Study Finds Nearly 400 Medical Devices, Procedures and Practices That Are Ineffective (sciencealert.com) 153
An anonymous reader quotes a report from ScienceAlert: A recent study has unearthed nearly 400 established treatments, devices and procedures that are no better than previous or lesser alternatives. [This is referred to as a "medical reversal" in the medical industry.] The findings are based on more than 15 years of randomized controlled trials, a type of research that aims to reduce bias when testing new treatments. Across 3,000 articles in three leading medical journals from the UK and the US, the authors found 396 reversals. While these were found in every medical discipline, cardiovascular disease was by far the most commonly represented category, at 20 percent; it was followed by preventative medicine and critical care.
Taken together, it appears that medication was the most common reversal at 33 percent; procedures came in second at 20 percent, and vitamins and supplements came in third at 13 percent. This line-up is unsurprising given the history of medical reversals that we do know about. In the late 20th century, for instance, sudden cardiac death was deemed a "world wide public health problem." Most cases were thought to arise from an irregular heart rhythm, and so a new generation of antiarrhythmic drugs were developed. "In the late 1980s, the Cardiac Antiarrhythmic Suppression Trial (CAST) was conducted to assess the safety of what was then commonplace. Interestingly, recruitment for the trial was hindered by physicians who refused to let patients undergo randomization with a 50 percent chance of not receiving these medications." In the end, however, the randomized trial found that the medication was even more deadly than a placebo. While not all of these medical reversals are deadly, they are all, by definition, useless expenses. The research has been published in the journal eLife.
Taken together, it appears that medication was the most common reversal at 33 percent; procedures came in second at 20 percent, and vitamins and supplements came in third at 13 percent. This line-up is unsurprising given the history of medical reversals that we do know about. In the late 20th century, for instance, sudden cardiac death was deemed a "world wide public health problem." Most cases were thought to arise from an irregular heart rhythm, and so a new generation of antiarrhythmic drugs were developed. "In the late 1980s, the Cardiac Antiarrhythmic Suppression Trial (CAST) was conducted to assess the safety of what was then commonplace. Interestingly, recruitment for the trial was hindered by physicians who refused to let patients undergo randomization with a 50 percent chance of not receiving these medications." In the end, however, the randomized trial found that the medication was even more deadly than a placebo. While not all of these medical reversals are deadly, they are all, by definition, useless expenses. The research has been published in the journal eLife.
But we have to have new drugs (Score:5, Insightful)
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It's not just the drugs. 20% of it are procedures.
And in all presented "Selected reversal summaries" it seems that the main reason behind the reversal is cost reduction.
And some of those are REALLY bad ideas.
Like the first one, where they "found no clinically important difference in the incidence of neonatal sepsis between women who birth immediately and those managed expectantly in PPROM prior to 37 weeks' gestation."
I.e. In case of a pre-labour rupture of the membranes close to term they've decided "to ju
Re:But we have to have new drugs (Score:4, Insightful)
You seem to be advocating doing the most possible number of tests, as frequently as possible.
Why not mammograms every 6 months? Every quarter? Monthly? Surely monthly diagnostic tests would find more early cancers than waiting for a yearly test.
You seem to be missing balancing the benefits against the cost, time, and false positives.
I can't tell you how many thousands of dollars I personally have had to pony up because a doctor went "test happy", chasing things that months later were summarized as "Oh, it's nothing. You're fine."
Now I refuse to go to a doctor unless absolutely necessary. I've had it with the endless tests.
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I can't tell you how many thousands of dollars I personally have had to pony up because a doctor went "test happy", chasing things that months later were summarized as "Oh, it's nothing. You're fine."
Now I refuse to go to a doctor unless absolutely necessary. I've had it with the endless tests.
I've found that my doctor has responded well to, "How much will that cost?"
This is the problem you're going to run into when it is normally someone else paying for you. Not ever stopping to consider the costs.
Re:But we have to have new drugs (Score:4, Insightful)
You appear to not understand uncertainty, or statistical methods of accounting for it.
