[HN Gopher] The illusion of evidence based medicine ___________________________________________________________________ The illusion of evidence based medicine Author : pueblito Score : 104 points Date : 2022-03-24 17:59 UTC (5 hours ago) (HTM) web link (www.bmj.com) (TXT) w3m dump (www.bmj.com) | tensor wrote: | Drug company bias is definitely a well known issue. But there are | even bigger issues with science based medicine. | | * MDs are not PhDs for one, though people often equate the two. | | * Things like surgery is in fact hard to test. There are ethical | issues around it. E.g. are you really going to do a shame surgery | "for science" if you think there is a chance it might save the | patients life? On the flip side, surgery has a lot of risk, and | performing surgery that doesn't work exposes patients to | unnecessary risk. | | * There are entire fields where pseudo-science is common. Notably | a lot of physical therapy and chiropracty is not science based. | willhinsa wrote: | On the difficulty of testing lifesaving treatments, there's a | great paper on this topic: | | "Parachute use to prevent death and major trauma related to | gravitational challenge: systematic review of randomised | controlled trials" [0] | | It has some great gems like: - No randomised | controlled trials of parachute use have been undertaken | - The basis for parachute use is purely observational, and its | apparent efficacy could potentially be explained by a "healthy | cohort" effect - Individuals who insist that all | interventions need to be validated by a randomised controlled | trial need to come down to earth with a bump | | [0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/ | slibhb wrote: | I think profit motive and regulatory capture are real problems | but I don't think they're the only problems and maybe not the | biggest. | | For example, the FDA is generally agreed to have dropped the ball | by dragging its feet on approving covid tests. I don't think | profit motive or regulatory capture explain that. What does? | | More transparency (as the authors recommend) sounds great but | giving more power to regulatory bodies is no panacea. | ouid wrote: | Big Pharma _derives_ its oligopoly from the barriers to entry | that the FDA imposes. Presumably they take every opportunity to | lobby for more rigorous extensive testing. Not because they | want to pay more to run tests, but because they want their | smaller competitors to pay more to run studies for drugs that | might compete. | | This is, of course, not an explanation for _how_ they have | variously captured the components of the FDA, but it does | explain how such a capture is an explanation for foot-dragging. | mikekij wrote: | > For example, the FDA is generally agreed to have dropped the | ball by dragging its feet on approving covid tests. I don't | think profit motive or regulatory capture explain that. What | does? | | I'm no fan of over-regulation, but the FDA finds itself in an | impossible situation: approve tests quickly to slow the spread | of Covid, only to later find that the tests don't work, or test | the products rigorously, while patients suffer. | | It's a very difficult balance to strike, and I would argue | they've done as good a job as one could hope. | Terry_Roll wrote: | As someone who recently complained to the UK Royal College of | Veterinary Surgeons and got palmed off because the UK legislation | doesnt quantify "reasonable care", the whole system is one giant | authoritarian money making scam. | | I dont know what professionals are being taught in med/vet/law | school now a days, but technology is increasingly demonstrating | that professionals could be out of date by the end of their | course! | | So that problem of trying to stay current in IT is spreading out | into other professions and I dont see them tackling this problem | like the IT sector has/does. | yes_man wrote: | Another great argument I have heard against EBM (or maybe rather | against being religious about it) is that the studies and papers | held to highest regard are made in circumstances that do not | apply to most of healthcare: the studies might be done in the | best hospitals like Johns Hopkins, with practically limitless | human resources for the study, and very carefully selected | patient groups. In a normal hospital situation you won't have the | time or the resources to dedicate the same care for each patient, | and the patients might have other conditions (which would rule | you out of the big studies). | | Still, as a layman who is not a doctor, evidence based medicine | sounds like a good idea, but as with everything, taking it to | extreme is probably harmful | medymed wrote: | Science marches on one funeral at a time, medicine marches on one | expired patent at a time. | tomohawk wrote: | It's not just corruption, it is an idea that seems very correct, | but which