Lies, Damned Lies, and Medical Science

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Very thought-provoking

Also super excited about the double Tufts mention in the article xD!!
 
lies in medical science? I am bound to agree!!!
from the article:
Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong.
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i agree, i would go further and say more than 50%
 
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Kahreek said:
lies in medical science? I am bound to agree!!!
from the article:
i agree, i would go further and say more than 50%
Click to expand...


Many studies arguing is somewhat
like those skin creams advertising
1- Skin has collagen
2- Cream has collagen
3- Cream is going to regenerate your skin
 
yep, this prevalent in the basic sciences as well. No one understands statistics, so they just run any and all statistical analysis until a significant p value pops up. I'm guilty as hell as doing this, but frankly, few people understand statistics and fewer still even care.

personally, I don't trust nothing unless it was a t test or simple anova. if not, **** it, it's black magic to me. running a kerswath romenstein regressive analysis doesn't tell me dick and for all i know, the researchers just made it up for the study.
 
notbobtrustme said:
yep, this prevalent in the basic sciences as well. No one understands statistics, so they just run any and all statistical analysis until a significant p value pops up. I'm guilty as hell as doing this, but frankly, few people understand statistics and fewer still even care.

personally, I don't trust nothing unless it was a t test or simple anova. if not, **** it, it's black magic to me. running a kerswath romenstein regressive analysis doesn't tell me dick and for all i know, the researchers just made it up for the study.
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I hate that. When I did my SMP, I took the epidemiology course required for the students who also wanted a MPH (I decided against it in the end). The professor absolutely hated P values (or worse... simply stating "statistically significant" with no P value at all) and really pushed other calculations like relative risk as a better measurement. It's painful to sit in a journal club with people who cry out about how the P value of 0.06 means something doesn't work, but the RR of 0.99 and P of 0.05 is absolutely awesome!
 
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Siggy said:
I hate that. When I did my SMP, I took the epidemiology course required for the students who also wanted a MPH (I decided against it in the end). The professor absolutely hated P values (or worse... simply stating "statistically significant" with no P value at all) and really pushed other calculations like relative risk as a better measurement. It's painful to sit in a journal club with people who cry out about how the P value of 0.6 means something doesn't work, but the RR of 0.99 and P of 0.05 is absolutely awesome!
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While statistical significance does not always (or even often) equal clinical significance, you still have to calculate it, because if something is NOT statistically significant, no matter how nice the trend is, you can't make any conclusions about the data. That is, your RRR 0f 0.8 but your p value of 0.2 may look like it could be clinically significant (20% reduction in whatever), but all it really means is your study was too underpowered to overcome what could just be random chance.
 
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Raryn said:
While statistical significance does not always (or even often) equal clinical significance, you still have to calculate it, because if something is NOT statistically significant, no matter how nice the trend is, you can't make any conclusions about the data. That is, your RRR 0f 0.8 but your p value of 0.2 may look like it could be clinically significant (20% reduction in whatever), but all it really means is your study was too underpowered to overcome what could just be random chance.
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Shoot... I meant P of 0.06, not 0.6. 0.6 is obviously bad. o.06... not so much.

The problem is that when we use hard lines (because the line has to be drawn someplace), anything around the line becomes more ambiguous. Otherwise it's like saying a K of 5.3 needs a full court hyperkalemia treatment, but a K of 5.2 is fine. Why can we use judgement to determine when to say, "meh, what ever" to slightly abnormal lab values, but not "meh, what ever" to the 0.05 P value with little clinical effect or decide to use the 0.06 P value with a large clinical effect? If the only thing a provider is looking at is a P value (either way), then that's a huge problem.
 
WhippleWhileWeWork said:
Ben Goldacre has been harping on stuff like this for a while. TED talks, books, articles, the works.

https://www.ted.com/talks/ben_goldacre_what_doctors_don_t_know_about_the_drugs_they_prescribe

http://www.amazon.com/Bad-Pharma-Companies-Mislead-Patients/dp/0865478007/ref=sr_1_2?ie=UTF8&qid=1400765638&sr=8-2&keywords=bad pharma

And former NEJM editor: "
“No longer possible to believe much of clinical research published”

http://ethicalnag.org/2009/11/09/nejm-editor/
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It's so scary! It's really wrong and no matter the number of doctor out there, the problem is still there! To me, it takes a strong mental conditionning to keep in silence professional doctors who have a certain knowledge of the human anatomy, physiology and health in general and even more; they observe patients and are the first to notice what doesn't work and what does. I really love medecine, in its principle of using science to help people but I don't wanna spend years studiying medecine to finish like a miserable ignorant who doesn't know what he precribes and what is good for the patients!

