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Medical-evidence giant Cochrane battles funding cuts and closures

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51–60 of 73 posts

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

#51

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.

Much of the scientific literature in biology is working off of hypotheses that don't have a huge amount of evidence. There are a large number of studies that present a molecular mechanism which, if studied in depth, will not always be consistent with what is presented in the literature. This is often dealt with by appending several conditions that must be met, such that the combinatorial space grows large enough and the only study that is done that meets the requirements is the one being presented. In this way, almost anything can be stated to fit some shiny new hypothesis.

This is effectively the science based method, since it can be tracked to a, perhaps, 'plausible' mechanism (although often now lean towards more 'intriguing' than parsimonious, especially if published somewhere like Nature)

Evidence based medicine has other faults. One subfield is meta-analysis, which looks for very solid observations that are reproducible, but often lacks the complicated modeling that may be necessary to see any highly conditional effects. So the findings tend to be real, but boring and often "well-known". It is however, a good way to check if the "well-known" observations in the literature are reproducible.

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

#52

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…

However the median household income is half the US. You can’t compare nominal values.

OECD numbers show that UK medical pay is internationally competitive when compared to average national income.

Summary: https://i.imgur.com/DGT0d0d.png

From: https://www.oecd.org/health/recent-trends-in-international-m...

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

#53

Earlier quoted context omitted.

My brother has lived in all three of the US, UK and Australia, doing non-professional jobs (construction, agriculture, gardening, cellar hand in the wine industry). He didn't last long in London – he was working as an unskilled labourer in the construction industry, the pay was terrible, and the basic necessities of life were so expensive, he could hardly afford to eat. He'd worked similar jobs in Australia and got p…

Absolutely true. But saying UK doctors are underpaid because they’re paid half of a US doctor while ignoring everyone is paid half of a US person for everything is disingenuous. Everyone in the UK is inexplicably underpaid, and everything is expensive. What was your brothers take on the US?

> What was your brothers take on the US?

He lived in a small town in Oregon with his first wife. While they weren’t paid a lot, life wasn’t expensive either. I think he would have stayed except the marriage didn’t work out. Obviously that isn’t an entirely fair comparison to London, but I still think the pay-to-expenses ratio would be more favourable in small-town US than small-town UK

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

#54
post #46

Earlier quoted context omitted.

I don't remember hearing anything about Cochrane in mainstream news until they put out an unfavorable review on the effectiveness of mask usage during covid 19.

A very unfortunate, badly run meta analysis as I understand it which fundamentally undermined trust in their governance because it was so easily critiqued. I haven't seen a robust defence of that one.

My opinion (feel free to have another one) is that it points to the need for training and more comfortable masks. The studies weren't WRONG per se, but they are very hard to interpret.

My whacky opinion: human facing sciences (medicine, psychology, diet, sociology, economics, etc.) have a huge problem with solutions that require motivation to succeed. In other words, if you are motivated, you can make masks work. If you are motivated, you can make intermittent fasting work. Same for EVs, Solar Panels, etc.

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

#55

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…

The highest marginal tax rate in the UK is 45% [1] and you only pay that on income above 125 140 GBP.

Where did your 60% come from?

[1] https://www.gov.uk/income-tax-rates

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

#56
post #51

Earlier quoted context omitted.

> 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.

Much of the scientific literature in biology is working off of hypotheses that don't have a huge amount of evidence. There are a large number of studies that present a molecular mechanism which, if studied in depth, will not always be consistent with what is presented in the literature. This is often dealt with by appending several conditions that must be met, such that the combinatorial space grows large enough and…

You're (correctly) addressing some of the issues in biomedical research but even the most rigorous and validated science does not necessarily translate into clinical outcomes for a laundry list of reasons.

Evidence based medicine includes lab/animal studies (i.e. scientific literature in biology) but when we talk about EBM what we really mean is "outcomes based medicine" rather than relying on the science.

EBM reduces the question to "Does intervention X change clinical outcome Y in population Z" to obviate many (but not all) of the clinical translation issues.

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

#58

Earlier quoted context omitted.

Absolutely true. But saying UK doctors are underpaid because they’re paid half of a US doctor while ignoring everyone is paid half of a US person for everything is disingenuous. Everyone in the UK is inexplicably underpaid, and everything is expensive. What was your brothers take on the US?

> What was your brothers take on the US? He lived in a small town in Oregon with his first wife. While they weren’t paid a lot, life wasn’t expensive either. I think he would have stayed except the marriage didn’t work out. Obviously that isn’t an entirely fair comparison to London, but I still think the pay-to-expenses ratio would be more favourable in small-town US than small-town UK

Yeah skilled labor in construction fields in the US can be very well paid, and there’s a massive demand and short supply.

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

#59

Dark public choice perspective: this is incentive compatible for pharmaceutical companies and governments who can now give out their guidelines and solutions without as strong scrutiny. Too cynical??

"incentive compatible" is doing a lot of heavy lifting in that sentence.

Meta-analysis and systematic reviews were done before Cochrane, and will be done after it. And most pharma companies are banking on RCT results - Cochrane can't do systematic reviews before there's multiple studies, so it's significantly further downstream than what makes pharma money.

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

#60

> 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…

One of the most "fun" things to do on HN is translate startup funding amounts into things like multiples of Cochrane's budget, or NIH R01s.
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