PubHawk
Circ Cardiovasc Qual Outcomes March 2018 PMID 29530888

'Faith Healing' and 'Subtraction Anxiety' in Unblinded Trials of Procedures: Lessons from DEFER and FAME-2 for End Points in the ISCHEMIA Trial.

Christopher A Rajkumar, Sukhjinder S Nijjer, Graham D Cole, Rasha Al-Lamee, Darrel P Francis

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Mentions

60
Peak: 6 in Oct 2024
across 6 sources since Jan 2019

Extended reach

244,601
potential audience

Total likes

76

Video views

1,020

Mentions per month

Jan 2019 – Mar 2025

Where it's discussed

  • X / Twitter30 posts
  • News16 articles
  • Blogs5 articles
  • Facebook4 posts
  • YouTube3 videos
  • Reddit2 posts

AI synopsis

What people are saying

Several discussions highlight the importance of controlling for psychological biases in unblinded studies, with phrases like 'faith healing' and 'subtraction anxiety' used to emphasize how patient and doctor expectations can skew results. Words like 'problematic' and 'artifact' reflect critical engagement with trial methodology, while references to well-known studies, such as FAME 2 and ISCHEMIA, demonstrate a depth of understanding and concern about research validity. The tone varies from critical to inquisitive, reinforcing the perception that this publication adds valuable insights into improving clinical trial design and interpretation.

AgreementModerate agreement

Most discussions acknowledge the challenges posed by psychological biases like faith healing and subtraction anxiety, with many aligning with the article's focus on trial design issues.

InterestHigh interest

The posts demonstrate high curiosity, especially when explaining concepts like subtraction anxiety and referencing pivotal trials such as FAME 2 and ISCHEMIA.

EngagementModerate engagement

Comments include references to specific trials, criticisms of methodology, and suggestions for better trial designs, indicating active and thoughtful engagement.

ImpactModerate impact

Participants appear to see the publication as relevant to ongoing debates about clinical trial reliability and interpretation, suggesting it influences perspectives on future research.

Abstract in brief

  • The paper discusses how faith healing and anxiety about missing out on effective treatments can influence patient behavior and trial outcomes in unblinded clinical studies, using DEFER and FAME2 as examples.
  • It highlights the challenges in designing trials where patients and doctors know the treatment assignments, which can affect the reliability of end points, especially in procedures like coronary interventions.
  • The authors suggest that lessons from these trials can help improve the design and interpretation of future studies like ISCHEMIA, emphasizing the need for careful consideration of psychological factors and trial endpoints.]
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Top posts

Most liked on X and Bluesky
Gaurav Gulsin
@GauravGulsin · X

@drjohnm @rajkumar_chris This seems pretty relevant, especially for those unfamiliar with subtraction anxiety: https://t.co/ChPgpSX1nD

Oct 28, 2024 · 14 likes · 3 shares · 804 followers View post →
Less-Is-More Cardiologist
@DavidLBrownMD · X

@GreggWStone @babytea96 @afshinfarzan @JACCJournals @djc795 @SVRaoMD @mmamas1973 @DrMarthaGulati @venkmurthy @ProfDFrancis @MortonKern Only true in unblinded studies due to subtraction anxiety https://t.co/Y0up992y3N. See ORBITA trial where there was no interaction between FFR or iFR, PCI and exercise time or angina frequency. https://t.co/vmIZLqiqTf

Sep 26, 2022 · 11 likes · 22,151 followers View post →
Circ: CQO
@CircOutcomes · X

Next up, "‘Faith Healing’ and ‘Subtraction Anxiety’ in Unblinded Trials of Procedures" by @rajkumar_chris et al https://t.co/DYesetP98g

Jan 10, 2019 · 7 likes · 14,459 followers View post →
Less-Is-More Cardiologist
@DavidLBrownMD · X

@btweeter82 FAME 2 was stopped early because a bogus endpoint called urgent revascularization was significantly increased in the OMT arm. This was an artifact of the lack of binding causing "subtraction anxiety " in the OMT arm. This is explained here. https://t.co/Y0up99k9sn

Nov 6, 2021 · 5 likes · 1 share · 22,151 followers View post →
Prof Darrel Francis ☺ Mk CardioFellows Great Again
@ProfDFrancis · X

Well, well, well. Now those have you who have been following that naughty boy Chris Rajkumar (@rajkumar_chris), will know the correct answer to this. As you know, Chris wrote a disappointingly disrespectful and cheeky article in Circ CQO: https://t.co/5ZtRRBb9hr

Apr 14, 2020 · 3 likes · 17,784 followers View post →
Jeremy Sussman
@JeremySussman · X

@mikejohansenmd @MaartenvSmeden @rwyeh @ProfHayward @raj_mehta @CRichardsonmd Totally agree. In particular the combination of usual care control plus measurement error in dependent variable could create substantial biases, a la their myth #3 & subtraction anxiety. https://t.co/SA08w2lGAl

