Is it as bad as he says?

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:laugh: well, I actually think he is being a little unfair, but let's get a few more opinions in here before we address that :whoa:
 
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I wonder how this alleged publication bias affects studies on the existence of publication bias? Maybe it only seems there is rampant bias because a small amount of bias is preventing studies from being published that show there is not much bias. The speaker doesn't address this at all.
 
Encouraging publication of negative results or so called failed studies is very important, i just warched the first few minutes.
 
DrSnips said:
I wonder how this alleged publication bias affects studies on the existence of publication bias? Maybe it only seems there is rampant bias because a small amount of bias is preventing studies from being published that show there is not much bias. The speaker doesn't address this at all.
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researchiception
 
Put all failed projects into the New England Journal of Unsuccessful Medicine.
 
There IS a journal of negative results out there. Impact factor of 1.3 (estimated) :thumbup:
 
Journal of Serendipitous Unexpected Results. Google it...pssssst nejm, JSUR all day baby!
 
he's pretty on point

private sector pharmaceutical studies, while flawed, are still the best information we can use to assess new drugs

attendings are limited to whatever the insurance companies covers anyways right?
 
PrideNeverDie said:
he's pretty on point

private sector pharmaceutical studies, while flawed, are still the best information we can use to assess new drugs

attendings are limited to whatever the insurance companies covers anyways right?
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No, insurance doesnt dictate clinical practice it just limits the economic feasibility of it. A physician can always write to the insurance company when they dont cover a drug and they are required to have other physicians review the claim and make a decision whether to pay or not. They always give some discount too if its not covered under their formulary
 
"What doctors don't know about the drugs they prescribe "

Who wants to do the

"What doctors don't know about drugs because they either don't care or are too dumb to understand and end up hurting patients, sometimes irreversibly"
 
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I feel like you are missing something to make your post a complete thought... :confused:
 
I think it's a bigger problem than doctor's making decisions based on the literature. Most doctors probably do not read journals. Most don't know a damn thing about the side effects of the drugs they prescribe, and don't bother educating the patient when they do know about it. The bigger problem comes way before the doctor's who actually actively try to find the best treatments out there and are affected by the bias or whatever,
 
JP2740 said:
I think it's a bigger problem than doctor's making decisions based on the literature. Most doctors probably do not read journals. Most don't know a damn thing about the side effects of the drugs they prescribe, and don't bother educating the patient when they do know about it. The bigger problem comes way before the doctor's who actually actively try to find the best treatments out there and are affected by the bias or whatever,
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This hasnt been my experience at all. Knowledge of side effects is pretty central to both didactic pharmacology as well as clinical training where I go to school. It is true that many doctors become comfortable with a handful of drugs and use them nearly exclusively in practice, but CME is designed to keep that knowledge from becoming too outdated. Personally, I think the guy in the video is putting a very specific spin on publication and ignoring the fact that we all assume a finding is negative until shown otherwise, which is why most negative findings are not published. Yes, some papers are pushed which show a benefit when really there may not be one, but this isn't the same as a treatment that is harmful being passed off as either benign or helpful. We spend quite a bit of time looking through primary literature and dissecting the papers. It is up to the individual to critically look at literature, but to say they are too dumb to know better seems a little jaded, especially from someone within the group in question.
 
Maybe I just have limited experience? Most doctors I've encountered are smart and good people, who neglect key side effects of drugs and treatments or choose not to let the patient know even when asked. I've seen many patients also when shadowing doctors who have had to see other doctors because of bad decisions by other physicians.

A general surgeon I shadowed as an undergrad, who is VERY respected in that hospital, and who I think is an excellent doctor in every sense, once told me that 85% absolutely do not give a **** about the patient. In my experience since then, I've come to agree (not so much with the number but the overall message).
 
What year are you? I feel like you are severely undercutting the knowledge of physicians on the drugs they use. I mean, honestly it isnt the stuff you learn first year that keeps coming up in practice. Medicine is just pharmacology and pathology twisted together, with a little bit of interpersonal skills sprinkled around. I don't know all the ins and outs of CME, but I do believe that there is a literature component to it, and your license is tied to completion. You also don't have to care about the patient to know what the drugs are and do. You seem to be connecting two otherwise unconnected complaints.
 
JP2740 said:
Maybe I just have limited experience? Most doctors I've encountered are smart and good people, who neglect key side effects of drugs and treatments or choose not to let the patient know even when asked. I've seen many patients also when shadowing doctors who have had to see other doctors because of bad decisions by other physicians.

A general surgeon I shadowed as an undergrad, who is VERY respected in that hospital, and who I think is an excellent doctor in every sense, once told me that 85% absolutely do not give a **** about the patient. In my experience since then, I've come to agree (not so much with the number but the overall message).
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in my experience this has not been the case

even the ****tiest doctors know all the side effects of the drugs they prescribe

most of the doctors i know care about their patients

if you mention the 0.01% chance of death everytime you ask for consent of the drug, you end up doing the patient more harm because fewer people will give you consent and won't get the treatment they need.
 
