8 ms·

In view of other comments, it seems useful to point out that credible evidence is nonexistent in the medical field. I am an M.D. with 7y experience in the clini

• WheelsAtLarge 10y ago
  I'm not an MD but after reading about how the USDA's pyramid of foods came to be. It shows how the power of politics and the power of money dictated grains as the base rather than vegetables. Or how eggs became enemy number one against cholesterol, not because of research but because someone thought that high cholesterol food equals high cholesterol in people. While it may seem to make sense that should not be the way to recommend food choices for millions. Where's the science? Yet it was sold as advice based on science. Anyhow I agree with you 100%.
  • tiglionabbit 10y ago
    And the assumption that cholesterol even causes heart disease.
• wfunction 10y ago
  I'm afraid I see literally no way to evaluate this sort of comment based on its merits. Given you're anonymous here, any chance you could link to well-known/credible professionals who agree with you?
  • WheelsAtLarge 10y ago
    I know you're not asking me but here are 2 that back my claims. http://www.healthy-eating-politics.com/usda-food-pyramid.html http://www.healthy-eating-politics.com/usda-food-pyramid.htm... http://well.blogs.nytimes.com/2014/11/14/ask-well-how-many-eggs-can-i-eat/ http://well.blogs.nytimes.com/2014/11/14/ask-well-how-many-e...
  • droopyEyelids 10y ago
    This will get you started https://en.wikipedia.org/wiki/Evidence-based_medicine https://en.wikipedia.org/wiki/Evidence-based_medicine Evidence based medicine. An idea that is really less than 50 years old, and still strugging to gain widespread acceptance.
    • phrh8 10y ago
      I won't pretend to know about or have any background in medicine, but based on a cursory reading of the article, it seems to be a term for applying the Scientific method to medicine. The idea that we only started doing this 50 years ago is terrifying to say the least. It seems to me that the problem here is that our industry, built around throwing expensive drugs at problems, paying for results and lobbying governments and insurance companies is ripe for abuse of "science". That said, "pure" science is about more than published papers: it's about taking the data and observations you have and constructing the most likely theories and explanations around the observed evidence. If we had a capability to separate funding (and emotions) from research we might be able to produce good results given enough open data (which is itself a challenge). As an uninformed software developer, I think medicine is a field where machine learning based tools will shine: ethical ("hippa") issues aside, we eventually might be able to feed all observed data, from diagnosis to results years after treatment into computer systems which might be able to make sense of the data and allow us to construct conclusions of the data unbiased by personal and business incentives. Obviously our current eco-policital climate is strewn with roadblocks, but just wanted to put it out there that science doesn't have to lead us down this path if done right.
      • Fomite 10y ago
        > The idea that we only started doing this 50 years ago is terrifying to say the least. It's also a flawed notion. There has been a concerted push in the last 50 years, but applying the scientific method to medicine is considerably older. Koch's Postulates, for example, were published in 1890.
        • droopyEyelids 10y ago
  • rscho 10y ago
    I am sure I am very easily identifiable for someone lurking on hackernews. What do you consider a well-known, credible medical professional? A Harvard professor? I happen to have worked with world-renowed clinical researchers, and I have nothing but disrespect for their scientific abilities. I do however, value their clinical teachings very much, and I am thankful for the training they provided in the clinics. I am frankly not motivated enough to look for papers about it, and I clearly speak from my own experience. I do know that the proportion of research considered as valid is very difficult to estimate, though. If you are interested in "evidence-based medicine", I am sure you know PubMed and related websites. At this point however, I find it extremely difficult to believe any medical paper containing statistics.
    • wfunction 10y ago
      Forget "medical professional". Forget my criteria. Just cite someone, anyone, whom YOU believe is well-respected in medicine and whose view on this agrees with you. If you can't find anyone well-respected, then cite the best source you can. My point is, just cite someone. For someone who cares about science it's sure ironic that you're expecting us to trust your judgment with zero backing.
      • kem 10y ago
        I offer this in the interests of maintaining what I see as a useful, if difficult, discussion, not to be antagonistic: http://www.jclinepi.com/article/S0895-4356(16)00147-5/abstract http://www.jclinepi.com/article/S0895-4356(16)00147-5/abstra... What the OP is referring to isn't unique to MDs, it's endemic to much biomedical research today. I blame it on lack of tenure protections and science-as-university-income, which in many cases ultimately stems from indirect costs charged to federal grants, or the current grant system. For me, the concerns mentioned in this thread about scientific research and MD training in particular, bring up bigger issues pertaining to the culture of hierarchy in medicine and its implications for quality of care and competition in service provision and training models.
        • wfunction 10y ago
• nether 10y ago
  > M.D. with 7y experience in the clinics, have done my share of research, and i can assure you that "scientific evidence" in medicine is a humongous s*load of tampered data written by people who have absolutely zero idea of what science is. Are they fellow MD's? What gives you the authority to determine whether their work constitutes legitimate science or not? Can you be more specific on their shortcomings?
  • deleted 10y ago
    [deleted]
  • rscho 10y ago
    They mostly were my superiors. My fellows were more often employed as scientific slaves, understanding nothing they were doing while collecting huge amounts of unusable data. When I finished my studies, I was extremely motivated, and wanted to do research (clinical and translational). My first few projects were quite horrible: very little supervision, huge amount of time and paperwork, very little result (2 peer-reviewed papers). I thought I was the problem, although my fellow junior M.Ds did not seem to fare much better. So I began studying science (a lot): informatics, statistics, physics. I did not become good at it, but I learned a huge amount. After a few years of that, I found myself unable to collaborate on new projects, and that is actually a sad result. You see, M.Ds, having no science background, view statistics and physiology as they view medicine: a bunch of facts that you must learn off by heart. I cannot begin to describe the statistical heresy I witnessed in clinical trials. You should also know that professional statisticians are rarely implicated in medical research, because they are expensive. Add to that a good amount of dishonesty motivated by the refusal to admit that nothing positive comes out of the dataset, due to the hard work done to collect the data in the first place, and a huge amount of pressure to publish, and you have a recipe for disaster. TL;DR: MDs with no specific scientific background will not magically be able to do valid science without additional education, even if they are full professors.