My mum is a doctor and she told me that she prescribed a few times the drug Diane35 which is for hormonal regulation, for women with a lot of acnea and I don't know the rest of cases in which it is prescribed but it happens to be a deadly drug! Can you imagine prescribing something that can kill your patient? Horrible!
 
notbobtrustme said:
yep, this prevalent in the basic sciences as well. No one understands statistics, so they just run any and all statistical analysis until a significant p value pops up. I'm guilty as hell as doing this, but frankly, few people understand statistics and fewer still even care.

personally, I don't trust nothing unless it was a t test or simple anova. if not, **** it, it's black magic to me. running a kerswath romenstein regressive analysis doesn't tell me dick and for all i know, the researchers just made it up for the study.
Click to expand...

It's not only a matter of statistics and correlations...Let's say you found out that factor A grows in correlation with factor B, how zwould you interpret that? Is it because A is the cause of B or because B is the cause of A or because A and B are both caused by a C and C wasn't tested or even expected to play a role.
 
i would like also to see more studies try to build up on things rather than crunching data and repeting "scientific procedures" in hope of finding paterns in chaos.
 
Kahreek said:
i would like also to see more studies try to build up on things rather than crunching data and repeting "scientific procedures" in hope of finding paterns in chaos.
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Yes
Also, the doctor Andre Gernez said once that medecine needs an integration work, meaning a revision of what is already known, gethering the data, and drowing conclusions from what is already known.

I think this work involves doctors and not pharmacists
 
Not surprising. The decreasing amount of funding opportunities in the US (compared to the number of labs currently operating) means that researchers (especially basic science ones) have to publish consistently to continue getting grants.

It's all for the money, really. Drug research is biased so pharma companies can get start selling their drugs on the marketplace. It's one of those things that happens more often than anyone is willing to admit. As to clinical research, people trying to push more marketable/profitable treatments (say protons now, or IMRT in the past, for certain types of cancers, or pre-emptive stenting to prevent MIs) may be biased. Journals are also to blame here, as they will accept a 'positive' result much, much more often than a negative result. The Ben Goldacre links are good, I've listened to him before. That's one of his main points with the weakness in medical research.

That being said, I think that until you have a study that refutes something (unless the original study has such severe methodological errors that are easily picked out) you have to go with it until it is refuted. Scientists have been refuting each other since the scientific method started. The issue nowadays is to get those studies that refute previous research published and out there.
 
There will not be any move to try to address issues like these, while the US gov has "pay-for-performance" type deals

X% of your pts have had their screening tests = better payments
Y% of your pts have their HgbA1C @ goal = better payments .....etc etc
 
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FutureInternist said:
There will not be any move to try to address issues like these, while the US gov has "pay-for-performance" type deals

X% of your pts have had their screening tests = better payments
Y% of your pts have their HgbA1C @ goal = better payments .....etc etc
Click to expand...


...and patients who refuse to either get their screening tests (unless it only requires the tests be ordered) or are non-compliant and their A1C doesn't drop gets dropped from the physician's service. Poof... instant compliance.
 
FutureInternist said:
There will not be any move to try to address issues like these, while the US gov has "pay-for-performance" type deals

X% of your pts have had their screening tests = better payments
Y% of your pts have their HgbA1C @ goal = better payments .....etc etc
Click to expand...

The concept of "pay for performance" is just another examples of the human tendency to create solutions that make things worst instead of better.
 
Press Ganey is a real shameful method of quality control, and especially terribad when you consider the medicolegal comsequences of unnecessary procedures/tests coupled with the fact that human trash cans with eyeballs (medmal lawyers) can capitalize at both ends.

As to the issue in general.. I read my weekly JAMA and NEJM like I read a garfield comic or my wife reads People magazine. Lots of unrequited narcissism, interesting anecdotes about life, and even some neat suggestions .. but at the end of the day it's just fiction.
 
cbrons said:
Press Ganey is a real shameful method of quality control, and especially terribad when you consider the medicolegal comsequences of unnecessary procedures/tests coupled with the fact that human trash cans with eyeballs (medmal lawyers) can capitalize at both ends.

As to the issue in general.. I read my weekly JAMA and NEJM like I read a garfield comic or my wife reads People magazine. Lots of unrequited narcissism, interesting anecdotes about life, and even some neat suggestions .. but at the end of the day it's just fiction.
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yeah, that's the word: fiction
 
cbrons said:
As to the issue in general.. I read my weekly JAMA and NEJM like I read a garfield comic or my wife reads People magazine. Lots of unrequited narcissism, interesting anecdotes about life, and even some neat suggestions .. but at the end of the day it's just fiction.
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I think of many of them as synonymous with the term "limousine liberals". Very much detached from real life.
 
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