Meta-Research Debunks Medical Study Findings 261
jenningsthecat writes "From The Atlantic comes the story of John Ioannidis and his team of meta-researchers, who have studied the overall state of medical research and found it dangerously and widely lacking in trustworthiness. Even after filtering out the journalistic frippery and hyperbole, the story is pretty disturbing. Some points made in the article: even the most respected, widely accepted, peer-reviewed medical studies are all-too-often deeply flawed or outright wrong; when an error is brought to light and the conclusions publicly refuted, the erroneous conclusions often persist and are cited as valid for years, or even decades; scientists and researchers themselves regard peer review as providing 'only a minimal assurance of quality'; and these shortcomings apply to medical research across the board, not just to blatantly self-serving pharmaceutical industry studies. The article concludes by saying, 'Science is a noble endeavor, but it's also a low-yield endeavor ... I'm not sure that more than a very small percentage of medical research is ever likely to lead to major improvements in clinical outcomes and quality of life.' I've always been somewhat suspicious of research findings, but before this article I had no idea just how prevalent untrustworthy results were."
For example (Score:3, Insightful)
That fat in your diet is bad for you.
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There is fat in diet?
Good thing I drink Coke Zero instead of Diet Coke!
Re:For example (Score:5, Informative)
That's one of my favorites... or the presumption that eating fat makes you fat.
People seriously do not understand nutrition or how diet and exercise work. Lately, I have been doing an kind of experiment for the people around me. First, for about a month or more, I started riding my bicycle to work. I was working it hard. Then, after it was established that I had been riding my bike for at least a month, I started on a low-carb diet. Within two weeks people started to notice the weight loss. Some still wanted to believe it was the bicycle riding. I had to lay it out to them what the deal was. Exercise burns carbs and then fat. Trouble is, the carbs we take in our daily diet still outnumbers that which I burn from riding 10 miles each day. It is only after I limited the intake of carbs that a difference could be made and observed.
Here's why I did it like this:
People don't listen for more than a few sentences and are especially resistant when the information conflicts with what they think they know. Eating fatty meats is contrary to their beliefs about what a weight loss program should contain so they simply refused to accept it. Hell, even many doctors don't yet fully acknowledge that making your body burn fat will reduce cholesterol. (Hello? cholesterol is fat floating in the blood!)
Having lost almost 30 lbs in a 6 week period has been noticed by all and the evidence is right in front of their faces. I lost the weight, and this is what I have been eating.
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Do some reading in the Paleo and low carb communities, there is no data that exercise leads to weight loss (it is good for health reasons, etc, but it will not make you thin). Unless you really want the goal (winning aerobic fitness based events, ie tour de france or just a marathon), high output aerobics seems to be harmful (check out Mark's Daily Apple, he made his living in that world for two decades).
Low output aerobics, occasional max effort work, seems to be what people are made for. The Army has move
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Eating fatty meats is contrary to their beliefs about what a weight loss program should contain so they simply refused to accept it.
At least in the Military pretty much EVERYBODY is aware of low-carb diets, especially Atkins.
What I hate is the amount of No Fat/Sugar products out there. I have nothing against fat or sugar. I like fats and sugars. What I want is LESS of them, or at least more bulk in proportion. I want reduced calorie stuff that tastes 90% as good as the 'real deal' more than 'no calorie' stuff that's 50% as tasty.
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Eating fat is still unhealthy as animals store up what they eat in it and if they get fed chemicals, antibiotics and dioxins (which a lot of mass-farmed animals like chickens do get a lot off) that ends up in their fat and intestines. However, you are right that a balanced diet and exercise will work off most of your extra pouches even if you do end up eating a baked potato and steak dinner without trimming the fat or excluding the beer, cream cheese and bacon bits (which is delicious imho).
I recently start
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First, for about a month or more, I started riding my bicycle to work.
Then, after it was established that I had been riding my bike for at least a month, I started on a low-carb diet.
Here's why I did it like this:
People don't listen for more than a few sentences and are especially resistant when the information conflicts with what they think they know.
So, I have to ask...
Why didn't you do it in the reverse order? Low-Carb first.
They see you on the bike. Then they see you slimmer. They don't watch what you eat. They just attribute it all to the bike.
You could have skipped the bike, or delayed it till WELL after weight loss of the low-carb. The point would have been without the providing yet another opportunity for people to jump to the wrong conclusion. They probably attribute it ALL to the bike riding finally taking affect.
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That would be contrary to my point and purpose. There are a lot of people at my office who are overweight. It isn't enough to tell them they are eating wrong. I have to show them. Exercise alone didn't do the trick. It was the change in diet. By doing the exercise thing first and then the diet, I could show that one is clearly more effective than the other.
I really want people to change what they do. The only way I can really do it is by example. I am not a charismatic speaker... no one wants to lis
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Then you needed to eat fewer calories, and not just from carbs. Low carb diets work only when caloric intake decreases. (If you consume 3000 calories of fat and protein and burn 2000 calories, just what do you think happens to that other 1000 calories?)
