8 ms·

Fighting Against Evidence

45 points by tokenadult 13y ago

TempleOSV2 13y ago
Doctors are niggers. If you don't do calculus, yer a nigger. God says... You_fix_it pet game_over bad what's_up I_donno well_I_never God says... engage instruction Frenzied dangerous fled woman-servant hurting worshipped discern advices overcast destroy ceasing solaces stir believe- second gnawed
thrush 13y ago
It would be nice if we had some sort of independent research verification system. Basically a group or individual that validates the most important (or highest paying) publications.
- nocoment 13y ago
  I still don't understand why a consortium of insurance companies doesn't run studies looking for better outcomes with out-of-patent and un-patented drugs. Their tests would be of already approved drugs. In many situations they could save a bundle and in others they would dissuade drug companies from pushing the advertising and costs. The statistics on everything they test would show their general level of bias (assuming drugs aren't getting any worse.)
  - Mz 13y ago
    Um, no offense, but do you have any idea what insurance companies are really all about? That sounds, well, crazy to me (as someone with a) a serious medical condition and b) who used to work for an insurance company).
  - glomph 13y ago
    Because if treatment gets cheaper they have less business?
  - ensignavenger 13y ago
    Many insurance companies (I think that now perhaps all of them in the US, thanks to ObamaCare) have to pay out a certain percent of what they take in to health providers. Thus if they want to increase premiums, and therefore profits, the only way to do it is to increase the cost of care. Preferably, they increase the cost of care for everyone, which drives more people to buy insurance, and means that some other company isn't able to undercut them on premiums by reducing costs. Of course, they als get more float, which insurance companies love. That is the model that health care insurance companies follow, and ObamaCare was a huge gift to helping them out.
- shimms 13y ago
  We do - cochrane reviews (http://www.cochrane.org http://www.cochrane.org). From their about us page: "Cochrane is a global independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making the vast amounts of evidence generated through research useful for informing decisions about health. We are a not-for-profit organisation with collaborators from over 120 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest."
benched 13y ago
Terry, why do you regularly use racially charged language? I understand your meaning fine, I'm just curious whether there's any specific reason you use racial language so much, or if it's just sort of one of your things.
- tokenadult 13y ago
  Did you put this comment in the wrong thread? There is no one named Terry here (the author of the submitted article is Steven Novella). It doesn't look like you read the article that was submitted to open this thread before you typed your comment here.
  - anonymoushn 13y ago
    benched is replying to TempleOSV2, who is hellbanned.
- Crito 13y ago
  I don't think that he is well; I wouldn't read to much into it.
  - benched 13y ago
    I understand that he has schizophrenia, but they're people with thoughts and reasoning, too, though they may be more loosely aligned with the consensus style of cognition. For example, the statement he made makes perfect sense semantically - it's just said in a way that a lot of people find offensive.
- BlackDeath3 13y ago
  >I understand your meaning fine You do?
  - Crito 13y ago
    I thought the overall meaning was clear, no matter how poorly stated: "Doctors do not do calculus" -> "medicine is not a hard science" "People who are not in hard sciences should not be trusted" Then he has the output of a markov chain or whatever that he seeded with biblical texts. You can safely ignore those sections. Basically (racist language aside), his comment boils down to "Anyone who isn't STEM sucks." It would be an extremely low-quality comment even if it were articulated well.
jostmey 13y ago
I am torn. On the one hand I firmly believe that medicine should be evidence based. Treatments should be based on the best possible scientific evidence. Inevitably, such evidence will rely on large, randomized controlled clinical trials... On the other hand, I take it as my own personal responsibility to take care of my own health. This means that I have to rely on a sample size of one. If I try something, and I feel better then I try more of it. My prescription for myself may not work for anyone else, it could be specific to me. I personally believe that Western medicine is awesome because it is evidence based. At the same time, Western medicine has removed from the individual a sense of personal responsibility, and this must change.
- icebraining 13y ago
