No, it's not. Any individual's anecdote is not evidence. It's a story. Were you to collate thousands of stories, you would just have a bigger work of fiction.
This is how, for years, people insisted that homeopathy was a vaild treatment - the overwhelming weight of "anecdotal evidence," which has absolutely no relationship to the truth, …
No, it's not. Any individual's anecdote is not evidence. It's a story. Were you to collate thousands of stories, you would just have a bigger work of fiction.
This is how, for years, people insisted that homeopathy was a vaild treatment - the overwhelming weight of "anecdotal evidence," which has absolutely no relationship to the truth, which is, of course, that this form of treatment is worthless.
The belief that water is wet is based on stories, then. Also the belief that parachutes save lives.
And I am also trained in chemistry and physics and have done physics research.
Homeopathy has a deductive basis for some treatments. The intestines have a lot of immune function, so giving an allergen to the gut may "turn off" allergenicity in the skin and respiratory system. Apparently, there are journals of homeopathy where studies are published.
Lol. Homeopathy has been conclusively "debunked" from a scientific perspective.
Water is not "wet" based on stories, but by definition.
And parachutes can be demonstrated to save lives. And we got that way not by throwing people out of planes but by using makeshift parachutes on non-human items, so we could see how they slow the fall of an object.
I am sorry you don't understand evidence Tom, but if I were you, I would stop offering your opinion on anything until you do.
Most of our knowledge is based on observational evidence, isn't it? We don't have to get picky about the strength of evidence unless the observational evidence is doubted, such as occurs when someone has an alternative theory to explain the existing evidence.
Tom, there's nothing sadder than seeing a stupid man get desperate in his ridiculous arguments.
You have reached that point.
I pity you, but I will no longer respond to you - you have nothing of value to offer and I have no idea where you think I said you need an RCT to measure the value of a parachute? Because I didn't. That's in your La-La Land, not mine.
Run along now, I am sure you have plenty of windows that need licking.
I don't know about the rest of the readers here, but I think it is likely that you may have misunderstood one of the key ideas of this substack: civil and vigorous discussion of the ideas. You have the vigorous part, but I think you missed the civil part. I noticed that you made quite a few personal attacks on other commenters throughout this particular post of Adam's. Could you please dial it back a bit? Thanks!
While I appreciate (and agree with) your desire to focus on RCTs (and on your opinion on masks) I think it is unwise to ignore the experience of experts in the field. As Masic et. al cite "Evidence Based Medicine – New Approaches and Challenges", while EBM reduces the value of intuition, non-systematic clinical experience and pathophysiology as sufficient basis in making clinical decisions, and emphasizes the value of evidence obtained by clinical research, good doctors apply their clinical observation and experience, together with the best scientific evidence from medical literature.
They define EBM as the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients. EBM integrates clinical experience and patient values with the best available research information.
EBM categorizes different types of clinical evidence and ranks them according to the strength of their freedom from the various biases that beset medical research.
1. Evidences obtained by meta-analysis of several randomized controlled research (RCR).
1b. Evidences from only one RCR.
2a. Evidences from well designed controlled research RCR.
2b. Evidences from one quasi experimental research.
3. Evidences from non experimental studies (comparative research, case study), according to some, for example Textbooks.
4. Evidences from experts and clinical practice.
While it's not wise to reach conclusions on mere anecdote, it's an important first step in the process of evaluating evidence, which often leads to further inquiry, fine tuning hypothesis (which probably never ends), & eventually coming to a conclusion on better evidence.
Philosophy of Medicine thinks a little differently about EBM than most of the doctors who favor EBM. RCTs are not necessarily stronger evidence than observational studies. RCTs attempt to limit researcher bias involved in selecting subjects for treatment--RCTs have strong intrinsic linkage, but weak extrinsic linkage. Their test is great for the subject population tested, but conclusions often don't apply to the general population or to subgroups in the general population. RCTs only limit one type of bias and can be subject to many other biases. For example, designed-to-fail studies incorporate designer bias even in RCTs. Designer bias is often weightier than the bias from cherry-picking data.
I'm sure there are always different opinions. That doesn't change that meta-analysis of RCTs and RCTs themselves are widely accepted as superior to cohort studies, case control studies, cross sectional studies, case studies, & mechanistic studies.
I would certainly be prepared to use anecdotes to inform the direction of any given aspect of research but to base real world decisions on them? Nope.
