61–70 of 73 posts
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>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.
Only 7%?!
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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.
Their findings:
On medical/surgical vs. nothing:
"Wearing masks in the community probably makes little or no difference to the outcome of laboratory‐confirmed influenza/SARS‐CoV‐2 compared to not wearing masks (RR 1.01, 95% CI 0.72 to 1.42; 6 trials, 13,919 participants; moderate‐certainty evidence)"
On N95/P2 respirators vs. medical/surgical:
"The use of a N95/P2 respirators compared to medical/surgical masks probably makes little or no difference for the objective and more precise outcome of laboratory‐confirmed influenza infection (RR 1.10, 95% CI 0.90 to 1.34; 5 trials, 8407 participants; moderate‐certainty evidence)."
[0] https://www.cochranelibrary.com/web/cochrane/content?templat...
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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.
I haven't seen compelling critiques of it[0]. Curious to read them. Their findings: On medical/surgical vs. nothing: "Wearing masks in the community probably makes little or no difference to the outcome of laboratory‐confirmed influenza/SARS‐CoV‐2 compared to not wearing masks (RR 1.01, 95% CI 0.72 to 1.42; 6 trials, 13,919 participants; moderate‐certainty evidence)" On N95/P2 respirators vs. medical/surgical: "The u…
https://www.cochrane.org/news/statement-physical-interventio...
The original Plain Language Summary for this review stated that 'We are uncertain whether wearing masks or N95/P2 respirators helps to slow the spread of respiratory viruses based on the studies we assessed.' This wording was open to misinterpretation, for which we apologize. While scientific evidence is never immune to misinterpretation, we take responsibility for not making the wording clearer from the outset. We are engaging with the review authors with the aim of updating the Plain Language Summary and abstract to make clear that the review looked at whether interventions to promote mask wearing help to slow the spread of respiratory viruses.
The problem was how they communicated. The data is the data.
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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…
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.
> 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?
"Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial"
https://www.bmj.com/content/363/bmj.k5094
"Conclusions Parachute use did not reduce death or major traumatic injury when jumping from aircraft in the first randomized evaluation of this intervention."
Please read the context: https://blogs.bmj.com/bmj/2018/12/13/we-jumped-from-planes-w...
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…
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.
"Adapt or die: how the pandemic made the shift from EBM to EBM+ more urgent"
https://ebm.bmj.com/content/27/5/253
"Evidence-based medicine (EBM’s) traditional methods, especially randomised controlled trials (RCTs) and meta-analyses, along with risk-of-bias tools and checklists, have contributed significantly to the science of COVID-19. But these methods and tools were designed primarily to answer simple, focused questions in a stable context where yesterday’s research can be mapped more or less unproblematically onto today’s clinical and policy questions. They have significant limitations when extended to complex questions about a novel pathogen causing chaos across multiple sectors in a fast-changing global context. Non-pharmaceutical interventions which combine material artefacts, human behaviour, organisational directives, occupational health and safety, and the built environment are a case in point: EBM’s experimental, intervention-focused, checklist-driven, effect-size-oriented and deductive approach has sometimes confused rather than informed debate. While RCTs are important, exclusion of other study designs and evidence sources has been particularly problematic in a context where rapid decision making is needed in order to save lives and protect health. It is time to bring in a wider range of evidence and a more pluralist approach to defining what counts as ‘high-quality’ evidence. We introduce some conceptual tools and quality frameworks from various fields involving what is known as mechanistic research, including complexity science, engineering and the social sciences. We propose that the tools and frameworks of mechanistic evidence, sometimes known as ‘EBM+’ when combined with traditional EBM, might be used to develop and evaluate the interdisciplinary evidence base needed to take us out of this protracted pandemic. Further articles in this series will apply pluralistic methods to specific research questions."
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Only 7%?!
There are a lot of systematic reviews. They're a very popular "Grad student's first paper" in public health fields, because if you're writing Chapter 1 of your dissertation, you're already halfway there.