  Well, Eric Topol[1] argues that evidence-based medicine, coupled with copious amounts of data and better tools, will allow treatments to be much more individualized, not less. [1] http://www.scripps.edu/research/faculty/topol http://www.scripps.edu/research/faculty/topol http://www.econtalk.org/archives/2013/04/topol_on_the_cr.html http://www.econtalk.org/archives/2013/04/topol_on_the_cr.htm... http://www.amazon.com/Creative-Destruction-Medicine-Digital-Revolution/dp/0465025501/ http://www.amazon.com/Creative-Destruction-Medicine-Digital-...
- Crito 13y ago
  IMHO, the problem with "alternative medicine" is less what adults do (or do not do) to themselves, and more with what adults do to children that they have been entrusted with. Thankfully there has been progress in recent years on this front, with adults who neglected to seek evidence-based medicine for the children that they were entrusted with being charged with homicide (http://en.wikipedia.org/wiki/Kara_Neumann_case http://en.wikipedia.org/wiki/Kara_Neumann_case). There is more progress to be made however.
- npsimons 13y ago
  Western medicine has removed from the individual a sense of personal responsibility, and this must change. I must heartily disagree. Well, perhaps not so much disagree as clarify: Western medicine as it is practiced, perhaps discourages personal responsibility (and how many times would you tell patients to eat better and exercise more if they never did?). Evidence based medicine is just that: based on evidence. There's no "removal" of personal responsibility, there are simply facts, as in your case you have brilliantly demonstrated: when something works for you, you continue to use it. My immediate reaction to "trying something" that you mentioned, however was "how many things did you try?" How many people won't research different options, much less put them into practice, simply because it would require them to try something different, or something hard (like exercise)? How many people would rather take some snake-oil to lose weight than eat less and exercise more? How many people will refuse vaccines because they believe it's a government conspiracy? And let's not forget all the other confounding factors, such as big pharma with 85+% of their money dedicated to marketing, or the placebo affect, etc, etc.
gress 13y ago
The problem is not with the concepts of SBM and EBM but with the fact that they are not understood and applied well by doctors, and often just translate into not being able to think beyond 'results' handed down from the establishment.
aaronem 13y ago
"Do you know what they call 'alternative medicine' that's been proved to work? Medicine." (from http://www.altairiv.net/Storm.html http://www.altairiv.net/Storm.html)
- glomph 13y ago
  This quip really annoys me. It only seems true because of a confusion or blurring of two very distinct concepts. There is tested treatment, which has been tested and come out effective. This can be put in dichotomy with untested or failed treatment. That is logical. Some treatments have been tested and passed some haven't. This is an entirely different dichotomy to that of mainstream and alternative or complementary medicine. Many forms of medicine have been thoroughly tested and come out effective and are not offered by pharmacies and national health services. Unless you want to claim that absolutely all proven effective treatment is offered by mainstream medical providers then this has to be acknowledged. Then on the other side there is a large array of medicine that is provided by mainstream medical providers that has not been proven effective. Many antidepressants consistently score the same or worse than a placebo in blind tests. The distinction between alternative medicine and mainstream medicine is not proof, but the provider. So while Minchin may be eloquent he is confusing terms to make his point.
  - reverius42 13y ago
    The difference is not in the provider, but in what is being provided. Alternative providers provide alternative medicine. What you call "mainstream" providers provide tested, evidence-based medicine. Certainly there are some who provide both, but they should probably know better.
    - carbocation 13y ago
      > What you call "mainstream" providers provide tested, evidence-based medicine. I think there is more nuance than that. Modern medicine is a mix of things that people have been doing for a long time and things that newer that are proven to work in randomized, controlled trials (for certain values of "work"). The things we've been doing for a long time might not work. An important difference between the field of modern medicine and the field of alternative medicine, in my biased view, is that modern medicine actively attempts to figure out what works based on evidence, and evidence hugely changes practice and standards of care. In contrast, I do not believe that the same is equally true in general in alternative medicine, at least not with well designed studies.