In fact, people can lose weight on either low carb (preferable a vegetarian low carb [unreasonable.org], if one doesn't want to
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I wish that were the case... I actually still eat like a pig. Big steaks, burger, pork, eggs, cheese... lotsa heavy and often creasy stuff. (Burger wraps are AWESOME... finding low-carb tortillas is surprisingly difficult though)
You have to accept that the body metabolizes carbohydrates and other calories in completely different ways. It's far from pseudoscience. It's a basic knowledge that we all already knew. "What is fat? Stored Energy!" We all know this. How do you get the body to use it? Reduc
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You have to accept that the body metabolizes carbohydrates and other calories in completely different ways. It's far from pseudoscience. It's a basic knowledge that we all already knew.
Um, no. Do yourself a favor and listen to the man. You're spitting out pseudo-scientific nonsense that's been fed to you by like-minded people who also have no clue what they're talking about. The only thing that matters as far as weight is concerned is calories in versus calories out.
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That's a gross oversimplification of a complicated process. The 1st law of thermodynamics isn't useful when considering factors like hunger, satiation, fat mobilization and storage, basal metabolic rate. Yes, you can override the internal wiring that regulates energy intake and use that simple equation, but it's kind of like telling someone building an airplane that all that matters is F=M*A. It's not all that helpful.
Re:For example (Score:5, Informative)
"Reduce the primary source of fuel so that it will use the secondary source of fuel. It's really that simple."
No, it isn't.
The (almost) only direct source of "fuel" for the organism is sugar (glucose), full stop*1.
Anything else the body ingests or stores has to be reduced to sugar (usually by means of the krebs cycle) prior to be "burned".
While this is a very basic simplification, this, and the fact that the blood can carry a limited level of sugar at a time, is what explains, at a whole body level, everything else.
Like...:
* Since you can only burn sugar, sugar-equivalent contents is all that counts for weight imballance (of course, within limits: you can't just stop your ingestion of, say, oligoelements). That's what we really talk about when we talk about food calories.
* If you directly eat sugar (glucose), the sugar will be immediatly burn, but since your blood has limited sugar carriage capacity, you should be continously eating like a hummingbird to sustain that, so you usually just can't eat sugar in excess.
* If you eat carbs, they'll be transformed into sugar and burned. Any carb in excess will be stored as glucogen in your liver. If there's still carbs in excess once your liver can't hold any more glucogen, it will be transformed into fat and stored under your skin.
* If you eat fat, it will be transformed into sugar and burned. Any fat in excess will be stored under your skin unless you are so low in glucogen (which usually won't happen) that part of the fat is transformed into glucogen and stored in the liver.
* If you eat proteins, they'll be used for structural development (like muscle mass). Usually, anything in excess will be trashed away, unless you are very low in sugar, carbs and fat intake (it usually doesn't happen) in which case, it will be uneffitiently transformed into sugar and then, burned.
* To explain for long term weigth, all that's needed is accounting for your ballance between ingested calories and burned calories: if you eat more calories than you burn, your weight increases; if you eat less, you lose weight.
For a practical example:
If you eat less carbs and more fat to the point that daily calories stay the same, You Will Not Lose Weight (but in the long run you will develop cardiovascular illness).
If you eat less carbs and more proteins to the point that daily calories stay the same, You Will Not Lose Weight (but in the long run you will destroy your liver).
Given the ballance between ingress and burn, you can obviously go two (complimentary) routes:
1) Eat less calories. Sustaining a varied and ballanced diet, only eating less, is the way any sensible nutritionist will suggest since it's the easiest to do properly long term and the easiest to lead to you changing your habits. But as long as you stay to the First Principle "eat less calories", and within sensible limits, you will get it right.
2) Burn more calories. That's where exercise and rising your basal metabolism come into account. Aerobic exercise is an obvious recomendation, but other less obvious things like lowering your home thermostat 3~4 degrees in winter will have it's effect too. Again, it's not what you do, but what you achieve with regards of burned calories.
Everything else about diets is about making acceptable for you to eat less calories/burn more calories (like, unless you are a kind of iron-man you won't have the will for strengh training like weight lifting unless you go heavy on sugars; the same with aerobics, like long distance running or bycicling unless you go heavy on carbohidrates, or you'll probably break your diet if you are just told "eat exactly the same as you did, only on third the quantities", so you are offered a diet with much less calories but about the same or even more volume so you feel satiated, or you'll probably will abandon a diet if you don't see fast results at least at the beginning, so you are offered a diet very low in calories for the first weeks so you fastly see your efforts are
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The only thing that reliably results in weight loss is lower intake of calories. Low-carb diets do this because most of our intake of calories is via carbs. It's not rocket science, and it's not easy, a lot of the time. "Low carb" diets are actually just "eat less" diets....