is subtly wrong. | | Take a substance like chlorine. It is put into municipal drinking | water because it kills things - things that can kill us or harm | us. It is credited with making municipal water a lot safer. | | It has been shown to be safe and effective for most people. | | The key is most people. Some people, at the edges of the bell | curve, cannot tolerate chlorine. If they drink water with it, or | bathe in water with it, it harms them. I have family members who | have this sensitivity. Since moving to a place with well water, | their health has improved immensely. | | If you were to be guided only by studies that show the safety and | effectiveness of the chlorine treatment, then you could overlook | the fact that some people are outliers. | | Evidence based medicine will guide you to things that will work | for most people in a given situation. However, for a specific | patient, you may need to depart from that evidence. | | Limiting doctors to only evidence based approaches prevents them | from treating specific patients. | Nuzzerino wrote: | > Take a substance like chlorine. It is put into municipal | drinking water because it kills things - things that can kill | us or harm us. It is credited with making municipal water a lot | safer. | | > It has been shown to be safe and effective for most people. | | And yet it wasn't until I was well into my 30s that I learned | that not cleaning your shower head often enough or thorough | enough can block the effects of the chlorine and spray | aerosolized bacteria everywhere. | | It doesn't matter what kind of medicine you have when there are | plenty of problems that would be prevented if not for the | obscene asymmetry of information and poor cultural health | habits. But as long as big tech continues to believe that | steering people toward political propaganda is what's best for | society, that will be the narrative of the day rather than real | progress. | nonameiguess wrote: | The EPA guidelines limit chlorine content in potable water to 1 | PPM. That is well below the level at which even the most | sensitive person is affected. The problem is this guideline has | no legal enforcement mechanism, so whether or not your | municipal water district follows it is up to them. If they're | not, they're not practicing evidence-based anything. They're | ignoring evidence-based guidelines for some other reason. | | Whether any US water district is really doing this seems | debatable anyway. Maybe this is just a consequence of the poor | state of search engines, but every source I can find claiming | specific US water supplies contain unsafe levels of chlorine | seem to be exclusively limited to companies trying to sell you | expensive filtration systems you almost certainly do not need. | rscho wrote: | That some people are sensitive to chlorine should then be | scientifically studied, to expand the knowledge on that topic. | Counting on individual practitioners to cook up artisanal | individualized treatment on their own is both unscientific and | the antithesis of what you (and everyone) want. | tricky777 wrote: | Evidence is king. | | But hyphoteticaly... | | if I'm an outlier, and blind test is made on only me, and | reveals that I am sensitive to chlorated water. | | ...I would count that as evidence based. | tomohawk wrote: | Where did I say a practitioner should "cook up artisanal | treatments"? | | That's a strawman, for sure. | | Doctors have a lot of education, and gain a lot of experience | over time. | | What I pointed out is that the studies are not enough. Where | they leave off is where a doctor needs to be able to apply | their education, experience, and knowledge of the case to | make progress. Doctors are trained to apply scientific | approaches to bridge the gap between the broad science and | the individual patient. The big health co's do not like | doctors doing this because it takes time and is expensive. | So, they tie their hands because they only want the doctors | to focus on the easiest fixes that solve the most problems. | stonemetal12 wrote: | What do you think evidence based means? There is evidence that | some people are sensitive to chlorine. In an evidenced based | approach it would be considered a possible cause until there is | evidence to rule it out. If other issues present similar | symptoms and are more likely then they should be tested and | ruled out first. | obscur wrote: | Might be wrong, but I think they just mean that when you do | large scale trials you aggregate over the population, and | determine if the medication had a statistically significant | effect. You can get evidence that a subgroup does not react | well, but you might not, if that is not your focus. | | A key concept and solution here is 'precision medicine', | tailoring medicine based on more precise information about | the individual. | dekhn wrote: | chloramine is