Correspondence  |   August 2016
In Reply
Author Notes
  • Washington University School of Medicine, St. Louis, Missouri (M.S.A.). avidanm@anest.wustl.edu
  • (Accepted for publication April 20, 2016.)
    (Accepted for publication April 20, 2016.)×
Article Information
Correspondence
Correspondence   |   August 2016
In Reply
Anesthesiology 8 2016, Vol.125, 428-429. doi:10.1097/ALN.0000000000001181
Anesthesiology 8 2016, Vol.125, 428-429. doi:10.1097/ALN.0000000000001181
We thank Drs. Eckenhoff, Evered, and Hogan for engaging in an important debate on the issues we raised in our editorial, “The Fallacy of Persistent Postoperative Cognitive Decline.”1  Their letter challenges several aspects of our editorial including (1) our use of the word “fallacy”; (2) the content of our analysis; and (3) the logic of our argument. We welcome the opportunity to sequentially respond to each of these points.
First, we stand by our use of the word fallacy. To be clear, we are not asserting that the existence of persistent postoperative cognitive decline (POCD) has been definitively refuted, and is thus fallacious. Rather, our editorial suggests that persistent POCD is likely a post hoc, ergo propter hoc (after this, therefore because of this) misattribution fallacy. The fallacy is to assume causation purely on the basis of a temporal relationship. A relevant example of this type of fallacy is the assertion that measles vaccine causes autism. There is currently an alarming increase in the prevalence of autism spectrum disorders. Largely uncontrolled observational research has implicated measles vaccination, and tellingly, there are compelling anecdotes of toddlers who are cognitively normal before their vaccine and who shortly after become neurodevelopmentally impaired.2  Yet, based on the preponderance of evidence,3  most scientists are convinced that it is incorrect to attribute autism to measles vaccination. There is similarly an alarming increase in the prevalence of cognitive decline among older adults. Highly publicized uncontrolled observational studies have implicated surgery and anesthesia,4,5  and tellingly, there are compelling anecdotes of older adults who are cognitively normal before surgery, and thereafter rapidly become demented. Yet, based on the preponderance of evidence referred to in our editorial,1  we suggest that it is likely a fallacy to attribute persistent cognitive decline or incident dementia to uncomplicated surgery with general anesthesia.
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