It looks like he gave a 30 minute talk [0] on this paper.
___
“Evidence-based medicine has been hijacked”: John Ioannidis (2016)
11–20 of 79 posts
Re: “Evidence-based medicine has been hijacked”: John Ioannidis (2016)
#12There wasn’t a lot of substance in this article, would have to read Dr. Ioannidis’ referenced papers to actually understand his point.
Off the top of my head:
He does meta studies -- aka studies of studies -- and finds that most studies are flawed, so most of the evidence we think we have isn't really there.
It doesn't exactly make him popular because he calls into question a lot of existing supposedly "proven" medical science.
He talks a lot about the biased assumptions that are the foundation of a lot of the framing of studies. If your baseline framing is sufficiently flawed, the entire study is junk. He thinks a lot of studies are, in fact, junk.
Re: “Evidence-based medicine has been hijacked”: John Ioannidis (2016)
#13> The sales and marketing departments in most companies are more powerful than their R&D departments. Yes, this is correct. > Hence, the design, conduct, reporting, and dissemination of this clinical evidence becomes an advertisement tool. This does not follow well logically. The design of clinical trials still belongs to R&D and not Marketing/Sales departments. Even if Marketing/Sales want to target for a specific o…
> This does not follow well logically. Instead of trying to reason from first principles about whether or not what he's saying is true, maybe instead go on Amazon and buy one of the dozens of books on the subject.
I don't know if what he is saying is true, but I do know from having worked in another industry that the idea of sales/marketing dictating product development is not necessarily illogical, even if at face value it is.
Re: “Evidence-based medicine has been hijacked”: John Ioannidis (2016)
#14> JI: A systematic review that combines biased pieces of evidence may unfortunately give another seal of authority to that biased evidence.
Basically the same problem as CDOs.
Re: “Evidence-based medicine has been hijacked”: John Ioannidis (2016)
#15There wasn’t a lot of substance in this article, would have to read Dr. Ioannidis’ referenced papers to actually understand his point.
Off the top of my head: He does meta studies -- aka studies of studies -- and finds that most studies are flawed, so most of the evidence we think we have isn't really there. It doesn't exactly make him popular because he calls into question a lot of existing supposedly "proven" medical science. He talks a lot about the biased assumptions that are the foundation of a lot of the framing of studies. If your baseline fr…
Stupid question - what makes us think the meta studies are themselves valid?
Also wouldn't junk itself have many subclassifications as how it is junk? Say poor study data quality, wrong assumptions of wider applicability, wrong analysis or conclusions, etc.
Re: “Evidence-based medicine has been hijacked”: John Ioannidis (2016)
#16> The sales and marketing departments in most companies are more powerful than their R&D departments. Yes, this is correct. > Hence, the design, conduct, reporting, and dissemination of this clinical evidence becomes an advertisement tool. This does not follow well logically. The design of clinical trials still belongs to R&D and not Marketing/Sales departments. Even if Marketing/Sales want to target for a specific o…
Sales and Marketing do control which outcomes are allowed to be published though. If you allow me selective disclosure of trials I can show you that my roulette strategy is infallible.
Re: “Evidence-based medicine has been hijacked”: John Ioannidis (2016)
#17> The sales and marketing departments in most companies are more powerful than their R&D departments. Yes, this is correct. > Hence, the design, conduct, reporting, and dissemination of this clinical evidence becomes an advertisement tool. This does not follow well logically. The design of clinical trials still belongs to R&D and not Marketing/Sales departments. Even if Marketing/Sales want to target for a specific o…
> If it were meaningless, FDAs and other regulatory bodies would not even accept it during the clinical trial design review phase. Go look up how many corporate stooges are in the place in the FDA over the years. A good starting point is the history of Aspartame, I'd link some articles, but I suspect the sources would be shot down and evidence ignored. The people at the FDA were complicit in its approval, despite sci…
Aspartame is ironically a substance we are most sure of its safety because of how fixed many were on the idea it was dangerous. Few substances were given such exhaustive testing.
The sources would be shot down for a reason and not some vast conspiracy but because the hill they chose to die on wasn't even real.
I would draw the opposite conclusion - safety analysis by whatever becomes a cause is a very poor way to both allocate resources.
Re: “Evidence-based medicine has been hijacked”: John Ioannidis (2016)
#18> The sales and marketing departments in most companies are more powerful than their R&D departments. Yes, this is correct. > Hence, the design, conduct, reporting, and dissemination of this clinical evidence becomes an advertisement tool. This does not follow well logically. The design of clinical trials still belongs to R&D and not Marketing/Sales departments. Even if Marketing/Sales want to target for a specific o…
> If it were meaningless, FDAs and other regulatory bodies would not even accept it during the clinical trial design review phase. Go look up how many corporate stooges are in the place in the FDA over the years. A good starting point is the history of Aspartame, I'd link some articles, but I suspect the sources would be shot down and evidence ignored. The people at the FDA were complicit in its approval, despite sci…
> I'd link some articles, but I suspect the sources would be shot down and evidence ignored
Why would you say that? This is a serious accusation made without offering evidence and the only effect it can have is to greatly diminish the probability of having a productive debate.
Re: “Evidence-based medicine has been hijacked”: John Ioannidis (2016)
#19Earlier quoted context omitted.
I would appreciate links to articles on the subject, if you have them handy!
The tl;dr is that the same guys who fabricated the evidence about Saddam Hussein having WMDs also fabricated evidence for aspartame being safe. https://www.huffpost.com/entry/donald-rumsfeld-and-the-s_b_8...
Did Donald Rumsfeld also convince the European Union, who have their own interests and a similar sized economy, that it was safe? https://www.efsa.europa.eu/en/press/news/131210 or the “more than 90 countries worldwide” [1] that the Canadian government refers to on their own website? https://www.canada.ca/en/health-canada/services/food-nutriti...
There are certainly cases where I don’t trust USA regulations. This just isn’t one of them.
[1] number includes EU and US, but that still leaves more than sixty others.
Re: “Evidence-based medicine has been hijacked”: John Ioannidis (2016)
#20Earlier quoted context omitted.
Off the top of my head: He does meta studies -- aka studies of studies -- and finds that most studies are flawed, so most of the evidence we think we have isn't really there. It doesn't exactly make him popular because he calls into question a lot of existing supposedly "proven" medical science. He talks a lot about the biased assumptions that are the foundation of a lot of the framing of studies. If your baseline fr…
Stupid question - what makes us think the meta studies are themselves valid? Also wouldn't junk itself have many subclassifications as how it is junk? Say poor study data quality, wrong assumptions of wider applicability, wrong analysis or conclusions, etc.
what makes us think the meta studies are themselves valid?
A. This is one guy, basically. I mean, I agree with him, generally, but not everyone does.
B. It's easier to poke holes in someone else's thing than create a good study.
So study A: "I wonder how fat you have to be to not fit through this door. Let's weigh people (instead of measuring them) to see how fat you have to be not fit through the door."
Study B: "It's a great question, but it's badly done. Weighing them won't work. Let's just interview people and write down their self reported height!"
Meta analyst: "Y'all are both wrong and stupid, geez."
Scientists A and B: "Let's take the meta-analyst out back and beat him up!" "Sounds good to me!"