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I bet the doctors’ lobby will deny that payments will have any impact on their behavior. The same way they deny that working 24 hour shifts and being sleep depr

I bet the doctors’ lobby will deny that payments will have any impact on their behavior. The same way they deny that working 24 hour shifts and being sleep deprived has no impact on their performance.

rjkennedy98 7y ago
Its amazing how the people we trust with understanding science and evidence-based medicine are completely unable to unable to act in accordance with evidence when it comes to themselves. Good lesson for anyone who trusts our medical system.
- rscho 7y ago
  Doctors are not scientists. Doctors understanding basic science are 1:1000, and the rest of us follow EBM practices blindly similarly to a religion. However, it's not scientific ability that makes a good doc. Scientific ability is really not a criteria for adjusting your trust in a particular practitioner. I'd even say it's often that supposedly doctor-scientists (academics) are the worst.
  - Scoundreller 7y ago
    From what I’ve seen in those doctor review sites and some pharmacy experience, what makes a good doctor in a lot of patient’s minds is whether they get whatever they want or not. Telling patients that a requested test/referral/intervention isn’t supported by evidence really upsets people. And being nice goes a long way.
    - rscho 7y ago
      Indeed. And 'flexibly sticking to guidelines' goes a long way too. There's a balance to find between pleasing your patient and doing the 'medically correct' thing. That's where the difficulty lies.
- linuxftw 7y ago
  Now apply this same line of skepticism to a certain class of inject-able drugs and be labeled a crackpot.
  - krageon 7y ago
    It's not scepticism when you are ignoring evidence. It crosses into ignorance then.
    - linuxftw 7y ago
      The evidence that doctors and compensated by drug manufacturers unethically? Or the evidence of regulatory capture?
  - mattkrause 7y ago
    Is there a heroin epidemic amongst scientists?!
    - linuxftw 7y ago
      Not what I was referring to. Injections that everyone gets, and are mandated.
      - rscho 7y ago
        You are a crackpot indeed, sorry.
wpietri 7y ago
They will certainly deny the impact. Which is absurd given that pharma companies all spend that money as vigorously as they can. Do doctors believe that pharma companies are extremely good at optimizing complex systems when it comes to drug production, but suddenly really bad at it when it comes to how they sell the drugs?
- wpietri 7y ago
  And as an aside, I think the long-shifts thing is a slightly different case. I've talked with doctors, and one pointed out that a big threat to patients is information loss during handoffs. The more you change shifts, the more information gets lost. It's similar to how we developers will often keep working on a problem until it's solved. That's especially true in incident response, where the same people tend to keep working on an issue until it's solved, rather than saying, "Oh, it's 5 pm, I'm going home; somebody else can figure out why the site is down." That's not to say doctors have the right balance now; they definitely have a macho-culture problem where people tough it out when it isn't necessary or beneficial. But it's definitely not as simple as I thought at first.
- Scoundreller 7y ago
  Also absurd because these are the people that should be following the evidence. Plenty of great theories have been crushed by evidence.
- malka 7y ago
  No. They are just corrupted.
carbocation 7y ago
When I was in medical school, a question posed to us in lecture was, "Would a pharmaceutical company giving out free pizza at lunch influence you?" I think fewer than 5 of us agreed that it would. Of course it would! I was really struck by this. It's hard to have a conversation about proper vs improper influence when we can't even agree about what would influence us.
- mirimir 7y ago
  It's not just free pizza that med students and interns get! They get lots of equipment, supplies, and so on. And it's a great investment. Because prescribing habits tend to persist after training, for many years. Sort of like Kuhn argued for science.
  - carbocation 7y ago
    Of course! My point just being that even if it were simply free pizza, that’s still an influence, even if small. Talking about what to allow or disallow would be So much easier if we could all agree that the phenomenon exists at all (which of course I am convinced it does).
    - mirimir 7y ago
      Right. I know that it does. Or at least, I recall seeing studies about that. But it's been too many years, and I didn't retain any records of that life.

rjkennedy98 7y ago

Its amazing how the people we trust with understanding science and evidence-based medicine are completely unable to unable to act in accordance with evidence when it comes to themselves. Good lesson for anyone who trusts our medical system.

rscho 7y ago
Doctors are not scientists. Doctors understanding basic science are 1:1000, and the rest of us follow EBM practices blindly similarly to a religion. However, it's not scientific ability that makes a good doc. Scientific ability is really not a criteria for adjusting your trust in a particular practitioner. I'd even say it's often that supposedly doctor-scientists (academics) are the worst.
- Scoundreller 7y ago
  From what I’ve seen in those doctor review sites and some pharmacy experience, what makes a good doctor in a lot of patient’s minds is whether they get whatever they want or not. Telling patients that a requested test/referral/intervention isn’t supported by evidence really upsets people. And being nice goes a long way.
  - rscho 7y ago
    Indeed. And 'flexibly sticking to guidelines' goes a long way too. There's a balance to find between pleasing your patient and doing the 'medically correct' thing. That's where the difficulty lies.
linuxftw 7y ago
Now apply this same line of skepticism to a certain class of inject-able drugs and be labeled a crackpot.
- krageon 7y ago
  It's not scepticism when you are ignoring evidence. It crosses into ignorance then.
  - linuxftw 7y ago
    The evidence that doctors and compensated by drug manufacturers unethically? Or the evidence of regulatory capture?
- mattkrause 7y ago
  Is there a heroin epidemic amongst scientists?!
  - linuxftw 7y ago
    Not what I was referring to. Injections that everyone gets, and are mandated.
    - rscho 7y ago
      You are a crackpot indeed, sorry.

wpietri 7y ago

They will certainly deny the impact. Which is absurd given that pharma companies all spend that money as vigorously as they can. Do doctors believe that pharma companies are extremely good at optimizing complex systems when it comes to drug production, but suddenly really bad at it when it comes to how they sell the drugs?

wpietri 7y ago
And as an aside, I think the long-shifts thing is a slightly different case. I've talked with doctors, and one pointed out that a big threat to patients is information loss during handoffs. The more you change shifts, the more information gets lost. It's similar to how we developers will often keep working on a problem until it's solved. That's especially true in incident response, where the same people tend to keep working on an issue until it's solved, rather than saying, "Oh, it's 5 pm, I'm going home; somebody else can figure out why the site is down." That's not to say doctors have the right balance now; they definitely have a macho-culture problem where people tough it out when it isn't necessary or beneficial. But it's definitely not as simple as I thought at first.
Scoundreller 7y ago
Also absurd because these are the people that should be following the evidence. Plenty of great theories have been crushed by evidence.
malka 7y ago
No. They are just corrupted.

carbocation 7y ago

When I was in medical school, a question posed to us in lecture was, "Would a pharmaceutical company giving out free pizza at lunch influence you?" I think fewer than 5 of us agreed that it would. Of course it would! I was really struck by this. It's hard to have a conversation about proper vs improper influence when we can't even agree about what would influence us.

mirimir 7y ago
It's not just free pizza that med students and interns get! They get lots of equipment, supplies, and so on. And it's a great investment. Because prescribing habits tend to persist after training, for many years. Sort of like Kuhn argued for science.
- carbocation 7y ago
  Of course! My point just being that even if it were simply free pizza, that’s still an influence, even if small. Talking about what to allow or disallow would be So much easier if we could all agree that the phenomenon exists at all (which of course I am convinced it does).
  - mirimir 7y ago
    Right. I know that it does. Or at least, I recall seeing studies about that. But it's been too many years, and I didn't retain any records of that life.