Lawrence Lynn
@patientstormdoc.bsky.social
Pulmonary critical care research physician. #medsky CoAuthor of “The Physician’s War” the story of the history of critical care science.
https://a.co/d/5C2A7Sm
https://a.co/d/5C2A7Sm
I asked Grok to “Summarize REMAP CAP using two DAGs”
But Grok only looks at work I did on X and discussions at datamethods and provides a
Well organized summary. Grok is a sophisticated text review parrot. Which is nice.
discourse.datamethods.org/t/the-petty-...
But Grok only looks at work I did on X and discussions at datamethods and provides a
Well organized summary. Grok is a sophisticated text review parrot. Which is nice.
discourse.datamethods.org/t/the-petty-...
The Petty/Bone RCT
Looking forward and seeking a solution hypothesis to the present critical care research crisis highlighted by the recent REMAP CAP, what are the thoughts of adding symbolic causal modeling with DAGs o...
discourse.datamethods.org
June 3, 2025 at 11:48 AM
I asked Grok to “Summarize REMAP CAP using two DAGs”
But Grok only looks at work I did on X and discussions at datamethods and provides a
Well organized summary. Grok is a sophisticated text review parrot. Which is nice.
discourse.datamethods.org/t/the-petty-...
But Grok only looks at work I did on X and discussions at datamethods and provides a
Well organized summary. Grok is a sophisticated text review parrot. Which is nice.
discourse.datamethods.org/t/the-petty-...
Grok does fairly well. Can you provide an example of failure ?
June 2, 2025 at 8:46 PM
Grok does fairly well. Can you provide an example of failure ?
showing that lumping dilutes significant effects and masks weak ones
2. Highlighting heterogeneity (disease subtype: C1) and confounding biases (severity: C2), necessitating stratification by etiology…
2. Highlighting heterogeneity (disease subtype: C1) and confounding biases (severity: C2), necessitating stratification by etiology…
June 1, 2025 at 6:21 PM
showing that lumping dilutes significant effects and masks weak ones
2. Highlighting heterogeneity (disease subtype: C1) and confounding biases (severity: C2), necessitating stratification by etiology…
2. Highlighting heterogeneity (disease subtype: C1) and confounding biases (severity: C2), necessitating stratification by etiology…
Now Quoting Grok 3:
“Conclusion
Performing DAGs prior to REMAP-CAP would have led researchers to recognize the error of lumping viral and bacterial pneumonia by:
1. Revealing distinct causal pathways for strong antibiotics (bacterial DAG) versus weak antivirals (viral DAG)…
“Conclusion
Performing DAGs prior to REMAP-CAP would have led researchers to recognize the error of lumping viral and bacterial pneumonia by:
1. Revealing distinct causal pathways for strong antibiotics (bacterial DAG) versus weak antivirals (viral DAG)…
June 1, 2025 at 6:18 PM
Now Quoting Grok 3:
“Conclusion
Performing DAGs prior to REMAP-CAP would have led researchers to recognize the error of lumping viral and bacterial pneumonia by:
1. Revealing distinct causal pathways for strong antibiotics (bacterial DAG) versus weak antivirals (viral DAG)…
“Conclusion
Performing DAGs prior to REMAP-CAP would have led researchers to recognize the error of lumping viral and bacterial pneumonia by:
1. Revealing distinct causal pathways for strong antibiotics (bacterial DAG) versus weak antivirals (viral DAG)…
Note:
Grok refers here to the standard method in critical care which lumps multiple diseases by a set of opinion based non disease specific criteria to test a single treatment
This method was used in REMAP CAP lumping viral & bacterial pneumonia & excluding pneumonia types acquired in hospital
Grok refers here to the standard method in critical care which lumps multiple diseases by a set of opinion based non disease specific criteria to test a single treatment
This method was used in REMAP CAP lumping viral & bacterial pneumonia & excluding pneumonia types acquired in hospital
June 1, 2025 at 6:14 PM
Note:
Grok refers here to the standard method in critical care which lumps multiple diseases by a set of opinion based non disease specific criteria to test a single treatment
This method was used in REMAP CAP lumping viral & bacterial pneumonia & excluding pneumonia types acquired in hospital
Grok refers here to the standard method in critical care which lumps multiple diseases by a set of opinion based non disease specific criteria to test a single treatment
This method was used in REMAP CAP lumping viral & bacterial pneumonia & excluding pneumonia types acquired in hospital
Read the whole linked article not the abstract. The guessed Sepsis 3 platform of failed PettyBone sepsis “science”
Time for young to lead Abandon guess of Vincent which like Bone’s SIRS guessed when they were young.