replacing chlorine in municipal treatment. | | I'd be amazed if somebody was really sensitive to chlorine, to | the point where typical municipal water caused rashes. After | all, all of us contain 80grams of it and consume 500mg/day. | auslegung wrote: | I think you're getting down-voted because yourcomment indicates | you think this article says that doctors should only be able to | use evidence-based approaches. That's not at all with this | article is about. | FabHK wrote: | Related: The delicious paper | | _Parachute use to prevent death and major trauma related to | gravitational challenge: systematic review of randomised | controlled trials_. | | > the effectiveness of parachutes has not been subjected to | rigorous evaluation by using randomised controlled trials. | Advocates of evidence based medicine have criticised the adoption | of interventions evaluated by using only observational data. We | think that everyone might benefit if the most radical | protagonists of evidence based medicine organised and | participated in a double blind, randomised, placebo controlled, | crossover trial of the parachute. | | https://pubmed.ncbi.nlm.nih.gov/14684649/ | caycep wrote: | granted, there is the day-to-day human physician "bayesian" | evidence-based-medicine...for better or worse... | qnsi wrote: | Medical industry is corruption prone. | | Another example: Industry sponsored conferences. Doctors are | invited to a 3 day 4 star hotel stay to attend a conference. | Technically, talks that are paid shilling are specially marked as | sponsored talks. | | But are the other doctors, who are getting paid to speak there | 100% independent? | | Will you be a 100% independent doctor after getting free | presents? | | Maybe you will. But industry probably found its profitable if | they spent millions on these kinds of conferences. | | Also lie repeated multiple times makes you believe in, there are | psychological studies. So when you spend hour listening how drug | X is gold, you might start believing its gold | sarchertech wrote: | My wife's a doctor and the "free presents" she's gotten from | conferences are laughable. A 128mb flash drive and a canvas bag | are about the best things I've seen. | | She's also never gotten a free hotel stay at a conference | unless her group was paying for it. | | She tells me there are strict (very small) limits on gifts from | drug companies. | Enginerrrd wrote: | >Will you be a 100% independent doctor after getting free | presents? | | >Maybe you will. But industry probably found its profitable if | they spent millions on these kinds of conferences. | | So... theoretically the industry putting on the conference is | also pushing the state of the art pharmaceutically and believe | that they have an improvement on the existing standard of care. | I don't think it's got anything to do with the presents as much | as the message. | obscur wrote: | Seems very unlikely to me that it would not be a combination. | We have both rational and irrational parts, conscious and | unconscious parts. | | I'd venture one does not have to look far in the anthropology | literature to find good evidence that gifts just like other | favors serves a function in building reciprocal | relationships. Since it is likely so fundamental, I have a | hard time believing it would not have any effect on the | independence of the doctor. | pessimizer wrote: | Nah. Speakers fees are a way to launder direct contributions. | There was at least one famous case where the "conference" was | done in one of the speakers' living rooms. Imagine getting a | speaking fee for speaking extemporaneously in a Florida hotel | room with two pharma reps and one other doctor five minutes | before you all leave for golf. | nobody9999 wrote: | >Nah. Speakers fees are a way to launder direct | contributions | | The comparison to money laundering is specious, IMHO. | | In the US, at least, there is a database[0] of _any_ value | (including monetary and in-kind) exchange between doctors | and medical companies. | | As such, there is no "laundering" at all. All moneys and | in-kind (hotel rooms, meals, swag, etc.) payments are | documented and detailed. | | Is there an incentive for doctors to favor a particular | pharma or medical device company based on those payments? | Perhaps. But since (again, at least in the US) such | payments are documented and _publicly available_ , it isn't | some sort of secret set of payments designed to | _surreptitiously_ co-opt doctors. | | Sure, some payments (my brother, a physician, received | ~US$20,000 in 2020, mostly (~$13,000) from a single | consulting fee. | | Is my brother favoring the company who paid him $13,000 in | 2020? Maybe. But _if and only if_ their products /devices | have clear beneficial effects over other products/devices. | | What's more, that $20,000 (aside from the consulting fee, | it was food/beverage