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About that about that, can you point us to that study? I ask because unless you reversed the figures, it is the immediate birth group (intervention) that saw the 1% increase in morbidity and mortality vs. the expectant management arm (wait and see), which suggests that intervention does more harm than good.
Note also that the case of mammograms, false positives are not benign. In other words, while a few true positives might be missed by not doing the mammograms (not necessarily resulting in fatality), a gr
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Yeaaah... about that...
In this trial, participants assigned to the expectant management group did not have any worse outcomes regarding the primary outcomes of neonatal sepsis (2%; n = 924 in the immediate birth arm vs. 3%; n = 915 in the expectant management arm; RR = 0.8; 95% CI = 0.5-1.3; p=0.37) or neonatal morbidity and mortality (8% vs. 7%; p=0.32) than those assigned to immediate delivery, and had less respiratory distress (p=0.008) and need for mechanical ventilation (p=0.02).
That's a difference of 9 dead babies.
And they are not very certain of that count... like in around 37% of cases... it's more of a maybe than a baby.
But hey... what's a dozen or two dead babies here and there?
In your haste to rant you've conflated the figures for neonatal sepsis (infection) with neonatal morbidity (death). In addition, using these figures and your logic, the 'immediate birth' intervention is actually what causes an increase in the number of dead babies.
Rather more to the point, it appears awfully like you don't understand, or are very happy to misrepresent, confidence intervals. Similarly you give a very one sided view when it comes to testing: false positives matter!
Despite our best wishes, sin
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Yes... (Score:2, Interesting)
Doctors form beliefs about what works. The best of those beliefs are driven by research, but frequently they are driven by narrative because doctors are human. They believe plenty of things without evidence because those things make sense and/or are consistent with their training or experience. But that doesn't mean they're always right.
It does mean that they want their patients to do the thing they think will work.
So they don't want a patient assigned randomly.
Unless, of course, they are comfortable with d
Re:Yes... (Score:5, Interesting)
In addition, MDs are usually neither educated as scientists nor as engineers. To be fair, the amount of unavoidable failure an MD has to deal with is making things harder and more fuzzy, as does the personal interaction with patients. But we do throw an engineer that had a bridge collapse because of false calculations in jail on the first failure if people were killed, no fuzziness there and much, much higher standards.
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No, it's true; he's from Europe.
Re:Yes... (Score:5, Informative)
But we do throw an engineer that had a bridge collapse because of false calculations in jail
No we don't.
We do not put people in jail for mistakes or incompetence.
A conviction for criminal negligence [wikipedia.org] requires showing mens rea, an intentional act with knowledge of the consequences.
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In addition, MDs are usually neither educated as scientists nor as engineers.
It might be helpful (but probably not, because AC's and all) to clarify that "scientists" means "full-time, professional research scientists". Medical students obviously learn a lot of science, particularly biology. They learn the scientific method, since that's the basis for diagnosing illnesses. What they usually don't learn and gain experience in is conducting a long-term research project. Practicing medicine and conducting research are somewhat different skill sets, and a person who is good at one of th
Re:Yes... (Score:4, Insightful)
Medicine used to be random. The treatment a physician gave you might help, might hurt, or might do nothing. On average, physician treated patients got better due to the placebo effect. Because of that, it was critical that the physician be extremely well respected and also have unshakeable confidence.
Things improved as science started getting applied to medicine. The first things that could be called randomized controlled trials were done during WWII. Fast forward to the late 80s and someone had the bright idea that medical treatments should routinely be evaluated in carefully controlled trials, with actual statisticians involved. Yes, it was really that late.
Medicine is a very old profession, with a lot of history, and retains some baggage from that. One of those things is the dependence on the individual physician's personal expertise. Many (I know quite few) regard scientific evidence as nice to have, but ultimately secondary to their convictions. Unfortunately, medicine is one of the fields where uncontrolled observations are most likely to be wrong, and logical deduction really doesn't work very well.
