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Medical-evidence giant Cochrane battles funding cuts and closures

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

#21

Post by patel011393 »

This may seem like bad news, but as a grad student studying evidence synthesis I can say that there is a silver lining here. The quality of studies in systematic inputs is low and even Cochrane's reviews have been critiqued for missing things. It's a big factory that hasn't fundamentally innovated how research is synthesized. There are newer forms of synthesis like realist reviews, meta-modeling, and model-driven meta-analyses (those are just a few examples).

Hopefully this results in some innovation at the conceptual and financial levels. For those who lost their income, they have transferrable skills that would be welcomed in healthtech companies, other governmental groups, and academic positions. It's really not as bad as it seems.

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

#22

Post by trust_bt_verify »

gruez wrote: post #10
msie wrote: post #6

[flagged]

>misleading review on mask effectiveness (with Tom Jefferson)? Can you provide more context for this? What was the study? Why was it misleading?

As the sibling in the thread detailed: https://www.factcheck.org/2023/03/scicheck-what-the-cochrane...

The misleading part was done by Tom during an interview with a major media organization with a similar established narrative.

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

#23

Post by dent9876543 »

scrollop wrote: post #17
msie wrote: post #6

[flagged]

[flagged]

> Therefore, the review does not imply that masks do not work [...]

Actually, for all intents and purposes, it does imply exactly that.

The RCTs involved sufficiently large sample sizes that they are representative of real-world outcomes. As such, masks, as we have generally deployed them, simply do not offer significant control over the trajectory of C-19-like infection at the population level.

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

#24

Post by fnordpiglet »

psychphysic wrote: post #18
fnordpiglet wrote: post #12

Earlier quoted context omitted.

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 astoundin…

https://www.salary.com/research/salary/benchmark/physician-i...

$230k, which when indexed by median household income, is comparable to the UK at 100k (I assume you used dollars? If not that’s $126k).

Edit: I’m not making any tax statements because taxes are unavoidable and applied to everyone in the nation, so are part of the indexing. That said US taxes sound comparable or more in some areas (taxes in NYC for instance can exceed 50%)

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

#25

Post by cabalamat »

psychphysic wrote: post #18
fnordpiglet wrote: post #12

Earlier quoted context omitted.

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 astoundin…

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

According to https://www.moneysavingexpert.com/tax-calculator/ , someone in the UK who earns £100k takes home £67,049:

>Earn £100,000 in 2023/24 and you'll take home £67,049. This means £5,587 in your pocket a month. Over the year you'll pay £27,432 income tax and £5,519 in national insurance.

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

#26

Post by haldujai »

patel011393 wrote: post #21

This may seem like bad news, but as a grad student studying evidence synthesis I can say that there is a silver lining here. The quality of studies in systematic inputs is low and even Cochrane's reviews have been critiqued for missing things. It's a big factory that hasn't fundamentally innovated how research is synthesized. There are newer forms of synthesis like realist reviews, meta-modeling, and model-driven met…

> The quality of studies in systematic inputs is low and even Cochrane's reviews have been critiqued for missing things.

Criticism is good, expecting perfection is not.

Quality issues are a problem of the underlying research rather than the review process. High quality reviews, like Cochrane, assess risk of bias which can limit the strength of conclusion they make where the underlying studies are poor quality.

> There are newer forms of synthesis like realist reviews, meta-modeling, and model-driven meta-analyses (those are just a few examples).

All of these answer different questions/have different use cases than a SR and are much harder to do while maintaining comparable quality and risk of bias.

What's your gripe with high quality SRs following standards like PRISMA, STARD and QUADAS-2?

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

#27

Post by cscurmudgeon »

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…

A lot of folks are now angry that Cochrane went slightly against masks. There is a religious war unfortunately.

There is even one comment here along that line.

https://www.forbes.com/sites/brucelee/2023/03/11/cochrane-sa...

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

#28

Post by [deleted] »

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…

[deleted]

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

#30

Post by haldujai »

raincom wrote: post #16
jimbob45 wrote: post #11

Earlier quoted context omitted.

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 mech…

I would add that EBM took over because science-based medicine (at least the historical definition, how it's used now is more of a hybrid) didn't work out too well. Often the mechanism thought to be understood is incorrect or more complicated and the outcomes don't correlate well with what's expected, sometimes resulting in significant harm.

Fundamentally, the mechanism of why a medical intervention works isn't that important if you're thoroughly evaluating outcome measures and controlling confounders.

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