"(People) who have excessive faith in their theories or ideas are not only ill prepared for making discoveries; they also make very poor observations. Of necessity, they observe with a preconceived idea, and when they devise an experiment, they can see, in its results, only a confirmation of their theory. In this way they distort observation and often neglect very important facts because they do not further their aim." — Claude Bernard
There are many studies that are ground breaking but nobody pays attention to them because they do not sell medical care or drugs.
For instance, it was established before the 1930s that high cholesterol results from low thyroid activity. It is completely ignored in order to sell statins.
Other studies show stents rarely prolong life. But nobody pays attention because they want to sell stents.
I could go on and on and on, Dr. Mandrola. I’m seeing studies that make the CAST event look like small beer.
And don’t get me started on the so-called evidence for the Covid “vaccine”.
As a prospective patient, I do not believe in medicine as you guys preach, practice and dictate it. Therefore, I refuse to enter the medical maze of lunacy and trickery.
Great column. And fantastic talk at UBC cardiology grand rounds last week. I know many of my colleagues consider this newsletter and TWIC to be mandatory reading. It gives voice to aspiring, budding, and closet medical conservatives.
The power of a quality newsletter like this one is the democratization of information that diverges from named journals, societies, and associations, who are beholden to industry interests and varying degrees of industry capture, and who collectively fuel the “therapeutic fashion” you speak of. The study discussed here is a good example thereof.
You have performed a very valuable service in revisiting this important study. It should be an effective cautionary example because the logic behind the decision to use anti-arrhythmic drugs in that setting seemed so obvious. Hopefully, it will cause some of the more "proactive" doctors to exercise a little more caution with medications and interventions intended to be "preventive" measures. I wonder what would have happened had the results merely shown that there was little or no difference between the drug and placebo groups. I suspect the practice would have continued and spurred on further research to find "better" drugs.
‘So many of you, those that are truly independent thinkers, if you allowed yourself to realize how truly moronic every doctor you’ve ever met is, you not only would never speak to them again, you would put a leash on them.
One that could be seen and held.
In contrast to the intellectual choke collars the medical schools put on each of them.
I don't understand the Nottingham researchers' vague guesses about the significance of the treatment group's 9-fold increase in death. Did no one think to calculate the P value?
Relative to your note of surprise about the degree to which Sensible Medicine is appreciated -- you're not just being read by physicians. I'm a patient-centered care PhD type working in Rehab Medicine and you guys are a breath of fresh air. I was red-pilled about how problematic many studies are a few years back in the course of a psychosocial research fellowship where my brilliant mentor INSISTED I go hang out with the Measurement and Stats folks for a while. Many investigators are still deer-in-the-headlights about what their data can and can't demonstrate.
It's been a long time since I got used to reading and enjoying John Mandrola's comments. He is a true scientist, one of the few who from a scientific point of view interprets the results of medical trials. And I say this with the certainty of someone who is over seventy years old and has spent his life researching and publishing.
J. Mandrola's attitude is all the more commendable as current Medicine has almost been transformed into a religion dominated by non-scientific interests.
Is there a word missing in your last sentence? “But due to my age, I can testify that we quite sure that ventricular arrhythmias needed to be suppressed after an MI.” It doesn’t make sense!
"Some things will surely hold up: PCI for MI, fixing displaced fractures, antibiotics for bacterial infection, and of course, caring and empathy." Antibiotics for infections? They certainly can be effective, but with so many organisms becoming resistant to them, not to mention their effect on the gut biome, maybe there is a better therapy out there.
Unfortunately, “fashion based medicine” or “opinion based medicine” makes the problem seem more benign than it actually is. Studies don’t just go unpublished randomly according to individual reviewers whims and opinions. There are very clear financial incentives for publishing journals to bias in favor of industry products, resulting in an artificial abundance of visible data favoring industry products and scant evidence against them. Evidence based medicine feels like it’s really just becoming sponsored medicine.
You didn't even mention the moracizine arm, where they had to stop the trial after a mere 2 weeks because the treatment group did so much worse! https://www.nejm.org/doi/full/10.1056/NEJM199207233270403
"(People) who have excessive faith in their theories or ideas are not only ill prepared for making discoveries; they also make very poor observations. Of necessity, they observe with a preconceived idea, and when they devise an experiment, they can see, in its results, only a confirmation of their theory. In this way they distort observation and often neglect very important facts because they do not further their aim." — Claude Bernard
There are many studies that are ground breaking but nobody pays attention to them because they do not sell medical care or drugs.