Re:For example (Score:5, Interesting)
For a year and a half I tracked every ounce of food I ate, recorded it in software I wrote, meticulously recorded calories burned on exercise machines (this is the largest source of error, but I did my best to compensate) and found the following:
Graphing my actual weight and my projected weight using (start weight - ((2660 - calories eaten + calories exercised) / 3500) will never be more than 3 pounds apart, even over a weight change of over 100 lbs, regardless of whether my caloric intake was from a tub of Crisco or from cucumbers dipped in virgin blood. Conclusion: eat whatever the hell kind of food you want, just keep the calories low, your long-term weight change will be the same. But it's easier to eat fewer calories, in my experience, if you cut out carbs. They make me hungrier.
The +/- 3 pounds fluctuates based on when you last peed, how much you drank and when, and how much meat is sitting in your colon pending expulsion.
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Neither fat nor carbs are bad for you. It's the extreme exclusion of one or the other that is bad. You know vegetables, fruit and such are carbs, right?
Extremes work in the short term but long term your health will suffer.
This is the nutritionist line that comes up every time someone mentions a low card diet.
There are all the dread long term affects, never very specific, and always based on the assumption someone will stop eating carbs for the rest of their life, or never eat any carbs at all while on a low carb diet.
This just a perpetuation of the misunderstanding of the low carb diet. Yet its been proven in the Military, proven even by organizations that were vocal foes for years [cbsnews.com]. Every serious study [scientificamerican.com] has supported the low
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You will find that you go through plateau periods of limited to no loss. You just have to survive it and keep your spirits high. Riding the bicycle to keep my systems moving better, increasing circulation and your stamina just helps the body to process things easier and faster. I recently made a LONG road trip that would ordinarily have exhausted me. It didn't...not at all! The stamina from riding the bicycle has likely benefited me in that respect among others. I also do that for the purpose of setti
Re:For example (Score:4, Informative)
Not healthy, dude, and Ketosis is not your friend. In the short term, ok, you're probably not going to kill yourself. In the long term, you're going to burn lean muscle, including some important ones like, oh, I don't know ... the heart. And by "long term" I mean "you crossed the line 20 days ago". I suggest you stop. Being overweight may be bad for you, but starvation diets are far worse.
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Who decided to eat a lot of carbs? People who didn't sit on their ass all day and needed energy and couldn't afford lots of meat. Potatoes, bread, oatmeal ... staple diet for my parents when they were kids long before the 70s. If your parents ate a lot better it's probably because they were rich, not because they lived in a better age.
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I'm starting to think the very term 'Carbs' is meaningless from a health standpoint. Our digestive tracts are so long to handle the complex carbohydrates found in green vegetables and related sources - it is not required for the simple starches and sugars that are also lumped in together as carbs. You just said something that is technically true, but terribly misleading, in much the same way as showing nine homeless bums in the same room with Bill Gates, telling us what their average income is, and not givi
Reality check (Score:5, Insightful)
If medical research were really as close-to-useless as The Fine Summary claims, we'd be hardly better off with modern Western medicine than with homeopathy and prayer. Clearly, we are, refuting the idea that medical research doesn't do a huge amount of good. I'm not saying it isn't flawed, but give it some credit.
Re:Reality check (Score:4, Insightful)
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Well, there is reason to think the flu vaccine does nothing.
You are far less likely to die of the flu if you get it, but it seems equally effective at preventing accidental death, and all cause mortality, which makes it seem that it is compliance effect (that people who are good about taking what the doc gave them live longer, even if it is a placebo).
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Science is a noble endeavor, but it's also a low-yield endeavor ... I'm not sure that more than a very small percentage of medical research is ever likely to lead to major improvements in clinical outcomes and quality of life.
TFS seems to be suggesting there is no value in incremental knowledge. No, no you don't discover penicillin every day you go to the lab. But you usually achieve something that advances the state-of-the-art and the things that you learned from your predecessor(s).
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Right. Whether it's "low yield" is irrelevant. Brute forcing a password is "low yield" too -- only a very tiny percentage of times you try a password will it be the correct one.
Doesn't mean you won't get it eventually.
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Will one million monkeys with one million typewriters someday come up with the entire works of Shakespeare?
Or, less random: Would one million students working one million man-years have discovered with General Relativity?
How many students are needed to produce a total output in "knowledge generating power" to one Heisenberg and two Hawkings?
Can diligence replace genius?
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No, it can't, but it can certainly complement it.
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I think the implication is that "low-yield" generally means "unprofitable", so the honestly involved in the claimed results a scientific endeavor has a lot to do with how much profit is expected from said results.
Note that TFS says "major improvements", not "improvements". Pharma/Med companies generally only profit significantly from "major improvements".
