6 ms·

> Genuine question: how does someone in her position know they're right and the research is wrong, and not the reverse? She doesn't know, and that's the proble

by rscho 5y ago

> Genuine question: how does someone in her position know they're right and the research is wrong, and not the reverse? She doesn't know, and that's the problem with medical research: being a specialized surgeon is like a carpenter who's made hundreds of a particular kind of furniture. Then a scientist comes along, saying we should change how we do it. As an experienced carpenter, you know that most of those scientists actually have very little practical experience, because they used that time to publish and are actually very bad, practically speaking. And therefore oftentimes reach nonsensical conclusions. So, what to do? You go ask the most practically experienced guy you can find, hoping he'll be able to guide you. Repeat 100x/year. I'm not exaggerating: some of our academic practitioners who've published a lot are really among the worst practitioners I know, and do kill people who should have lived on a regular basis! Ironically, some of them are respected professors and patients often seek their care thinking it'll be better. One of them is a surgeon and has received an award for outstanding teaching. He's the absolute worst surgeon I know. So, no easy conclusion here...

dr_dshiv 5y ago
> scientist comes along, saying we should change how we do it That doesn’t sound like science. An example or pointer would be helpful.
- rscho 5y ago
  Remember the start of the pandemic? Some prof published that we should withold steroids and intubate ASAP on the basis of preliminary evidence, throwing basically everything we knew about ARDS out of the window. Most reasonable ICU guys were skeptical on the basis of their own practical experience, but had no choice because who would dare contradict science, right?? We very likely killed many people that way. What do we do now? The exact opposite, and much closer to usual ARDS practices. You can argue that wasn't a mistake because it followed the process of scientific discovery, but it's nevertheless a tragic example of experience trumping the advice of the scientific community.
  - dr_dshiv 5y ago
    I feel like we should be critiquing society’s response to science rather than implying that their paper should never have been published.
    - rscho 5y ago
      > implying that their paper should never have been published. That's really not what I meant. I have no problem with the publication. But put yourself in the shoes of someone such as myself, who's intubated tens of cases on admission and probably killed many doing so. Wouldn't you be questioning the structure of our research system then? Not that I have any better solution at hand, mind you...
  - ModernMech 5y ago
    > but had no choice because who would dare contradict science, right?? This is what I don't get. Science is contradicted and questioned all the time. It's the main mechanism by which science evolves. Also a crucial feature of science is that it's literally always wrong. Science is the iterative process of building models of reality, and those models by virtue of being models never 100% represent reality. Scientists understand this and are always working to improve our knowledge by further refining our models. Why do you feel like science is not to be questioned? Moreover, if you're dissatisfied as a practitioner with scientific review, why don't you get involved more with the review process? In my field practitioners publish and are involved with our research and peer review all the time, is this not true for your field? Can you work to change it? In my experience if you don't agree with published research, you don't just lay down and accept it, you do your own research to counter it, and publish that with a big fat citation of the old paper saying they're wrong. Where does this idea come from that science is proclaimed from on high? If you don't like it, roll up your sleeves and prove them wrong -- science is done from the bottom-up.
    - deadwanderer 5y ago
      What you're saying is technically accurate to the intended definition and purpose of science, but if you're seriously asking why these people didn't question or contradict, I'm not sure where you've been for the last several years. So many pandemic response items, in particular, have been "Trust the science"/"Follow the science", and any questions or possible alternatives to the prescribed Method Of Treatment are not only dismissed, but actively persecuted.
mrjangles 5y ago
This reminds me of agriculture under the Soviet Union. Stalin wanted to build a technocracy with the brightest in charge of there specialized fields, so he brought in the most famous Russian agronomist, Lysenko, and gave him complete control over the Soviet agricultural system. Lysenko took control away from those ignorant and backward Russian farmers and revolutionized Soviet farming with all the latest scientific breakthroughs.... It wasn't long before millions of people were starving to death.
- sdoering 5y ago
  Except that this is not the only (or even the main reason) the big starvation happened. It was because Stalin had to pay the US for their technological knowledge and deliveries of factories and as the Ruble wasn't worth much the US demanded to be payed in natural resources, mainly agricultural products. As Stalin saw the writing on the wall in regards to the danger of a middle European nation trying to overtake Russia he made that deal and ferried most of the Russian produce towards the US. So to be able to (at first) produce tractors and later switch that to tanks he sold his people to the US that knowingly and gladly accepted the cheap food. So both nation's political and industrial leaders are responsible for the mass starvations. One can't just blame it on Stalin or on Lysenko. But Lysenko might have made the problem even worse. That much we can agree on. Source for further reading: https://twitter.com/kamilkazani/status/1505247886908424195 https://twitter.com/kamilkazani/status/1505247886908424195
  - diordiderot 5y ago
    So if a parent spends their whole paycheck on a new shotgun and their child goes hungry, it is equally Remington's fault. Got it
    - vermilingua 5y ago
      Remington’s raison d’être is producing shotguns. The US’ raison d’être is (hopefully) not knowingly starving millions of people to death. When you’re making a deal of that size (between countries, not a company and consumer) no deal is purely transactional, there are ramifications.
codeflo 5y ago
I can totally believe that. What you’re describing has an uncanny resemblance to academic software engineering research: many of the published insights scale up all the way to one semester student projects — in other words, are completely useless in the real world.
r_hoods_ghost 5y ago
Not the OP, but one of the organisations I work for publishes best practice guidelines for diagnostic tests for various rare genetic disorders in an attempt to avoid this issue. However the process takes between 1 and 2 years and starts from identifying a group of leading clinicians and academics who specialise in that condition who are willing to write the guidelines (on their own time, for free). They then do a literature search to gather any relevant material and at the same time put out a call for submissions to clinicians around the world asking them to contribute. A (usually virtual) conference is then held and the writing begins. Over the next few months a set of draft guidelines are produced and then put out for comment. After a period for feedback a second draft is produced and sent out again. A consensus building exercise is then conducted (aka another mini conference involving the guideline writers and others) and the guidelines finalised according to the consensus. They're then published in a peer reviewed journal. As you can imagine this takes time and money and all of it is sponsored by a not for profit EQA organisation, with no pharma companies involved (since they're who provide the tests and that's a massive conflict of interest). As a result the org only manages to produce two or three guidelines a year, when really they'd like to be able to produce a dozen or more. And they also need to be reviewed at regular intervals which while slightly less long winded is still long winded. Really this is the sort of thing that is a prime candidate for being sponsored by government, and sometimes it is, but since these are rare conditions the cost / benefit analysis is not always favourable.
hardware2win 5y ago
Afrer getting degree and working in the software industry im kinda worried when going to the doc, LOL.
- refurb 5y ago
  Not to trash the profession, but in reality it's no different than a computer engineer, plumber, accountant or anything else. I used to think "well med school is really hard, so the bare minimum for a doctor is pretty good". Then I started working in healthcare and realize, no, that's not true at all. The best example I can think of is when I worked on a project where we wanted to get ready for a much better competitor in a disease area. Not "slightly better", but "mind blowing better and not using it would be malpractice". Most doctors had heard of it, but we want to remind them not to purchase the company's older drug because they'll just return it a year later. Turns out there were multiple doctors, after the new drug was approved and available, that continued to use the old drug. We literally had to go to them and say "hey stop buying the company's drug please". And I realized, damn, these doctors' patients are getting really shitty treatment.
  - ryathal 5y ago
    This is why pharmaceutical sales representatives are so important. Most doctors are far too busy treating patients day to day to stay up on every new drug that comes out. CME can help cover some of this, especially with new procedures or treatments, but nothing can keep up with the 100 new drugs for diabetes. what really helps doctors is having people that can come talk to them, tell them that drug X is better than Y, give them the literature if they want it, tell them what insurance has a chance of covering it. Some doctors will always do what they know, but the majority just need to know there is a better option.
    - markus92 5y ago
      Or just follow the clinical guidelines and associated updates. They're there for this exact reason, to make sure every doctor uses up-to-date methods. No need for sales reps in this case.