For instance, it was established before the 1930s that high cholesterol results from low thyroid activity. It is completely ignored in order to sell statins.
Other studies show stents rarely prolong life. But nobody pays attention because they want to sell stents.
I could go on and on and on, Dr. Mandrola. I’m seeing studies that make the CAST event look like small beer.
And don’t get me started on the so-called evidence for the Covid “vaccine”.
As a prospective patient, I do not believe in medicine as you guys preach, practice and dictate it. Therefore, I refuse to enter the medical maze of lunacy and trickery.
Great column. And fantastic talk at UBC cardiology grand rounds last week. I know many of my colleagues consider this newsletter and TWIC to be mandatory reading. It gives voice to aspiring, budding, and closet medical conservatives.
The power of a quality newsletter like this one is the democratization of information that diverges from named journals, societies, and associations, who are beholden to industry interests and varying degrees of industry capture, and who collectively fuel the “therapeutic fashion” you speak of. The study discussed here is a good example thereof.
Thanks Steve and great to meet in Vancouver!
oh you were in Vancouver last week!!! Next time, drinks on me.
You have performed a very valuable service in revisiting this important study. It should be an effective cautionary example because the logic behind the decision to use anti-arrhythmic drugs in that setting seemed so obvious. Hopefully, it will cause some of the more "proactive" doctors to exercise a little more caution with medications and interventions intended to be "preventive" measures. I wonder what would have happened had the results merely shown that there was little or no difference between the drug and placebo groups. I suspect the practice would have continued and spurred on further research to find "better" drugs.
‘So many of you, those that are truly independent thinkers, if you allowed yourself to realize how truly moronic every doctor you’ve ever met is, you not only would never speak to them again, you would put a leash on them.
One that could be seen and held.
In contrast to the intellectual choke collars the medical schools put on each of them.
That's pretty unfair.
That is the mindset of those who would like to put a leash on those they disagree with.
I don't understand the Nottingham researchers' vague guesses about the significance of the treatment group's 9-fold increase in death. Did no one think to calculate the P value?
“industry-free thinking” didn’t play out well for Semmelweis
Relative to your note of surprise about the degree to which Sensible Medicine is appreciated -- you're not just being read by physicians. I'm a patient-centered care PhD type working in Rehab Medicine and you guys are a breath of fresh air. I was red-pilled about how problematic many studies are a few years back in the course of a psychosocial research fellowship where my brilliant mentor INSISTED I go hang out with the Measurement and Stats folks for a while. Many investigators are still deer-in-the-headlights about what their data can and can't demonstrate.
It's been a long time since I got used to reading and enjoying John Mandrola's comments. He is a true scientist, one of the few who from a scientific point of view interprets the results of medical trials. And I say this with the certainty of someone who is over seventy years old and has spent his life researching and publishing.
J. Mandrola's attitude is all the more commendable as current Medicine has almost been transformed into a religion dominated by non-scientific interests.
Someone should start a journal called: The Journal of Negativity and Non-Significance
It could be a home for high-quality studies that can't get published elsewhere due to publication bias
Is there a word missing in your last sentence? “But due to my age, I can testify that we quite sure that ventricular arrhythmias needed to be suppressed after an MI.” It doesn’t make sense!
Yes. Gosh darn it. Thanks. I fixed it.
I think Dr. Prasad would be shocked by the salty language here!
"Some things will surely hold up: PCI for MI, fixing displaced fractures, antibiotics for bacterial infection, and of course, caring and empathy." Antibiotics for infections? They certainly can be effective, but with so many organisms becoming resistant to them, not to mention their effect on the gut biome, maybe there is a better therapy out there.
Unfortunately, “fashion based medicine” or “opinion based medicine” makes the problem seem more benign than it actually is. Studies don’t just go unpublished randomly according to individual reviewers whims and opinions. There are very clear financial incentives for publishing journals to bias in favor of industry products, resulting in an artificial abundance of visible data favoring industry products and scant evidence against them. Evidence based medicine feels like it’s really just becoming sponsored medicine.