Well done, John, to calmly fight calumny with data. An example for us all to follow.
One small point:
It takes an enormous amount of energy and daily enthusiasm for a researcher to fight for funding, deal with the usual setbacks of bad hypotheses, and doggedly persist in sweating every detail to ensure that the data are as good as they can be in order to publish any good study, be it in basic research or as a clinical trial. All researchers worth their salt know this. Those who can’t maintain this enthusiasm fall by the wayside.
Please don’t tell researchers to be less enthusiastic about their work. With less enthusiasm, most of us would do something else. A better request might be not to shamelessly self-promote.
Karl Popper, the father of modern scientific philosophy, would not understand the question. One option represents the sine qua non of scientific thinking. The other is something else, entirely.
Deep gratitude to Dr.'s Cifu, Prasad, and Mandrola for representing science.
“this statement has not been evaluated by the FDA” , oh, I’m scared now.
“ This product is not intended to diagnose, treat, cure, or prevent any disease" So, is it to help your engine run cooler and give you more miles per gallon or to prevent shedding from your labraskyoodlehua rescue dog ?
“ what your doctor don’t tell you “ What, you’re on your own for placing your faith and $ on unproven claims ? The paper will stand anything that’s written on it.
And who is holding the charlatans feet to the fire ?
Gotta laugh every day 😂 or end up in a Corinthian leather padded room.
“In my opinion, the biggest problem in medicine are the utterly incompetent people who are frequently quoted in the media as medical experts.” I can not agree more. This same dogmatic delusion has infiltrated from the talking heads into how hijacked our medical journals have become. Approximately 70% of published clinical trials are funded by pharmaceutical companies and cheered on by either research morons or those with deep pockets investments. Pay to play peer review funded by pharma also needs to end. Until we break this stranglehold the skeptics will remain marginalized. Medical research should be open source. No more NEJM or Lancet that serves “the experts.”
As to teaching medical literature interpretation in medical school I am all in. Getting an MPH in epi was where I learned more about reading, interpreting and conducting studies than I did in medical school.
If you don't have skepticism you can't advocate for the best care (or cheerlead for the best) because you can't discern what is truly good. Thank you John for helping all of us discern good care. Without good skepticism (which I would claim is discernment) we can't be curious about what is needed or what is better. Then we get automatons spouting whatever they are told in blind faith and claiming it as gospel, without curiosity. Curiosity is what advanced medicine. Not dogma. Thank you John for being a champion of curiosity!
What are the chances that medical schools would include in their curricula a lecture or mini-course on the importance of skepticism in medicine using published studies and practices as discussed here? I think that this would be hugely important and augment the importance of the public responsibility of having a medical license.
In these essay, the term 'cheerleader' isn't clearly defined. It could run from someone expressing a non-controversial assertion that well designed studies have show net benefit from a given intervention. Pretty rare these days. Far more likely are the myriad promoters hardly distinguishable from snake oil salesmen. Studies should speak for themselves and not need a ethically challenged sales force, otherwise known as cheerleaders. If research survives the gantlet of scientific skepticism, then it may be considered useful and possibly become a standard of care (subject to many possible trade-offs).
Btw, I appreciate Vinay's numbers from his survey of those at top cancer centers. I almost feel as if the actual numbers are even more skewed towards cheerleaders, but I accept the 37 to 4 ratio as close to reality.
Great discussion. We need far more healthy skepticism. Therapeutic bias in medicine is very strong. We tend to naturally disregard and minimize evidence of harms. Need more trials to look at net clinical benefit.
Well done, John, to calmly fight calumny with data. An example for us all to follow.
One small point:
It takes an enormous amount of energy and daily enthusiasm for a researcher to fight for funding, deal with the usual setbacks of bad hypotheses, and doggedly persist in sweating every detail to ensure that the data are as good as they can be in order to publish any good study, be it in basic research or as a clinical trial. All researchers worth their salt know this. Those who can’t maintain this enthusiasm fall by the wayside.
Please don’t tell researchers to be less enthusiastic about their work. With less enthusiasm, most of us would do something else. A better request might be not to shamelessly self-promote.
Karl Popper, the father of modern scientific philosophy, would not understand the question. One option represents the sine qua non of scientific thinking. The other is something else, entirely.
Deep gratitude to Dr.'s Cifu, Prasad, and Mandrola for representing science.
“this statement has not been evaluated by the FDA” , oh, I’m scared now.
“ This product is not intended to diagnose, treat, cure, or prevent any disease" So, is it to help your engine run cooler and give you more miles per gallon or to prevent shedding from your labraskyoodlehua rescue dog ?
“ what your doctor don’t tell you “ What, you’re on your own for placing your faith and $ on unproven claims ? The paper will stand anything that’s written on it.
And who is holding the charlatans feet to the fire ?
Gotta laugh every day 😂 or end up in a Corinthian leather padded room.
“In my opinion, the biggest problem in medicine are the utterly incompetent people who are frequently quoted in the media as medical experts.” I can not agree more. This same dogmatic delusion has infiltrated from the talking heads into how hijacked our medical journals have become. Approximately 70% of published clinical trials are funded by pharmaceutical companies and cheered on by either research morons or those with deep pockets investments. Pay to play peer review funded by pharma also needs to end. Until we break this stranglehold the skeptics will remain marginalized. Medical research should be open source. No more NEJM or Lancet that serves “the experts.”
As to teaching medical literature interpretation in medical school I am all in. Getting an MPH in epi was where I learned more about reading, interpreting and conducting studies than I did in medical school.
If you don't have skepticism you can't advocate for the best care (or cheerlead for the best) because you can't discern what is truly good. Thank you John for helping all of us discern good care. Without good skepticism (which I would claim is discernment) we can't be curious about what is needed or what is better. Then we get automatons spouting whatever they are told in blind faith and claiming it as gospel, without curiosity. Curiosity is what advanced medicine. Not dogma. Thank you John for being a champion of curiosity!
"Any first-year medical student will tell you that a study of an intervention without a control is uninformative."
Sorry Dr Cifu, it's not only the first year medical students that have this prerogative.
"John Mandrola would make more money on Only Fans." Actual LOL.
Easy controlled study with clear primary endpoints. Accepts no surrogate substitutions
What are the chances that medical schools would include in their curricula a lecture or mini-course on the importance of skepticism in medicine using published studies and practices as discussed here? I think that this would be hugely important and augment the importance of the public responsibility of having a medical license.
In these essay, the term 'cheerleader' isn't clearly defined. It could run from someone expressing a non-controversial assertion that well designed studies have show net benefit from a given intervention. Pretty rare these days. Far more likely are the myriad promoters hardly distinguishable from snake oil salesmen. Studies should speak for themselves and not need a ethically challenged sales force, otherwise known as cheerleaders. If research survives the gantlet of scientific skepticism, then it may be considered useful and possibly become a standard of care (subject to many possible trade-offs).
Btw, I appreciate Vinay's numbers from his survey of those at top cancer centers. I almost feel as if the actual numbers are even more skewed towards cheerleaders, but I accept the 37 to 4 ratio as close to reality.
Great discussion. We need far more healthy skepticism. Therapeutic bias in medicine is very strong. We tend to naturally disregard and minimize evidence of harms. Need more trials to look at net clinical benefit.