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Your statement: False. And clueless. But what can you expect from AC scum.
Re:Yes... (Score:5, Interesting)
By your argument, only people that are MDs and are also PhDs in a proper science are allowed to comment on this. That is obviously nonsense. And you are still an AC that snipes form the dark, with no honor and no credibility.
It is well-known though that many MDs are under the illusion of being scientists. They are not. They are just being given the illusion because their teachers are under the same illusion. Just compare an average medical PhD thesis and the time it takes to do one to the average STEM PhD. The difference is eye-opening and extreme. Also, talk to some real scientists that work with MDs on scientific projects. I know a few.
Good MDs are very versatile, very experienced technicians, but not more. To be fair, these are very useful, but when they start doing research, nonsense like the original story describes results.
Re: Yes... (Score:1)
Being familiar with scientific concepts and being a scientist are two different things. MDs do not generally do research, they go to a residency where they practice medicine under supervision. Learning about science does not make you a scientist. Research is an entirely different skill set and thinking like a scientist, distinguishing signal from noise, identifying bias and errors in experiments, takes years of experience and training most MDs will never achieve. Typically research MDs don't treat patients
Re: //thebestschools.org/magazine/15-logical-fal (Score:1)
I understand, because you've never done research you might confuse a residency for research. You're clearly not a scientist or even educated in medical education. There are MD-PhDs, but most practicing doctors are not PhDs.
https://en.m.wikipedia.org/wiki/MDâ"PhD
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Keep dreaming. Unlike you, I do have the minimal honor to at least give a consistent pseudonym. You have no honor at all.
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There are also others that claim anybody "practicing the scientific method" is a scientist. No requirements as to quality, level of insight, non-triviality, ability to habdle complexity, etc. By their definition (just as this one AC here, cannot even properly refer to that coward) about everyone that finished school successfully is a scientist. That is obviously nonsense.
I guess some people just have so big egos they cannot see the truth about themselves and then keep lying to themselves and others about it
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You keep sniping from the dark. And you keep being wrong. By your standard, basically everyone that finished school is a scientist. Because statistics and science are taught at school. Obviously, that is nonsense. Obviously, you do not have what it takes to understand that. Which, incidentally, also means you are currently nicely demonstrating that _you_ are not a scientist either.
To be trained as a scientist, you have to do research and you have to demonstrate that you can do non-trivial research to scient
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Uh, "opine" is a verb, not a noun...
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"And you are still an AC that snipes form the dark, with no honor and no credibility." - And that's ad hominem, which definitely isn't science.
Nice, so you can do pattern matching. But do you understand the pattern? No. This is actually a statement of fact. For it to be "ad hominem", you would need to give at the very least an identity and the statement would need to not be relevant. Ad hominem is not really possible against somebody anonymous. Also, coward => no honor, anonymous => no credibility. So relevant. Does not even have to be true to not be ad hominem, relevancy is enough. Any questions?
What's your background, educationally? May I ask? Because I'm fairly sure you're neither a doctor, "scientist" nor lawyer, PhD, or even someone whose argument on the face of itself above is deserving of any actual respect.
Why should I answer to that? You already know
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"Most ACs are not even worth the keystrokes to insult them."
Exception to your rule?
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It is well-known though that many MDs are under the illusion of being scientists.
I'm not sure how your MDs are trained but in universities in my country you're required to do a Bachelor of Science Degree (with any major you want) before starting medical school.
Now the whole illusion that they are "doctors" just like PhDs rather than the honorary title they actually have is a different story. But a good many of them definitely have qualifications to be "scientists".
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True.
A very few medical doctors also have some sort of advanced scientific training. Very occasionally one will have gone to engineering school and then decided to become an MD (I know one of these). The *vast* majority have, at best, some undergrad biochem and maybe a six month research fellowship.
I'm the one those research fellows used to get sent to. They were expecting to be given a spreadsheet and walked through doing a t-test.