If research were to uncover a drug that is 1% more effective in preventing hayfever than existing prescription meds, that would be an "improvement". Hard
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You ARE aware of the placebo effect, right? It is a BIG problem for big pharma ...
http://www.newscientist.com/article/mg18524911.600-13-things-that-do-not-make-sense.html [newscientist.com]
--
"The Inner Space (of Mind), not Outer Space is the FINAL frontier."
Re:Reality check (Score:5, Funny)
Over time I became immune to placebos, I now take Extra-Strength Placebos (liqui-gels). Twice the inert ingredients!
Re:Reality check (Score:4, Funny)
Over time I became immune to placebos, I now take Extra-Strength Placebos (liqui-gels). Twice the inert ingredients!
I only use homeopathic remedies.
Now with 1000x less inert ingredients!
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Idiot. Everyone knows that homeopathic placebos don't work as well as real placebos. They dilute them so much, there's no placebo left in them!
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After I overdosed by a trillion through not taking a pill, I stopped doing homeopathy.
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You ARE aware of the placebo effect, right?
I've always considered the Placebo Effect to be a good thing. If your mind affecting your biochemistry works as well as the actual drugs, that's less we need to give to people.
It is a BIG problem for big pharma ...
Oh. OH. Problem for big pharmaceutical companies. They don't want people to cure their ailments unless its going to cost em.
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Yeah, but what if they are being told over and over again by "alternative practicioners" that the medicine doesn't work, and has terrible side effects? That has a placebo effect, too.
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N it's not. What the article failed to mention is that in ALL cases, it's was temporary.
It never cures anything, and all objective tests show that..it's doesn't help. Subjectively it certainly does.
For example, lets say you have a stiff back and it hurts. So I test your movement. Things like, how fast can you get out of the chairs, how far can you bend, and so on. I give you a Obecalp. Pretty quickly you may start to feel less pain. But if you are tested, none of the range of motion increases.
Placebo is ab
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A lot of modern medicines are not better than older medicines.
They had a big push to replace metformin (1950's super cheap) diabetes drug with something new--- it was the new big thing until it wasn't.
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It is still used by 42 million people. I'm not sure why you think there was ever a big push to replace it.
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Because the new drug was supposed to be BETTER! New IMPROVED!
And patented.
And then it turned out that the new drug was no better than metformin.
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In further news, Meta-Meta-Research Debunks Meta-Research Study Findings...
Re:Reality check (Score:5, Interesting)
I skimmed TFA, and it's important to note that scientific base research (for new pills, procedures, etc.) is not the issue here. This is about studies, i.e. field testing of large numbers of patients, and the (wrong, causation != correlation, etc.) interpretations that are made public afterwards. Funny enough, until recently, criticising the official results of medical studies was seen as conspiracy theory by those in power in medical circles.
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You're suggesting a conspiracy of "those in power in medical circles"? Which people specifically? What criticism? Some criticism is conspiracy theory, some isn't. As far as I know, there is robust debate in 'medical circles' about much medical research, so certainly 'they' accept criticism, whoever they are.
Re:Reality check (Score:4, Interesting)
For example, I'm proposing a model of cognitive dysfunction in patients with Parkinson's disease (for my dissertation) that flies in the face of what most people who deal with Parkinson's disease believe is the case. My dissertation is not complete so I cannot say if my findings match my hypotheses but preliminary data are encouraging.
My point is that we have certain set beliefs about the way things are and some people (myself included) have a hard time challenging those beliefs. What I've seen is that many researchers don't actually follow the scientific method and so at the core, their research has methodological weaknesses.
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``If medical research were really as close-to-useless as The Fine Summary claims, we'd be hardly better off with modern Western medicine than with homeopathy and prayer. Clearly, we are''
Oh? I suspect you're right, but I do note that you said that without providing any support for your claim, let alone convincing study results. How, then, is it supposed to be _clear_ that we are better off?
This gets to the heart of the problem. It's easy to claim things, and many people will believe whatever it is you claim
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Sanitation has a far bigger impact. Even with no medical progress it would limit the spread of disease.
Re:Reality check (Score:5, Insightful)
If medical research were really as close-to-useless as The Fine Summary claims, we'd be hardly better off with modern Western medicine than with homeopathy and prayer.
True.
Top notch research is what makes all the medical breakthroughs, but this is only the top few percent of ALL medical research. IMHO one of the main reasons there are so much bogus papers out there is because of the publish or perish attitude in academia, which requires researchers to have a set number of papers published to be eligible for research funding, tenure, other career advancements. I know from experience (although not in medical research, but natural sciences) that sometimes you have to publish a paper even if you know that the results aren't meaningful, or of value to anyone. Then there are people who publish things that were not subjected to rigorous testing, double checking of data, etc. which can easily turn out to be wrong. Lastly there are the cheats. All I'm trying to say is that it's more of a science policy problem than a problem with the integrity of researchers. If the number of publications has to go up, then their quality will surely decrease. Very few research groups (the ones which have good funding) have the luxury of publishing only every now and then. But when they do it's usually a Science or Nature paper. This problem os quality VS quantity is most serious in China. [nature.com] However, not even journals such as Nature are immune to this. [nature.com]
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The summary is scaremongering; the article is more in depth and interesting. Basically it says that researchers need money in order to, you know, actually research Because they need money they need to receive grants. In order to get grants, they need their grant approved. In order to get approval, their research needs to show "promise". In order to increase the amount of "promise" in their research, they need to have flashy results.
