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> Cholesterol levels are associated with major adverse cardiovascular events > statins lower cholesterol levels and therefore You lost me here - because the s

> Cholesterol levels are associated with major adverse cardiovascular events > statins lower cholesterol levels and therefore You lost me here - because the science based one is just stating unproven statements to come to some conclusion. If you were to expand on why those two sentences are "proven" you'd likely come to evidence based reasons.

haldujai 3y ago
> You lost me here - because the science based one is just stating unproven statements to come to some conclusion. If you were to expand on why those two sentences are "proven" you'd likely come to evidence based reasons. I'm not sure I'm exactly understanding what you're getting at. If you expand on those statements to find direct evidence of MACE (of which there is plenty) then it is an evidence based medicine decision not a science based one. Please disregard the specific intervention being discussed, it's just an example of the different thought processes and decision making between SBM and EBM. In real life there is plenty of science and evidence behind statins but I'm not intending on addressing reality or why this specific intervention is in use today. Note the "medicine" part in these refers to the clinical practice of medicine. Maybe this is clearer: The science based medicine approach (as traditionally defined) only considers the mechanisms and "indirect evidence" when making the clinical recommendation (i.e. statins are proven to lower cholesterol which are strongly correlated with MACE. Cholesterol reduction has also been proven to reduce plaque formation and artery stenosis, therefore we expect MACE will be reduced through statin use and are deciding to administer the intervention). In this thought process we have not directly measured the outcome of interest (MACE) but we are giving an intervention because it makes sense/through chain of thought, or in other words we are intervening to optimize a variable (serum cholesterol levels) because we have reason to believe this variable reduces MACE based on the mechanism (which may have components proven by evidence like reduction in plaque formation but the primary outcome measure we are discussing, MACE, has not been measured). In the evidence based medicine approach we are deciding to provide an intervention based on direct measurements of the outcome of interest in a specific population (i.e. less MACE was directly proven) and the decision making process is entirely independent of the mechanism or nature of the intervention (i.e. we are not considering plaque formation and cholesterol levels, simply that statins reduce MACE).
chaxor 3y ago
Much of the scientific literature in biology is working off of hypotheses that don't have a huge amount of evidence. There are a large number of studies that present a molecular mechanism which, if studied in depth, will not always be consistent with what is presented in the literature. This is often dealt with by appending several conditions that must be met, such that the combinatorial space grows large enough and the only study that is done that meets the requirements is the one being presented. In this way, almost anything can be stated to fit some shiny new hypothesis. This is effectively the science based method, since it can be tracked to a, perhaps, 'plausible' mechanism (although often now lean towards more 'intriguing' than parsimonious, especially if published somewhere like Nature) Evidence based medicine has other faults. One subfield is meta-analysis, which looks for very solid observations that are reproducible, but often lacks the complicated modeling that may be necessary to see any highly conditional effects. So the findings tend to be real, but boring and often "well-known". It is however, a good way to check if the "well-known" observations in the literature are reproducible.
- haldujai 3y ago
  You're (correctly) addressing some of the issues in biomedical research but even the most rigorous and validated science does not necessarily translate into clinical outcomes for a laundry list of reasons. Evidence based medicine includes lab/animal studies (i.e. scientific literature in biology) but when we talk about EBM what we really mean is "outcomes based medicine" rather than relying on the science. EBM reduces the question to "Does intervention X change clinical outcome Y in population Z" to obviate many (but not all) of the clinical translation issues.

haldujai 3y ago

> You lost me here - because the science based one is just stating unproven statements to come to some conclusion. If you were to expand on why those two sentences are "proven" you'd likely come to evidence based reasons. I'm not sure I'm exactly understanding what you're getting at. If you expand on those statements to find direct evidence of MACE (of which there is plenty) then it is an evidence based medicine decision not a science based one. Please disregard the specific intervention being discussed, it's just an example of the different thought processes and decision making between SBM and EBM. In real life there is plenty of science and evidence behind statins but I'm not intending on addressing reality or why this specific intervention is in use today. Note the "medicine" part in these refers to the clinical practice of medicine. Maybe this is clearer: The science based medicine approach (as traditionally defined) only considers the mechanisms and "indirect evidence" when making the clinical recommendation (i.e. statins are proven to lower cholesterol which are strongly correlated with MACE. Cholesterol reduction has also been proven to reduce plaque formation and artery stenosis, therefore we expect MACE will be reduced through statin use and are deciding to administer the intervention). In this thought process we have not directly measured the outcome of interest (MACE) but we are giving an intervention because it makes sense/through chain of thought, or in other words we are intervening to optimize a variable (serum cholesterol levels) because we have reason to believe this variable reduces MACE based on the mechanism (which may have components proven by evidence like reduction in plaque formation but the primary outcome measure we are discussing, MACE, has not been measured). In the evidence based medicine approach we are deciding to provide an intervention based on direct measurements of the outcome of interest in a specific population (i.e. less MACE was directly proven) and the decision making process is entirely independent of the mechanism or nature of the intervention (i.e. we are not considering plaque formation and cholesterol levels, simply that statins reduce MACE).

chaxor 3y ago

Much of the scientific literature in biology is working off of hypotheses that don't have a huge amount of evidence. There are a large number of studies that present a molecular mechanism which, if studied in depth, will not always be consistent with what is presented in the literature. This is often dealt with by appending several conditions that must be met, such that the combinatorial space grows large enough and the only study that is done that meets the requirements is the one being presented. In this way, almost anything can be stated to fit some shiny new hypothesis. This is effectively the science based method, since it can be tracked to a, perhaps, 'plausible' mechanism (although often now lean towards more 'intriguing' than parsimonious, especially if published somewhere like Nature) Evidence based medicine has other faults. One subfield is meta-analysis, which looks for very solid observations that are reproducible, but often lacks the complicated modeling that may be necessary to see any highly conditional effects. So the findings tend to be real, but boring and often "well-known". It is however, a good way to check if the "well-known" observations in the literature are reproducible.

haldujai 3y ago
You're (correctly) addressing some of the issues in biomedical research but even the most rigorous and validated science does not necessarily translate into clinical outcomes for a laundry list of reasons. Evidence based medicine includes lab/animal studies (i.e. scientific literature in biology) but when we talk about EBM what we really mean is "outcomes based medicine" rather than relying on the science. EBM reduces the question to "Does intervention X change clinical outcome Y in population Z" to obviate many (but not all) of the clinical translation issues.