gone35 13y ago
Evidence-based medicine. As opposed to what, speculation-based medicine? Call me old-fashioned, but shouldn't all modern medicine be 'evidence-based' by definition??
- Crito 13y ago
  > As opposed to what, speculation-based medicine? Well, yes. The idea is that "speculation-based medicine" (better known as "alternative medicine") is, despite the name, not actually medicine. Hence the Tim Minchin joke: "You know what they call alternative medicine that's been proved to work? ...Medicine."
  - dllthomas 13y ago
    I wasn't under the impression that alternative medicine was the only thing that was not "evidenced based" - that while clearly it's an extreme example, there is plenty of traditional medicine that doesn't make the cut. Wikipedia seems, at a skim, to concur: http://en.wikipedia.org/wiki/Evidence-based_medicine http://en.wikipedia.org/wiki/Evidence-based_medicine
    - Crito 13y ago
      Evidence-based techniques can become discredited when the state of the science advances, and I would agree that those techniques would not then become "alternative medicine"... unless perhaps they remain in practice. Unless somebody is still doing it, I'd just call it "discredited". Things like psychoanalysis do not typically get the "alternative medicine" label, but they probably should.
- fishtoaster 13y ago
  You'd think so, wouldn't you? However: http://en.wikipedia.org/wiki/Alternative_medicine http://en.wikipedia.org/wiki/Alternative_medicine
- mturmon 13y ago
  I don't know, there are plenty of cases where the stuff we thought qualified as "evidence", and definitely turned into medical practice, turned out to be wrong. Examples: stress causing ulcers, cough medicine for children, diet (carbs good or bad? cholesterol horrible or inconsequential?), prostate cancer screening, certain kinds of corrective surgeries.
Intermernet 13y ago
Firstly I find it amazing that people would argue against "Evidence Based Medicine" at all. Isn't the alternative "Medicine without a shred of evidence that it works"? Why would that even deserve the name "medicine"? Secondly, I find it scary that there is so much tip-toeing around charlatans selling snake oil. It seems similar to when the British Chiropractic Society sued Simon Singh [1] for libel, and then had to back down as they couldn't actually prove that chiropracty was at all based on scientific evidence. These scammers need to be called out and challenged. If you want to sell something as "medicine" (at least in the USA) it had better get FDA approval [2], and classification as a "drug". Although this approval process still leaves the onus for testing on the drug developer, it also provides a means for FDA dis-approval if the drug is subsequently found to be dangerous or ineffective. Not perfect, but better than nothing. I really feel that science and evidence are losing in this battle due to the lack of PR and marketing. Last year saw the release of a few major studies showing the lack of strong evidence for the efficacy of multivitamins [3]. This hasn't stopped almost everyone I know from still buying and popping those pills all the time. [1]: http://en.wikipedia.org/wiki/BCA_v._Singh http://en.wikipedia.org/wiki/BCA_v._Singh [2]: http://www.fda.gov/Drugs/DevelopmentApprovalProcess/HowDrugsareDevelopedandApproved/default.htm http://www.fda.gov/Drugs/DevelopmentApprovalProcess/HowDrugs... [3]: http://www.medicaldaily.com/vitamins-and-supplements-waste-your-money-physicians-say-265176 http://www.medicaldaily.com/vitamins-and-supplements-waste-y...
- glenra 13y ago
  > Firstly I find it amazing that people would argue against "Evidence Based Medicine" at all. Isn't the alternative "Medicine without a shred of evidence that it works"? You're reading too much into the name. Suppose I discover that whenever I eat carrots I get a horrible rash the next day. I track it carefully and find the effect is 100% reproducible. Eat carrots for a week, have a rash for a week; stop eating carrots for a week, it goes away. Eat them again, it comes right back. I cycle several times, the effect persists. That is pretty powerful evidence that the right medicine for my rash is to avoid eating carrots. But this sort of knowledge doesn't count as "evidence" under EBM because it wasn't part of a massive random controlled trial. And it never COULD count as evidence under EBM because nobody can profit by the advice "stop eating carrots" enough for it to be worth doing a massive placebo-controlled random trial - "not eating carrots" can't be patented. So long as FDA-type drug tests are ridiculously expensive, there is bound to be a LOT of perfectly valid medicine that IS evidence-based - there's evidence for it - but doesn't count as "evidence based medicine" according to the EBM enthusiasts.