All of these steps give a lot of reason for scientists to introduce bias int
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Certainly the Slashdot Summary is misleading and hyped, but that's SOP. Ho
well, that's actually mostly true (Score:2)
If medical research were really as close-to-useless as The Fine Summary claims, we'd be hardly better off with modern Western medicine than with homeopathy and prayer.
In fact, we aren't: medical research has added fairly little to our life expectancy. Most increase in life expectancy is due to improved public health, hygiene, quarantine, isolation, city planning, etc. Of course, there are some success stories: some vaccinations, antibiotics, some surgeries, but they represent a tiny fraction of all medica
Re:Reality check II (Score:2)
And exactly how are we to determine wether homeopathy or prayer doesn't work as well as the results found in medical journals / studies, if they are all flawed and biased in different sorts of ways.
I am glad I am not the only one who sighs every morning when reading a newspaper about some study claiming all sorts of stupid "facts" we:
A) already know about, ie. common sense. Example: Your hygiene may affect how many mating partners you may get, or some other ridiculously subjective and unnecessary study. Jus
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So when the quality of science today is so low, how can we REALLY know that prayer doesn't work (btw, lots of studies show that prayer DO work in many cases, ie. as a placebo effect or something similar), or homeopathy?
We can't prove a negative. Lots of studies funded by religious groups show that prayer does work in many cases. Lots of independent studies show that prayer has no effect whatsoever. Homeopathy studies have almost always shown no effect... one years old did show an effect, but you're go
Re:Reality check III (Score:2)
We can't prove a negative. Lots of studies funded by religious groups show that prayer does work in many cases. Lots of independent studies show that prayer has no effect whatsoever
Are you sure, or do you just relabel those positive findings to be "religious" and negative findings to be "independent". Honestly, I can see anyting sponsored by a following will of course have a bias in their results, however, maybe the "independent" studies are flawed in some ways also, and therefore unable to repeat the exper
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1. Emergency solutions: Setting bones, removing bullets, removing cancers
2. Proactive Prevention.
When it comes to Emergncy stuff, western medicine far outpaces homeopathy. You got a bullet in you? A surgeon can remove it.
This article is not about the emergency solutions, but about the proactive prevention. Those kind of things we are not demonstratable better at than homeopathy. That includes things like:Implanting stents (no none increase in
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In aggregate that seems like a very specious argument. SOMETHING has caused average lifespan to rise from circa 45 in 1900 to 75 today. The well known causes like chlorinated drinking water can only account for half of that.
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Are we? What's the evidence?
Most of the improved health we enjoy has more to do with sanitation and nutrition than medicine -- remember to say thanks to your plumber, your garbage collector, your farmer, and your grocer for that. Of the fraction that medicine makes, most of it is due to a handful of advances like vaccination and effective antibiotics (which we are now losing, partly due to faming practic
Research or the people? (Score:2, Flamebait)
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Everyone is different, both in terms of genetic makeup and environment, and that's going to mean that everyone has different reactions to just about anything.
Indeed. We get it drilled into our heads over and over that fat is bad for you, salt is bad for you, but not all of us sit at the top of the bell curve. I'm a naturally thin man whose blood pressure is either normal or low every time it's tested, so a low fat low salt diet is bad for me, while most people (in America anyway) are overweight and have hig
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The problem I think is the people doing the research and not the research itself. People can lie about the results, which happen far to often.
I think you've found the problem of every institution in the history of humanity, from governments to your Linux Users Group. People. They lie, act selfishly, do dumb things, become jealous and political, etc etc. But until we build the perfect robotic overlord, we're stuck with people running things.
The question is not, do the people do these things. The question is, does the institution work regardless.
It seems that, though flawed (shocking!), we benefit from medical research. Yes the information is impe
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People can be wrong, but I think out right lying isn't that common at all. You do see conclusion that don't match the data, often the people in the study don't realize it because of certain bias. Sometime people do outright lie. Andrew Wakefield springs to mind.
Both case are exactly why multiple studies need to be done, and peer review must be adhered to. It's also why when just a few studies counter consensus, you need to be extra careful when reading them. Sometime that find something, but usually they do
I'd comment on that scientific study ... (Score:2)
But the results are copyrighted and can't be used without a licensing fee.
Study shows (Score:4, Funny)
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It's not nice to confuse people like that.
Just like democracy.... (Score:3, Insightful)
... it's the most useless way to progress, except for all others.
