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Medical-evidence giant Cochrane battles funding cuts and closures

nature.com

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Re: Medical-evidence giant Cochrane battles funding cuts and closures

#11

Post by jimbob45 »

Traubenfuchs wrote: post #2

> Cochrane says that the lost NIHR funding — around £4.2 million (US$5.3 million) — does not affect its core income, which was £8.9 million in 2022. However, a more existential threat looms. Around £6.8 million of that core income came from subscriptions to the Cochrane Library, but Cochrane aims to make all its reviews open access by 2025 What the actual fuck, those are peanuts for any single country or health care…

evidence-based

What’s the difference between something being scientific and something being evidence-based?

Re: Medical-evidence giant Cochrane battles funding cuts and closures

#12

Post by fnordpiglet »

psychphysic wrote: post #7
Traubenfuchs wrote: post #2

> Cochrane says that the lost NIHR funding — around £4.2 million (US$5.3 million) — does not affect its core income, which was £8.9 million in 2022. However, a more existential threat looms. Around £6.8 million of that core income came from subscriptions to the Cochrane Library, but Cochrane aims to make all its reviews open access by 2025 What the actual fuck, those are peanuts for any single country or health care…

Given in the UK doctors have taken a real terms paycut circa of over 25% [0] the UK is not currently fit to fund anything. [0] https://www.bma.org.uk/media/6882/bma-ia-juniors-fact-sheet-...

Except this sort of funding has multiplicative effects. Funding for a single doctor helps only that doctor and their patients. Funding for this sort of work helps all doctors and all patients. When austerity cannibalizes your force multiplying efforts, that’s truly the end.

Edit:

For context the thing you linked says UK medical residents (in US language) make $36k/year, and the median household income is also $36k/y[0] .

In the US the average non specialist income is $60k[1], and the median household income is $69k[2]

This tells me things aren’t out of whack.

They also say 40% of residents in the UK want a different job. But residencies are temporary. In a few years they will have a new job - a full doctor.

I’m not saying there’s not a crisis, but that sheet doesn’t explain to me what the crisis actually is. They seem to be doing on par with US residents.

0 https://www.ons.gov.uk/peoplepopulationandcommunity/personal...

1 https://mededits.com/residency-admissions/residency-salary/

2 https://www.deptofnumbers.com/income/us/

Re: Medical-evidence giant Cochrane battles funding cuts and closures

#13

Post by raincom »

MostlyStable wrote: post #5
MithrilTuxedo wrote: post #3

Earlier quoted context omitted.

>evidence based medicine They do mention that Cochrane is only accounting for 7% of systematic reviews these days. BTW, evidence-based medicine is not the same as science-based medicine. The Placebo Effect is evidence-based medicine.

I'm not sure what you are trying to say. Are you implying that the placebo effect is magic, or in some other way non-scientific?

Evidence based medicine (EBM) = population, intervention, comparison and outcome (PICO). In other words, PICO = RCT Randomized Control Trials. To me, EBM is medical instrumentalism (instrumentalism is one of philosophies of sciences): pick a treatment that works, without understanding the underlying mechanism. Even today, we use many drugs with unknown mechanisms of action[0].

Often times, you can find cures just by discovering mechanism of action, without PICO/RCT: for example, Helicobacter pylori causing peptic ulcers.

Placebo effect is NOT magic, but we don't understand the mechanism. Good relationship between doctors and patients help recover patients. Patients prefer to see particular doctors, even if the latter prescribe same medications as others, yet the differential effects on patients (when treated by preferred doctors vs others) is non-trivial.

[0] https://en.wikipedia.org/wiki/Category:Drugs_with_unknown_me...

Re: Medical-evidence giant Cochrane battles funding cuts and closures

#14

Post by [deleted] »

fnordpiglet wrote: post #12
psychphysic wrote: post #7

Earlier quoted context omitted.

Given in the UK doctors have taken a real terms paycut circa of over 25% [0] the UK is not currently fit to fund anything. [0] https://www.bma.org.uk/media/6882/bma-ia-juniors-fact-sheet-...