And in the instance of masks, I don't need anecdotes, I have overwhelming amounts of research that conclude they don't work - no need for a physician's gut feeling that they might. They don't.
Totally agree Nick, anecdotes are not a strong basis for making decisions. And, when we have better evidence, which when it comes to masks we do, we should prioritize that over anecdotal experiences. However, it is clear anecdotal experience from experts in the field is a form of evidence that any good practitioner should take into account. Usually those experiences should trigger folks to look for better evidence to help ensure recommendations are grounded in the best evidence we have, which of course in this case we know are 1) the 2 RCTs specific to Covid (Bangladesh & Danish mask trials), and 2) the 14 RCTs on other respiratory diseases that were completed pre-covid. In total of these 16 RCTs (2 on covid & 14 on other respiratory diseases), 14 of them failed to find a statistically significant difference to not masking. That means approximately 88% of the RCTs failed to find a statistically significant difference between masking and not masking while only 12% found modest significance. This should certainly trump any anecdotal experience and is not compelling evidence to support masks can prevent transmission of respiratory disease and covid.
Aren't parachutes based on anecdotal evidence? How about the belief that the sun rises in the east and sets in the west? How about the belief that we all will die some day?
I contend that anecdotal evidence informs the vast preponderance of our beliefs. RCTs can be valuable for investigating some small fraction of controversial questions where researcher bias may be an issue. Observational studies are valuable for investigating population groups where impact is high enough relative to the data to be able to test a hypothesis adequately.
Sounds like an argument just to talk. My point was anecdotal experience from experts in the field is a form of evidence that any good practitioner should take into account. Unless you're disagreeing with that, put your comment elsewhere.
No, it's not. Any individual's anecdote is not evidence. It's a story. Were you to collate thousands of stories, you would just have a bigger work of fiction.
This is how, for years, people insisted that homeopathy was a vaild treatment - the overwhelming weight of "anecdotal evidence," which has absolutely no relationship to the truth, which is, of course, that this form of treatment is worthless.
The belief that water is wet is based on stories, then. Also the belief that parachutes save lives.
And I am also trained in chemistry and physics and have done physics research.
Homeopathy has a deductive basis for some treatments. The intestines have a lot of immune function, so giving an allergen to the gut may "turn off" allergenicity in the skin and respiratory system. Apparently, there are journals of homeopathy where studies are published.
Lol. Homeopathy has been conclusively "debunked" from a scientific perspective.
Water is not "wet" based on stories, but by definition.
And parachutes can be demonstrated to save lives. And we got that way not by throwing people out of planes but by using makeshift parachutes on non-human items, so we could see how they slow the fall of an object.
I am sorry you don't understand evidence Tom, but if I were you, I would stop offering your opinion on anything until you do.
I suspect such a put-down is not warranted. We don't know each other well enough for that.
Feel free to suspect whatever you like. It's a free country. I stand by it.
"Lol. Homeopathy has been conclusively "debunked" from a scientific perspective."
You have managed to demonstrate that you understand neither science nor philosophy of science.
You, unfortunately, don't understand that "wetness" is a sensation, not a definition.
You say that parachutes have been demonstrated to save lives, but I have yet to see a RCT proving it. All of the evidence is anecdotal.
Discoveries of new species of birds are generally based on anecdotes of sightings.
Unfortunately, your epistemology and your metaphysics are lacking rather severely. You should have taken a course or two in philosophy.
I absolutely understand your point here. This is a very good takedown of reflexive rejection of observational evidence.
Thank you.
Most of our knowledge is based on observational evidence, isn't it? We don't have to get picky about the strength of evidence unless the observational evidence is doubted, such as occurs when someone has an alternative theory to explain the existing evidence.
Tom, there's nothing sadder than seeing a stupid man get desperate in his ridiculous arguments.
You have reached that point.
I pity you, but I will no longer respond to you - you have nothing of value to offer and I have no idea where you think I said you need an RCT to measure the value of a parachute? Because I didn't. That's in your La-La Land, not mine.
Run along now, I am sure you have plenty of windows that need licking.
I don't know about the rest of the readers here, but I think it is likely that you may have misunderstood one of the key ideas of this substack: civil and vigorous discussion of the ideas. You have the vigorous part, but I think you missed the civil part. I noticed that you made quite a few personal attacks on other commenters throughout this particular post of Adam's. Could you please dial it back a bit? Thanks!