Don’t waste your career on 20th century guesses
pubmed.ncbi.nlm.nih.gov/9824069/
Time for young to lead Abandon guess of Vincent which like Bone’s SIRS guessed when they were young.
Don’t waste your career on 20th century guesses
pubmed.ncbi.nlm.nih.gov/9824069/
Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the Europ...
The SOFA score is a simple, but effective method to describe organ dysfunction/failure in critically ill patients. Regular, repeated scoring enables patient condition and disease development to be mon...
pubmed.ncbi.nlm.nih.gov
May 29, 2025 at 7:48 PM
Read the whole linked article not the abstract. The guessed Sepsis 3 platform of failed PettyBone sepsis “science”
Time for young to lead Abandon guess of Vincent which like Bone’s SIRS guessed when they were young.
Don’t waste your career on 20th century guesses
pubmed.ncbi.nlm.nih.gov/9824069/
Time for young to lead Abandon guess of Vincent which like Bone’s SIRS guessed when they were young.
Don’t waste your career on 20th century guesses
pubmed.ncbi.nlm.nih.gov/9824069/
Young need to start afresh. In 1998, SOFA was found to be so nonspecific for sepsis they changed the first word of name from “Sepsis-Related” to “Sequential”. Did you know?
Each study they laud “heterogeneous syndrome”. A meaningless term. Can’t build science on an ambiguous & variable platform
Each study they laud “heterogeneous syndrome”. A meaningless term. Can’t build science on an ambiguous & variable platform
May 29, 2025 at 7:32 PM
Young need to start afresh. In 1998, SOFA was found to be so nonspecific for sepsis they changed the first word of name from “Sepsis-Related” to “Sequential”. Did you know?
Each study they laud “heterogeneous syndrome”. A meaningless term. Can’t build science on an ambiguous & variable platform
Each study they laud “heterogeneous syndrome”. A meaningless term. Can’t build science on an ambiguous & variable platform
You can’t start with PettyBone science & lumped set of different diseases triaged by Vincent’s 1996 guessed threshold set, then phenotype the improperly lumped diseases.
All critcare fellows should watch this brief video.
Study Science not the latest opinion of a task force!
youtu.be/BTgEU07FI9o
All critcare fellows should watch this brief video.
Study Science not the latest opinion of a task force!
youtu.be/BTgEU07FI9o
Lawrence Lynn | The Science Monopoly
YouTube video by Consilium Scientific
youtu.be
May 29, 2025 at 6:20 PM
You can’t start with PettyBone science & lumped set of different diseases triaged by Vincent’s 1996 guessed threshold set, then phenotype the improperly lumped diseases.
All critcare fellows should watch this brief video.
Study Science not the latest opinion of a task force!
youtu.be/BTgEU07FI9o
All critcare fellows should watch this brief video.
Study Science not the latest opinion of a task force!
youtu.be/BTgEU07FI9o
Yet they virtually always have been in PettyBone science with ARDS and CAP trials.
13000 ppl died last year due to influenza pneumonia and we have no substantive RCT to tell us if steroids help or harm because our 35 yr old standard are “PettyBone RCT mimics” not Bradford Hill RCT.
13000 ppl died last year due to influenza pneumonia and we have no substantive RCT to tell us if steroids help or harm because our 35 yr old standard are “PettyBone RCT mimics” not Bradford Hill RCT.
May 29, 2025 at 6:03 PM
Yet they virtually always have been in PettyBone science with ARDS and CAP trials.
13000 ppl died last year due to influenza pneumonia and we have no substantive RCT to tell us if steroids help or harm because our 35 yr old standard are “PettyBone RCT mimics” not Bradford Hill RCT.
13000 ppl died last year due to influenza pneumonia and we have no substantive RCT to tell us if steroids help or harm because our 35 yr old standard are “PettyBone RCT mimics” not Bradford Hill RCT.
Of course not. Influenza lacks the secure safety of antibiotics to offset the potential reduced viral clearance due to corticosteroids. The DAGs are markedly different so they can’t be lumped in the first instance.
May 29, 2025 at 5:59 PM
Of course not. Influenza lacks the secure safety of antibiotics to offset the potential reduced viral clearance due to corticosteroids. The DAGs are markedly different so they can’t be lumped in the first instance.
I have been blocked by the thought leaders because I argue they were indoctrinated in PettyBone pseudoscience (as we all were)
Really though did you think we could lump influenza pneumonia and pneumococcal pneumonia for a REMAP CAP hydrocortisone RCT?
