6 ms·

Obviously you don't understand HN.. everyone here is a "very smart software engineer" and knows far better than a simpleton like you with your decades of medica

Obviously you don't understand HN.. everyone here is a "very smart software engineer" and knows far better than a simpleton like you with your decades of medical training and experience.

cwyers 9y ago
There are professional statisticians who believe the same as this HN cult. http://andrewgelman.com/2017/01/30/no-guru-no-method-no-teacher-just-nature-garden-forking-paths/ http://andrewgelman.com/2017/01/30/no-guru-no-method-no-teac...
torstenvl 9y ago
God forbid that anyone with a mathematical inclination begin to question study methodology... https://mobile.nytimes.com/2008/04/08/science/08tier.html https://mobile.nytimes.com/2008/04/08/science/08tier.html
wavegeek 9y ago
> decades of medical training and experience http://slatestarcodex.com/2013/12/17/statistical-literacy-among-doctors-now-lower-than-chance/ http://slatestarcodex.com/2013/12/17/statistical-literacy-am... Ask your local doctor next time you visit to tell you what a P value means. The medical literature is a tragicomedy of statistical incompetence and malpractice. Specifically on this study it has a lot of red flags: not pre-registered so p hacking can be assumed, industry sponsored which studies show greatly skews results, small numbers, unrealistically high effect sizes.
- WalterSear 9y ago
  It was pre-registered. However, they did a battery of tests, and only report on a few. This is a method of cheating on the pre-registry process.
jeffdavis 9y ago
The neurologist wants what's best for his patients today, which is to know whether a treatment is likely to work or not. Others may value the mechanism more for very legitimate reasons. For instance, if you underatand the mechanism it leads to further research that could utilize a related mechanism or perhaps see potential side effects that would otherwise be hard to identify. You really need both. "Is it true?" is a great starting place and oofers some treatments, but discovering the mechanism gives potentially a whole new class of treatments.
- neltnerb 9y ago
  It's a matter of practicality too. A scientific experiment of any kind can only in full honestly provide a set of results given a set of conditions. No matter how well your theory may fit the existing data, fundamentally your data may simply be responding to some other mechanism you're not aware of or not measuring. There is a huge amount of effort required to say why something works with certainty. Usually to get there requires many years of experience with a new surprising result. Which requires publishing lots of results before understanding the mechanism. If you refuse to believe anything that isn't figured out from first principles is true... I mean... I have a condition and if someone told me a higher percentage of patients on a new drug did well than on the one I use, do I care if they can tell me exactly why? Not in the slightest. I will wait a year or two to see if side-effects crop up and ideally see the results confirmed, but I'm not going to not get a treatment likely to help just because they don't know how exactly how it works. I think it's good practice to assume the results of a paper are accurate, even if you give no credence to the interpretation.
- dumbneurologist 9y ago
  completely true. the problem is that efficacy studies (like I want) are not that exciting to report. as a result, the lay press reports only mechanism studies (because their readers like to be "wowed" and think about things, like the poster I originally replied to). that wouldn't matter at all, but we all get sick. and when a person gets sick with this mentality that they need to understand the mechanism, then they start overthinking the treatments that are available today, drawing all kinds of spurious conclusions, and making medical decisions that are unjustified at best and harmful at worst. and in my experience, the smarter the patient is, the more willing (and insistent) they are to take this approach (witness Steve Jobs). This is absolutely not the patient being "dumb" or stubborn: it's completely understandable given how they understand science. But it hurts them, which no physician likes to see. let's note how incredible it is that we are having this conversation in the setting of some incredibly expert scientists (albeit in other fields). it really shows how hard science can be to understand sometimes.
geezerjay 9y ago
Appeals to authority, such as those you've made, are worthless. The motto of the Royal Academy of Sciences is quite literally "take no one's word for it". If you wish to blindly swallow assertions made by people with academic titles, perhaps you should start to listen to those who advise against it.
- bildung 9y ago
  An appeal to authority is perfectly reasonable if the person in question is actually an authority in the topic discussed. The logic fallacy you probably meant is about appeals to authority in cases where the authority is in another domain.
  - neltnerb 9y ago
    Yeah, if I'm going to be wrong I'd rather be wrong alongside a bunch of people who are way more qualified than me to guess. What's the P-value on trust in expert advice improving outcomes? For every case where the "x was wrong" there are 1000 non-controversial cases where x was right.
  - torstenvl 9y ago
    No. An appeal to authority is always fallacious. Your heuristic may be useful, but it is just that - a heuristic, not an argument.
    - bildung 9y ago
      > No. An appeal to authority is always fallacious. Says who? ;) > Your heuristic may be useful, but it is just that - a heuristic, not an argument. Indeed, but in many but the most trivial cases (stuff like newtonian physics, or computer science, where most arguments are easily falsifiable) heuristics is all we have. Just look at the set of comments we are currently part of, e.g. many of the p-value posts, or the criticism of the small sample size. Those are valid arguments, but also wrong. But how can someone not trained in empirical science find out? Relying on an authority (relevant to the topic at hand) is a valid way to be wrong less often. To put it pointedly: How do you know its always fallacious? Have you actually proved it yourself, or is this from a textbook/the internet, e.g. - from an authority? ;)

