Bad Medical Science

Heather wrote yesterday about some woo-like nonsense published in the opinion piece of the Nursing Times. Basically, the article said that obese patients were the cause of nurses back injuries. It was one of those wonderful articles that the print media so love. It had the air of self evident logic and attacked the current social demons (fat people). I am surprised it hasn’t been syndicated out to the Daily Mail (etc).

I had two main problems with the article (obviously lots of minor ones…). First, and most basic, the author of the article makes many, unsupported, assumptions. Statistical correlations supporting their claims are not shown (if they exist) so I have no idea where they drew the data for the claim made. It is shocking that being told “there is no evidence to suggest a link” was viewed as simply meaning more research is required. While continued research into every field of human endeavour would be fantastic, the line has to be drawn every now and then.

Healthcare is (rightly) a science, so one would assume the scientific method is used as they investigate new ideas and methods. This is a topic which appears to have been researched in the past, without finding the causal link the writer alludes to. Is the previous research flawed sufficiently to be dismissed? If so, then yes, do more research. If the previous research is valid, then it doesn’t matter if you (or I) disagree with the findings, they stand. In the current climate, fat people are viewed as the Devil Incarnate, so attributing as many things to them as possible is seen as the right thing to do. Even if 99% of the claims are valid, it does not justify bad science, nor scapegoating in the manner this opinion piece seems to show.

The recommendation made by the article are equally bizarre. Basically (again) it says that health care workers should pressure the fat patients to lose weight. How this would help reduce back injuries in anything but the longest term, I have no idea.

The second issue which got to me was the concept that “obese” patients were the cause at all. Interestingly, back injuries from lifting will almost always be related to the ratio of weight of patient to strength of nurse doing the lifting. “Obese” does not mean a specific weight, it is a term with a totally different meaning.

As an example, a nurse trying to lift a 6’5″ (1.9m) man who was 13 stone (182lbs, 82.5kg) would be lifting someone who was in the “healthy” weight zone. The same nurse trying to lift a 5’0″ (1.5m) woman who was 11 stone (154lbs, 70kg) would be lifting someone who was “obese.” Assuming the nurse is the same person, which is most likely to cause back injury? A similar situation occurs with athletes (especially bodybuilders). They are (generally anyway, do sumo wrestlers count?) not going to be obese but they will weigh a lot more than a “normal person” of the same age and height.

It is possible the author of the opinion piece was talking more about the “morbidly obese” people and there is significant difference between trying to lift a 13 stone person and a 30 stone (420lbs, 190.5kg) person but this is certainly not clear from the article. For those who question my example: an obese person is normally described as some one with a BMI of over 30. BMI is weight (kg) / height2(m), so the 6’5″ person would be obese if they were over 108kg (which is heavy…) and the 5′ woman would be obese over 67.5kg. It seems the 11 stone, short, woman is obese while the much heavier man is not.

Personally, lifting techniques aside, I would rather lift a person who weighed 67.5kg than 82.5kg even if one was “obese” while the other wasn’t.

Interestingly, if the author of the opinion article is to be assumed as correct, then it is not just “obese” people causing the problems, but tall ones, athletic ones, bodybuilders and the like. Maybe healthcare should be weight tested?  Alternatively, the government could legislate that only tall, strong backed, heavy, bodybuilding men can be nurses… Oh yeah, now that would be bad science…