SpecterGT260 said:
What year are you? I feel like you are severely undercutting the knowledge of physicians on the drugs they use. I mean, honestly it isnt the stuff you learn first year that keeps coming up in practice. Medicine is just pharmacology and pathology twisted together, with a little bit of interpersonal skills sprinkled around. I don't know all the ins and outs of CME, but I do believe that there is a literature component to it, and your license is tied to completion. You also don't have to care about the patient to know what the drugs are and do. You seem to be connecting two otherwise unconnected complaints.
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Im 2nd year and I already said I might not be experienced enough to say these things. But I've shadowed many physicians (researched with many, etc), some of them I'm related to and so I could bring up conversations like this. And they are connected in the sense of the conversation I had with them and talking now. I know you don't have to give a **** about patients to educate/know about drugs, but the latter is connected to not caring about patients and that's what I'm talking about here.

I've also seen this personally. A relative of mine had been prescribed topical steroids for over a month for an anal fissure, and told her that there's nothing wrong with taking it for an extended period of time. Anecdotal? Yes. But it's just one example I've seen. It's funny, I know this isn't scientific evidence, but you can google situations that a patient unnecessarily has been through and find the SAME EXACT thing that countless others have to go through. Some of the most disheartening when a doctor has to treat a problem caused by another physician who didn't know what the **** he was doing. The more I know about medicine now the more shocked I am sometimes by what family members are told or prescribed. I'm mainly shocked because I'm a second year who's only grazed the level of knowledge and wisdom needed to be a physician. I understand that I don't know **** compared to attendings, so don't get the impression I think that I'm smarter. I used to be a guy who defended this profession against every complaint. I still think it's the greatest job in the world (laugh), but I think my experiences along the way have made me realize how great is the doctor's ability to hurt if he/she doesn't know what the **** they're doing. It happens more than you might think.

Oh well, if anything it just motivates me to always, always do what's best for the patient and educate them on side effects, why I think the benefits outweigh the risks, etc.
 
PrideNeverDie said:
in my experience this has not been the case

even the ****tiest doctors know all the side effects of the drugs they prescribe

most of the doctors i know care about their patients

if you mention the 0.01% chance of death everytime you ask for consent of the drug, you end up doing the patient more harm because fewer people will give you consent and won't get the treatment they need.
Click to expand...

That's good to know. Hopefully as I work more I'll be exposed more to these kind of doctors. I just hate hearing the stories from other physicians. **** is disheartening what some patients have to go through.
 
Well, I think your perceptions will change next year. Until then :thumbup:
 
Sorry for the thread derailing bra. I'm gonna go back to marijuana legalization
 
loveoforganic2 said:
Aren't you a 2nd year too? Maybe I've got you confused with someone else
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Yes. Just heard enough from my friends in M3/4/PGY1 to know better than to make a generalization about physicians in such a way. Also, I refuse to believe that I am destroying myself learning all of these side effects and drug interactions for nothing :thumbup:
 
Word. Since I'm questioning you, is your icon supposed to look like a side-profile of a guy with a big chin in a hat? It took me like 6 months to look closely and realize it was a caduceus
 
loveoforganic2 said:
Word. Since I'm questioning you, is your icon supposed to look like a side-profile of a guy with a big chin in a hat? It took me like 6 months to look closely and realize it was a caduceus
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:laugh: it can be whatever you want it to be

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Saw this video a while ago.

I have seen negative trials published in certain journals, but it definitely makes you think. This is why we need non-Pharma funded studies for the new drugs that are approved. If Pharma is conducting the studies, they won't publish negative trials.

Now if it's a secondary bias (where it is trials with no conflicts of interest), then yes, it's an issue. Negative trials are just as important, if not more, than positive trials. Unfortunately, negative trials don't sell subscriptions.
 
evilbooyaa said:
Saw this video a while ago.

I have seen negative trials published in certain journals, but it definitely makes you think. This is why we need non-Pharma funded studies for the new drugs that are approved. If Pharma is conducting the studies, they won't publish negative trials.

Now if it's a secondary bias (where it is trials with no conflicts of interest), then yes, it's an issue. Negative trials are just as important, if not more, than positive trials. Unfortunately, negative trials don't sell subscriptions.
Click to expand...

pharma isnt the only entity which publishes studies on these things. They will most certainly be some of the initial papers out, but not for long. Nearly every department at nearly every major medical center in the country (and ALL of them in academic centers) are constantly putting out data concerning whatever facet of practice seems most pertinent. It is very often tied to tenure or is simply an expectation of the job. The trick is getting the idea out there that maybe another look is warranted and then it will happen a little more quickly
 
My MS3 rotations took place in some fairly questionable settings, not always in academic hospitals, with a fair bit of rural medicine.

I think some of you are severely overestimating how exceptional the physicians you are rotating with are. It was very common over the last year for both the doctors and the bulk of medical care provided by PAs/NPs/CMAs to completely gloss over all the problems, side effects, etc. Even the pharmacists would not tell patients about blatant obvious stuff, like no alcohol with metronidazole. A few times someone would have a severe iatrogenic side effect and no explanation would be provided (stroke after surgery due to a cholesterol embolism; bowel adhesions, etc).

Sometimes it would be all like "hey that's not how we do it in the real world" e.g. the book says no traction on the umbilical cord after delivery, no tamoxifen if uterine cancer is a possibility. At other times it would be like no, there's no problem with prescribing ACE inhibitors to a pregnant lady.

I was left with the distinct impression that most medicine in the US is not done with a medical student / residents looking over the MD's shoulder and judging their competence.

You're also severely overestimating the difficulty of doing CME, which can be a total joke.
 
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