5 ms·

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 fo

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.

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.