Re:Yes... (Score:5, Interesting)
Doctors form beliefs about what works. The best of those beliefs are driven by research, but frequently they are driven by narrative because doctors are human. They believe plenty of things without evidence because those things make sense and/or are consistent with their training or experience. But that doesn't mean they're always right.
It does mean that they want their patients to do the thing they think will work.
So they don't want a patient assigned randomly.
Unless, of course, they are comfortable with deliberately killing patients, which most of them aren't.
Medical error in America accounts for more deaths than alcohol, automobiles, and illegal drugs combined. If you think they're not "comfortable", think again. Doctors are now a leading cause of death.
You're right. They do believe plenty of things without evidence, because the only evidence that matters is profit. Death is dismissed as a mere side effect.
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Yeah, people going to doctors in less than perfect health because something is wrong has nothing to do with those statistics, eh?
Re:Yes... (Score:4, Informative)
He's actually correct. I know it's a surprising finding to grasp.
The average hospital-goer is at greater risk of dying going to the hospital than not going. That's because the majority of people who go to the hospital aren't sick enough to be there, but also because medical errors are the third or fourth leading cause of death in the US.
The studies on this are very carefully done because it is such a challenging conclusion. Just to give you some examples though, when the local hospitals around the Pentagon were swamped with casualties from September 11th, the death rate in those communities went down. Similar things have been observed in other communities where strikes have closed or restricted access to hospitals.
Medicine is going through a renaissance. It's becoming evidence-based (the term evidence based medicine was coined in 1987) and is slowly moving towards adopting (and enforcing) standard operating procedures. Medical scientists are also crawling through the backlog of unproven traditional treatments and checking to see if they actually work. This paper is a summary of some of that work.
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because medical errors are the third or fourth leading cause of death in the US.
Be careful with that statistic. Somone who has a fatal but treatable condition but is misdiagnosed and given no or the wrong treatment dies because of a medical error, but they would not have survived if they didn't go to the doctor.
Be careful? Ironically we should be mandating that our doctors fucking do that.
Believe me, I see your point clearly, but this wouldn't be a Catch-22 if we weren't so damn tolerant of "professionals" fucking up in massive numbers.
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Yeah, people going to doctors in less than perfect health because something is wrong has nothing to do with those statistics, eh?
Apparently you're suffering from a reading or comprehension deficiency. The key word here, is error. As in mistake. Fuck-up. Something that's preventable.
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Doctors are now a leading cause of death.
Tell me about it. Next time I'm bleeding from my anus I sure as hell won't see a doctor. They may kill me.
Just so you know your statistic is utterly useless.
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I don't think that's true. Not your statistics, they're spot on. Your interpretation. The majority of physicians genuinely think they're doing the right thing. They're not trying to harm patients.
It's extremely difficult for a profession to evolve from artists to technicians.
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This "evidence" is quite shaky and not reproducable. Read this and double check your facts:
https://sciencebasedmedicine.org/are-medical-errors-really-the-third-most-common-cause-of-death-in-the-u-s-2019-edition/ [sciencebasedmedicine.org]
Wearables (Score:4, Informative)
One point is that wearable tech doesn't yet seem to equate to losing weight, if that is one's goal.
"2017. While this review concluded that wearable technology reduces sedentary behavior, there were no SR/MA on whether these devices reduce weight (Stephenson et al., 2017). This review did not include the RCT."
"This is a reversal of wearable technology for long-term weight loss."
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you are lighter naked than wearing tech. duh.
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Isn't reducing sedentary behaviour a good outcome in and of itself?
Circumcision (Score:1, Interesting)
There. I said it.
Of all men on Earth, 30% have circumcised penises; of those circumcised men:
* 68.8% are Muslims.
* 0.8% are Jewish.
12.8% are non-Muslim, non-Jewish residents of the United States.
17.6%, the rest, mainly come from backwards third-world tribal cultures with a long history of ritual genital cutting. South Korea circumcises boys when they are 10 years old, a practice which they started only after the Americans showed up to occupy their country militarily.
