

Why Almost Everything You Hear About Medicine Is Wrong - gatsby
http://www.newsweek.com/2011/01/23/why-almost-everything-you-hear-about-medicine-is-wrong.html

======
yummyfajitas
_Negative results sit in a file drawer, or the trial keeps going in hopes the
results turn positive._

Therein lies the problem. We know the solution: tweak the publishing process.

Currently: 1) Do study 2) Submit paper, including conclusions. 3) Journal
accepts, based on correctness of methodology and interestingness of
conclusion.

To prevent this result, just change the order of things.

1) Submit paper explaining methodology, and "alternate endings" (positive and
negative). 2) Journal accepts paper based on _methodology only_. Methodology
section of paper is published. 3) Authors do study and submit results. Journal
publishes appropriate conclusion section. 4) If necessary, authors submit
additional observational results.

~~~
weego
_Negative results sit in a file drawer, or the trial keeps going in hopes the
results turn positive._

There is a more unfortunate scenario that often plays out. That is that they
get a different statistician in who has a goal of getting positive looking
results out of a negative result set though various means and then often
carefully manipulating the wording of the success criteria to match their best
attempt at making the data work. This is quite common, my partner (in the
girlfriend sense) work within medial journal publishing and sees it quite a
lot.

~~~
yummyfajitas
_...manipulating the wording of the success criteria to match their best
attempt at making the data work._

While not impossible, it is very tricky to do this before you actually have
the data. I'm advocating that the wording of the test criteria, statistical
tests to perform, etc, are all decided _before the trial_.

Bringing in a different statistician post-hoc is pointless, all he could do is
run the exact predetermined statistical test. In fact, you can do even better:
submit code to the journal before the study, and submit data after the study.
The journal runs the code on the data and decides which conclusion to publish.

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ffffruit
Always relevant, the article from Ioannides - the man who dedicated this
entire career on examining the way in which research is done rather than the
actual research.

[http://www.plosmedicine.org/article/info:doi/10.1371/journal...](http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0020124)

#1 in downloads on PLoS for many years.

~~~
ThomPete
Thomas Kuhn is another one worth reading although more philosophical (none the
less - relevant)

"The Structure of Scientific Revolutions"

[http://en.wikipedia.org/wiki/The_Structure_of_Scientific_Rev...](http://en.wikipedia.org/wiki/The_Structure_of_Scientific_Revolutions)

~~~
stcredzero
And none the less widely misused.

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maurits
For a bit more detail:

The New Yorker

[http://www.newyorker.com/reporting/2010/12/13/101213fa_fact_...](http://www.newyorker.com/reporting/2010/12/13/101213fa_fact_lehrer?currentPage=all)

The actual referenced article (PDF)

<http://www.edwardtufte.com/files/Study1.pdf>

~~~
GiraffeNecktie
also this one

[http://www.theatlantic.com/magazine/archive/2010/11/lies-
dam...](http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-
and-medical-science/8269/)

------
gohat
I've been writing about health and medical topics for a long time and this
piece does a good job of discussing how the science can get 'icky.'

First, let me say that in general, modern medicine has done wonders,
increasing duration and quality of life in astonishing ways.

That said, the system is set up to promote positive studies/findings, and
there are _a lot_ of ways you can play with the data. Very competent
statisticians/researchers are capable of helping studies, sometimes, be more
positive than they might otherwise be.

That, plus the many millions of dollars you can make from a drug, has often
resulted in questionable - but predictable - results.

~~~
antidaily
right, less money to be made if people just ate much less and stopped smoking.

------
alecco
And there's the deeper trouble with method:

[http://en.wikipedia.org/wiki/Paul_Feyerabend#Nature_of_scien...](http://en.wikipedia.org/wiki/Paul_Feyerabend#Nature_of_scientific_method)

~~~
ThomPete
Kuhn, Feyrabend and Lakatos all worth reading. Even tough they might be a tad
to postmodern for some people.

None the less they are all valuable thinkers.

~~~
rbarooah
What do you mean by 'postmodern'? Is this a real criticism of what they are
saying?

~~~
gilesc
Oversimplifying things a bit, these writers are saying that scientific
objectivity is impossible. This line of argument tends to reduce the
credibility of science in the eyes of the public, with negative consequences
for research funding. This is a bad thing because, even if not "objective",
science has singlehandedly transformed life for the better in the past century
by reducing disease, poverty, manual labor, etc, and should continue to be
funded.

~~~
ThomPete
I don't think any would claim otherwise.

