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Medical-evidence giant Cochrane battles funding cuts and closures
- Traubenfuchs 3y ago> Cochrane says that the lost NIHR funding — around £4.2 million (US$5.3 million) — does not affect its core income, which was £8.9 million in 2022. However, a more existential threat looms. Around £6.8 million of that core income came from subscriptions to the Cochrane Library, but Cochrane aims to make all its reviews open access by 2025 What the actual fuck, those are peanuts for any single country or health care system. What a tragedy and a blow to evidence based medicine.
- MithrilTuxedo 3y ago>evidence based medicine They do mention that Cochrane is only accounting for 7% of systematic reviews these days. BTW, evidence-based medicine is not the same as science-based medicine. The Placebo Effect is evidence-based medicine.
- lostlogin 3y agoOnly 7%?!
- MostlyStable 3y agoI'm not sure what you are trying to say. Are you implying that the placebo effect is magic, or in some other way non-scientific?
- raincom 3y agoEvidence based medicine (EBM) = population, intervention, comparison and outcome (PICO). In other words, PICO = RCT Randomized Control Trials. To me, EBM is medical instrumentalism (instrumentalism is one of philosophies of sciences): pick a treatment that works, without understanding the underlying mechanism. Even today, we use many drugs with unknown mechanisms of action[0]. Often times, you can find cures just by discovering mechanism of action, without PICO/RCT: for example, Helicobacter pylori causing peptic ulcers. Placebo effect is NOT magic, but we don't understand the mechanism. Good relationship between doctors and patients help recover patients. Patients prefer to see particular doctors, even if the latter prescribe same medications as others, yet the differential effects on patients (when treated by preferred doctors vs others) is non-trivial. [0] https://en.wikipedia.org/wiki/Category:Drugs_with_unknown_mechanisms_of_action https://en.wikipedia.org/wiki/Category:Drugs_with_unknown_me...
- Spooky23 3y agoAs a comparison, New York Presbyterian hospital in NYC probably spent at least twice that deficit to put their logo on New York Mets jerseys. I’m not what 7% of reviews represents, but it seems like particularly dumb austerity measure.
- pcrh 3y agoIt's a bit more important than that number suggests. For one, 7% of global systematic reviews is not a trivial proportion. But more importantly Cochrane allows for the pre-registration of such reviews, i.e. where the methodology and goals (hypotheses) are stated before the review is conducted. This is probably the most scientifically rigorous method of assessing evidence, and is not performed for most systematic reviews.
- psychphysic 3y agoGiven in the UK doctors have taken a real terms paycut circa of over 25% [0] the UK is not currently fit to fund anything. [0] https://www.bma.org.uk/media/6882/bma-ia-juniors-fact-sheet-for-journalists.pdf https://www.bma.org.uk/media/6882/bma-ia-juniors-fact-sheet-...
- fnordpiglet 3y agoExcept this sort of funding has multiplicative effects. Funding for a single doctor helps only that doctor and their patients. Funding for this sort of work helps all doctors and all patients. When austerity cannibalizes your force multiplying efforts, that’s truly the end. Edit: For context the thing you linked says UK medical residents (in US language) make $36k/year, and the median household income is also $36k/y[0] . In the US the average non specialist income is $60k[1], and the median household income is $69k[2] This tells me things aren’t out of whack. They also say 40% of residents in the UK want a different job. But residencies are temporary. In a few years they will have a new job - a full doctor. I’m not saying there’s not a crisis, but that sheet doesn’t explain to me what the crisis actually is. They seem to be doing on par with US residents. 0 https://www.ons.gov.uk/peoplepopulationandcommunity/personalandhouseholdfinances/incomeandwealth/bulletins/householddisposableincomeandinequality/financialyear2020 https://www.ons.gov.uk/peoplepopulationandcommunity/personal... 1 https://mededits.com/residency-admissions/residency-salary/ https://mededits.com/residency-admissions/residency-salary/ 2 https://www.deptofnumbers.com/income/us/ https://www.deptofnumbers.com/income/us/
- deleted 3y ago[deleted]
- psychphysic 3y agoWhat's the difference in pay between a "full doctor" as you put it consultant (UK) or attending (US)? UK a consultant earns £100k pretax and pays approximately 30% net tax rate and 60% marginal rate. What about US? Apparently family medicine in the US brings in 130% more than the equivalent in the UK (GP which makes up half of all UK doctors). https://revisingrubies.com/us-vs-uk-doctors-salary/ https://revisingrubies.com/us-vs-uk-doctors-salary/ That's truly astounding.
- KRAKRISMOTT 3y agoAny of the top tier Ivies or US research schools could single handedly cover the cost.
- jimbob45 3y agoevidence-based What’s the difference between something being scientific and something being evidence-based?
- SamoyedFurFluff 3y agoEvidence-based is a subset of scientific, imo. A study of cells in a Petri dish is science but I wouldn’t recommend a drug to a person from such a study.
- raincom 3y agoAs I wrote in another reply, evidence based medicine (EBM) = population, intervention, comparison and outcome (PICO). In other words, PICO = RCT Randomized Control Trials. To me, EBM is medical instrumentalism (as instrumentalism is one of philosophies of sciences): pick a treatment that works for a large number of people, without understanding the underlying mechanism. Even today, we use many drugs with unknown mechanisms of action (MOA).
- haldujai 3y agoI would add that EBM took over because science-based medicine (at least the historical definition, how it's used now is more of a hybrid) didn't work out too well. Often the mechanism thought to be understood is incorrect or more complicated and the outcomes don't correlate well with what's expected, sometimes resulting in significant harm. Fundamentally, the mechanism of why a medical intervention works isn't that important if you're thoroughly evaluating outcome measures and controlling confounders.