That's not medicine, folks.
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a small and evolutionarily unnecessary piece of skin
Up to half the penile skin, including the area with the highest concentration of fine touch nerve ends that give man most of his sexual sensation. Its functionality was shaped by millions of years of evolution, so you are a massive idiot for claiming something that flies in the face of reality and logic.
prevent a variety of conditions including cancer and STDs
So-called "medical" circumcision was introduced to curb masturbation during a Victorian age moral panic that saw "self-abuse" as the cause of countless illnesses. Every claimed benefit since that is total bu
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WALL OF TEXT
Real life numbers say otherwise. [circumstitions.com] In most countries for which this information was available, you could find higher HIV infection rates among circumcised men.
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Your shitty study uses Brian Morris as a source. Into the trash it goes.
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Trouble is, less destructive treatments (steroid creams, prepuceplasty) would work most of the time, but doctors are ignorant about them.
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If you do it to yourself, do whatever the hell you want.
But keep your hands off someone else's penis. Even and especially if it's your child.
I really like these statisticians (Score:5, Interesting)
Medical statistics (done properly by specialized _mathematicians_, not my MDs) finally puts some actual science and engineering into medicine by making it more and more evidence-based, instead of belief-based. Medicine has dragged its heals and often protests screaming, but hopefully it cannot resist this push much longer. Of course, anything going from belief-based to evidence-based does find a lot of these beliefs to be fundamentally faulty. That is normal. That is progress.
Next thing to _finally_ get under control: Management. Evidence-based management is in its infancy, but boy is it needed. After that, finally deal with religion, leaving Philosophy, and disposing with the fairy-tales. That one will probably be the hardest to do.
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Statistics - real statistical inference - is hard, and it's unfair to blame someone for poor intuitions about statistics if they have never been taught the subject properly.
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Actually, I was involved in a study looking at just that. The majority of MDs in the study had difficulty correctly explaining concepts such as confidence intervals, standard deviation, standard error, and variance. Nearly all confidentially rated their knowledge of statistics as poor, and it was a significant source of embarrassment for them.
Those last two items applied to most of the working scientists in the study as well. They were better at explaining basic statistical concepts though.
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I have no trouble believing that. I do _not_ blame the MDs themselves for this, this is just the kind of education they got and the kind of selection mechanisms applied to the students. It is, however, important to understand what type of qualification they have in order to have an idea where they are competent and were they are not. It is also important that they realize this themselves.
The main problem is that medicine is very slow to evolve as a result. Medical statistics at least has helped there and cl
Re:I really like these statisticians (Score:4, Interesting)
The problem with evidence-based medicine, based on my personal experience, is that too many doctors use it as code for "We give every patients with the same symptoms the same drugs, and don't bother to do any additional tests to verify that it is the correct course of treatment."
A couple of years ago, I was hospitalized with an intestinal infection. On the first day in the hospital, my temperature was a perfect 98.6 for the first time in years. (It was previously 97-ish.) After about a day, it went back up to about 99.1 while on the antibiotic. The doctors weren't at all concerned, but I immediately knew something was wrong, having never (even once) had a fever while on an antibiotic. So I immediately asked if they had changed my antibiotic. They said, "no," but when I pressed further, they mentioned that I had gotten a broad-spectrum antibiotic upon ER admission, but after that, I had been on a much more targeted antibiotic. I expressed concern that, based on the return of my fever, perhaps they should put me back on the broad-spectrum antibiotic. However, they dismissed those concerns, assuring me that it was the right call based on "evidence-based medicine".
After that, I experienced multiple recurrences over the following 1.5 years, requiring somewhere around nine weeks of antibiotics costing many thousands of dollars. By the fifth round of antibiotics, I started reading medical papers about the particular type of bacteria that we had (by then) determined was involved (which the hospital never cultured), and learned that although both the broad-spectrum antibiotic and the antibiotic they put me on later both can kill the particular strain of bacteria that was in my gut, the broad-spectrum antibiotic does so much more quickly, and as a result, has dramatically better odds of avoiding recurrence.
