“Evidence-based medicine has been hijacked”: John Ioannidis (2016) • Hacker News Board

Re: “Evidence-based medicine has been hijacked”: John Ioannidis (2016)

#21

Post by icelancer » Fri, Jul 05, 2019, 6:30 AM UTC

Nasrudith wrote: post #15

DoreenMichele wrote: post #12

Earlier quoted context omitted.

Off the top of my head: He does meta studies -- aka studies of studies -- and finds that most studies are flawed, so most of the evidence we think we have isn't really there. It doesn't exactly make him popular because he calls into question a lot of existing supposedly "proven" medical science. He talks a lot about the biased assumptions that are the foundation of a lot of the framing of studies. If your baseline fr…

Stupid question - what makes us think the meta studies are themselves valid? Also wouldn't junk itself have many subclassifications as how it is junk? Say poor study data quality, wrong assumptions of wider applicability, wrong analysis or conclusions, etc.

>> Stupid question - what makes us think the meta studies are themselves valid?

This is not a stupid question. Many meta studies are done by people with their own frameworks of deciding what is and isn't a legitimate approach to studying something. Unsurprisingly, their findings are overwhelmingly negative due to their own publication bias.

Meta studies are pretty worthless in my opinion. Primary studies in all fields should be forced to be published with open data, and any study that received - directly or indirectly - more than $1 from the public taxpayer should be forced to publish Open Access.

Lay bare all the raw data and let the software developers and data analysts get after it, not so-called expert meta reviewers.

Re: “Evidence-based medicine has been hijacked”: John Ioannidis (2016)

#22

Post by acqq » Fri, Jul 05, 2019, 6:38 AM UTC

nordsieck wrote: post #11

It looks like he gave a 30 minute talk [0] on this paper. ___ 0. https://www.youtube.com/watch?v=N63skNtYaJw

Yes, the aricle we comment here was posted March 2016. The video is from April same year.

Also June 2016 "John Ioannidis - Why most clinical research is not useful" (University of Oxford, Centre for Evidence-Based Medicine)

https://www.youtube.com/watch?v=Uok-7NPFn4k

The paper:

https://journals.plos.org/plosmedicine/article?id=10.1371/jo...

Re: “Evidence-based medicine has been hijacked”: John Ioannidis (2016)

#23

Post by wallace_f » Fri, Jul 05, 2019, 6:39 AM UTC

pessimizer wrote: post #14

> JI: A systematic review that combines biased pieces of evidence may unfortunately give another seal of authority to that biased evidence. Basically the same problem as CDOs.

CDOs and the subprime mortgage crisis have some analogues to pre-Enlightenment darkness in human intellectual history. The idea that authoritative figures can use maths to give junk debt the midas touch is basically financial alchemy.

There was no sound reasoning behind it. It was literally just "maths is really powerful, and these people are the Smartest Guys in the Room, which is not really that much different from "these guys are really Holy, and also the Smartest Guys in the Room" in previous generations of humanity. Just market it with Math, and you can defraud the most powerful and prosperous society in history.

Re: “Evidence-based medicine has been hijacked”: John Ioannidis (2016)

#24

Post by viraptor » Fri, Jul 05, 2019, 6:40 AM UTC

PeterStuer wrote: post #16

ekianjo wrote: post #2

> The sales and marketing departments in most companies are more powerful than their R&D departments. Yes, this is correct. > Hence, the design, conduct, reporting, and dissemination of this clinical evidence becomes an advertisement tool. This does not follow well logically. The design of clinical trials still belongs to R&D and not Marketing/Sales departments. Even if Marketing/Sales want to target for a specific o…

Sales and Marketing do control which outcomes are allowed to be published though. If you allow me selective disclosure of trials I can show you that my roulette strategy is infallible.

Hasn't this been fixed with the requirement to pre-register trials? https://chrisblattman.com/2016/03/01/13719/

I'm not sure if every org requires it now or not, but if not then it seems like a question of time only.

Re: “Evidence-based medicine has been hijacked”: John Ioannidis (2016)

#25

Post by hannob » Fri, Jul 05, 2019, 6:53 AM UTC

viraptor wrote: post #24

PeterStuer wrote: post #16

Earlier quoted context omitted.

Sales and Marketing do control which outcomes are allowed to be published though. If you allow me selective disclosure of trials I can show you that my roulette strategy is infallible.

Hasn't this been fixed with the requirement to pre-register trials? https://chrisblattman.com/2016/03/01/13719/ I'm not sure if every org requires it now or not, but if not then it seems like a question of time only.

> Hasn't this been fixed with the requirement to pre-register trials?

If it was that simple...

Preregistration is a step in the right direction, but there are still plenty of ways to game the system, particularly as it's not properly enforced: http://compare-trials.org/

Re: “Evidence-based medicine has been hijacked”: John Ioannidis (2016)

#26

Post by Jedd » Fri, Jul 05, 2019, 7:14 AM UTC

icelancer wrote: post #21

Nasrudith wrote: post #15

Earlier quoted context omitted.

