4 ms·

I understand that, looking at individual scientific problems, it's easy to get cynical. It's even fashionable to be so. Deaths attributable to heart disease in

I understand that, looking at individual scientific problems, it's easy to get cynical. It's even fashionable to be so. Deaths attributable to heart disease in 1970 were just shy of 800k per annum. As of 2010, it was about 600k. A 25% drop in the leading cause of death, in less than a generation. Life expectancy was 70.8 years in 1970, and 78.7 in 2010 - an increase of more than 10% in a single generation. Science isn't a process that moves along by weeks, months, or even years. It's something that moves generationally, and our society has made impressive strides. You're welcome to be skeptical - science would die without that. But be the "loyal opposition," not a casual cynic: help the process improve, don't discard it as some political shell-game. Lives are in the balance.

rscho 8y ago
I have both feet in the game, being a clinical researcher. So, cynic but not casual.
- carapace 8y ago
  "Politicized agenda-propelled random search" Lol! I think you and arkades both have it right. It's a "politicized agenda-propelled random search" on a large enough scale and over a rich enough search space that it "has made impressive strides" despite its flaws and inefficiencies. I have a friend who works as a Healer. People come to him and pay him good money and he gets results. He doesn't advertise, he gets referrals by word-of-mouth alone. My point is he gets results.[1] He can do things that are totally off the map of conventional medicine. However, he's uninterested in science and scientists (in general) are uninterested in him. "It's something that moves generationally" indeed, if paradigm shifts really require the dying out of the old guard. If we think of inefficiencies in the search due to e.g. politics and superstition as a kind of malady, then it seems we are witnessing a phase of "Physician heal thyself", what with the advent of mass medical monitoring and big data correlation, eh? [1] Have you heard the joke, "If alternative medicine works it's just called medicine."? Well, yes and no. Some things that work are too far outside the belief structures and will be ignored or ridiculed.
kevin_thibedeau 8y ago
That's mostly because smoking has been stigmatized.
- arkades 8y ago
  And nothing to do with the pile of research that’s been done in the past few decades identifying exactly which medications actually provide mortality benefit in cardiac disease and which don’t, of course.
  - rscho 8y ago
    Well, that's precisely my point. Yes, new drugs help, but often less so than the "dogma of the year" lets you hope at first. The point is that MDs are usually identified as scientists because many people think they actually had an important part to play in the development of new useful technology, and don't see that most of the time those new things come directly from the lab and clinicians just test drive them to find the optimal use case. It's true that test driving is essential, but I have a hard time calling it science when you see what people from hard science can do. Additionally, the proportion of MD researchers who understand nothing about what they do, or who even deliberately cook up results is absolutely alarming. To follow up on your cardiology example, I'd say that pills certainly helped, but the game changers really are the new toys of the interventional cardiologist. And I would also add one of my favourite pseudo quotes: "science advances one funeral at a time." -- Max Planck
    - arkades 8y ago
      > To follow up on your cardiology example, I'd say that pills certainly helped, but the game changers really are the new toys of the interventional cardiologist. Balloon caths re-stenosed 30% of the time. Balloon caths with bare metal stents re-stenosed about 15% of the time. Balloon caths with stents and dual-platelet drugs re-stenose about 3% of the time. I think this is one of those "drugs help ... but less so" situations where drugs get less credit than they're worth, and the physician scientists that did the endless slogging to figure out how to optimize interventional cardio's toys deserve real credit. But, yes, I agree: most MD's aren't scientists. Quite a lot of MDs are only barely science-literate. They're engineers: they're taught a body of science and its application, with the expectation that they apply it usefully.

rscho 8y ago

I have both feet in the game, being a clinical researcher. So, cynic but not casual.

carapace 8y ago
"Politicized agenda-propelled random search" Lol! I think you and arkades both have it right. It's a "politicized agenda-propelled random search" on a large enough scale and over a rich enough search space that it "has made impressive strides" despite its flaws and inefficiencies. I have a friend who works as a Healer. People come to him and pay him good money and he gets results. He doesn't advertise, he gets referrals by word-of-mouth alone. My point is he gets results.[1] He can do things that are totally off the map of conventional medicine. However, he's uninterested in science and scientists (in general) are uninterested in him. "It's something that moves generationally" indeed, if paradigm shifts really require the dying out of the old guard. If we think of inefficiencies in the search due to e.g. politics and superstition as a kind of malady, then it seems we are witnessing a phase of "Physician heal thyself", what with the advent of mass medical monitoring and big data correlation, eh? [1] Have you heard the joke, "If alternative medicine works it's just called medicine."? Well, yes and no. Some things that work are too far outside the belief structures and will be ignored or ridiculed.

kevin_thibedeau 8y ago

That's mostly because smoking has been stigmatized.

arkades 8y ago
And nothing to do with the pile of research that’s been done in the past few decades identifying exactly which medications actually provide mortality benefit in cardiac disease and which don’t, of course.
- rscho 8y ago
  Well, that's precisely my point. Yes, new drugs help, but often less so than the "dogma of the year" lets you hope at first. The point is that MDs are usually identified as scientists because many people think they actually had an important part to play in the development of new useful technology, and don't see that most of the time those new things come directly from the lab and clinicians just test drive them to find the optimal use case. It's true that test driving is essential, but I have a hard time calling it science when you see what people from hard science can do. Additionally, the proportion of MD researchers who understand nothing about what they do, or who even deliberately cook up results is absolutely alarming. To follow up on your cardiology example, I'd say that pills certainly helped, but the game changers really are the new toys of the interventional cardiologist. And I would also add one of my favourite pseudo quotes: "science advances one funeral at a time." -- Max Planck
  - arkades 8y ago
    > To follow up on your cardiology example, I'd say that pills certainly helped, but the game changers really are the new toys of the interventional cardiologist. Balloon caths re-stenosed 30% of the time. Balloon caths with bare metal stents re-stenosed about 15% of the time. Balloon caths with stents and dual-platelet drugs re-stenose about 3% of the time. I think this is one of those "drugs help ... but less so" situations where drugs get less credit than they're worth, and the physician scientists that did the endless slogging to figure out how to optimize interventional cardio's toys deserve real credit. But, yes, I agree: most MD's aren't scientists. Quite a lot of MDs are only barely science-literate. They're engineers: they're taught a body of science and its application, with the expectation that they apply it usefully.