Had they paid attention to my concerns, run the tests, and switched antibiotics, it would have saved my insurance company many thousands of dollars, and I'd have been a lot better off over the following two years.
So having experienced both evidence-based doctors and gut-feeling diagnosticians, I'd much rather have the latter, because if that person is wrong, he or she will recognize the mistake, and will try something else. Too many of the so-called evidence-based practitioners, by contrast, will just keep telling you that all available evidence shows that this is the correct treatment, while you circle the drain.
This is not to say that people shouldn't do the research, just that doctors need to be aware that where the research and practice intersect, there's an actual human being whose illness may behave very differently than that particular illness typically behaves, potentially leading to misdiagnosis and serious complications if you aren't paying enough attention.
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The problem with evidence-based medicine, based on my personal experience, is that too many doctors use it as code for "We give every patients with the same symptoms the same drugs, and don't bother to do any additional tests to verify that it is the correct course of treatment."
Sure. But that is not evidence-based medicine. That is technician-level people applying their tables without deeper understanding and claiming to follow a method they do not even begin to grasp.
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The problem with evidence-based medicine, based on my personal experience, is that too many doctors use it as code for "We give every patients with the same symptoms the same drugs, and don't bother to do any additional tests to verify that it is the correct course of treatment."
Sure. But that is not evidence-based medicine. That is technician-level people applying their tables without deeper understanding and claiming to follow a method they do not even begin to grasp.
I completely agree that what I experienced wasn't evidence-based in any meaningful sense of the word. But in practice, that seems to be what a lot of hospitals mean when they say it. I would call it "cookie cutter medicine". :-)
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I hate to bother you, but you are describing something I am currently going through, and I would like more information concerning the subject, so I am bothering you. I apologize.
Here we go:
Where can I find more information about modern medical practices regarding bacterial cultures, proper bacterial "colonies", and treatments concerning this?
This has been going on for decades and I am at the end of my rope. :(
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The most important thing is to figure out at least the genus and species of bacteria that is at issue. From there, just start searching for open access medical papers about curing that particular bacterium. Google is your friend.
Either way, be aware that often, the right treatment isn't killing the bad bacteria, but rather filling your gut with other bacteria and yeast to keep it in check. I've been on a daily regimen of the better part of a dozen probiotics since then, including Saccharomyces boulardii
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Actually, the medical papers that indicated that the doctor's choice of treatment wasn't the best choice were published *after* I was in the hospital. What they did was, in fact, the generally recommended treatment up until a few months ago.
So really, the only problem was that they didn't pay enough attention to the incoming data, and as a result, didn't see that data as a reason to challenge the accepted standards of treatment.
Re:I really like these statisticians (Score:5, Insightful)
Evidence based Management would be a great idea. But it will never catch on. Management is mostly emotional and political. Hard for people to get away from that.
But supposed you DO get away from it and have Evidence based management. You still have to deal with the metrics, and taking bad metrics is worse than have no metrics at all. It will result in creating the same effect that the bad emotional and political management create, maybe even worse because it might get great talent canned.
At the end of the day, the emotions, politics, and metrics cannot be ignored, if you do, then your eventual result is failure... no matter how successful you look. There is a reason they sometimes call the places you work gilded cages.
It is all made to look nice while still just being a cage.
Managing people, with bad metrics (Score:4, Interesting)
> Management is mostly emotional and political. Hard for people to get away from that.
Management is mostly managing people, with a side of managing business. People are emotionally driven. I'll give the example of Elon Musk, or JFK if you prefer. Musk gives no evidence that he pays any attention to even simple arithmetic; he's phenomenally successful because he motivated and inspires people - emotion.
> But supposed you DO get away from it
Then you are replaced by an algorithm. And your company fails.
> You still have to deal with the metrics, and taking bad metrics is worse than have no metrics at all.