Be a skeptic, but don't confuse skepticism with truthiness. Unfortunately, I expect a rise in the use of truthiness over science when people will investigate reality.
I couldn't get past the first paragraph (Score:3, Insightful)
In 2001, rumors were circulating in Greek hospitals that surgery residents, eager to rack up scalpel time, were falsely diagnosing hapless Albanian immigrants with appendicitis. At the University of Ioannina medical school’s teaching hospital, a newly minted doctor named Athina Tatsioni was discussing the rumors with colleagues when a professor who had overheard asked her if she’d like to try to prove whether they were true—he seemed to be almost daring her. She accepted the challenge and, with the professor’s and other colleagues’ help, eventually produced a formal study showing that, for whatever reason, the appendices removed from patients with Albanian names in six Greek hospitals were more than three times as likely to be perfectly healthy as those removed from patients with Greek names.
Okay - so I only bothered getting this far into TFA.
Now - I'm no medical junkie, I didnt' even take Bio in high school, but I have occaisonally watched Scrubs and House and ER and a bunch of other medical dramas from time to time.
One thing that always seems to surface in these TV shows is the patients history, like their religion, nationality, where they work, etc. This leads me to believe that maybe - JUST MAYBE - there is actually some correlation between something in the Albanian culture and society that has an increased chance of appendicitis, and that its entirely possible that this pushes doctors towards diagnosing that when some of the symptoms appear. (Not that this is particularily the best course of action, but what else would you do? Run every test?)
But at the same time I know how incredibly innaccurate a lot of television can be about portraying a subject. However, the IT Crowd has basically mimicked my life, but thats another story for another time. Anyways, so if I'm absolutely and completely wrong, feel free to mod me down - but I just thought I'd interject.
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Not likely, but I would say it warrants further studies.
It certainly doesn't prove it was done for more scalpel time.
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Logic comprehension:
Whether they were 3 times as likely to have them removed or whether they were 3 times as likely to be healthy is irrelevant: the fact is that they were removed under reasoning of Appendicitus, which means they had to have at least correlated to the symptoms of Appendicitus - when the appendix could have been naturally healthy is the claim they are making.
Essentially, all they are saying is that statistically it could have been something besides Appendicitus but because they were Albanian
Old news (Score:2)
We've known this for a while. Here's *how* they do it: http://www.guardian.co.uk/society/2003/dec/07/health.businessofresearch [guardian.co.uk]
Quack Attack (Score:5, Interesting)
The problem I know because I am (retired) RN. I went to my MD for a severe sinus infection and chest infection some years ago. During the visit I asked for Abuterol Inhailer to assist with clearing my chest. This is standard Respiratory Therapy stuff. They gave me a puffer which I took home, used 10 or 15 puffs out of and threw it in the drawer. Ever after that BCBC has me as Diagonsis Asthma. I am not asthmatic. This will screw up my healthcare for the rest of my life! Makeing all of these errored stupid databases cross link will do far worse than this. My daughter (age 23) was emergency taken to the local hospital with what appeared to be an Epileptic Seizure. Consequences included she couldn't drive for 6 months! I will skip the details, her seizure was a cardiac seizure. It took her actually taking her case to the local Fire Department to get a heart monitor strip to make this undeniable. She is now treated well but forever she will be DX Epileptic even though it is completely wrong. Does any sane person want this sort of a system where you cannot go to another doctor and have him/her look at you rather than some record first? Who wants in that trap? If you are an MD in that trap even if you see that the record is wrong, you can go to jail, lose your job etc all if you go against this insane record that is completely in error. Please wake up people this is a prison without walls! You cannot escape! You will have to leave the country to get away from a bad diagnosis or a stupid keystroke error. Remember the computers have a forever memory and no intelligence.
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Anytime a re
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Anytime a record follows a person there needs to be some form of error checking involved and the ability to fix it.
And on the electronic patient medical record system I worked on a decade ago (which was roughly 20 years old then) had not only the ability to change/correct, but also keep an audit trail of any revisions, so malicious or competing edits (think Wikipedia editing wars) could at least be logged.
This study may be misleading, too (Score:2)
"I'm not sure that more than a very small percentage of medical research is ever likely to lead to major improvements in clinical outcomes and quality of life."
I'm not surprised that this is true even of well-conducted research and well-written papers. How many baby steps had to be taken between the discovery of a disease and development of a way to cure it or control it? Every one of those baby steps would be a paper that had no real effect on clinical outcomes.
As far as I can see, the most import
These are well known problems (Score:5, Interesting)
I don't want to discount the value of the study itself. Clearly it's important to quantify how bad the problem is and try to develop solutions. But at the same time, the article and summary might give one the impression that the errors and biases involved were newly discovered by the researchers. A few examples:
The secondary marker problem (e.g. tracking cholesterol levels instead of real outcomes like deaths)
Comparing new drugs only to placebo or only to drugs that aren't best-in-class or using an intentionally weak dose of the comparison drug
Using meta-analysis of other studies instead of doing new research (and often doing it badly)
Doing retrospective analyses like chart reviews instead of prospective studies (and often doing those badly)
To expand upon that last example: common problems with the methodology of chart review studies were investigated thoroughly by Gilbert and Lowenstein in 1996 [nih.gov]. Despite their findings and recommendations for how to do a chart review properly, things haven't improved much since.
