If we accept the assumptions in this article, it's a wonder medicine ever helped anyone prior to the modern era.
Even in primitive times, there was very good medicine practice based only on clinical observations. The problem with today's medicine stems from the allopathic mindset ushered in by Pharma just over 100 years ago that sought to eliminate all other medical practitioners (osteopathic, homeopathic, etc.) by claiming only they had the knowledge which came from so-called studies when in fact all they had was a bunch of snake oil from the fledgling pharmaceutical companies who promoted "a pill for every ill."
You'd think that people who rejected their grandparent's complaints that medical doctors were "pill-pushers" would have woken up with the opioid crises the medical establishment created in the 1990s (which was about the time the deceptive "evidence based medicine" rhetoric began) and then the current vax-injury nightmare we are still living through, but no.... the magic potion narrative and believe in the infallibility of scientism continues to hold sway - even when scientism bemoans they don't have the "evidence based" studies because they are too onerous. It's all a profiteering scam.
We became lost when we started to give credence to the “experts” about every damn thing. Studies this and studies that! Where the hell did common sense go? Are we really better off now than we were 60 years ago? I don’t think so. I remember life 60 years ago and it was better by far.
Always appreciate your ways of pointing out the problems with scientific thinking and how badly it failed during CoVid. I don't know that I will ever stop talking about how badly things went in 2020-22.
The Covid debacle is the best, largest, and most recent demonstration of the fact that almost all of the medical information widely promulgated is DELIBERATELY not studied -- not because it is "too hard" or "too expensive" or too anything...just because it wrecks a narrative that is financially, emotionally or (worst of all) politically useful.
As the Danish studied showed, it would have been fairly simple to do masking studies. I volunteered to get funding for YOU to do a masking study when you first started this stack but the result was only crickets (I know you do not read any comments, but thought that someone might pass that on to you). This was important to know and the field could have been substantially advanced...but the interest was zero because it was politically inconvenient.
It would not be so bad, from my point of view(the patient) if clinicians were still allowed to use their clinical judgement, which comes from their n=1 trials and treatment knowledge gained over time. It seems clinical judgement outside the standard care is discouraged. For a patient like me, who is most definitely not the average when it comes to response to meds, I tend to take my allopathic doctor as one ‘skewed’ opinion.
The two examples given illustrate problems with the application of scientific principles to medicine; I don't know if that was the intent of showing the contrasts but it does that quite well.
1) Attempts (presumably) to determine the effects of screen time on child development and psychology by correlation with the percentage of time spent with their phones and computers.
2) Trying to determine the best therapy for a pediatric hematological problem.
The first is, in my opinion, logistically impossible. What are the end points? Good kid, bad kid? Are there gradations for that designation? What is the time period for the development? How on earth can anyone measure or quantify how much time is spent? But, most important, this is not the province of medicine. This is societal and parenting problem. Medical doctors are no more qualified to advise parents than is any other randomly selected member of society.
The second is clearly a medical issue that may well be amenable to exploration by employment of random trials that adhere to the scientific method.
So we should encourage and support the second and not waste resources on the first as well as many other areas that do not relate to the diagnosis and treatment of disease.
If a physician doesn't want to see the evidence, there's nothing we can do. I presented Vinay Prasad with ample evidence that excess breast cancers after mammography screening are radiation-induced cancers and not overdiagnosis, and in response he blocked me on Twitter.
The screen time recommendations relate to my ongoing beef with guideline writers: from what orifice are they extracting those very specific cut points (age such and such, less than this many screen hours)? It’s again the urge to pretend to know, when they haven’t got a clue (at least in terms of actual RCT evidence of causation that could justify those recommendations).
As for finding the answers, it’s an ongoing journey. It’s in my lifetime that MI’s were treated at one time with bedrest and stool softeners. I was already sentient when it was just ASA and UFH. So we’ve come a long way for that 1 condition even in the last 30 years. You will always find conditions and clinical scenarios for which there is no good evidence based answer today….but that number is probably slightly smaller than it was yesterday, and should be smaller still by tomorrow. Which is not to say we should be complacent about continuing to vigorously study and generating high quality evidence, but I do accept that not everything will (or can) come with high quality evidence today. What I want to see are guideline recommendations that are commensurate with the evidence, rather than wantonly superseding them.