and other in-kind stuff) is a small | fraction of his annual income and doesn't make a | significant difference in his quality of life. | | As such, while there may certainly be doctors who are co- | opted/corrupted by medical companies, assuming that the | majority of doctors are swayed by such things is iffy at | best. | | [0] https://openpaymentsdata.cms.gov/ | drewcoo wrote: | > Medical industry is corruption prone. | | Corruption is incentivized in any for-profit industry. | ipaddr wrote: | And non-for-profit industries | notriddle wrote: | And groups of people who are driven by ideology, rather | than profit. | TeeMassive wrote: | Here in Quebec the vaccine passport and the curfew was touted as | the pinnacle of "following the science"(tm). Anyone contradicting | their usefulness as effective sanitary measures were accused of | "spreading misinformation"(tm). | | The curfew was implemented twice. The vaccine passport was only | recently removed. | | Turns out, one FOIA request later, that they never consulted the | data scientists of the public health institute. They made it all | up. | cosmotic wrote: | This should not be considered evidence that other quack medicines | have any superiority over modern medicine. | trulyme wrote: | True. It is just evidence that _sometimes_ modern medicine | doesn 't have any superiority over quack medicines either. | [deleted] | tsoukase wrote: | EBM suggests that swimming in a heated swimming pool (controlled | studies) can be the same as swimming in open sea/ocean (applying | the result in any possible case) | FabHK wrote: | The distinction you allude to is _so_ well known and understood | that there are not only papers about it, but also special words | to distinguish them: efficacy (performance of an intervention | under ideal and controlled circumstances) and effectiveness | (performance under 'real-world ' conditions). | | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726789/ | | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3912314/ | smohare wrote: | One of the issues I've seen with EBP is that it's often not | necessarily science based. That is to say, prior plausibility | derived from basic science isn't fully incorporated, ergo undo | weight is given to noise. You see with in almost any study of | pseudoscientific modalities, where actual efficacy would require | a drastic reformation of our fundamental, very well tested models | of the natural world. Why should a particularly strong one-off | result for my made up pain treatment be afforded the same stature | as that of an pharmacological agent with clear physiological | pathways? | rscho wrote: | Evidence-based medicine does incorporate prior evidence for | causal evaluation. Check out the "Bradford criteria". They're | the basis of causal evaluation in epidemiology. | sammalloy wrote: | One thing that has always stuck with me in regards to this topic | is the lack of medical research in areas that need it but don't | get it because there isn't any money in it. One area that comes | to mind is feline urinary tract disease. Many years ago, I had a | cat who kept coming down with this, and the vet(s) were at a | total loss as to how this kept happening. So I decided to open up | the literature and plough into it as a layman with no knowledge | about animal medicine. Within the space of a single hour I | quickly learned that many of the most common diseases facing | animals have very little research behind them and a lot of | unknowns. Which brings me back to one of the main points of the | author. If the neoliberal approach to research is only going to | focus on what is profitable to treat, then medical science as a | whole has backed itself into a dark corner. | rafaelero wrote: | There is one simple solution: replication. Stop complaining and | start replicating. | chicob wrote: | After reading this article I find only one problem with it, and | that is the title. | | The problem the authors have so perfectly characterized has | nothing to do with the emphasis on evidence that medicine | requires, but on the distortion imposed on the system by large | pharmaceutical companies. | | The reality of the obstacles standing in the way of rigorous | testing for drug or therapy effectiveness does not make evidence- | based medicine an illusion. | | In fact, the authors actually make a strong argument in favor of | evidence-based medicine, by stating the need to acknowledge these | biases. And that the reason for all these biases is greed. | pmoriarty wrote: | The article shows how what passes for evidence based medicine | is an illusion. | | The "evidence" is biased and corrupted by corporations, as are | many of the people who evaluate it, set the standards, and make | decisions. | xmprt wrote: | I think you're misunderstanding the title. It's not that | evidence based medicine has problems. It's that there are | problems with how evidence based medicine is currently | practiced which gives it the appearance of evidence based | medicine while actually not being anything close, that is, an | illusion. | ouid wrote: | Stop calling it greed. It's corruption and regulatory capture. | Both of these, unlike greed, are problems that can be solved. | verisimi wrote: | > It's corruption and regulatory capture. | | Absolutely! | | > Both of these, unlike greed, are problems that can be | solved. | | Hmm... I don't see how. Pharmaceutical companies (and all | other corporations, for that matter) pay the lobbyists to | write the legislation that is then duly waved through. This | is to say the governance structure itself is captured. | | In fact, I think it always was captured, but only that we | have laboured erroneously under the idea that it was there to | help us. And creating that illusion is the job of education | and corporate media. | | Until we are disabused of the idea that government is | anything other than a parasitical, wealth extraction process, | that no one has the right to forcibly take another's money | (tax) and to do so means to be subjugated to a type of | slavery, that legislation has very little to do with | morality, that we are given our opinions first at school with | 18 years or so of indoctrination which is then topped up via | screens and newspapers - until we recognise that we are | sovereign beings that will stand up for what is right and | refuse what is wrong, we're not going to change much. | twofornone wrote: | >Scientific progress is thwarted by the ownership of data and | knowledge because industry suppresses negative trial results, | fails to report adverse events, and does not share raw data with | the academic research community. | | Not to derail the thread but this nicely encapsulates my | reservations toward the COVID vaccines, and why I think mandates | are egregiously unethical. The raw clinical trial data is still | effectively a secret between pharma and the FDA, and both are | under immense financial/political pressure to release a "safe and | effective" product, not to mention the incestuous relationship | between the ostensibly independent FDA and big pharma. | sebmellen wrote: | I find it very discomfiting that anyone suspicious of the | COVID-19 vaccine _(by that I mean the COVID vaccine /spike | protein in particular)_ is branded as anti-vax. I say this as a | vaccinated person who caught a heavy bout of COVID. I suppose | I'm grateful for the vaccine, but mandates scare me. | tricky777 wrote: | as chistians say, "turn the other cheek". (labeling did not | made much harm, dont get too ivested in that) | | reality is, that we can't have policy/public sentiment that | is nuanced. (I heard it breaks the timecontinuum) | | Find the silver lining and move on. I'm just glad that, a lot | of people are in pro-vaccine side overall. While in your case | it is a bit of mob mentality (mostly appeal to authority + | optimism + jugde_dissagreeing_side), in the long run "pro | vaccines" is (even if only on average) leaps and bounds and | couple of parsecs better than "no vaccines". | [deleted] | specialist wrote: | Do you school-aged children? Pets? | simonh wrote: | To a point that's understandable, based just on trials it's | reasonable to be skeptical of the results. However once the | vaccines have been in mass distribution and there is copious | evidence of their efficacy and the extreme rarity of adverse | affects, I don't think it's reasonable anymore. | | The mandates only came in once enough of the population had | been inoculated to make a requirement possible. At that point | the initial trials are a footnote compared to the results from | mass vaccinations. IMHO it's just not reasonable for that | objection to carry any weight. There may be other reasons, of | course. | cuspy wrote: | The problem with this line of reasoning is that there is a | huge difference between controlled trials (which are | obviously imperfect themselves) and post-hoc analyses of | uncontrolled real-world outcomes. There's a big leap of faith | in trusting our public health authorities' ability to | accurately measure and faithfully represent the real | situation. | | Just to name one small issue, our only measurements of | vaccine efficacy are case counts, covid hospitalizations and | covid deaths. Each one of these measurements is confounded by | population-level differences in testing rate, testing polices | (ie routine testing on entrance to hospital), PCR cycle | count, and many other factors. There is no longer a monitored | control group, so we can't ever account for any group-level | differences or confounds. I've seen no attempt to address | these issues. | | We also have no access to reliable data about confirmed | adverse effects. A year later, it is still very hard for a | person to quantitatively assess his/her