Really though did you think we could lump influenza pneumonia and pneumococcal pneumonia for a REMAP CAP hydrocortisone RCT?
May 29, 2025 at 3:10 PM
I have been blocked by the thought leaders because I argue they were indoctrinated in PettyBone pseudoscience (as we all were)
Really though did you think we could lump influenza pneumonia and pneumococcal pneumonia for a REMAP CAP hydrocortisone RCT?
Really though did you think we could lump influenza pneumonia and pneumococcal pneumonia for a REMAP CAP hydrocortisone RCT?
In the link I explain why REMAP CAP would not be expected to reproduce CAPE COD. (It’s not reversion to the mean)
We clinicians have to be smarter. We fooled the statisticians into thinking our synthetic syndromes were disease equivalents in the Bradford hill sense.Time to end PettyBone science
We clinicians have to be smarter. We fooled the statisticians into thinking our synthetic syndromes were disease equivalents in the Bradford hill sense.Time to end PettyBone science
May 29, 2025 at 3:01 PM
In the link I explain why REMAP CAP would not be expected to reproduce CAPE COD. (It’s not reversion to the mean)
We clinicians have to be smarter. We fooled the statisticians into thinking our synthetic syndromes were disease equivalents in the Bradford hill sense.Time to end PettyBone science
We clinicians have to be smarter. We fooled the statisticians into thinking our synthetic syndromes were disease equivalents in the Bradford hill sense.Time to end PettyBone science
The formal symbolic causal modeling is the spice for the pul crit care physician
The CI extension of that may be a bridge too far in our complex environment.
The synergy between this modeling exploits our knowledge of pathophysiology, used fir RCT interpretation and RCT design.
a.co/d/eaISGSp
The CI extension of that may be a bridge too far in our complex environment.
The synergy between this modeling exploits our knowledge of pathophysiology, used fir RCT interpretation and RCT design.
a.co/d/eaISGSp
Amazon.com
a.co
May 29, 2025 at 2:44 PM
The formal symbolic causal modeling is the spice for the pul crit care physician
The CI extension of that may be a bridge too far in our complex environment.
The synergy between this modeling exploits our knowledge of pathophysiology, used fir RCT interpretation and RCT design.
a.co/d/eaISGSp
The CI extension of that may be a bridge too far in our complex environment.
The synergy between this modeling exploits our knowledge of pathophysiology, used fir RCT interpretation and RCT design.
a.co/d/eaISGSp
Formal Symbolic causal modeling is the way to optimize the design of these RCT and to speak of them in more formal objective terms.
Clinicians need to up their game bringing formality to their physiology expertise interpreting these trials.
It shows why 35 years of PettyBone RCT mimics failed.
Clinicians need to up their game bringing formality to their physiology expertise interpreting these trials.
It shows why 35 years of PettyBone RCT mimics failed.
May 29, 2025 at 2:18 PM
Formal Symbolic causal modeling is the way to optimize the design of these RCT and to speak of them in more formal objective terms.
Clinicians need to up their game bringing formality to their physiology expertise interpreting these trials.
It shows why 35 years of PettyBone RCT mimics failed.
Clinicians need to up their game bringing formality to their physiology expertise interpreting these trials.
It shows why 35 years of PettyBone RCT mimics failed.
No one will discuss or retweet PettyBone RCT mimics. But your generation needs the courage to break out. Study and teach Pearl’s symbolic causal modeling
Send your pul fellows to see this alternative view explaining REMAP CAP at datamethods. 6.8k views
discourse.datamethods.org/t/the-petty-...
Send your pul fellows to see this alternative view explaining REMAP CAP at datamethods. 6.8k views
discourse.datamethods.org/t/the-petty-...
The Petty/Bone RCT
Looking forward and seeking a solution hypothesis to the present critical care research crisis highlighted by the recent REMAP CAP, what are the thoughts of adding symbolic causal modeling with DAGs o...
discourse.datamethods.org
May 29, 2025 at 2:12 PM
No one will discuss or retweet PettyBone RCT mimics. But your generation needs the courage to break out. Study and teach Pearl’s symbolic causal modeling
Send your pul fellows to see this alternative view explaining REMAP CAP at datamethods. 6.8k views
discourse.datamethods.org/t/the-petty-...
Send your pul fellows to see this alternative view explaining REMAP CAP at datamethods. 6.8k views
discourse.datamethods.org/t/the-petty-...