45 points by tokenadult 13y ago

Doctors are niggers. If you don't do calculus, yer a nigger. God says... You_fix_it pet game_over bad what's_up I_donno well_I_never God says... engage instruction Frenzied dangerous fled woman-servant hurting worshipped discern advices overcast destroy ceasing solaces stir believe- second gnawed

thrush 13y ago

It would be nice if we had some sort of independent research verification system. Basically a group or individual that validates the most important (or highest paying) publications.

nocoment 13y ago
I still don't understand why a consortium of insurance companies doesn't run studies looking for better outcomes with out-of-patent and un-patented drugs. Their tests would be of already approved drugs. In many situations they could save a bundle and in others they would dissuade drug companies from pushing the advertising and costs. The statistics on everything they test would show their general level of bias (assuming drugs aren't getting any worse.)
- Mz 13y ago
  Um, no offense, but do you have any idea what insurance companies are really all about? That sounds, well, crazy to me (as someone with a) a serious medical condition and b) who used to work for an insurance company).
- glomph 13y ago
  Because if treatment gets cheaper they have less business?
- ensignavenger 13y ago
  Many insurance companies (I think that now perhaps all of them in the US, thanks to ObamaCare) have to pay out a certain percent of what they take in to health providers. Thus if they want to increase premiums, and therefore profits, the only way to do it is to increase the cost of care. Preferably, they increase the cost of care for everyone, which drives more people to buy insurance, and means that some other company isn't able to undercut them on premiums by reducing costs. Of course, they als get more float, which insurance companies love. That is the model that health care insurance companies follow, and ObamaCare was a huge gift to helping them out.
shimms 13y ago
We do - cochrane reviews (http://www.cochrane.org http://www.cochrane.org). From their about us page: "Cochrane is a global independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making the vast amounts of evidence generated through research useful for informing decisions about health. We are a not-for-profit organisation with collaborators from over 120 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest."

benched 13y ago

Terry, why do you regularly use racially charged language? I understand your meaning fine, I'm just curious whether there's any specific reason you use racial language so much, or if it's just sort of one of your things.

tokenadult 13y ago
Did you put this comment in the wrong thread? There is no one named Terry here (the author of the submitted article is Steven Novella). It doesn't look like you read the article that was submitted to open this thread before you typed your comment here.
- anonymoushn 13y ago
  benched is replying to TempleOSV2, who is hellbanned.
Crito 13y ago
I don't think that he is well; I wouldn't read to much into it.
- benched 13y ago
  I understand that he has schizophrenia, but they're people with thoughts and reasoning, too, though they may be more loosely aligned with the consensus style of cognition. For example, the statement he made makes perfect sense semantically - it's just said in a way that a lot of people find offensive.
BlackDeath3 13y ago
>I understand your meaning fine You do?
- Crito 13y ago
  I thought the overall meaning was clear, no matter how poorly stated: "Doctors do not do calculus" -> "medicine is not a hard science" "People who are not in hard sciences should not be trusted" Then he has the output of a markov chain or whatever that he seeded with biblical texts. You can safely ignore those sections. Basically (racist language aside), his comment boils down to "Anyone who isn't STEM sucks." It would be an extremely low-quality comment even if it were articulated well.

jostmey 13y ago

I am torn. On the one hand I firmly believe that medicine should be evidence based. Treatments should be based on the best possible scientific evidence. Inevitably, such evidence will rely on large, randomized controlled clinical trials... On the other hand, I take it as my own personal responsibility to take care of my own health. This means that I have to rely on a sample size of one. If I try something, and I feel better then I try more of it. My prescription for myself may not work for anyone else, it could be specific to me. I personally believe that Western medicine is awesome because it is evidence based. At the same time, Western medicine has removed from the individual a sense of personal responsibility, and this must change.