Thanks for giving personal examples of how this lack of rigorous data affects both doctors and patients. I can see why you get frustrated! (But you didn't do any ad hominems - YAY! You're learning! 😁) It seems like it starts with medical schools, and whether or not they instill an attitude that doctors are practitioner-SCIENTISTS. What you hear on the nightly news are the egregious cases of negligence, like improper telemetry monitoring (link below). You don't hear about all the negative consequences that come from not knowing what to do because there is no data to guide you. I guess it's not that sexy for the media to cover, but maybe you should go on TikTok and do a rap song about it! If the public knew.....
You do know that an ad hominem is a kind of fallacy, right? Mostly our boy Prasad straight up insults people. There's no argument, so no fallacy. There's a lot of people to be upset about, thousands of doctors who decided to not think for themselves and rather to clamp down onto an ultimately tyrannical, profiteer perspective, and who probably for this reason, deserve to be insulted, relative to the profundity of their arrogance.
"An ad hominem argument is not always fallacious." (link below) But since Prasad always critiques the argument while he's insulting the person who made it, your point is taken. Personally, I don't believe anybody "deserves" to be insulted, although I understand the common human impulse to do so. I don't have the same dark opinion of the medical profession as you seem to, but even if I did, my point is that nobody EVER has been persuaded by insults. In fact, insults create defensiveness, which in turn, causes people to double down. The only point I was making is that it is not an effective communication strategy unless the sole purpose of the communication is to vent frustration. Even then, it's not always effective, since excessive venting can make a person feel worse and not better. But I think Vinay is trying to do more than vent, but perhaps I'm wrong.
Yes, exactly. I’m afraid that they don’t do the trials because they DO NOT WANT to know more about what they are doing. How else do you explain it? Lazy medicine
Well, that's interesting. It appears that "medical freedom" doesn't include people that disagree with the authors. While I don't go along with his tone, many of his posts that I saw on this thread ring true. And his opinions are in fact echoed by many clinicians, if not his tone. Questioning the idealistic idolatry of RCTs needs to be done on a regular basis. His last paragraph made perfect sense.
I don't understand why this particular post by MD,MPH was banned. It seems rather innocuous
compared to a lot of the public health nonsense that this commenter usually posts. He/she (for those concerned with pronouns) actually makes some good points. The sarcasm is rather mild and there is no ad hominem attack.
I suspect that Vinay is just tired of him. I would lean toward letting him rant because his comments typically illustrate his arrogance and politically vs factually driven conclusions. To think he claims to be a doctor treating actual patients?
I agree the comment above is not political. In several past interactions with this individual, he has shown himself to be an ideologue mindlessly pushing the politically approved narrative and attacking anyone that disagrees or questions this narrative with breathtaking arrogance. He has a real personal animus toward Vinay as he has attacked him in the comments on other Substack posts in which Vinay was not involved.
You are probably correct. I initially thought this might be a robot but finally decided that a robot couldn't be programmed to exude this much arrogance.
"How can you control for parents and find the independent effect of screen time? How can you arrive at the truth? Is it good or bad for cognitive growth to give 30 mins, or 2 hours or 4 hours of screen time to a 1 year old — all else being equal?"
If you actually had a good faith argument, rather than spewing frustration, you might respond to these questions. Instead, you ignore those questions and just acknowledge:
"There are no good data to advise parents, and yet, the American Academy of Pediatrics does."
So let's think about this. Science is designed to try to answer basic questions about reality. If the basic questions remain inconclusive, or if cofounders make it impossible to distinguish effects from causes, then you don't have a good study. Period. And, reading these summary articles you post, they still lack the information or statistical robustness in order to make that call.
So, yes. Quality of science matters. If it's not possible to use research to make meaningful distinctions and the net result is still a shoulder shrug, it's probably not really worth publishing because it only enables further, low quality, junk papers clogging up the reports that actually have any substantive scientific work completed.
The COVId vaccine link studied those age 60 and over. I don’t think there is as much controversy wrt the vaccine recommendations in that age group. The issue is to suggest “vaccinate everyone” (in Dec 2023) based on data from the 60+ cohort. I think Prasad’s biggest beef has been the recommendations in children. What is the evidence for COVId vax in kids in late 2023? Also, the methods section wasn’t clear as to how they determined “COVId 19 hospitalizations “ etc. Were those admitted/ICU “cuz” COVId, or merely “with” COVId?
The screen time review is fine. Lots of epidemiology and not much RCT data of any sort. It’s sufficient to maybe support motherhood statements like “less screen time is better”. But where on earth are they getting the specific age/time cut points for those recommendations?