own age-stratified | risk/benefit tradeoff, even with the confounded efficacy | measures. | | So, given all that, why isn't skepticism reasonable anymore? | simonh wrote: | I really don't see why there is a huge leap of faith with | coronavirus vaccines, but not with the many safe, effective | vaccines and medications we all benefit from throughout our | lives. | | Have you always felt this way about the medical profession? | Have you any specific reasons to doubt the medical | profession and it's institutions, across many nations and | accreditation agencies, now in particular? | fabian2k wrote: | The effect of vaccinations is huge here, especially if we | focus on deaths and hospitalisations in elderly people. | There are of course issues with using data that only | observed and not part of a strict randomized and blinded | trial. But the difference observed in many different | studies between unvaccinated and fully vaccinated is simply | so enormous that it doesn't really leave any room for | doubt. | | The effect of the vaccines is so huge that you only have to | look at a Kaplan-Meier plot and will immediately see the | huge difference. And we don't have a single study here, we | have a lot of different ones that all indicate that the | vaccines are very effective and safe. | cuspy wrote: | I would trust sound data and transparent analyses showing | age-stratified risk analyses if they existed. With all | respect, what you just wrote is essentially hand-waving | and talking past what I wrote. High effectiveness for | elderly people (which I find plausible but also still | deeply confounded by testing rate differences) in no way | justifies mandates for people in their early 20s. | | In some proportion of hospitals, when someone who is not | vaccinated goes to hospital for any reason, they are | tested for COVID-19. If found positive this is counted as | a COVID-19 hospitalization. We have no access to the | precise rate of these incidental hospitalizations. In | some of these hospitals, it is the policy that vaccinated | people who go to the hospital are NOT routinely tested | unless they have symptoms. If this is the policy at a | substantial number of hospitals, it could dramatically | change the "effect size" of the measurements that we are | talking about. The same issues essentially applies to | COVID-19 deaths and cases. | | Large effect size alone generally isn't convincing when | you're using such fundamentally confounded sampling | procedures, merged age-groups with wildly different risk | profiles, and data aggregated across long time-windows | with different population sizes. | tricky777 wrote: | Even if this particular vaccine was ok (and I still feel fine | after the booster), the process seems shady if results are | kept secret (having good processes is very important. | remember "checks and balances") | simonh wrote: | Trial data is kept confidential due to the risk that access | to the data or information about it by research teams could | influence or bias the design or conduct of further trials. | This is routine in medical trials based on hard won lessons | from previous problems due to biased trials and conflicts | of interest. | | It might seem shady if you don't know the reasons for it | (what are they hiding?). I understand that, but the fact is | this is standard practice and releasing the raw data would | be reckless and irresponsible. | twofornone wrote: | >and the extreme rarity of adverse affects, I don't think | it's reasonable anymore | | There's a major caveat here, sudden and obvious adverse | effects are rare. The subtle and possibly long term ones are | still unknown. It took some 5-10 years before Thalidomide was | found to cause severe birth defects, for example. | simonh wrote: | Thalidomide isn't a vaccine so that hardly seems relevant. | We have extensive experience with many vaccines across huge | populations and no reason to expect these ones to be any | more dangerous than the others. Also it seems somewhat | unlikely that any possible side effects, if they were to | manifest, could possibly be as bad as millions of deaths | and tens of millions with long term complications . | | The vast majority of people objecting to covid vaccines | have no history of vaccine denial, and no good reason to | suspect the covid vaccines are particularly dangerous | compared to the many vaccines they have accepted previously | without a thought or any interest in their history, testing | or method of action. It's politically motivated from start | to finish and has nothing to do with the medical facts. | fabian2k wrote: | It took 4 years for thalidomide until it was removed from | the market. And this is the text book case that triggered | more stringent regulation for drugs. | _jal wrote: | > The subtle and possibly long term ones are still unknown | | So just say you won't take it and be done, because