Are you the Substack police, Marlon? I checked the authors for this Substack, you're not one of them.
So, feel free to mind your own business as I debate as I see fit. Thanks.
Ok, Oh Brainiac. Are you published in Philosophy of Science? I am. I guess that makes me "stupid" somehow.
While I appreciate (and agree with) your desire to focus on RCTs (and on your opinion on masks) I think it is unwise to ignore the experience of experts in the field. As Masic et. al cite "Evidence Based Medicine – New Approaches and Challenges", while EBM reduces the value of intuition, non-systematic clinical experience and pathophysiology as sufficient basis in making clinical decisions, and emphasizes the value of evidence obtained by clinical research, good doctors apply their clinical observation and experience, together with the best scientific evidence from medical literature.
They define EBM as the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients. EBM integrates clinical experience and patient values with the best available research information.
EBM categorizes different types of clinical evidence and ranks them according to the strength of their freedom from the various biases that beset medical research.
1. Evidences obtained by meta-analysis of several randomized controlled research (RCR).
1b. Evidences from only one RCR.
2a. Evidences from well designed controlled research RCR.
2b. Evidences from one quasi experimental research.
3. Evidences from non experimental studies (comparative research, case study), according to some, for example Textbooks.
4. Evidences from experts and clinical practice.
While it's not wise to reach conclusions on mere anecdote, it's an important first step in the process of evaluating evidence, which often leads to further inquiry, fine tuning hypothesis (which probably never ends), & eventually coming to a conclusion on better evidence.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3789163/
Philosophy of Medicine thinks a little differently about EBM than most of the doctors who favor EBM. RCTs are not necessarily stronger evidence than observational studies. RCTs attempt to limit researcher bias involved in selecting subjects for treatment--RCTs have strong intrinsic linkage, but weak extrinsic linkage. Their test is great for the subject population tested, but conclusions often don't apply to the general population or to subgroups in the general population. RCTs only limit one type of bias and can be subject to many other biases. For example, designed-to-fail studies incorporate designer bias even in RCTs. Designer bias is often weightier than the bias from cherry-picking data.
https://plato.stanford.edu/entries/medicine/#RandContTriaEvidBaseMedi
I'm sure there are always different opinions. That doesn't change that meta-analysis of RCTs and RCTs themselves are widely accepted as superior to cohort studies, case control studies, cross sectional studies, case studies, & mechanistic studies.
Sure, everyone is free to engage in dodgy philosophy and ignore the writings of philosophers.
I would certainly be prepared to use anecdotes to inform the direction of any given aspect of research but to base real world decisions on them? Nope.
And in the instance of masks, I don't need anecdotes, I have overwhelming amounts of research that conclude they don't work - no need for a physician's gut feeling that they might. They don't.
Totally agree Nick, anecdotes are not a strong basis for making decisions. And, when we have better evidence, which when it comes to masks we do, we should prioritize that over anecdotal experiences. However, it is clear anecdotal experience from experts in the field is a form of evidence that any good practitioner should take into account. Usually those experiences should trigger folks to look for better evidence to help ensure recommendations are grounded in the best evidence we have, which of course in this case we know are 1) the 2 RCTs specific to Covid (Bangladesh & Danish mask trials), and 2) the 14 RCTs on other respiratory diseases that were completed pre-covid. In total of these 16 RCTs (2 on covid & 14 on other respiratory diseases), 14 of them failed to find a statistically significant difference to not masking. That means approximately 88% of the RCTs failed to find a statistically significant difference between masking and not masking while only 12% found modest significance. This should certainly trump any anecdotal experience and is not compelling evidence to support masks can prevent transmission of respiratory disease and covid.
Aren't parachutes based on anecdotal evidence? How about the belief that the sun rises in the east and sets in the west? How about the belief that we all will die some day?
I contend that anecdotal evidence informs the vast preponderance of our beliefs. RCTs can be valuable for investigating some small fraction of controversial questions where researcher bias may be an issue. Observational studies are valuable for investigating population groups where impact is high enough relative to the data to be able to test a hypothesis adequately.
Sounds like an argument just to talk. My point was anecdotal experience from experts in the field is a form of evidence that any good practitioner should take into account. Unless you're disagreeing with that, put your comment elsewhere.
I'm interested in epistemology, generally. It has been useful during the pandemic.