But you don't need objective for that all you need is useful.

~~~
derleth
Except if some people think science is not objective, they conclude that
religion is just as valid, and that, therefore, Creationism (er, Creation
'Science') needs to be taught in schools alongside the 'fact' that gays and
liberals are evil, diseased beings. After all, if it's all subjective,
everything is equally valid!

~~~
ThomPete
Science isn't objective as such. It's testable.

That is the defining factor between religion and science.

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bryanlarsen
The vitamin D claim is misleading. Sure, most people have enough vitamin D for
bone health. But vitamin D does a lot more than make your bones healthy, so
supplementation is still probably useful. Luckily, unlike vitamin C, too much
vitamin D is not harmful so all you're wasting is money if the other claims
for vitamin D also get disproved.

~~~
michael_dorfman
First of all: it's probably not a good idea to be dispensing (or receiving)
medical advice on HN.

That being said-- Vitamin D is fat soluble, and too much vitamin D is
_definitely_ harmful. Take a look
here:<http://en.wikipedia.org/wiki/Hypervitaminosis_D>

Vitamin C, on the other hand, is water soluble, and much harder to overdose
on.

~~~
pjscott
The biggest Vitamin D supplements I've seen have 1000 IU per tablet, and the
bottle suggests one tablet per day. According to the article you linked,
10,000 IU/day is safe (we can get that much from sunshine in a day), and long-
term overdose has been observed at 77,000 IU/day. You'd have to go pretty hog-
wild with the Vitamin D supplements to overdose.

~~~
nkurz
2000 and 5000 IU are quite common and can be bought at any US pharmacy and
many grocery stores. It looks like 10000 to 50000 IU pills are easily
available online:
[http://www.amazon.com/s/?url=index%3Dblended&keywords=vi...](http://www.amazon.com/s/?url=index%3Dblended&keywords=vitamin+d3+10000)

For what it's worth, I supplement using the 5000 IU pills taken at about
7/week (irregularly, making up doses as necessary). I recently had my blood
tested for D3 levels, and found it was close to but not exceeding the standard
recommended level.

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KirinDave
While this article is correct and talks about Ioannides's work—which is good,
respectable stuff by the way—it does paint a picture like this should be a
shock to you.

Folks, it isn't just medicine; _Science_ in general must be comfortable with
the proposition of being wrong. The more complex the field, the more often
replication will fail (and the tighter standards need to be). There are very
few pursuits that our race engages in that are more difficult than
understanding life itself.

One of the biggest problems is that physicians and the press tend to get very
hasty with pushing new research. It's not their fault, mind you, they're
trying to inform us about health. If a doctor could save a life with an
experimental treatment that has yet to reach thorough replication, shouldn't
s/he? And it's the media's _job_ to get us interesting new stories (albeit
they could be far better at putting their information into context).

The nature of science is such that refinements occur over time. Unfortunately,
the nature of most people receiving medical treatment is to believe it works
or doesn't work based of extremely subjective data. If we want to attack that
problem head on, we should begin with education. All the improvements in
methodology imaginable cannot stop science from being what it is, and as such
cannot eliminate the sawtoothed slope of medical progress.

------
alecco
Also, Jaynes had a very interesting take on how to address these issues.

Probability Theory: The Logic of Science
<http://bayes.wustl.edu/etj/prob/book.pdf> (draft)

[http://www.amazon.com/Probability-Theory-Logic-Science-
Vol/d...](http://www.amazon.com/Probability-Theory-Logic-Science-
Vol/dp/0521592712)

------
Symmetry
Which just goes to show that you should learn about settled science before
worrying about the latest findings.

<http://lesswrong.com/lw/ow/the_beauty_of_settled_science/>

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tokenadult
A place to hear things about medicine that are more often than not correct:

<http://www.sciencebasedmedicine.org/?p=8198>

<http://www.sciencebasedmedicine.org/?cat=11>

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Mz
One of the problems with drugs studies is that the very point is to develop a
drug and that intent is generally commercial in nature. At no point does
anyone seem to stop and wonder what might be _the best solution_. In
addressing my health issues, I have had to infer a lot of things based on drug
studies because there is a dearth of good studies on other topics (at least
specific to my medical condition). Yet the general consensus is that diet and
lifestyle play a major role in every major deadly medical condition.
Encouraging people to live right just doesn't have the splash and dash and
isn't generally as a lucrative.

It also gets a lot of resistance from the intended audience: An awful lot of
folks don't want to do the hard work of changing their lives. In many cases,
they just want a new drug, one that won't make them sick...etc (I'm sure
someone can quote song lyrics better than I can).