Most metrics are bad. Essentially all metrics are extremely incomplete. They can only provide an *indication* of how things might be going. Like taking someone's temperature as an indication of medical condition - it suggests in a very general way that they might be doing better or worse, but very non-specific. Someone can easily be 98.6 at time of death. Dead is pretty unhealthy, and temperature doesn't indicate a problem when they die. (Though it does after it's far too late).
Of course there are certain specific job roles where certain metrics make sense. Even I those cases, they are quite incomplete. Consider the bank that used the metric of "new accounts opened" and failed to measure questionable sales practices - it got to the point of outright identify theft and fraud, which cost the bank a lot of money and bad publicity.
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"Most metrics are bad." - Saying something is bad is a bad metric.
Do some real science involving metrics and you will run into that one. Most metrics are bad, many are worse than worthless. Everybody smart working with metrics realizes that sooner or later. It is a meta-constant in this universe. And it is one the bits of insight that separates a real scientist from somebody just following the rituals.
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There are great examples of this from medicine. There's one given in the summary: minor arrhythmias were believed to be associated with sudden cardiac death, so lots of drugs were invented to correct them. Turns out, the drugs are ineffective for preventing death.
Medicine does have one very good metric though. Death.
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Actually, even "death" sucks as a metric. Little things like what your quality of life is matter very much. Or whether you are in a coma. Technically alive, practically not so much. Unless you think that living longer is always desirable? I do not.
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Most metrics are bad. Essentially all metrics are extremely incomplete. They can only provide an *indication* of how things might be going.
They can also be extremely misleading and often are. One problem with metrics is oversimplification. Most real-world problems are massively multi-dimensional and for most dimensions there are no good metrics. If you then pick one or two of these dimensions and apply some metric, that does not give you much. A second problem is that many metrics are pretty meaningless in themselves. The metric most often found is counting. Counting-metric are easy to generate, but very often worthless. More complex metrics m
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Actually, it is a scientific direction at this time https://en.wikipedia.org/wiki/... [wikipedia.org]. If it turns into ab applied science that does return superior results, it may catch on. It may not catch on for the reasons you state and others. We will see. But if it gets to a point where it works and delivers, it may be a real success story. The huge waste stemming from incompetent management (middle and upper level, usually) at large corporations is staggering.
Incidentally, it does not mean to use "metrics". People t
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I wouldn't say it will never catch on. Big tech firms are notorious for their heavy use of data to make decisions, to the extent that they collect so much data it's turned into a PR problem for them. There was the famous "50 shades of blue" rant by an ex-Google designer some years ago where he lamented that visual design was put through measurement rather than managers approving redesigns based on their personal perceptions.
Arguably one reason tech firms dominate is that they use evidence based management m
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and disposing with the fairy-tales. That one will probably be the hardest to do.
My tarot cards say that you're exactly right on that one.
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Hehehehe, nice!
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Something that I think has largely gone unnoticed is that doctors in medical schools are really trained as technicians, not as scientists. Nothing wrong with technicians, and I have worked in health care and been genuinely astounded at the incredible and exceptional intelligence of some of the doctors (and yes, I know, some doctors are not so impressive). But medicine as a profession, even when it adopts innovations, seems to revolve around anecdotal rather than statistical or experimental evidence.
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I agree. An exceptional technician is worth a lot. Much more than a mediocre scientist. And I do not claim an exceptional scientist is worth more than an exceptional technician either. The thing is you need both (in different numbers) and they need to know what they are and where their limits are. An exceptional technician, for example, is the only thing that can help you when the problem cannot wait a few years or decades and there is no science that already has a solution. This is not different in other f
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Medicine has dragged its heals ...
I see what you did there.
- Freud
Were the 'Lobbyists' among them? (Score:3)
Here's the tabulated results (Score:3, Informative)
https://elifesciences.org/arti... [elifesciences.org]
Scroll down and expand the Results section.
