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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

#31

Post by haldujai »

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?

A simple example is (using the traditional understanding of these differences):

Science-based: Cholesterol levels are associated with major adverse cardiovascular events (MACE), statins lower cholesterol levels and therefore statin therapy is recommended to reduce MACE.

Evidence-based: A [specifically defined population] was given statin therapy or placebo. We observed lower MACE in the statin group, therefore statin therapy is recommended in [specifically defined population] to reduce MACE.

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

#32

Post by cyrillite »

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…

This is an insane ask, but I would love to hear more about various reviewing and synthesis styles, their strengths and weaknesses, which are particularly promising and why, etc. you’re welcome to link me to material, but I’d also appreciate a brief overview.

I have nothing to offer other than thinking that this is a super cool area of study and I’d love to hear more

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

#33

Post by robertlagrant »

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…

Consultants also get a guaranteed pension funded by the net-contributing taxpayers.

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

#34

Post by coding123 »

haldujai wrote: post #31
jimbob45 wrote: post #11

Earlier quoted context omitted.

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

A simple example is (using the traditional understanding of these differences): Science-based: Cholesterol levels are associated with major adverse cardiovascular events (MACE), statins lower cholesterol levels and therefore statin therapy is recommended to reduce MACE. Evidence-based: A [specifically defined population] was given statin therapy or placebo. We observed lower MACE in the statin group, therefore statin…

> Cholesterol levels are associated with major adverse cardiovascular events

> statins lower cholesterol levels and therefore

You lost me here - because the science based one is just stating unproven statements to come to some conclusion. If you were to expand on why those two sentences are "proven" you'd likely come to evidence based reasons.

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

#35

Post by spamizbad »

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…

The US or EU should pick up the tab. The UK is not really a wealthy country anymore and things critical to STEM should slowly be transferred out as it doesn’t have the economic power to sustain them any longer.

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

#36

Post by thedailymail »

cyrillite wrote: post #32
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…

This is an insane ask, but I would love to hear more about various reviewing and synthesis styles, their strengths and weaknesses, which are particularly promising and why, etc. you’re welcome to link me to material, but I’d also appreciate a brief overview. I have nothing to offer other than thinking that this is a super cool area of study and I’d love to hear more

This site provides a concise description of many review types: https://guides.mclibrary.duke.edu/sysreview/types

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

#37

Post by SoftTalker »

fnordpiglet wrote: post #24
psychphysic wrote: post #18

Earlier quoted context omitted.

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 instan…

> taxes in NYC for instance can exceed 50%

Is that a marginal rate or total tax burden?

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

#38

Post by aaron695 »

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…

[dead]

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

#39

Post by haldujai »

coding123 wrote: post #34
haldujai wrote: post #31

Earlier quoted context omitted.

A simple example is (using the traditional understanding of these differences): Science-based: Cholesterol levels are associated with major adverse cardiovascular events (MACE), statins lower cholesterol levels and therefore statin therapy is recommended to reduce MACE. Evidence-based: A [specifically defined population] was given statin therapy or placebo. We observed lower MACE in the statin group, therefore statin…

> Cholesterol levels are associated with major adverse cardiovascular events > statins lower cholesterol levels and therefore You lost me here - because the science based one is just stating unproven statements to come to some conclusion. If you were to expand on why those two sentences are "proven" you'd likely come to evidence based reasons.

> You lost me here - because the science based one is just stating unproven statements to come to some conclusion. If you were to expand on why those two sentences are "proven" you'd likely come to evidence based reasons.

I'm not sure I'm exactly understanding what you're getting at. If you expand on those statements to find direct evidence of MACE (of which there is plenty) then it is an evidence based medicine decision not a science based one.

Please disregard the specific intervention being discussed, it's just an example of the different thought processes and decision making between SBM and EBM. In real life there is plenty of science and evidence behind statins but I'm not intending on addressing reality or why this specific intervention is in use today.

Note the "medicine" part in these refers to the clinical practice of medicine. Maybe this is clearer:

The science based medicine approach (as traditionally defined) only considers the mechanisms and "indirect evidence" when making the clinical recommendation (i.e. statins are proven to lower cholesterol which are strongly correlated with MACE. Cholesterol reduction has also been proven to reduce plaque formation and artery stenosis, therefore we expect MACE will be reduced through statin use and are deciding to administer the intervention).

In this thought process we have not directly measured the outcome of interest (MACE) but we are giving an intervention because it makes sense/through chain of thought, or in other words we are intervening to optimize a variable (serum cholesterol levels) because we have reason to believe this variable reduces MACE based on the mechanism (which may have components proven by evidence like reduction in plaque formation but the primary outcome measure we are discussing, MACE, has not been measured).

In the evidence based medicine approach we are deciding to provide an intervention based on direct measurements of the outcome of interest in a specific population (i.e. less MACE was directly proven) and the decision making process is entirely independent of the mechanism or nature of the intervention (i.e. we are not considering plaque formation and cholesterol levels, simply that statins reduce MACE).

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

#40

Post by flextheruler »

spamizbad wrote: post #35
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…

The US or EU should pick up the tab. The UK is not really a wealthy country anymore and things critical to STEM should slowly be transferred out as it doesn’t have the economic power to sustain them any longer.

Isn’t the UK in the top 6 or 5 economies in the world? Are you saying that there are only 5 wealthy countries in existence? I mean the UK definitely has problems but it’s a bit hysterical to say they’re not wealthy.
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