Oct 1, 2019 · 3 likes · 1,944 followers View post →

All mentions

Tom Hyde
@CotsCardiology · X

@susan_bewley @HealthSenseUK @EvidenceMatters @NIHRresearch @Healthy_Control @GLADDUK Susan, any trial involving obvious changes may be biased by the outcomes for individuals, we call it "faith healing" and "subtraction anxiety" in cardiology can you see a design that will negate that? https://t.co/gf3q8hF9HJ

Mar 18, 2025 · 1 like · 1,555 followers View post →
Tom Hyde
@CotsCardiology · X

@BayswaterSG More than that, how can the trial be blinded? There are 2 well known concepts - Subtraction Anxiety and Faith Healing in treatments that are impossible to blind. It would be hard to think of a design that is not confounded by that. https://t.co/gf3q8hF9HJ

Mar 17, 2025 · 1,555 followers View post →
Gabriel Largaespada Pérez
@largaesEP · X

RT @GauravGulsin: @drjohnm @rajkumar_chris This seems pretty relevant, especially for those unfamiliar with subtraction anxiety: https://t…

Nov 1, 2024 · 3 shares · 162 followers View post →
Adrian Carlessi
@adrianocarlessi · X

@matiasrg @VictorDayan1 @clinicasac @SAC_54 I've just learnt a new concept: subtractionAnxiety . As @drjohnm said It's a good example. https://t.co/xjkb3Gf7Dw

Oct 29, 2024 · 1 like · 247 followers View post →
Dr Duncan Hogg
@drduncanhogg · X

RT @GauravGulsin: @drjohnm @rajkumar_chris This seems pretty relevant, especially for those unfamiliar with subtraction anxiety: https://t…

Oct 29, 2024 · 3 shares · 1,305 followers View post →
Todd C. Lee
@DrToddLee · X

RT @GauravGulsin: @drjohnm @rajkumar_chris This seems pretty relevant, especially for those unfamiliar with subtraction anxiety: https://t…

Oct 28, 2024 · 3 shares · 14,929 followers View post →
Diego Segura-Rodríguez
@SeguraCardio · X

Great point

Oct 28, 2024 · 1 like · 25,812 followers View post →
Gaurav Gulsin
@GauravGulsin · X

@drjohnm @rajkumar_chris This seems pretty relevant, especially for those unfamiliar with subtraction anxiety: https://t.co/ChPgpSX1nD

Oct 28, 2024 · 14 likes · 3 shares · 804 followers View post →
Mohammed Ruzieh, MD
@MRuzieh · X

Also read https://t.co/lV9roi06gm

Sep 12, 2024 · 774 followers View post →
Vinson Yew
@Dokutah_Vyew · X

https://t.co/TDRynmmCJa Telling patients they have no significant ischaemia by FFR is enough to reduce angina

Sep 1, 2024 · 431 followers View post →
Taishi Okuno
@taishiokuno · X

‘Faith Healing’ and ‘Subtraction Anxiety’ in Unblinded Trials of Procedures | Circulation: Cardiovascular Quality and Outcomes https://t.co/qgHsbDADBt

Apr 8, 2024 · 1 like · 441 followers View post →
Jacob Søby
@JacobSoeby · X

@Medicinmanden Desuden er det problematisk at måle effekten af en større procedure vs. tabletter på et subjektivt endepunkt: https://t.co/4t5qrswa5l

Nov 16, 2023 · 83 followers View post →
Linda
@wordfinga · X

RT @DavidLBrownMD: @spitzertweets @kaulcsmc @pash22 @ovidiogarciav @rahatheart1 @hect2701 @BCase07 @Ortega_Paz @sbrugaletta @sjorge4 @DFCap…

Feb 27, 2023 · 1 share · 4,593 followers View post →
Less-Is-More Cardiologist
@DavidLBrownMD · X

@spitzertweets @kaulcsmc @pash22 @ovidiogarciav @rahatheart1 @hect2701 @BCase07 @Ortega_Paz @sbrugaletta @sjorge4 @DFCapodanno @ESHLOF @Costa_F_8 @CRT_meeting @NielsRHolm @news_hart @lamelaspablo @ColletCarlos @RaberLorenz @VictorDayan1 @FaisalBakaeen @BiykemB @Vilavaite @MarionKCampbell https://t.co/Y0up99kHhV

Feb 27, 2023 · 2 likes · 1 share · 22,151 followers View post →
Less-Is-More Cardiologist
@DavidLBrownMD · X

@GreggWStone @babytea96 @afshinfarzan @JACCJournals @djc795 @SVRaoMD @mmamas1973 @DrMarthaGulati @venkmurthy @ProfDFrancis @MortonKern Only true in unblinded studies due to subtraction anxiety https://t.co/Y0up992y3N. See ORBITA trial where there was no interaction between FFR or iFR, PCI and exercise time or angina frequency. https://t.co/vmIZLqiqTf

Sep 26, 2022 · 11 likes · 22,151 followers View post →
Less-Is-More Cardiologist
@DavidLBrownMD · X

@Shekarbohra @kaulcsmc @djc795 https://t.co/1EUvxksq0J.