FYI - your first link is to an article about the Covid vaccine - assume that was in error? I'm mostly retired but when I worked in schools as a psychologist and did classroom observations of kids with academic struggles, I would always compare the target child to a "typical" child, and the one with academic problems inevitably yawned frequently and the typical child did not. I think we have pretty solid data on the impact of sleep deficits on learning and behavior. A relatively easy study to do would be to study whether more screen time equals less sleep time. But that's just correlational, so then to satisfy the purists, one would need to do an RCT, which would necessitate limiting screen time in the experimental group. I have seen the meltdowns that happen with that!
It would be an interesting experiment. Sometimes restrictions increase attractiveness and, depending on the age, might actually increase surreptitious screen time. It's not an easy restriction to enforce. I generally advocate using a problem solving approach with kids and teens so that they are more motivated and have buy-in. I wrote a 10-part series, "Can you Change Someone?" on LinkedIn, with the first one below. Because it's such a common problem, I used screen time as a "problem" to be solved as an illustration. If you are interested, I'd recommend reading from the beginning because just going to that section will not provide enough info. I'm pretty sure Vinay is not a parent!
If we accept the assumptions in this article, it's a wonder medicine ever helped anyone prior to the modern era.
Even in primitive times, there was very good medicine practice based only on clinical observations. The problem with today's medicine stems from the allopathic mindset ushered in by Pharma just over 100 years ago that sought to eliminate all other medical practitioners (osteopathic, homeopathic, etc.) by claiming only they had the knowledge which came from so-called studies when in fact all they had was a bunch of snake oil from the fledgling pharmaceutical companies who promoted "a pill for every ill."
You'd think that people who rejected their grandparent's complaints that medical doctors were "pill-pushers" would have woken up with the opioid crises the medical establishment created in the 1990s (which was about the time the deceptive "evidence based medicine" rhetoric began) and then the current vax-injury nightmare we are still living through, but no.... the magic potion narrative and believe in the infallibility of scientism continues to hold sway - even when scientism bemoans they don't have the "evidence based" studies because they are too onerous. It's all a profiteering scam.
We became lost when we started to give credence to the “experts” about every damn thing. Studies this and studies that! Where the hell did common sense go? Are we really better off now than we were 60 years ago? I don’t think so. I remember life 60 years ago and it was better by far.
Even when doctors do know, the public message is often the opposite. I was just reading about the Salk vaccine, where experts complained about "double-talk and an unwillingness to face facts" of ineffectiveness and deep safety problems. https://www.civilianintelligencenetwork.ca/wp-content/uploads/2021/11/ThePresentStatusOfPolioVaccines-1960-Chicago.pdf
Only because there was a competing vaccine, did that bit of truth even get written.
There are so many parallels to the COVID shots including:
1. Blaming the unvaccinated for outbreaks.
2. Not counting cases to make the vaccine look effective.
3. A big change in the vaccine production process after the randomized trials.
4. Israeli data showing lack of effectiveness.
5. Using antibody levels to "infer" effectiveness.
6. Hiding widespread safety problems and blaming only one manufacturer.
7. The vaccine doesn't stop infection but supposedly prevents serious disease.
8. Endless boosters (up to six inoculations) and people still got seriously ill.
The propaganda is not due to lack of data.
Always appreciate your ways of pointing out the problems with scientific thinking and how badly it failed during CoVid. I don't know that I will ever stop talking about how badly things went in 2020-22.
The Covid debacle is the best, largest, and most recent demonstration of the fact that almost all of the medical information widely promulgated is DELIBERATELY not studied -- not because it is "too hard" or "too expensive" or too anything...just because it wrecks a narrative that is financially, emotionally or (worst of all) politically useful.
As the Danish studied showed, it would have been fairly simple to do masking studies. I volunteered to get funding for YOU to do a masking study when you first started this stack but the result was only crickets (I know you do not read any comments, but thought that someone might pass that on to you). This was important to know and the field could have been substantially advanced...but the interest was zero because it was politically inconvenient.
Mirrors need to be held up all around.
If medicine was ever to generate truthful unencumbered evidence that its wares are worthy of use, they would go out of business.
It would not be so bad, from my point of view(the patient) if clinicians were still allowed to use their clinical judgement, which comes from their n=1 trials and treatment knowledge gained over time. It seems clinical judgement outside the standard care is discouraged. For a patient like me, who is most definitely not the average when it comes to response to meds, I tend to take my allopathic doctor as one ‘skewed’ opinion.
The two examples given illustrate problems with the application of scientific principles to medicine; I don't know if that was the intent of showing the contrasts but it does that quite well.
