This article is a big problem. I don't expect that people would neccessarily know these nuances, but there are a lot of problems with the interpretation of the data that is presented in the actual paper, and I do not think that it supports the conclusion that is being headlined. I'm a statistician, so I look at these things carefully.
For example, when you look at the actual numbers, there is NO statistical difference between the two groups in rates of headache, which is the basis of the LLC for determining altitude illnesses.
Another example. They state:
Quote:Although a decrease in severity of
acute mountain sickness symptoms was found in the ibuprofen
group, statistical significance was not met (Table 2). There were
no statistically significant differences between treatment and
control groups in the secondary outcome measures of headache
severity by visual analog scale or peripheral oxygen saturation
change (Table 3). No differences in significance were observed
between the placebo and treatment groups after adjusting for
age, sex, ethnicity, and oxygen saturation by multivariate logistic
regression.
Subgroup analysis of Lake Louise Questionnaire symptom
prevalence did not reveal statistically significant differences
between placebo and ibuprofen groups in any of the individual
complaints other than gastrointestinal, with greater occurrences
in the placebo group (Table 4).
This is NOT impressive.
There was also another thing that was not really addressed: In the paper, they had a flow chart that showed how they split up the patients. In it they showed at the bottom, the number of climbers who required "rescue treatment" for AMS.
Quite interesting was that only 1 placebo patient required "rescue" treatment, but SIX patients required it
who were taking the Ibuprofen.
That is not success in my book, that is failure.
Additionally, they go on to say:
Quote:Our measure of success in preventing severity of acute
mountain sickness suggested that ibuprofen was beneficial,
although the improvement did not meet our predetermined
statistical significance of greater than 2 Lake Louise
Questionnaire points. This endpoint was established as a
clinically meaningful difference;
A clinically meaningful difference means something that actually makes a difference to a person, not just something that is a number on a paper. So what they are saying is that the difference that they observed would NOT, by their own definition, make a difference that the average climber would actually be able to tell.
They also say:
Quote:These findings show the clinical effectiveness of ibuprofen as
an agent to protect against acute mountain sickness. Ibuprofen
is a commonly used and well-tolerated medication, making it a
reasonable alternative to acetazolamide in individuals affected by
its adverse effects or challenged by prescription accessibility. We
suggest that availability alone makes ibuprofen an appealing
drug for individuals who travel to high altitudes.
This is simply wrong. The effect of Ibuprofen as stated in their paper is minimal, in contrast to acetazolamide which is substantial.
Something that doesn't work is NOT an appealing alternative to something that ACTUALLY works!
Full article:
http://www.annemergmed.com/webfiles/images/journals/ymem/FA-gslipman.pdf
