7 ms·

> 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

> 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 ago
  Only 7%?!
  - Fomite 3y ago
    There are a lot of systematic reviews. They're a very popular "Grad student's first paper" in public health fields, because if you're writing Chapter 1 of your dissertation, you're already halfway there.
    - lostlogin 3y ago
      That’s what I mean, and one group doing 7% is impressive.
- MostlyStable 3y ago
  I'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 ago
    Evidence 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 ago
  As 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 ago
  It'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 ago
Given 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 ago
  Except 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 ago
    What'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 ago
Any of the top tier Ivies or US research schools could single handedly cover the cost.
jimbob45 3y ago
evidence-based What’s the difference between something being scientific and something being evidence-based?
- SamoyedFurFluff 3y ago
  Evidence-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 ago
  As 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 ago
    I 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 ago
  A 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 ago
A 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 ago
  As 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 ago
The 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 ago
  Isn’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 ago
One 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.

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 ago
Only 7%?!
- Fomite 3y ago
  There are a lot of systematic reviews. They're a very popular "Grad student's first paper" in public health fields, because if you're writing Chapter 1 of your dissertation, you're already halfway there.
  - lostlogin 3y ago
    That’s what I mean, and one group doing 7% is impressive.
MostlyStable 3y ago
I'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 ago
  Evidence 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 ago
As 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 ago
It'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 ago

Given 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 ago
Except 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 ago
  What'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 ago

Any of the top tier Ivies or US research schools could single handedly cover the cost.

jimbob45 3y ago

evidence-based What’s the difference between something being scientific and something being evidence-based?

SamoyedFurFluff 3y ago
Evidence-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 ago
As 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 ago
  I 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 ago
A 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 ago

A 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 ago
As 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 ago

The 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 ago
Isn’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 ago

One 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.