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The Rise and Fall of Evidence Based Medicine (1998) [pdf]

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131–136 of 136 posts

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#131

Earlier quoted context omitted.

I have never heard of or seen statin-induced cirrhosis practicing in a liver transplant center so if this is real it’s a case report.

Google it. Its well known.

“However, the rate of true statin-induced hepatotoxicity is exceedingly low. Moreover, multiple retrospective studies have shown that statins are not only safe for use in patients with cirrhosis, but are also likely beneficial in reducing liver decompensation, hepatocellular carcinoma, infections, and death.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6170890/

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#132

Earlier quoted context omitted.

As stated thennt is from 2013, many statin trials have come out since. 2% diabetes is overstated as in link 1 except you discount it because of declared disclosures despite the fact that it’s one of the most highly cited papers on the subject in the last 10 years and the study was a review. You also discount a well respected guideline on lipids out of principle. Then you cite unrelated data from 2006 as a good refere…

I cannot make it anymore clearer: statins reduce your absolute risk of mortality by at most 2%; not smoking reduces your absolute risk by 7%. Statins provide meager benefit for the associated risks. It does not take an expert to do math.

I must have missed the clinical practice guideline that said keep smoking just take a statin instead.

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#133
post #110

Earlier quoted context omitted.

The author of the article was in favor of face masks even in the early stages of the COVID pandemic. Meanwhile, the mask opponents concluded from the principles of evidence-based medicine that masks are not effective. During a pandemic, there is no time to wait for 10 years until sufficient evidence accumulates. If evidence-based medicine cannot be used in the case of pandemics, an improved methodology is needed.

Whether or not "guesswork that's probably scientifically informed" is in fact "improved methodology" is the question. As is using the fact that heads came up when you flipped a coin hoping for heads is sufficient grounds for applying the same method to much more consequential tasks. I for one am very glad we didn't abandon the supposedly far too cautious approach of evidence-based medicine when we properly tested the…

You can check the author ( Trisha Greenhalgh ) other articles:

"But there is a more fundamental—i.e. philosophical rather than methodological or practical—objection to the emphasis on RCTs to the exclusion of other kinds of evidence, and that is the assumption, based on what might be called naive empiricism, that data can be identified, collected, analysed and summarized without the need for theory. Academics in many other scientific disciplines emphatically reject the assumption that controlled experiments should always and necessarily over-ride mechanistic evidence, defined as evidence produced by multiple different methods which help illuminate and explain phenomena at a theoretical level [40,41]."

https://royalsocietypublishing.org/doi/10.1098/rsfs.2021.001...

or ..

"Adapt or die: how the pandemic made the shift from EBM to EBM+ more urgent "

https://ebm.bmj.com/content/27/5/253.full

"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."

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#134
post #46

Earlier quoted context omitted.

[flagged]

Regardless of what the GP said, you broke the site guidelines here, which ask you to edit out swipes (like "What are you talking about"). Your comment would be just fine without that bit. We've to ask you this kind of thing more than once before. If you wouldn't mind reviewing https://news.ycombinator.com/newsguidelines.html and taking the intended spirit of the site more to heart, we'd be grateful.

this is heavy handed moderation. I actually wanted to know what he's talking about, as in, to what approval process is GP referring? And when faced with what appeared to be actual vaccine misinformation, you decide to come down on my post instead? do you just not like my vernacular? Have a problem with my username?

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#135
post #46

Earlier quoted context omitted.

Regardless of what the GP said, you broke the site guidelines here, which ask you to edit out swipes (like "What are you talking about"). Your comment would be just fine without that bit. We've to ask you this kind of thing more than once before. If you wouldn't mind reviewing https://news.ycombinator.com/newsguidelines.html and taking the intended spirit of the site more to heart, we'd be grateful.

this is heavy handed moderation. I actually wanted to know what he's talking about, as in, to what approval process is GP referring? And when faced with what appeared to be actual vaccine misinformation, you decide to come down on my post instead? do you just not like my vernacular? Have a problem with my username?

"What are you talking about" is a common swipe and guaranteed to land as such. It isn't used in contemporary English to ask neutrally what someone is referring to. If that's what you wanted to do, there are plenty of other phrases to use.

> And when faced with what appeared to be actual vaccine misinformation, you decide to come down on my post instead?

By the time I saw the GP post, it had been replaced with "[deleted]", so it wasn't a question of "instead". (It's not a good practice to replace a comment with "[deleted]", but that's a different issue.) As for "misinformation", people mostly use that term to mean something they strongly disagree with. It isn't against HN's rules to be wrong. Possibly the GP did break HN's rules in some other way, but that's independent of whether you broke the rules (which you did). Users here need to follow the rules regardless of how bad another post is or you feel it is.

Re: The Rise and Fall of Evidence Based Medicine (1998) [pdf]

#136

Earlier quoted context omitted.

My dad was sent to a nutritionist to deal with his spare tire. She gave him a meal plan, and told him to come back in a couple months for a followup. When he did, she was shocked that he'd actually followed the meal plan, and his spare tire deflated the expected amount. He kept it deflated for the rest of his life, though he said it was a constant struggle.

Glad it worked for your dad and I can definitely see it working for others. Part of the difficulty with being told that I need to make life style changes is how open ended it can be. It can make it hard to plan or know what to do or stick with it. I can definitely see it makes the on ramp to life style changes so much easier if you're given a plan and have to think little about it. This helped me. My doctor recommend…

Awesome stories! A key element in them (IMO) is in both of them the end result was recognized to be in the hands of the person doing it (not the Dr.), and they put the work in to accomplish it because they believed it was important for them. And that work was tractable.

For many people, the hard part is getting to the point they (mentally) are able to do that, which is the psychiatric and environmental elements IMO.

If someone has been convinced that they can't actually solve the problem, or that it is dangerous to solve the problem, they will avoid trying, or sabotage themselves when it looks like they could potentially succeed.

If someone is in an environment where it is impossible to get proper nutrition, or get time/space to try things or do the planning required, or where they aren't allowed to make the decisions necessary for a better outcome, then they'll also be frustrated and unable to make the change.

Luckily, both are addressable except in very rare edge cases, but it is rarely comfortable or easy to do.

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