Many doctors and researchers have been critiquing studies and warning about these problems for years. In the emergency medicine context, for example, Jerome Hoffman, a UCLA medical professor and emergency department physician, is well known as a critic of poorly designed studies in the emergency medicine literature. He has critically reviewed studies since 1977 as part of a continuing medical education program called Emergency Medical Abstracts [ccme.org].
So the problems are well known. The bigger issue is how to fix them.
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What? Doctors have to be convinced to follow evidence-based medicine? What were they practicing before? And why are they against it?
You know, there's never been a randomized control trial of the effectiveness of parachutes versus placebo when jumping out of planes at high altitude. Would you care to volunteer?
Some things are just obvious or can be deduced from retrospective analysis or theoretical modeling. And some times it would be unethical or impractical to conduct a randomized control trial of a trea
Don't get Vaccinated (Score:2)
So which shot is "the autism shot" you could probably ask 10 moms and 5 would tell you "MMR", even though the whole thing is obvious fraud horseshit.
I have no idea why "information" is perpetuated so quickly but "rebuttal" is so slow.
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Please don't make light of Autism. It is deeply insensitive. You might try being positive instead. Find the cure, and enjoy your instant celebrity. But beating up on people searching for answers, for no other reason than to look cool in front of your peers, is just plain evil. Jenny McCarthy didn't ask for an Autistic child, but she got one anyway, and she's coping with that. Why on earth would you choose to make that harder than it already is? Your passions could be towards assisting the people unde
If there was a better way, I'd be all for it (Score:2)
Science is a noble endeavor, but it's also a low-yield endeavor
This may be true, but it is the ONLY reliable yielding endeavor. Everything else that works, can't prove it works. If you could prove it, it would be science.
Science is like democracy. It's the worse system there is, except for all the other systems.
Then we shouldn't trust these researchers either? (Score:2)
Why should I trust the researchers in TFA? Oh ... I see ... they have the truth.
The Real Shocker (Score:2)
... is it took a meta review to bring this forward. What do you think will happen when University research funding sources are corporations with very specific short term interests?
The social phenomena described is quite common. People in general trust the messages coming from some sources more than others. Being high on the trust ladder is what Marketing people are hoping to achieve with their efforts. My favorite example in the "trust the messenger" department is Microsoft. How many times over how many
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I'm not shocked at all. If you doubt that there is any semblance of trust left in modern science, I invite you to openly doubt AGW. Try it on slashdot the next time a news topic comes around. Make a sockpuppet so your Karma survives, but give it a try. Challenge people to cite their sources, show you the data, and eliminate any competing conclusions. You'll be burned as a heretic. The actual scientists, as opposed to we amateurs here, do the exact same thing in the exact same way.
People are as people
Meta-researchers (Score:3, Interesting)
Why I don't doubt that some good critical thinking, and legitimate questioning come from these meta-research studies, I fear that the process is ripe for abuse, as basically being so awash in data (information overload) that given enough data you can pick and choose to fit your a priori or posteriori hypothesis.
I applaud the increased scrutiny of statistical analysis, which is truly difficult to administer on even the best designed and controlled biological and medical studies, where you have very little "total control" of the experimental subjects - damn ethics committees on testing human subjects, and using double blind testing is the best you can do to eliminate bias, yet may mask discovery of experimental flaws during the testing phase. Things go "wonky" in strange ways, for example testing a heart medication, and a freak snowstorm skews all the results because of the rise of heart attacks from the increase in shovelling. We can't legally put 1000s of humans in vats for 10-20 years to test everything, and computational models are primitive and only address what the model is designed to look for, while most medical testing focuses on the unexpected results and effects that may only appear in a small fraction of society, yet if the consequences are dire, it can kill an entire potentially life-saving product.
I fear that the "undergrad social science" approach of meta-study research will make the approach stained with a reputation of people who want to "do science", but without the messy get-your-hands-dirty that costs money (an increasingly mythical subatomic particle in most fields of science and labs around the world) and just do a PR-style re-spin (think: re-branding) of the results of multiple similar but different experiments to reach a conclusion that was not considered by the original experimenters, so whom may not include appropriate experimental controls to minimize draw incorrect conclusions from this re-interpretation of the experimental data. Of if they are really lazy (like social science elective takers), draw conclusions from a compilation of results, and not even bother looking at the original (raw or filtered) data at all. I guess I'm trying to say that there is limited latitude for re-interpreting data for anything beyond what the experiment was designed to test. It can be very useful for detecting and thwarting bad or biased experiments, but as far as I know, it cannot produce trustworthy results from bad experiments.
