In this essay Dr. Rind counsels us on when to moderate our skepticism and recognize that our understanding of an illness or therapy might need to change
Our pediatrician said she always waits 6 months to see how a new drug or vaccine works before she recommends it. This gives time to see actual results rather than just test results. I think this is a good way of being skeptical but willing to try new treatments.
I really appreciated this article, thank you. I think we often get really accustomed to tagging flaws in any trial we read, especially when teaching, and it becomes as second-nature as reeling off familiar crossword answers: "apse", "rara avis", "immortal time bias", etc. It's good to be reminded that scouring a study for soft spots is not the same as invalidating it.
A very good dose of serious advice from David Rind. However, I do think that we should object firmly to the first sentence of the second paragraph: Note his chosen verbiage, ". . . .flaws that lead to the wrong answer". In biostatistical matters we actually never "uncover the right answer" and this startling point was made in a leading textbook some years ago by (I seem to recall) David Sackett (?) --- viz. in all applications of modern epidemiology sleuthing, including uses of even the most scrupulous RCTs, investigators will *always* get approximations of the Truth underlying some matter at hand. I think that epidemiologists sense reality through layers of fog, sometimes with greater difficulty than at other times, but never with 100.00 percent clarity despite strong applications of the most intense and au courant computational Kung Fu. In sum, I wish simply that Dr. Rind had said, ". . .focus on flaws that will lead the unwary to form misleading conclusions".
It doesn't seem convincing to make an argument against someone by calling them a name (i.e. contrarian). Nor by simply saying "those are facts". Would the Prasad you reference disagree with your second to last statement? I doubt so.
You are really going to try to defend the actions of public health "experts" during the past 3 years by citing masking and the disastrous vaccines. They have earned every bit of the enmity they receive. It is these "experts" that made indefensible decisions based not on science but on politics and/or tunnel vision to stop the virus. They ignored natural immunity, dramatically different risk by age or health status and the very real harms that the recommended/mandated interventions caused never once considering whether the collateral damage would be far more detrimental to the totality of public health. To make matters worse these same "experts" had the arrogance to censor, slander and ridicule those who dared ask the very questions that they should have considered. What has been proven is that these people should have never been "put in a position of having to make off the cuff decisions for entire populations...". Maybe the answer is no one should be in this position.
Your response uses the typical appeal to consensus (science is not based on consensus) and unsupported anecdotal emotional appeals. You fail to understand that there can both be a virus which causes real harms to certain portions of the population and a public health policy which ignores the collateral damage of interventions and past experience and science concerning respiratory viruses resulting in worse outcomes for the totality of public health. That you feel that you and your fellow "experts" should be "...put in a position of having to make off the cuff decisions for entire populations" is frightening. You and your peers refuse to honestly examine and learn from your failure but stand ready to make the same catastrophic decisions the next time we face a pandemic.
Just so I am prepared, what interventions do you think were effective and warrant reuse: mass mandated vaccination with an EUA vaccine of questionable effectiveness and safety, lockdowns, masks, etc. Please provide support for how these interventions benefits outweigh their harms.
Our pediatrician said she always waits 6 months to see how a new drug or vaccine works before she recommends it. This gives time to see actual results rather than just test results. I think this is a good way of being skeptical but willing to try new treatments.
It's good to know that people are willing to talk about skepticism. This is something we haven't had enough of in the last several years.
I really appreciated this article, thank you. I think we often get really accustomed to tagging flaws in any trial we read, especially when teaching, and it becomes as second-nature as reeling off familiar crossword answers: "apse", "rara avis", "immortal time bias", etc. It's good to be reminded that scouring a study for soft spots is not the same as invalidating it.
Having the self awareness to recognize one’s own biases is something every consumer of EBM should strive for.
This sentence really hit me: "We all have some degree of intellectual conflicts of interest – we all like to be right". I can certainly relate.
Probably one of the best ways to balance our own conflicts of interest is to ask others who disagree to engage with us.
A very good dose of serious advice from David Rind. However, I do think that we should object firmly to the first sentence of the second paragraph: Note his chosen verbiage, ". . . .flaws that lead to the wrong answer". In biostatistical matters we actually never "uncover the right answer" and this startling point was made in a leading textbook some years ago by (I seem to recall) David Sackett (?) --- viz. in all applications of modern epidemiology sleuthing, including uses of even the most scrupulous RCTs, investigators will *always* get approximations of the Truth underlying some matter at hand. I think that epidemiologists sense reality through layers of fog, sometimes with greater difficulty than at other times, but never with 100.00 percent clarity despite strong applications of the most intense and au courant computational Kung Fu. In sum, I wish simply that Dr. Rind had said, ". . .focus on flaws that will lead the unwary to form misleading conclusions".
It doesn't seem convincing to make an argument against someone by calling them a name (i.e. contrarian). Nor by simply saying "those are facts". Would the Prasad you reference disagree with your second to last statement? I doubt so.
You are really going to try to defend the actions of public health "experts" during the past 3 years by citing masking and the disastrous vaccines. They have earned every bit of the enmity they receive. It is these "experts" that made indefensible decisions based not on science but on politics and/or tunnel vision to stop the virus. They ignored natural immunity, dramatically different risk by age or health status and the very real harms that the recommended/mandated interventions caused never once considering whether the collateral damage would be far more detrimental to the totality of public health. To make matters worse these same "experts" had the arrogance to censor, slander and ridicule those who dared ask the very questions that they should have considered. What has been proven is that these people should have never been "put in a position of having to make off the cuff decisions for entire populations...". Maybe the answer is no one should be in this position.
Your response uses the typical appeal to consensus (science is not based on consensus) and unsupported anecdotal emotional appeals. You fail to understand that there can both be a virus which causes real harms to certain portions of the population and a public health policy which ignores the collateral damage of interventions and past experience and science concerning respiratory viruses resulting in worse outcomes for the totality of public health. That you feel that you and your fellow "experts" should be "...put in a position of having to make off the cuff decisions for entire populations" is frightening. You and your peers refuse to honestly examine and learn from your failure but stand ready to make the same catastrophic decisions the next time we face a pandemic.
Just so I am prepared, what interventions do you think were effective and warrant reuse: mass mandated vaccination with an EUA vaccine of questionable effectiveness and safety, lockdowns, masks, etc. Please provide support for how these interventions benefits outweigh their harms.
Appreciate the space to broadly reflect on my own biases. Thank you.
Hear here!