icebraining 13y ago
Well, Eric Topol[1] argues that evidence-based medicine, coupled with copious amounts of data and better tools, will allow treatments to be much more individualized, not less. [1] http://www.scripps.edu/research/faculty/topol http://www.scripps.edu/research/faculty/topol http://www.econtalk.org/archives/2013/04/topol_on_the_cr.html http://www.econtalk.org/archives/2013/04/topol_on_the_cr.htm... http://www.amazon.com/Creative-Destruction-Medicine-Digital-Revolution/dp/0465025501/ http://www.amazon.com/Creative-Destruction-Medicine-Digital-...
Crito 13y ago
IMHO, the problem with "alternative medicine" is less what adults do (or do not do) to themselves, and more with what adults do to children that they have been entrusted with. Thankfully there has been progress in recent years on this front, with adults who neglected to seek evidence-based medicine for the children that they were entrusted with being charged with homicide (http://en.wikipedia.org/wiki/Kara_Neumann_case http://en.wikipedia.org/wiki/Kara_Neumann_case). There is more progress to be made however.
npsimons 13y ago
Western medicine has removed from the individual a sense of personal responsibility, and this must change. I must heartily disagree. Well, perhaps not so much disagree as clarify: Western medicine as it is practiced, perhaps discourages personal responsibility (and how many times would you tell patients to eat better and exercise more if they never did?). Evidence based medicine is just that: based on evidence. There's no "removal" of personal responsibility, there are simply facts, as in your case you have brilliantly demonstrated: when something works for you, you continue to use it. My immediate reaction to "trying something" that you mentioned, however was "how many things did you try?" How many people won't research different options, much less put them into practice, simply because it would require them to try something different, or something hard (like exercise)? How many people would rather take some snake-oil to lose weight than eat less and exercise more? How many people will refuse vaccines because they believe it's a government conspiracy? And let's not forget all the other confounding factors, such as big pharma with 85+% of their money dedicated to marketing, or the placebo affect, etc, etc.

gress 13y ago

The problem is not with the concepts of SBM and EBM but with the fact that they are not understood and applied well by doctors, and often just translate into not being able to think beyond 'results' handed down from the establishment.

aaronem 13y ago

"Do you know what they call 'alternative medicine' that's been proved to work? Medicine." (from http://www.altairiv.net/Storm.html http://www.altairiv.net/Storm.html)

glomph 13y ago
This quip really annoys me. It only seems true because of a confusion or blurring of two very distinct concepts. There is tested treatment, which has been tested and come out effective. This can be put in dichotomy with untested or failed treatment. That is logical. Some treatments have been tested and passed some haven't. This is an entirely different dichotomy to that of mainstream and alternative or complementary medicine. Many forms of medicine have been thoroughly tested and come out effective and are not offered by pharmacies and national health services. Unless you want to claim that absolutely all proven effective treatment is offered by mainstream medical providers then this has to be acknowledged. Then on the other side there is a large array of medicine that is provided by mainstream medical providers that has not been proven effective. Many antidepressants consistently score the same or worse than a placebo in blind tests. The distinction between alternative medicine and mainstream medicine is not proof, but the provider. So while Minchin may be eloquent he is confusing terms to make his point.
- reverius42 13y ago
  The difference is not in the provider, but in what is being provided. Alternative providers provide alternative medicine. What you call "mainstream" providers provide tested, evidence-based medicine. Certainly there are some who provide both, but they should probably know better.
  - carbocation 13y ago
    > What you call "mainstream" providers provide tested, evidence-based medicine. I think there is more nuance than that. Modern medicine is a mix of things that people have been doing for a long time and things that newer that are proven to work in randomized, controlled trials (for certain values of "work"). The things we've been doing for a long time might not work. An important difference between the field of modern medicine and the field of alternative medicine, in my biased view, is that modern medicine actively attempts to figure out what works based on evidence, and evidence hugely changes practice and standards of care. In contrast, I do not believe that the same is equally true in general in alternative medicine, at least not with well designed studies.

gone35 13y ago

Evidence-based medicine. As opposed to what, speculation-based medicine? Call me old-fashioned, but shouldn't all modern medicine be 'evidence-based' by definition??