there is | no mechanism that can satisfy you. | fabian2k wrote: | The original clinical trials are essentially irrelevant now for | the vaccines, we have a lot more data from using the vaccines | in the real world now. Of course that data is not randomized | and double-blind, but because of the sheer numbers you can | still do very good science on this. The original trials are | also simply outdated because the virus changed, we're several | big variants later now. | | There are also more agencies than just the FDA that approved | these vaccines, if you don't trust them specifically. | | Publication bias is a real issue, and I'm annoyed that all | efforts to reduce it seem to be rather ineffective. The ideas | behind requiring registration of trials is good, but it doesn't | do much if you don't actually police the rules. But the COVID | vaccines got such enormous amounts of attention that it really | doesn't matter in this specific case. | twofornone wrote: | > Of course that data is not randomized and double-blind, but | because of the sheer numbers you can still do very good | science on this | | But is the science being done "good" considering that the | political and social pressures around reporting of negative | results/adverse effects still exists? How do you get good | data on adverse events if vaccine recipients don't even think | to correlate strange symptoms x weeks or months post | vaccination with the vaccine? How would you detect an | autoimmune disorder with vague and nonspecific symptoms, for | example, when doctors also are unwilling or unable to collect | relevant data out of a combination of bias and ignorance? | | It's a double whammy, because of the novelty we don't know | exactly what we're looking for, and because of | stigma/political pressure we are arguably not looking hard | enough. Being labeled an anti-vaxxer is effectively career | and social suicide, how many researchers are willing to stick | out their necks, especially when rigorous proof would take | years of research and funding to aggregate? | fabian2k wrote: | There was a very rare side effect in the Astra Zeneca | vaccine that was discovered quite quickly. Not in the | original trials as they are simply not powerful enough to | detect side effects that rare, but in later observations. | We also pretty quickly figured out that the risk is age- | related, and many regulating authorities reacted based on | that and adjusted the recommendations. | | To me this is pretty good evidence that the existing | mechanisms for detecting rare side effects work in general. | One can argue about the details in this case on how exactly | the authorities responded, and I think also reasonably | disagree on how to weigh the risk/benefit in this | particular case for specific age groups. But those are much | more difficult questions based on inherently fuzzy data due | to the low frequency of this serious side effect. But the | detection itself worked well, and also produced very quick | reactions. | hgomersall wrote: | What? There was lots of work looking at side effects of the | vaccines. The AZ vaccine was paused in several places | whilst rare and unexplained blood clots were better | understood. It was only because the huge numbers of | recipients that such information was available. What point | are you trying make? That somehow scientists are not | willing to raise problems with the vaccines? That's | demonstrably not true. | | What is also demonstrably true is that the death rate from | COVID is now negligible for those vaccinated. Might there | be some super rare interaction we don't know about? For | sure, but there's also as likely to be super rare | interactions with COVID itself, or whatever crank treatment | of choice replaces a vaccine. | rscho wrote: | Evidence-based medicine, more than the indeed important issues | raised in the article, is mostly impaired by the absolutely | abysmal average quality of clinical research papers. The | absolutism of higher-ups combined with their unrivalled (in the | scientific world) statistical ignorance is hurting science more | than anything else. And there's a reason to that: MDs are not | scientists. We're highly-skilled workers, and more of the blue- | collar kind. | dr_dshiv wrote: | Disagree. Think your standards are too high. | mananaysiempre wrote: | > We're highly-skilled workers, and more of the blue-collar | kind. | | While it's a bit of a problem that sometime during the last | century a skilled profession got equated with a research one (I | remember hearing somewhere that a commercial pilot's education | costs about as much as a tenured professor's, and it seems | plausible to me), there's also the fact that the people you | call "workers" are more distanced from research than they used | to be; my impression is that this is even stronger among | engineers than it is among medical