Aug 13, 2022 · 2 likes · 22,151 followers View post →
Less-Is-More Cardiologist
@DavidLBrownMD · X

@SossouMd @GabashaMD @OmarChehab1 @HeartDrTiffany @KevinRabii @CSmuclovisky Not "primarily" driven. Completely driven. https://t.co/Y0up99k9sn

Mar 16, 2022 · 2 likes · 22,151 followers View post →
Less-Is-More Cardiologist
@DavidLBrownMD · X

@kaulcsmc @GreggWStone @GabashaMD @evandrofilhobr @KambisMashayek1 @DKarmpaliotis Subtraction anxiety. https://t.co/Y0up99k9sn

Dec 5, 2021 · 2 likes · 22,151 followers View post →
Linda
@wordfinga · X

RT @DavidLBrownMD: @btweeter82 FAME 2 was stopped early because a bogus endpoint called urgent revascularization was significantly increase…

Nov 8, 2021 · 1 share · 4,593 followers View post →
Less-Is-More Cardiologist
@DavidLBrownMD · X

@btweeter82 FAME 2 was stopped early because a bogus endpoint called urgent revascularization was significantly increased in the OMT arm. This was an artifact of the lack of binding causing "subtraction anxiety " in the OMT arm. This is explained here. https://t.co/Y0up99k9sn

Nov 6, 2021 · 5 likes · 1 share · 22,151 followers View post →
Will Meurer
@willmeurer · X

@NickJohnsonMD Telling people they had a good stress test reduced symptoms of chest pain. Presumably, telling kids they have inflammation around their heart will also induce some symptoms. https://t.co/IK3KPvYK26 https://t.co/tpVE30o6ii

Sep 14, 2021 · 1 like · 787 followers View post →
Prof Darrel Francis ☺ Mk CardioFellows Great Again
@ProfDFrancis · X

Well, well, well. Now those have you who have been following that naughty boy Chris Rajkumar (@rajkumar_chris), will know the correct answer to this. As you know, Chris wrote a disappointingly disrespectful and cheeky article in Circ CQO: https://t.co/5ZtRRBb9hr

Apr 14, 2020 · 3 likes · 17,784 followers View post →
Felix Valencia
@FelixValencia10 · X

@egutibanes Faith healing and sustraction anxiety https://t.co/SESUEcyzam

Jan 5, 2020 · 1,707 followers View post →
Andrew Althouse
@ADAlthousePhD · X

@pomyers @djc795 @ProfDFrancis @bnallamo And here is the piece Francis' group corrected after the ISCHEMIA trialists' response: https://t.co/WRWeIlYEHe

Oct 7, 2019 · 2 likes · 11,058 followers View post →
Jeremy Sussman
@JeremySussman · X

@mikejohansenmd @MaartenvSmeden @rwyeh @ProfHayward @raj_mehta @CRichardsonmd Totally agree. In particular the combination of usual care control plus measurement error in dependent variable could create substantial biases, a la their myth #3 & subtraction anxiety. https://t.co/SA08w2lGAl

Oct 1, 2019 · 3 likes · 1,944 followers View post →
SCTorg
@SCTorg · X

RT @willmeurer: “When the trial reports, we suggest that readers focus on the primary end point of cardiovascular death and nonfatal MI tha…

May 21, 2019 · 1 share · 992 followers View post →
Will Meurer
@willmeurer · X

“When the trial reports, we suggest that readers focus on the primary end point of cardiovascular death and nonfatal MI that was originally pre-specified...” avoiding the subjective endpoints in an unblinded trial @SCTorg ISCHEMIA trial session https://t.co/iDxNB3PdVy #sct2019

May 21, 2019 · 2 likes · 1 share · 787 followers View post →
Andy McCullough
@DrAMcCullough · X

@jehanalladina @ChrisWorsham @AnupamBJena Though the issue of chest pain and angina is probably even more complex than we like to believe (https://t.co/IIXQFLw2eJ). That said, as @ajaykirtane and many others (who have far more experience that I) have stated, there is a group of pts who don’t tolerate medical therapy well

Jan 30, 2019 · 1,837 followers View post →
Jason Doctor
@jasndoc · X

"Faith healing" in medicine: "the simple act of telling a patient that the physiology test shows no significant ischemia dramatically improve[s] symptoms." -- @ProfDFrancis https://t.co/q434SOYnGb https://t.co/pDzrifm3OC

Jan 14, 2019 · 2,001 followers View post →
Circ: CQO
@CircOutcomes · X

Next up, "‘Faith Healing’ and ‘Subtraction Anxiety’ in Unblinded Trials of Procedures" by @rajkumar_chris et al https://t.co/DYesetP98g

Jan 10, 2019 · 7 likes · 14,459 followers View post →