by rscho 5y ago

dr_dshiv 5y ago

> scientist comes along, saying we should change how we do it That doesn’t sound like science. An example or pointer would be helpful.

rscho 5y ago
Remember the start of the pandemic? Some prof published that we should withold steroids and intubate ASAP on the basis of preliminary evidence, throwing basically everything we knew about ARDS out of the window. Most reasonable ICU guys were skeptical on the basis of their own practical experience, but had no choice because who would dare contradict science, right?? We very likely killed many people that way. What do we do now? The exact opposite, and much closer to usual ARDS practices. You can argue that wasn't a mistake because it followed the process of scientific discovery, but it's nevertheless a tragic example of experience trumping the advice of the scientific community.
- dr_dshiv 5y ago
  I feel like we should be critiquing society’s response to science rather than implying that their paper should never have been published.
  - rscho 5y ago
    > implying that their paper should never have been published. That's really not what I meant. I have no problem with the publication. But put yourself in the shoes of someone such as myself, who's intubated tens of cases on admission and probably killed many doing so. Wouldn't you be questioning the structure of our research system then? Not that I have any better solution at hand, mind you...
- ModernMech 5y ago
  > but had no choice because who would dare contradict science, right?? This is what I don't get. Science is contradicted and questioned all the time. It's the main mechanism by which science evolves. Also a crucial feature of science is that it's literally always wrong. Science is the iterative process of building models of reality, and those models by virtue of being models never 100% represent reality. Scientists understand this and are always working to improve our knowledge by further refining our models. Why do you feel like science is not to be questioned? Moreover, if you're dissatisfied as a practitioner with scientific review, why don't you get involved more with the review process? In my field practitioners publish and are involved with our research and peer review all the time, is this not true for your field? Can you work to change it? In my experience if you don't agree with published research, you don't just lay down and accept it, you do your own research to counter it, and publish that with a big fat citation of the old paper saying they're wrong. Where does this idea come from that science is proclaimed from on high? If you don't like it, roll up your sleeves and prove them wrong -- science is done from the bottom-up.
  - deadwanderer 5y ago
    What you're saying is technically accurate to the intended definition and purpose of science, but if you're seriously asking why these people didn't question or contradict, I'm not sure where you've been for the last several years. So many pandemic response items, in particular, have been "Trust the science"/"Follow the science", and any questions or possible alternatives to the prescribed Method Of Treatment are not only dismissed, but actively persecuted.