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Even better
https://elifesciences.org/down... [elifesciences.org]
Money Talks... (Score:2)
and the Bullshit Walks.
No matter where you go, what you do, or how you do it. Once humans institutionalize it, the only direction is downhill morally speaking, even if things technically go uphill in capability.
And it is not always just greed based morality as well. Some medical professionals just stick to what they know because they are scared of the new, do not trust it, don't think it has proven itself, or because they just do not care to keep up. But this is all still technically a part of that faile
At least some of these reversals are not new (Score:3, Insightful)
For instance, the idea that routine mammograms for women age 40-49 are not as beneficial as originally thought seems to be already broadly accepted.
Based on the "Methods" section, it seems these were chosen specifically because there were already counter-indications to the original conclusions - so they basically just wanted to put better numbers behind them.
So this isn't all new knowlege, it's largely iterative (and there's nothing wrong with that).
Re: (Score:2)
Depends on the breasts.
https://www.cbc.ca/radio/white... [www.cbc.ca]
Ineffective and Defective. (Score:4, Interesting)
Old News.
https://www.youtube.com/watch?... [youtube.com]
John Oliver discusses the medical device industry, which is a huge business with a hugely troubling lack of regulation.
not surprised (Score:2)
https://www.theatlantic.com/he... [theatlantic.com]
Drugs vs not eating garbage. (Score:5, Interesting)
This one I found interesting (Score:2)
Moss et al. 2006. Effect of mammographic screening from age 40 years on breast cancer mortality at 10 years' follow-up: a randomized controlled trial. The Lancet 368:2053â"2060. (12/9/2006) [Public health and general preventive medicine]
In the past, the American Cancer Society recommended that women between the ages of 40 and 49 get mammograms every 1â"2 years (American Cancer Society, 2018). However, the benefit of mammograms for women under the age of 50 has not been established. 160 921 women a
More deadly than a placebo? (Score:3)
So just how deadly was the placebo? And have they changed the definition of a placebo recently?
Re: (Score:2)
Maybe the point is that *less* "deadly than a placebo" should be an easy target to meet no matter how ineffective an intervention is.
Canada bragging (Score:2)
Not just medicine (Score:2)
So... medical devices are undergoing the same trend as every other technology sector is: change for the sake of change, and once some technology reaches a local maximum every possible new change is something for the worse.
But they do make lots of money! (Score:3)
These procedures, drugs, etc. may be ineffective or even harmful but they all are big moneymakers for doctors, hospitals, and the manufacturers.
Hard to give up the income stream when you can plausibly rationalize their use on innocent patients.
Said everyone who worked in medicine (Score:1)
I paid good money for these leeches, damn it! (Score:1)
Duh $$$$ (Score:2)
Profit motives and vague outcomes OK? (Score:1)
Color me surprised we cannot make these ineffective medical "treatments" work. I mean I don't know about you, but if you have one of the typical western culture issues then you probably have lots. And if we could cure them...they'd be gone.
All doctors can/want to do is offer expensive palliative care. Treat the symptom not the disease to make $$$. That or tell us to "do as I say, not as I do" and even then often their directions only make vague directional changes we can't precisely correlate with "cure
Glass half empty (Score:2)
This story rightly focuses on new treatments that DON'T work better. But there are so many more treatments that are far and away better than before.
To name a few
- Today's allergy medicines are far more effective, with far fewer side effects, than what we had 30 years ago
- Today's acid reducers (PPIs), despite their risks, are much more effective and safe than previous drugs
- Today's laparoscopic surgical procedures are so much less painful, and require much less recovery time, than old-style surgeries
- Toda
Re: (Score:2)
If the drug kills animals but not humans, you've lost an animal and a potential drug won't get to market.
If the drug kills humans but not animals, you've eliminated whole classes of other problems with it, isolated the cause of the problem (because you can see what it affects in a human vs what it affects in an animal, and find the cause for that) and the drug won't get to market. But you might be able to make a new version that doesn't kill humans.
If the drug kills both humans and some animals, you might