patients that got TXA needed transfusions -> you can look at this as a positive just as well, that TXA reduced transfusions needs, or that TXA was used in a less sick group so it makes the benefits found more impressive (since you’d think higher mortality risk patients can get higher potential mortality reduction). -Randomization technique (particularly use of uncertainty principle) -> some legitimate concerns but nothing earth shattering at all. Running a trial of this scope requires some compromises. Of course the small trial you do at your own institution can be far… Read more »