Crito 13y ago
> As opposed to what, speculation-based medicine? Well, yes. The idea is that "speculation-based medicine" (better known as "alternative medicine") is, despite the name, not actually medicine. Hence the Tim Minchin joke: "You know what they call alternative medicine that's been proved to work? ...Medicine."
- dllthomas 13y ago
  I wasn't under the impression that alternative medicine was the only thing that was not "evidenced based" - that while clearly it's an extreme example, there is plenty of traditional medicine that doesn't make the cut. Wikipedia seems, at a skim, to concur: http://en.wikipedia.org/wiki/Evidence-based_medicine http://en.wikipedia.org/wiki/Evidence-based_medicine
  - Crito 13y ago
    Evidence-based techniques can become discredited when the state of the science advances, and I would agree that those techniques would not then become "alternative medicine"... unless perhaps they remain in practice. Unless somebody is still doing it, I'd just call it "discredited". Things like psychoanalysis do not typically get the "alternative medicine" label, but they probably should.
fishtoaster 13y ago
You'd think so, wouldn't you? However: http://en.wikipedia.org/wiki/Alternative_medicine http://en.wikipedia.org/wiki/Alternative_medicine
mturmon 13y ago
I don't know, there are plenty of cases where the stuff we thought qualified as "evidence", and definitely turned into medical practice, turned out to be wrong. Examples: stress causing ulcers, cough medicine for children, diet (carbs good or bad? cholesterol horrible or inconsequential?), prostate cancer screening, certain kinds of corrective surgeries.

Intermernet 13y ago

Firstly I find it amazing that people would argue against "Evidence Based Medicine" at all. Isn't the alternative "Medicine without a shred of evidence that it works"? Why would that even deserve the name "medicine"? Secondly, I find it scary that there is so much tip-toeing around charlatans selling snake oil. It seems similar to when the British Chiropractic Society sued Simon Singh [1] for libel, and then had to back down as they couldn't actually prove that chiropracty was at all based on scientific evidence. These scammers need to be called out and challenged. If you want to sell something as "medicine" (at least in the USA) it had better get FDA approval [2], and classification as a "drug". Although this approval process still leaves the onus for testing on the drug developer, it also provides a means for FDA dis-approval if the drug is subsequently found to be dangerous or ineffective. Not perfect, but better than nothing. I really feel that science and evidence are losing in this battle due to the lack of PR and marketing. Last year saw the release of a few major studies showing the lack of strong evidence for the efficacy of multivitamins [3]. This hasn't stopped almost everyone I know from still buying and popping those pills all the time. [1]: http://en.wikipedia.org/wiki/BCA_v._Singh http://en.wikipedia.org/wiki/BCA_v._Singh [2]: http://www.fda.gov/Drugs/DevelopmentApprovalProcess/HowDrugsareDevelopedandApproved/default.htm http://www.fda.gov/Drugs/DevelopmentApprovalProcess/HowDrugs... [3]: http://www.medicaldaily.com/vitamins-and-supplements-waste-your-money-physicians-say-265176 http://www.medicaldaily.com/vitamins-and-supplements-waste-y...

glenra 13y ago
> Firstly I find it amazing that people would argue against "Evidence Based Medicine" at all. Isn't the alternative "Medicine without a shred of evidence that it works"? You're reading too much into the name. Suppose I discover that whenever I eat carrots I get a horrible rash the next day. I track it carefully and find the effect is 100% reproducible. Eat carrots for a week, have a rash for a week; stop eating carrots for a week, it goes away. Eat them again, it comes right back. I cycle several times, the effect persists. That is pretty powerful evidence that the right medicine for my rash is to avoid eating carrots. But this sort of knowledge doesn't count as "evidence" under EBM because it wasn't part of a massive random controlled trial. And it never COULD count as evidence under EBM because nobody can profit by the advice "stop eating carrots" enough for it to be worth doing a massive placebo-controlled random trial - "not eating carrots" can't be patented. So long as FDA-type drug tests are ridiculously expensive, there is bound to be a LOT of perfectly valid medicine that IS evidence-based - there's evidence for it - but doesn't count as "evidence based medicine" according to the EBM enthusiasts.