mrjangles 5y ago

This reminds me of agriculture under the Soviet Union. Stalin wanted to build a technocracy with the brightest in charge of there specialized fields, so he brought in the most famous Russian agronomist, Lysenko, and gave him complete control over the Soviet agricultural system. Lysenko took control away from those ignorant and backward Russian farmers and revolutionized Soviet farming with all the latest scientific breakthroughs.... It wasn't long before millions of people were starving to death.

sdoering 5y ago
Except that this is not the only (or even the main reason) the big starvation happened. It was because Stalin had to pay the US for their technological knowledge and deliveries of factories and as the Ruble wasn't worth much the US demanded to be payed in natural resources, mainly agricultural products. As Stalin saw the writing on the wall in regards to the danger of a middle European nation trying to overtake Russia he made that deal and ferried most of the Russian produce towards the US. So to be able to (at first) produce tractors and later switch that to tanks he sold his people to the US that knowingly and gladly accepted the cheap food. So both nation's political and industrial leaders are responsible for the mass starvations. One can't just blame it on Stalin or on Lysenko. But Lysenko might have made the problem even worse. That much we can agree on. Source for further reading: https://twitter.com/kamilkazani/status/1505247886908424195 https://twitter.com/kamilkazani/status/1505247886908424195
- diordiderot 5y ago
  So if a parent spends their whole paycheck on a new shotgun and their child goes hungry, it is equally Remington's fault. Got it
  - vermilingua 5y ago
    Remington’s raison d’être is producing shotguns. The US’ raison d’être is (hopefully) not knowingly starving millions of people to death. When you’re making a deal of that size (between countries, not a company and consumer) no deal is purely transactional, there are ramifications.

codeflo 5y ago

I can totally believe that. What you’re describing has an uncanny resemblance to academic software engineering research: many of the published insights scale up all the way to one semester student projects — in other words, are completely useless in the real world.

r_hoods_ghost 5y ago

Not the OP, but one of the organisations I work for publishes best practice guidelines for diagnostic tests for various rare genetic disorders in an attempt to avoid this issue. However the process takes between 1 and 2 years and starts from identifying a group of leading clinicians and academics who specialise in that condition who are willing to write the guidelines (on their own time, for free). They then do a literature search to gather any relevant material and at the same time put out a call for submissions to clinicians around the world asking them to contribute. A (usually virtual) conference is then held and the writing begins. Over the next few months a set of draft guidelines are produced and then put out for comment. After a period for feedback a second draft is produced and sent out again. A consensus building exercise is then conducted (aka another mini conference involving the guideline writers and others) and the guidelines finalised according to the consensus. They're then published in a peer reviewed journal. As you can imagine this takes time and money and all of it is sponsored by a not for profit EQA organisation, with no pharma companies involved (since they're who provide the tests and that's a massive conflict of interest). As a result the org only manages to produce two or three guidelines a year, when really they'd like to be able to produce a dozen or more. And they also need to be reviewed at regular intervals which while slightly less long winded is still long winded. Really this is the sort of thing that is a prime candidate for being sponsored by government, and sometimes it is, but since these are rare conditions the cost / benefit analysis is not always favourable.

hardware2win 5y ago

Afrer getting degree and working in the software industry im kinda worried when going to the doc, LOL.

refurb 5y ago
Not to trash the profession, but in reality it's no different than a computer engineer, plumber, accountant or anything else. I used to think "well med school is really hard, so the bare minimum for a doctor is pretty good". Then I started working in healthcare and realize, no, that's not true at all. The best example I can think of is when I worked on a project where we wanted to get ready for a much better competitor in a disease area. Not "slightly better", but "mind blowing better and not using it would be malpractice". Most doctors had heard of it, but we want to remind them not to purchase the company's older drug because they'll just return it a year later. Turns out there were multiple doctors, after the new drug was approved and available, that continued to use the old drug. We literally had to go to them and say "hey stop buying the company's drug please". And I realized, damn, these doctors' patients are getting really shitty treatment.
- ryathal 5y ago
  This is why pharmaceutical sales representatives are so important. Most doctors are far too busy treating patients day to day to stay up on every new drug that comes out. CME can help cover some of this, especially with new procedures or treatments, but nothing can keep up with the 100 new drugs for diabetes. what really helps doctors is having people that can come talk to them, tell them that drug X is better than Y, give them the literature if they want it, tell them what insurance has a chance of covering it. Some doctors will always do what they know, but the majority just need to know there is a better option.
  - markus92 5y ago
    Or just follow the clinical guidelines and associated updates. They're there for this exact reason, to make sure every doctor uses up-to-date methods. No need for sales reps in this case.