The discovery went from narrow (IPF) out. Not starting with lumping
IPF -> PPF
The discovery would likely have been negative & abandoned if they started with PPF because of signal dilution
ARDS & sepsis PettyBone RCT mimics use triage for participants guessed threshold sets
hubs.la/Q03p8LgD0
IPF -> PPF
The discovery would likely have been negative & abandoned if they started with PPF because of signal dilution
ARDS & sepsis PettyBone RCT mimics use triage for participants guessed threshold sets
hubs.la/Q03p8LgD0
Redirecting
hubs.la
May 29, 2025 at 2:01 PM
The discovery went from narrow (IPF) out. Not starting with lumping
IPF -> PPF
The discovery would likely have been negative & abandoned if they started with PPF because of signal dilution
ARDS & sepsis PettyBone RCT mimics use triage for participants guessed threshold sets
hubs.la/Q03p8LgD0
IPF -> PPF
The discovery would likely have been negative & abandoned if they started with PPF because of signal dilution
ARDS & sepsis PettyBone RCT mimics use triage for participants guessed threshold sets
hubs.la/Q03p8LgD0
Yes I was consulted on a case of renal cell carcinoma that embolized to the Tricuspid valve where the tumor was stuck. He had a large ASD/PFO which saved him.
Significant hypoxemia unresponsive to FIO2 of 1 but not, as I recall, hypotensive.
Significant hypoxemia unresponsive to FIO2 of 1 but not, as I recall, hypotensive.
May 27, 2025 at 10:47 PM
Yes I was consulted on a case of renal cell carcinoma that embolized to the Tricuspid valve where the tumor was stuck. He had a large ASD/PFO which saved him.
Significant hypoxemia unresponsive to FIO2 of 1 but not, as I recall, hypotensive.
Significant hypoxemia unresponsive to FIO2 of 1 but not, as I recall, hypotensive.
Or bring your excellent points to Vanderbilt Datamethods forum.
discourse.datamethods.org/t/the-petty-...
discourse.datamethods.org/t/the-petty-...
The Petty/Bone RCT
Yes. The Petty/Bone RCT is a term used for a unique pathological modification of the RCT which dominates critical care science. Two USA pulmonologists, Thomas Petty (1960s) and Roger Bone (1980s) de...
discourse.datamethods.org
May 27, 2025 at 8:12 PM
Or bring your excellent points to Vanderbilt Datamethods forum.
discourse.datamethods.org/t/the-petty-...
discourse.datamethods.org/t/the-petty-...
The problem is more fundamental and relates to the “RCT mimic” itself. The conflation of synthetic syndromes for disease equivalents
Join discussion questioning whether or not formal symbolic causal modeling should be required in the application for an NIH grant for an RCT.
x.com/patientstorm...
Join discussion questioning whether or not formal symbolic causal modeling should be required in the application for an NIH grant for an RCT.
x.com/patientstorm...
Lawrence Lynn on X: "@5_utr @doc_BLocke @RWJE_BA @DongNguyeb @yudapearl Wonderful, your simplistic analysis is perfectly illustrative. It is this type of oversimplified thinking with no formal casual modeling (eg no DAGs) for which the public should not pay. But I don’t blame you for that as you are not a pulmonologist. You are trusting the thought" / X
@5_utr @doc_BLocke @RWJE_BA @DongNguyeb @yudapearl Wonderful, your simplistic analysis is perfectly illustrative. It is this type of oversimplified thinking with no formal casual modeling (eg no DAGs) for which the public should not pay. But I don’t blame you for that as you are not a pulmonologist. You are trusting the thought
x.com
May 27, 2025 at 8:09 PM
The problem is more fundamental and relates to the “RCT mimic” itself. The conflation of synthetic syndromes for disease equivalents
Join discussion questioning whether or not formal symbolic causal modeling should be required in the application for an NIH grant for an RCT.
x.com/patientstorm...
Join discussion questioning whether or not formal symbolic causal modeling should be required in the application for an NIH grant for an RCT.
x.com/patientstorm...
The history of “lemon juice science” and whatever treatment you fancy for the lumped set of diseases which meets the latest amazing international task force generated (guessed) threshold set.
youtu.be/BTgEU07FI9o
youtu.be/BTgEU07FI9o
Lawrence Lynn | The Science Monopoly
YouTube video by Consilium Scientific
youtu.be
May 26, 2025 at 6:05 PM
The history of “lemon juice science” and whatever treatment you fancy for the lumped set of diseases which meets the latest amazing international task force generated (guessed) threshold set.
youtu.be/BTgEU07FI9o
youtu.be/BTgEU07FI9o