- haldujai 3y agoA simple example is (using the traditional understanding of these differences): Science-based: Cholesterol levels are associated with major adverse cardiovascular events (MACE), statins lower cholesterol levels and therefore statin therapy is recommended to reduce MACE. Evidence-based: A [specifically defined population] was given statin therapy or placebo. We observed lower MACE in the statin group, therefore statin therapy is recommended in [specifically defined population] to reduce MACE.
- cscurmudgeon 3y agoA lot of folks are now angry that Cochrane went slightly against masks. There is a religious war unfortunately. There is even one comment here along that line. https://www.forbes.com/sites/brucelee/2023/03/11/cochrane-says-review-does-not-show-that-face-masks-dont-work-against-covid-19/?sh=5dfdafe81937 https://www.forbes.com/sites/brucelee/2023/03/11/cochrane-sa...
- ggm 3y agoAs I've said above it was subject to pretty hefty critique and I've never seen a robust defence. They meta combined papers which were not well grounded and it was unlike its RCT normal approach.
- deleted 3y ago[deleted]
- spamizbad 3y agoThe US or EU should pick up the tab. The UK is not really a wealthy country anymore and things critical to STEM should slowly be transferred out as it doesn’t have the economic power to sustain them any longer.
- flextheruler 3y agoIsn’t the UK in the top 6 or 5 economies in the world? Are you saying that there are only 5 wealthy countries in existence? I mean the UK definitely has problems but it’s a bit hysterical to say they’re not wealthy.
- Fomite 3y agoOne of the most "fun" things to do on HN is translate startup funding amounts into things like multiples of Cochrane's budget, or NIH R01s.
- msie 3y ago[flagged]
- gruez 3y ago>misleading review on mask effectiveness (with Tom Jefferson)? Can you provide more context for this? What was the study? Why was it misleading?
- trust_bt_verify 3y agoAs the sibling in the thread detailed: https://www.factcheck.org/2023/03/scicheck-what-the-cochrane-review-says-about-masks-for-covid-19-and-what-it-doesnt/ https://www.factcheck.org/2023/03/scicheck-what-the-cochrane... The misleading part was done by Tom during an interview with a major media organization with a similar established narrative.
- pcrh 3y agoTo be honest, that "factcheck" demonstrates the value of performing well-constructed systematic reviews, i.e. a clear and unbiased assessment of what the pertinent studies do and do not support.
- scrollop 3y ago[flagged]
- danpalmer 3y agoPlease don't just copy/paste LLM responses.
- dent9876543 3y ago> Therefore, the review does not imply that masks do not work [...] Actually, for all intents and purposes, it does imply exactly that. The RCTs involved sufficiently large sample sizes that they are representative of real-world outcomes. As such, masks, as we have generally deployed them, simply do not offer significant control over the trajectory of C-19-like infection at the population level.
- patel011393 3y agoThis may seem like bad news, but as a grad student studying evidence synthesis I can say that there is a silver lining here. The quality of studies in systematic inputs is low and even Cochrane's reviews have been critiqued for missing things. It's a big factory that hasn't fundamentally innovated how research is synthesized. There are newer forms of synthesis like realist reviews, meta-modeling, and model-driven meta-analyses (those are just a few examples). Hopefully this results in some innovation at the conceptual and financial levels. For those who lost their income, they have transferrable skills that would be welcomed in healthtech companies, other governmental groups, and academic positions. It's really not as bad as it seems.
- haldujai 3y ago> The quality of studies in systematic inputs is low and even Cochrane's reviews have been critiqued for missing things. Criticism is good, expecting perfection is not. Quality issues are a problem of the underlying research rather than the review process. High quality reviews, like Cochrane, assess risk of bias which can limit the strength of conclusion they make where the underlying studies are poor quality. > There are newer forms of synthesis like realist reviews, meta-modeling, and model-driven meta-analyses (those are just a few examples). All of these answer different questions/have different use cases than a SR and are much harder to do while maintaining comparable quality and risk of bias. What's your gripe with high quality SRs following standards like PRISMA, STARD and QUADAS-2?
- cyrillite 3y agoThis is an insane ask, but I would love to hear more about various reviewing and synthesis styles, their strengths and weaknesses, which are particularly promising and why, etc. you’re welcome to link me to material, but I’d also appreciate a brief overview. I have nothing to offer other than thinking that this is a super cool area of study and I’d love to hear more
- thedailymail 3y agoThis site provides a concise description of many review types: https://guides.mclibrary.duke.edu/sysreview/types https://guides.mclibrary.duke.edu/sysreview/types
- bomewish 3y agoDark public choice perspective: this is incentive compatible for pharmaceutical companies and governments who can now give out their guidelines and solutions without as strong scrutiny. Too cynical??
- Fomite 3y ago"incentive compatible" is doing a lot of heavy lifting in that sentence. Meta-analysis and systematic reviews were done before Cochrane, and will be done after it. And most pharma companies are banking on RCT results - Cochrane can't do systematic reviews before there's multiple studies, so it's significantly further downstream than what makes pharma money.
- bomewish 3y agoOK I buy that.
- Vecr 3y agoCochrane is kind of weird, though it probably is how frequentest science is supposed to work, where the null hypothesis is the default. If you actually followed their advice you would get vaccinated for hepatitis A every two years, because the protection lasting any longer is "unsupported by high quality sources".
- Vecr 3y agoFrequentist science, sorry.
- randyshirley23 3y ago[dead]