I'm going to stop... (Score:2)
Alright, I'm going to stop trusting scientific studies - starting with this one.
newsflash! (Score:2)
This is a bit like finding out politicians lie during campaigns.
I will often ask new grad students in my lab to try and find a new journal article that will never be superceded by future research. This is, of course, a nearly impossible task. Scientific publications are all a work in progress and represent one group's current understanding of some experiment. In physics (my field), this is all a nice scholarly activity and something that everyone knows and understands at some level. Einstein corrected N
Re:newsflash! or why no followup study (Score:2, Interesting)
It is rare for any medical journal to publish negative results, and yet that is precisely what we need to advance science.
Both positive results - and the failures that prove they were flawed. But journals only publish the former, not the latter.
I see your problem right there: "Science" (Score:5, Interesting)
Doctors are notoriously bad at doing scientific investigations, and since peer review journals are reviewed by peers, they don't know bad science when they see it.
I've been arguing with my father about this for... what, fifteen years?!? He subscribes to the New England Journal of Medicine and is forever telling me about the latest study telling you to that standing on one leg reduces breast cancer in nuns. These studies are, without fail, trivial to eviscerate as their control groups are either non-existent or very poorly picked.
Doctors just don't know much about science. That shouldn't be surprising. They have terrible educations. After all, they studied premed in college and then went to a vocational school. MD/PhDs really ought to do better, but I suspect they do their doctoral work with faculty who come from the same under-educated group.
The problem is one of prestige. You cannot walk into a group of doctors and tell them why they're dumbasses and what to change. They know, and society confirms for them, that they are the best educated people on the planet and smarter than anyone else. "Heck, just look at our paychecks," they might respond. "That proves it right there, doesn't it? Figure it out from that data point only -- you don't need a control group."
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"I just don't get what you are implying here. Do you think that Computer "scientists" are better scientists on average than doctors? because the answer is no."
No, computer scientist are not scientists at all.
Neither are doctors. Science classes generally don't prepare you for doing science. Chemistry, for example, most often does "experiments" in the lab which are actually demonstrations of observed phenomena. Stats classes do a far better job of preparing you to actually do science, but nothing prepares
Spinal Fusions and Hormone Replacement Therapy (Score:4, Interesting)
Don't do either without doing your own research.
I recently read a book called "How Doctors Think" by a Hematologist associated with Harvard. He went around interviewing the top doctors in the country about their cognitive fuck-ups and triumphs.
Serendipitously, along the way, some doctors were more than honest with him about medical dogma, being lazy in keeping up with research and how drug company money/gifts influence medical opinions.
Spinal fusions have no proven clinical benefit for reducing pain. At all. It has been known for a long time, but financial interests keep that procedure being done.
Hormone replacement therapy has been proven to be potentially dangerous ( cancer ,etc ) but with negligible benefit. Aside from middle aged women & estrogen, I'm sure you noticed the new commercials trying to convince aging men to supplement with testosterone.
It is natural for testosterone levels to gradually decrease as men age. Testosterone levels fluctuate often and hard. If a doctor tells you that you have below normal testosterone asked to be tested again. Get off of the things that lower testosterone ( ie alcohol ) and do the natural things that boost like hard exercise ( lift weights ) for a few weeks. Then get tested again.
Re:We've known this for years (Score:5, Funny)
I'd replace item C with regular fucking. Don't see the quacks, just fuck someone. Chiropractors are worthless and evil. Fucking is fucking AWESOME!
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you could fuck a chiropractor tho, just to be safe
Re:We've known this for years (Score:4, Funny)
I'm a firm believer in Homoeopathy. I don't believe in all of it though, just a homoeopathic proportion of its principles.
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Ask any Chiropractor, Naturopath or Homoeopath and they will all tell you the same thing: MODERN MEDICINE IS POISON
That's when you turn to another chiropractor, naturopath or homeopath, and discover *oh shocks*, that they have a different opinion! Hell, some of them even works WITH a doctor, a hospital or physician!
The flaw is in our mind: Our prejudices and secret biases. We think we don't reveal them, but they are revealed in everything we speak and do, and it limits our understanding of reality as it rea
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Homoeopathy. Heh. That's when you're just a little gay.
Actually, that should logically be when have the same problem as another person, but that's less funny.
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Ask any Chiropractor, Naturopath or Homoeopath and they will all tell you the same thing: MODERN MEDICINE IS POISON
Ask any pharmacist and they will say the same. It's the whole point of modern medicine: You introduce a poison into the human body that is more effective at killing off certain germs than it is at causing damage to the human body. Or, in other cases, you introduce a poison in such low dosages that it counters something unwanted (such as high blood pressure) without causing more harm than good.
If you want to argue that introducing any poison in any dosage is bad I'll remind you that even tap water is letha
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