1) Attempts (presumably) to determine the effects of screen time on child development and psychology by correlation with the percentage of time spent with their phones and computers.
2) Trying to determine the best therapy for a pediatric hematological problem.
The first is, in my opinion, logistically impossible. What are the end points? Good kid, bad kid? Are there gradations for that designation? What is the time period for the development? How on earth can anyone measure or quantify how much time is spent? But, most important, this is not the province of medicine. This is societal and parenting problem. Medical doctors are no more qualified to advise parents than is any other randomly selected member of society.
The second is clearly a medical issue that may well be amenable to exploration by employment of random trials that adhere to the scientific method.
So we should encourage and support the second and not waste resources on the first as well as many other areas that do not relate to the diagnosis and treatment of disease.
If a physician doesn't want to see the evidence, there's nothing we can do. I presented Vinay Prasad with ample evidence that excess breast cancers after mammography screening are radiation-induced cancers and not overdiagnosis, and in response he blocked me on Twitter.
"People would rather believe than know." -- E.O. Wilson
"Ignorance is preferable to error, and he is less remote from the truth that believes nothing than he who believes what is wrong." Thomas Jefferson
I agree and disagree here.
The screen time recommendations relate to my ongoing beef with guideline writers: from what orifice are they extracting those very specific cut points (age such and such, less than this many screen hours)? It’s again the urge to pretend to know, when they haven’t got a clue (at least in terms of actual RCT evidence of causation that could justify those recommendations).
As for finding the answers, it’s an ongoing journey. It’s in my lifetime that MI’s were treated at one time with bedrest and stool softeners. I was already sentient when it was just ASA and UFH. So we’ve come a long way for that 1 condition even in the last 30 years. You will always find conditions and clinical scenarios for which there is no good evidence based answer today….but that number is probably slightly smaller than it was yesterday, and should be smaller still by tomorrow. Which is not to say we should be complacent about continuing to vigorously study and generating high quality evidence, but I do accept that not everything will (or can) come with high quality evidence today. What I want to see are guideline recommendations that are commensurate with the evidence, rather than wantonly superseding them.
Thanks for giving personal examples of how this lack of rigorous data affects both doctors and patients. I can see why you get frustrated! (But you didn't do any ad hominems - YAY! You're learning! 😁) It seems like it starts with medical schools, and whether or not they instill an attitude that doctors are practitioner-SCIENTISTS. What you hear on the nightly news are the egregious cases of negligence, like improper telemetry monitoring (link below). You don't hear about all the negative consequences that come from not knowing what to do because there is no data to guide you. I guess it's not that sexy for the media to cover, but maybe you should go on TikTok and do a rap song about it! If the public knew.....
https://www.nbcnews.com/nightly-news/video/telemetry-is-key-for-treating-patients-improper-monitoring-can-lead-to-tragedy-200670789912
You do know that an ad hominem is a kind of fallacy, right? Mostly our boy Prasad straight up insults people. There's no argument, so no fallacy. There's a lot of people to be upset about, thousands of doctors who decided to not think for themselves and rather to clamp down onto an ultimately tyrannical, profiteer perspective, and who probably for this reason, deserve to be insulted, relative to the profundity of their arrogance.
Trust the science. Right?
"An ad hominem argument is not always fallacious." (link below) But since Prasad always critiques the argument while he's insulting the person who made it, your point is taken. Personally, I don't believe anybody "deserves" to be insulted, although I understand the common human impulse to do so. I don't have the same dark opinion of the medical profession as you seem to, but even if I did, my point is that nobody EVER has been persuaded by insults. In fact, insults create defensiveness, which in turn, causes people to double down. The only point I was making is that it is not an effective communication strategy unless the sole purpose of the communication is to vent frustration. Even then, it's not always effective, since excessive venting can make a person feel worse and not better. But I think Vinay is trying to do more than vent, but perhaps I'm wrong.
https://www.scribbr.com/fallacies/ad-hominem-fallacy/#:~:text=Poisoning the well is a,has been charged with embezzlement.”
Yes, exactly. I’m afraid that they don’t do the trials because they DO NOT WANT to know more about what they are doing. How else do you explain it? Lazy medicine
Well, that's interesting. It appears that "medical freedom" doesn't include people that disagree with the authors. While I don't go along with his tone, many of his posts that I saw on this thread ring true. And his opinions are in fact echoed by many clinicians, if not his tone. Questioning the idealistic idolatry of RCTs needs to be done on a regular basis. His last paragraph made perfect sense.
