4 ms·

> 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

by 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!
- Balgair 10y ago
  I'm interested to hear what you have to say about MD/PHD programs. How useful are they do you think. The ones I interact with mostly just used it as a way to pay for med-school. Almost none of them are professors 5+years on and most just practice. I have heard that the NIH is going to discontinue the program because of this.
  - rscho 10y ago
    MD-PhD is a good idea, and by all means, should be maintained. I think it could, however, use a big facelift. The fact is that even people who truly like science are drawn by familial and financial matters to the clinical activities, and particularly to the private practice (because that is where the money and good life is). The shape of the reform to be introduced is a complex one, though. I do not have a definite idea about it. What I would change however, is the curriculum. Currently, the PhD part consists in dabbling into statistics and sometimes also into lab work, with almost no training in basic sciences. I hope that in the future, MD-PhDs are taught much more about statistics in a fundamental way, more about physics, and more about computer science. Because in essence, the role of MD-PhDs should be to bridge the gap in communication that exists between pure scientists and clinical practitioners. Because those two are so far apart, that they currently are unable to understand each other. I am sure the scientists here who have had the occasion to lead a project with doctors know all about it.
    - Balgair 10y ago
      Thanks for the reply! An interesting person to talk to is Dr. Emery Brown at Mass Gen. [0] He is triply elected to the NAS in engineering, medicine, and biology. I recently saw a talk of his about his new auto-anesthesia machine. The data presented was very compelling. It seems his machine, for a 'normal' surgery, preforms much better than an anesthesiologist over many critical factors. The most interesting part was the Q&A afterwards in which the assembled neuroscientists and anesthesiologists tried their best to not understand a thing he presented and tear him down; their jobs were on the line after all. He is a good example of what the MD/PHD should be producing, I think. To your comment, though. In the PHD section, you have to preform as a normal PHD student, ie, you have to publish papers for your PI. The learning and the classes, already at 2 years of very intense study, do not have the time to continue into comp-sci or physics. Nor do the students have the training in the math. To do the comp-sci and physics classes with a modicum of understanding, you must come in with at least: Multi-variable calculus, matrix algebra and differential equations, a total of 6 extra semesters of classes. Most MD/PHD people I have interacted with never took calculus to begin with. The hill to climb is very very long and steep, and unless there is a much larger prize than a possible faculty position at Wherever State Univ. where you still have to publish or perish, you are going to get few people going after it and not just opting into private practice. Also, I have worked with a number of MDs, and yes, there is a Grand Canyon of misunderstanding between bio-peepz and the docs. Neither party really has the time to cross it, and so we just end up trying to use each other. Bio-peepz try to use the doc's name as leverage for increased grant funding from the NIH, and MDs are trying to get the bio people to patent something with their names on it to make more money. In the end, it's all about the money, or lack thereof. [0]https://sleep.med.harvard.edu/people/faculty/150/Emery+N+Brown+MD+PhD https://sleep.med.harvard.edu/people/faculty/150/Emery+N+Bro...

by nether 10y ago

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!
Balgair 10y ago
I'm interested to hear what you have to say about MD/PHD programs. How useful are they do you think. The ones I interact with mostly just used it as a way to pay for med-school. Almost none of them are professors 5+years on and most just practice. I have heard that the NIH is going to discontinue the program because of this.
- rscho 10y ago
  MD-PhD is a good idea, and by all means, should be maintained. I think it could, however, use a big facelift. The fact is that even people who truly like science are drawn by familial and financial matters to the clinical activities, and particularly to the private practice (because that is where the money and good life is). The shape of the reform to be introduced is a complex one, though. I do not have a definite idea about it. What I would change however, is the curriculum. Currently, the PhD part consists in dabbling into statistics and sometimes also into lab work, with almost no training in basic sciences. I hope that in the future, MD-PhDs are taught much more about statistics in a fundamental way, more about physics, and more about computer science. Because in essence, the role of MD-PhDs should be to bridge the gap in communication that exists between pure scientists and clinical practitioners. Because those two are so far apart, that they currently are unable to understand each other. I am sure the scientists here who have had the occasion to lead a project with doctors know all about it.
  - Balgair 10y ago
    Thanks for the reply! An interesting person to talk to is Dr. Emery Brown at Mass Gen. [0] He is triply elected to the NAS in engineering, medicine, and biology. I recently saw a talk of his about his new auto-anesthesia machine. The data presented was very compelling. It seems his machine, for a 'normal' surgery, preforms much better than an anesthesiologist over many critical factors. The most interesting part was the Q&A afterwards in which the assembled neuroscientists and anesthesiologists tried their best to not understand a thing he presented and tear him down; their jobs were on the line after all. He is a good example of what the MD/PHD should be producing, I think. To your comment, though. In the PHD section, you have to preform as a normal PHD student, ie, you have to publish papers for your PI. The learning and the classes, already at 2 years of very intense study, do not have the time to continue into comp-sci or physics. Nor do the students have the training in the math. To do the comp-sci and physics classes with a modicum of understanding, you must come in with at least: Multi-variable calculus, matrix algebra and differential equations, a total of 6 extra semesters of classes. Most MD/PHD people I have interacted with never took calculus to begin with. The hill to climb is very very long and steep, and unless there is a much larger prize than a possible faculty position at Wherever State Univ. where you still have to publish or perish, you are going to get few people going after it and not just opting into private practice. Also, I have worked with a number of MDs, and yes, there is a Grand Canyon of misunderstanding between bio-peepz and the docs. Neither party really has the time to cross it, and so we just end up trying to use each other. Bio-peepz try to use the doc's name as leverage for increased grant funding from the NIH, and MDs are trying to get the bio people to patent something with their names on it to make more money. In the end, it's all about the money, or lack thereof. [0]https://sleep.med.harvard.edu/people/faculty/150/Emery+N+Brown+MD+PhD https://sleep.med.harvard.edu/people/faculty/150/Emery+N+Bro...