professionals, but I can | hardly claim any deep knowledge here. | | MIT is originally an engineering college, so is the Ecole | polytechnique, and the Ecole normale is a school for | bureaucrats. Cauchy's seminal work on wave propagation was | presented at the French academy, had an epigraph from Virgil | ("how many waves / come rolling shoreward from the Ionian | sea"), and was signed by "Mr. Augustin-Louis Cauchy, road and | bridge engineer" (this being the title the Polytechnique | awarded him). | | It used to be normal (AFAIK) for articles in medical journals | to be essentially "hey, look what a weird thing happened with | this recent patient of mine", and some of seminal (if not the | most high-brow) mathematics journals started as "hey, solve | this problem I have recently done / want to know the answer to | ... if you're not chicken to try". | | What happened to all of this was, in a word, specialization-- | necessitated in part by the exhaustion of low-hanging fruit and | raising of epistemic standards, so not entirely pointless, but | I have to admit the comparative conservatism of medicine in | this regard always looked more hopeful to me than the, at | times, raging anti-intellectualism of engineers or the fiddly, | illogical, invented world of law. | | Certainly medicine is more engineering than science in that it | is driven more by immediate goals than by the pursuit of truth | alone (not the only possible definition of science, but a | useful distinction when it comes to the feeling of the field, | cf the 50s adage about physics and military physics being like | music and military music). And I certainly won't say you're | wrong. But I'm sad, and I can't help feeling the drive for | industrialization has done a disservice to us, scientists and | craftsmen both. | pmoriarty wrote: | _" raging anti-intellectualism of engineers"_ | | What makes you think engineers are anti-intellectual? | | Engineering is an intellectual discipline, after all. | lazide wrote: | I suspect the poster is referring to anti the type of | Intellectualism which is pure theory (or similar) and not | application focused. | | Which I'd agree with - most Engineers tend to hate that | kind of thing. | mananaysiempre wrote: | > What makes you think engineers are anti-intellectual? | | FWIW, I've encountered the thing I call anti- | intellectualism here among experimental physicists as well, | and even in some theorists and mathematicians as well, to | varying degrees. I don't mean being stupid or not using | your brain for work; I'm sure some of the people I'm | thinking of here are much smarter than me and/or have | contributed much more to society than I ever will. I'm not | thinking of _all_ engineering or science people, either; | the maths teacher I had in high school is perhaps the | strongest opposite of this stereotype I know. | | What I mean is a certain lack of wonder and ... suspension | of disbelief(?) when it comes to other kinds of | intellectual pursuits (sciences, arts, humanities, | philosophy, mathematics), like a feeling you're doing Real | Work while those other quacks do pointless things to amuse | themselves, and are not even particularly successful at | that. "Shut up and calculate", if brought out among people | who are past the basic level of understanding of the | subject in question, is a manifestation of this (even | though the originator of the saying in the context of | quantum mechanics, David Mermin, is now a proponent of the | "quantum Bayesianism" school of philosophical thought). | Lest it seem that I'm dunking on physicists here, the "Two | cultures" essay and Hardy's "Apology" also contain some of | this. | | If you've read the book, the shortest definition is perhaps | to say that my "anti-intellectualism" is the opposite of | _The Glass Bead Game_ , even if Hesse intended it as his | anti-Enligtenment manifesto. | | And I cannot say this sort of skepticism is _always_ wrong | --that way lies _Fashionable Nonsense_ and New Age | mysticism, and epistemic relativism scares me like little | else. We do owe some advances in quantum foundations to New | Age people, though, so sneering in that direction might not | be right either. | | (If you think that this anti-intellectualism thing and the | complement of the hacker spirit seem remarkably similar, | you're right.) | pmoriarty wrote: | I'd call that intellectual snobbery and scientism rather | than anti-intellectualism. | | This is especially evident towards fields one knows | little about, towards the so-called "soft sciences" and | the humanities. | kelseyfrog wrote: | It's easy to find them. Let us call them out using the | siren song. | | Psychology and sociology are just as much sciences as | mathematics, computer science, physics, chemistry, and | biology. ___________________________________________________________________ (page generated 2022-03-24 23:00 UTC)