I don't understand why this particular post by MD,MPH was banned. It seems rather innocuous
compared to a lot of the public health nonsense that this commenter usually posts. He/she (for those concerned with pronouns) actually makes some good points. The sarcasm is rather mild and there is no ad hominem attack.
I suspect that Vinay is just tired of him. I would lean toward letting him rant because his comments typically illustrate his arrogance and politically vs factually driven conclusions. To think he claims to be a doctor treating actual patients?
I've got no horse in this fight, but the posts I saw seemed entirely apolitical. Can't say the same for lots of other posts.
I agree the comment above is not political. In several past interactions with this individual, he has shown himself to be an ideologue mindlessly pushing the politically approved narrative and attacking anyone that disagrees or questions this narrative with breathtaking arrogance. He has a real personal animus toward Vinay as he has attacked him in the comments on other Substack posts in which Vinay was not involved.
That's unfortunate. But what is the "politically approved narrative" and why is it not open for discussion?
Are you being purposely obtuse? Everything should be open for discussion. True science requires it.
Yes. Totally agree. It’s not even worth responding to him bc it is so ego/ emotionally driven.
You are probably correct. I initially thought this might be a robot but finally decided that a robot couldn't be programmed to exude this much arrogance.
Let's work on some reading comprehension.
"How can you control for parents and find the independent effect of screen time? How can you arrive at the truth? Is it good or bad for cognitive growth to give 30 mins, or 2 hours or 4 hours of screen time to a 1 year old — all else being equal?"
If you actually had a good faith argument, rather than spewing frustration, you might respond to these questions. Instead, you ignore those questions and just acknowledge:
"There are no good data to advise parents, and yet, the American Academy of Pediatrics does."
So let's think about this. Science is designed to try to answer basic questions about reality. If the basic questions remain inconclusive, or if cofounders make it impossible to distinguish effects from causes, then you don't have a good study. Period. And, reading these summary articles you post, they still lack the information or statistical robustness in order to make that call.
So, yes. Quality of science matters. If it's not possible to use research to make meaningful distinctions and the net result is still a shoulder shrug, it's probably not really worth publishing because it only enables further, low quality, junk papers clogging up the reports that actually have any substantive scientific work completed.
The COVId vaccine link studied those age 60 and over. I don’t think there is as much controversy wrt the vaccine recommendations in that age group. The issue is to suggest “vaccinate everyone” (in Dec 2023) based on data from the 60+ cohort. I think Prasad’s biggest beef has been the recommendations in children. What is the evidence for COVId vax in kids in late 2023? Also, the methods section wasn’t clear as to how they determined “COVId 19 hospitalizations “ etc. Were those admitted/ICU “cuz” COVId, or merely “with” COVId?
The screen time review is fine. Lots of epidemiology and not much RCT data of any sort. It’s sufficient to maybe support motherhood statements like “less screen time is better”. But where on earth are they getting the specific age/time cut points for those recommendations?
FYI - your first link is to an article about the Covid vaccine - assume that was in error? I'm mostly retired but when I worked in schools as a psychologist and did classroom observations of kids with academic struggles, I would always compare the target child to a "typical" child, and the one with academic problems inevitably yawned frequently and the typical child did not. I think we have pretty solid data on the impact of sleep deficits on learning and behavior. A relatively easy study to do would be to study whether more screen time equals less sleep time. But that's just correlational, so then to satisfy the purists, one would need to do an RCT, which would necessitate limiting screen time in the experimental group. I have seen the meltdowns that happen with that!
The fact that you've seen "meltdowns" when children are limited in their screen time tells you all you need to know.
I totally agree, but suspect that would not be sufficient for Vinay! Also, it would be rather difficult to do a "double blind" intervention! :)
I would be the first to volunteer my children. Every parent has seen the deleterious effects of screen time on their children.
It would be an interesting experiment. Sometimes restrictions increase attractiveness and, depending on the age, might actually increase surreptitious screen time. It's not an easy restriction to enforce. I generally advocate using a problem solving approach with kids and teens so that they are more motivated and have buy-in. I wrote a 10-part series, "Can you Change Someone?" on LinkedIn, with the first one below. Because it's such a common problem, I used screen time as a "problem" to be solved as an illustration. If you are interested, I'd recommend reading from the beginning because just going to that section will not provide enough info. I'm pretty sure Vinay is not a parent!
https://www.linkedin.com/pulse/can-you-change-someone-part-i-dr-shawn-o-brien/?trackingId=bX544SPUTEOLCKvOetM2rA==