Except this sort of funding has multiplicative effects. Funding for a single doctor helps only that doctor and their patients. Funding for this sort of work helps all doctors and all patients. When austerity cannibalizes your force multiplying efforts, that’s truly the end. Edit: For context the thing you linked says UK medical residents (in US language) make $36k/year, and the median household income is also $36k/y[…

[deleted]

Re: Medical-evidence giant Cochrane battles funding cuts and closures

#15

Post by SamoyedFurFluff »

jimbob45 wrote: post #11
Traubenfuchs wrote: post #2

> Cochrane says that the lost NIHR funding — around £4.2 million (US$5.3 million) — does not affect its core income, which was £8.9 million in 2022. However, a more existential threat looms. Around £6.8 million of that core income came from subscriptions to the Cochrane Library, but Cochrane aims to make all its reviews open access by 2025 What the actual fuck, those are peanuts for any single country or health care…

evidence-based What’s the difference between something being scientific and something being evidence-based?

Evidence-based is a subset of scientific, imo. A study of cells in a Petri dish is science but I wouldn’t recommend a drug to a person from such a study.

Re: Medical-evidence giant Cochrane battles funding cuts and closures

#16

Post by raincom »

jimbob45 wrote: post #11
Traubenfuchs wrote: post #2

> Cochrane says that the lost NIHR funding — around £4.2 million (US$5.3 million) — does not affect its core income, which was £8.9 million in 2022. However, a more existential threat looms. Around £6.8 million of that core income came from subscriptions to the Cochrane Library, but Cochrane aims to make all its reviews open access by 2025 What the actual fuck, those are peanuts for any single country or health care…

evidence-based What’s the difference between something being scientific and something being evidence-based?

As I wrote in another reply, evidence based medicine (EBM) = population, intervention, comparison and outcome (PICO). In other words, PICO = RCT Randomized Control Trials. To me, EBM is medical instrumentalism (as instrumentalism is one of philosophies of sciences): pick a treatment that works for a large number of people, without understanding the underlying mechanism. Even today, we use many drugs with unknown mechanisms of action (MOA).

Re: Medical-evidence giant Cochrane battles funding cuts and closures

#18

Post by psychphysic »

fnordpiglet wrote: post #12
psychphysic wrote: post #7

Earlier quoted context omitted.

Given in the UK doctors have taken a real terms paycut circa of over 25% [0] the UK is not currently fit to fund anything. [0] https://www.bma.org.uk/media/6882/bma-ia-juniors-fact-sheet-...

Except this sort of funding has multiplicative effects. Funding for a single doctor helps only that doctor and their patients. Funding for this sort of work helps all doctors and all patients. When austerity cannibalizes your force multiplying efforts, that’s truly the end. Edit: For context the thing you linked says UK medical residents (in US language) make $36k/year, and the median household income is also $36k/y[…

What's the difference in pay between a "full doctor" as you put it consultant (UK) or attending (US)?

UK a consultant earns £100k pretax and pays approximately 30% net tax rate and 60% marginal rate.

What about US?

Apparently family medicine in the US brings in 130% more than the equivalent in the UK (GP which makes up half of all UK doctors).

https://revisingrubies.com/us-vs-uk-doctors-salary/

That's truly astounding.

Re: Medical-evidence giant Cochrane battles funding cuts and closures

#20

Post by pcrh »

MithrilTuxedo wrote: post #3
Traubenfuchs wrote: post #2

> Cochrane says that the lost NIHR funding — around £4.2 million (US$5.3 million) — does not affect its core income, which was £8.9 million in 2022. However, a more existential threat looms. Around £6.8 million of that core income came from subscriptions to the Cochrane Library, but Cochrane aims to make all its reviews open access by 2025 What the actual fuck, those are peanuts for any single country or health care…

>evidence based medicine They do mention that Cochrane is only accounting for 7% of systematic reviews these days. BTW, evidence-based medicine is not the same as science-based medicine. The Placebo Effect is evidence-based medicine.

It's a bit more important than that number suggests. For one, 7% of global systematic reviews is not a trivial proportion.

But more importantly Cochrane allows for the pre-registration of such reviews, i.e. where the methodology and goals (hypotheses) are stated before the review is conducted. This is probably the most scientifically rigorous method of assessing evidence, and is not performed for most systematic reviews.

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