Obviously you don't understand HN.. everyone here is a "very smart software engineer" and knows far better than a simpleton like you with your decades of medical training and experience.

cwyers 9y ago

There are professional statisticians who believe the same as this HN cult. http://andrewgelman.com/2017/01/30/no-guru-no-method-no-teacher-just-nature-garden-forking-paths/ http://andrewgelman.com/2017/01/30/no-guru-no-method-no-teac...

torstenvl 9y ago

God forbid that anyone with a mathematical inclination begin to question study methodology... https://mobile.nytimes.com/2008/04/08/science/08tier.html https://mobile.nytimes.com/2008/04/08/science/08tier.html

wavegeek 9y ago

> decades of medical training and experience http://slatestarcodex.com/2013/12/17/statistical-literacy-among-doctors-now-lower-than-chance/ http://slatestarcodex.com/2013/12/17/statistical-literacy-am... Ask your local doctor next time you visit to tell you what a P value means. The medical literature is a tragicomedy of statistical incompetence and malpractice. Specifically on this study it has a lot of red flags: not pre-registered so p hacking can be assumed, industry sponsored which studies show greatly skews results, small numbers, unrealistically high effect sizes.

WalterSear 9y ago
It was pre-registered. However, they did a battery of tests, and only report on a few. This is a method of cheating on the pre-registry process.

jeffdavis 9y ago

The neurologist wants what's best for his patients today, which is to know whether a treatment is likely to work or not. Others may value the mechanism more for very legitimate reasons. For instance, if you underatand the mechanism it leads to further research that could utilize a related mechanism or perhaps see potential side effects that would otherwise be hard to identify. You really need both. "Is it true?" is a great starting place and oofers some treatments, but discovering the mechanism gives potentially a whole new class of treatments.

neltnerb 9y ago
It's a matter of practicality too. A scientific experiment of any kind can only in full honestly provide a set of results given a set of conditions. No matter how well your theory may fit the existing data, fundamentally your data may simply be responding to some other mechanism you're not aware of or not measuring. There is a huge amount of effort required to say why something works with certainty. Usually to get there requires many years of experience with a new surprising result. Which requires publishing lots of results before understanding the mechanism. If you refuse to believe anything that isn't figured out from first principles is true... I mean... I have a condition and if someone told me a higher percentage of patients on a new drug did well than on the one I use, do I care if they can tell me exactly why? Not in the slightest. I will wait a year or two to see if side-effects crop up and ideally see the results confirmed, but I'm not going to not get a treatment likely to help just because they don't know how exactly how it works. I think it's good practice to assume the results of a paper are accurate, even if you give no credence to the interpretation.
dumbneurologist 9y ago
completely true. the problem is that efficacy studies (like I want) are not that exciting to report. as a result, the lay press reports only mechanism studies (because their readers like to be "wowed" and think about things, like the poster I originally replied to). that wouldn't matter at all, but we all get sick. and when a person gets sick with this mentality that they need to understand the mechanism, then they start overthinking the treatments that are available today, drawing all kinds of spurious conclusions, and making medical decisions that are unjustified at best and harmful at worst. and in my experience, the smarter the patient is, the more willing (and insistent) they are to take this approach (witness Steve Jobs). This is absolutely not the patient being "dumb" or stubborn: it's completely understandable given how they understand science. But it hurts them, which no physician likes to see. let's note how incredible it is that we are having this conversation in the setting of some incredibly expert scientists (albeit in other fields). it really shows how hard science can be to understand sometimes.

geezerjay 9y ago

Appeals to authority, such as those you've made, are worthless. The motto of the Royal Academy of Sciences is quite literally "take no one's word for it". If you wish to blindly swallow assertions made by people with academic titles, perhaps you should start to listen to those who advise against it.

bildung 9y ago
An appeal to authority is perfectly reasonable if the person in question is actually an authority in the topic discussed. The logic fallacy you probably meant is about appeals to authority in cases where the authority is in another domain.
- neltnerb 9y ago
  Yeah, if I'm going to be wrong I'd rather be wrong alongside a bunch of people who are way more qualified than me to guess. What's the P-value on trust in expert advice improving outcomes? For every case where the "x was wrong" there are 1000 non-controversial cases where x was right.
- torstenvl 9y ago
  No. An appeal to authority is always fallacious. Your heuristic may be useful, but it is just that - a heuristic, not an argument.
  - bildung 9y ago
    > No. An appeal to authority is always fallacious. Says who? ;) > Your heuristic may be useful, but it is just that - a heuristic, not an argument. Indeed, but in many but the most trivial cases (stuff like newtonian physics, or computer science, where most arguments are easily falsifiable) heuristics is all we have. Just look at the set of comments we are currently part of, e.g. many of the p-value posts, or the criticism of the small sample size. Those are valid arguments, but also wrong. But how can someone not trained in empirical science find out? Relying on an authority (relevant to the topic at hand) is a valid way to be wrong less often. To put it pointedly: How do you know its always fallacious? Have you actually proved it yourself, or is this from a textbook/the internet, e.g. - from an authority? ;)