4 ms·

> To think that all of a sudden it became more dangerous was silly and unreasonable. This is a dangerous view and not a fair take. Drugs CAN become more danger

> To think that all of a sudden it became more dangerous was silly and unreasonable. This is a dangerous view and not a fair take. Drugs CAN become more dangerous when used in a different context. The sheer permutation of prior/current medical conditions, interacting drugs, demographics, genetics, medical procedures, and a bunch of other factors all play into the equation that determines a drug's safety and efficacy profile. This is why we continue to do research. This is why guidelines are constantly shifting. This is why medicine requires years of study. > The media was so quick to champion it everywhere though. I definitely agree with this point. The media has caused harm to the population by taking the results of a single observational study, and parading it around like it was some new concrete medical certainty. This is not how professionals operate. We don't flip our practice on the whims of a single OBSERVATIONAL study. And I emphasize OBSERVATIONAL because most people here don't understand what that entails. Most people here who comment on clinical trials are not even trained to interpret them. Is it randomized/non-randomized? Double-blinded? What did data collection look like? How were results analyzed? What was the patient population? Timelines? Control arm? Placebos? Previous findings? Primary/secondary endpoint? Do you know the difference between a meta-analysis and a systematic review? NNT? Hazards ratios? Odds ratios? Too many people outside of medicine think they know how to interpret a study, when in reality they have no idea what they're looking at and cherry-pick the interesting sentences that they're looking for. > I know I'm not going to trust the Lancet or the NEJM ever again. This is not a fair take. The journals are responsible for reviewing and publishing the most influential clinical research in the world. Occasionally a bad study makes its way in due to falsified data or other illegitimate factors. Health care professionals are well-aware of this, which is why we are trained to interpret studies, and be conservative in the face of radical findings like this. If anyone has a problem with the Lancet or NEJM, they should see some of the mess found in lower-impact journals.

pacala 6y ago
Sadly, some of us are aware of the mess found in lower impact journals. It doesn't help with the trust issue. At all.
lbeltrame 6y ago
I did not agree with the conclusions of the paper, but I fell prey of the same bias that many others had: it was "published in Lancet" and "those journals have strict peer review". The lesson I learned is that I will always scrutinize papers I read with a more critical eye, regardless of where they were published in.
- caseysoftware 6y ago
  I think we need to understand exactly what "peer review" is required for publication or publication certain places. Is it: a) a grammar/spelling check b) a gut check to make sure it "makes sense" c) validation of the math/analysis d) validation of the underlying experimental procedure used to collect the data e) validation of the underlying selection criteria for inputs/candidates in the experiment f) reproducibility of the experiment and results g) something else? h) all of the above My impression is that "peer review" generally includes a & b and sometimes c & d.

pacala 6y ago

Sadly, some of us are aware of the mess found in lower impact journals. It doesn't help with the trust issue. At all.

lbeltrame 6y ago

I did not agree with the conclusions of the paper, but I fell prey of the same bias that many others had: it was "published in Lancet" and "those journals have strict peer review". The lesson I learned is that I will always scrutinize papers I read with a more critical eye, regardless of where they were published in.

caseysoftware 6y ago
I think we need to understand exactly what "peer review" is required for publication or publication certain places. Is it: a) a grammar/spelling check b) a gut check to make sure it "makes sense" c) validation of the math/analysis d) validation of the underlying experimental procedure used to collect the data e) validation of the underlying selection criteria for inputs/candidates in the experiment f) reproducibility of the experiment and results g) something else? h) all of the above My impression is that "peer review" generally includes a & b and sometimes c & d.