    • tomcam 10y ago
      I would so love to read your book, hint hint!
• ploxiln 10y ago
  Come on now, there is a good amount of scientific evidence, doctors do know some things ... it's just that, if you're not a decent doctor, you can't tell the bullshit from the useful information. My mother is a GP, but I'm a software engineer, so I'd like to make a software metaphor. The experts have come up with best practices and agile methodologies. If you follow the Agile processes rigorously and use industry-standard tools ... often the results are total crap, like the Military or the State of Virginia spending 300M on an accounting software project over 5 years and then just throw it away. I guess we don't know anything about software, do we? Well, some of us do. Some of us are reasonable about how much various techniques help, what the trade-offs are, the inherent uncertainties. Some get good results fairly consistently. And it isn't by rigorously following Agile Methodologies, it's more than that, you have to be thoughtful about the code itself. And, medicine is often like debugging a large complicated messy system. It takes time, and many practitioners are a bit lazy. They have a lot on their plate, the don't have the time to really dig in and figure out each case. They guess, patch in a work-around, and move on. But, frankly, western medicine has been massively useful, and I think we all know that. EDIT: and of course there's the hype cycle: everyone, especially those who are managers or customers rather than practitioners, are looking for the secret, the trick to getting good results. Before agile, it was object-oriented, etc...
  • newman314 10y ago
    Problem is that if she screws up, someone might die. I would be terrified if someone approached the medical profession the way people do software development.
    • ploxiln 10y ago
      You're right, there are differences - medicine is more rigorous (in a sense), processes are more regulated, there's more "standard procedure" which is more specifically taught and widely followed. But doctors screw up all the time. Sometimes it's dumb mistakes like instruments left in the body after surgery, or the wrong limb operated on. (Like failing to check length when copying a buffer perhaps? Sometimes it's just a bit embarrasing, sometimes catastrophic.) More often, it's just not finding the real cause of the "bug", applying a "fix" or "cleanup" that doesn't fix it.
• Gatsky 10y ago
  This is a fairly inflammatory comment. I would agree that as sciences, biology and medicine still have a long way to go. However, I definitely disagree that well conducted trials constitute 'nonexistent' evidence. Trials have their problems, but they still provide credible evidence. MD also.
  • rscho 10y ago
    Inflammatory, yes. But not without background. Like you, I will of course be more likely to be influenced by what I see as good research on the paper. However, my own experience tells me that what is written is seldom an exact reflection of how things did in fact go in practice. From that point of view, it becomes difficult to trust what people write.
• DanielBMarkham 10y ago
  I do not want to bash medical science. Every field of human endeavor has problems, and the longer it has been around and the more established it is, the more the cruft and the bigger the problems. I can't help but notice, however, that we're killing a ton of people because of the inefficiency of our research system. Fifty or sixty years ago, if we had simply taken people who were going to die soon and had them voluntarily submit to A/B testing? How many millions would be saved by now? How much better would it have been to have died knowing you were directly helping in a simple experiment that one day would save all of those lives? Instead we spend tens of billions, drugs take decades to get approval, and we have people dying of infections for which we have no drugs to address. We may have reached an inflection point here, folks. Instead of perfect safety, a better metric might be the most medical progress over the shortest amount of time -- in an ethical fashion, of course.
  • rscho 10y ago
    The goal of the medical system, as it currently stands, is explicitly and literally geared at making people feel cared for. Which is quite antagonistic to your above statement, which stems from utilitarian philosophy. The consequences are simple: in the recent years, we have seen a huge push for "medical humanities" in medical education (aimed at perfecting the doctor-patient relationship). But for scientific medical education? Niet. Nada. But people seem to like it that way...
    • DanielBMarkham 10y ago
      I hate making moral arguments, but dang. I'm not sure it's entirely utilitarian. People like to feel there is meaning to their life, some sort of story. Given a chance to directly contribute to science in an understandable way in their last days? I think for many it is the most humane thing to do. (But not all, of course) [1] Note that the key here is understandable, which would eliminate double-blind studies. 1. Related -- https://en.wikipedia.org/wiki/Man%27s_Search_for_Meaning https://en.wikipedia.org/wiki/Man%27s_Search_for_Meaning
      • notahacker 10y ago
• bobowzki 10y ago
  I'm also an MD. I agree with many of your points. Always interested to get in touch with colleagues with similar ideas. Would be interested to hear more about your opinions on the matter. You can email me at albin.stigo@gmail.com.
  • rscho 10y ago
    Coincidence, I happen to also be an anesthesiologist :-)
• Angostura 10y ago
  So you're saying that vaccines could well cause autism? If you're not saying that, why not? Given that "credible evidence is nonexistent in the medical field."
• whack 10y ago
  That sounds like a extreme statement. Surely the evidence against smoking is credible, as is the evidence against many things that are so uncontroversial that no one brings them up.
  • rscho 10y ago
    I do not put into question that we are seeing some real effects. I am questioning the quality of individual studies, which even when viewed collectively, almost always fail to yield a clear-cut answer. In summary, if I see a thousand studies of dismal quality all saying the same thing, I start to suspect there might be something. But that is not due to the scientific prowess of the authors, and the evidence, although abundant, is still of dismal quality. Every day, you will hear people say: "thi evidence about that is now extremely solid". Most often, things have flipped 5 years from then, with the latest fad.