Stupid question - what makes us think the meta studies are themselves valid? Also wouldn't junk itself have many subclassifications as how it is junk? Say poor study data quality, wrong assumptions of wider applicability, wrong analysis or conclusions, etc.

>> Stupid question - what makes us think the meta studies are themselves valid? This is not a stupid question. Many meta studies are done by people with their own frameworks of deciding what is and isn't a legitimate approach to studying something. Unsurprisingly, their findings are overwhelmingly negative due to their own publication bias. Meta studies are pretty worthless in my opinion. Primary studies in all field…

> Lay bare all the raw data and let the software developers ...

Really can't tell if you're being sarcastic here, even in the context of HN.

> Meta studies are pretty worthless in my opinion. Primary studies in all fields should be forced to be published with open data ...

And until that happens meta studies are both worthwhile and one of the most effective ways to correlate and sensibly interpret the existing published data sets.

Re: “Evidence-based medicine has been hijacked”: John Ioannidis (2016)

#27

Post by Pimpus » Fri, Jul 05, 2019, 7:24 AM UTC

ben_w wrote: post #19

Alex3917 wrote: post #7

Earlier quoted context omitted.

The tl;dr is that the same guys who fabricated the evidence about Saddam Hussein having WMDs also fabricated evidence for aspartame being safe. https://www.huffpost.com/entry/donald-rumsfeld-and-the-s_b_8...

Did Donald Rumsfeld also convince the European Union, who have their own interests and a similar sized economy, that it was safe? https://www.efsa.europa.eu/en/press/news/131210 or the “more than 90 countries worldwide” [1] that the Canadian government refers to on their own website? https://www.canada.ca/en/health-canada/services/food-nutriti... There are certainly cases where I don’t trust USA regulations. This jus…

Most of these same countries also outlawed dmt ¯\_(ツ)_/¯

Your argument is basically just an appeal to authority.

As far as artificial sweeteners go, you'd have to be an idiot to knowingly consume an unnatural, laboratory made chemical.

Re: “Evidence-based medicine has been hijacked”: John Ioannidis (2016)

#28

Post by ekianjo » Fri, Jul 05, 2019, 7:38 AM UTC

hannob wrote: post #25

viraptor wrote: post #24

Earlier quoted context omitted.

Hasn't this been fixed with the requirement to pre-register trials? https://chrisblattman.com/2016/03/01/13719/ I'm not sure if every org requires it now or not, but if not then it seems like a question of time only.

> Hasn't this been fixed with the requirement to pre-register trials? If it was that simple... Preregistration is a step in the right direction, but there are still plenty of ways to game the system, particularly as it's not properly enforced: http://compare-trials.org/

But it is the necessary step to highlight the problem so that actions can be taken.

Also, you can safely assume that the large majority of outcomes that were not published were:\

- negative

- worse than negative (i.e. safety issues?)

- not properly designed

So if you compare the number of trials disclosed/not disclosed for each drug/each company that gives you a pretty good picture of who is doing what already.

With that data, it's then a lot easier to approach regulators to do something about it.

Re: “Evidence-based medicine has been hijacked”: John Ioannidis (2016)

#29

Post by ekianjo » Fri, Jul 05, 2019, 7:39 AM UTC

BurningFrog wrote: post #5

ekianjo wrote: post #2

> The sales and marketing departments in most companies are more powerful than their R&D departments. Yes, this is correct. > Hence, the design, conduct, reporting, and dissemination of this clinical evidence becomes an advertisement tool. This does not follow well logically. The design of clinical trials still belongs to R&D and not Marketing/Sales departments. Even if Marketing/Sales want to target for a specific o…

> This does not follow well logically I think it's an observation, not a philosophical argument.

No, he said "Hence," right at the start of the sentence, as if it was a logical conclusion. It is not.

Re: “Evidence-based medicine has been hijacked”: John Ioannidis (2016)

#30

Post by ekianjo » Fri, Jul 05, 2019, 7:40 AM UTC

RobertRoberts wrote: post #4

ekianjo wrote: post #2

> The sales and marketing departments in most companies are more powerful than their R&D departments. Yes, this is correct. > Hence, the design, conduct, reporting, and dissemination of this clinical evidence becomes an advertisement tool. This does not follow well logically. The design of clinical trials still belongs to R&D and not Marketing/Sales departments. Even if Marketing/Sales want to target for a specific o…

> If it were meaningless, FDAs and other regulatory bodies would not even accept it during the clinical trial design review phase. Go look up how many corporate stooges are in the place in the FDA over the years. A good starting point is the history of Aspartame, I'd link some articles, but I suspect the sources would be shot down and evidence ignored. The people at the FDA were complicit in its approval, despite sci…

Assuming the FDA is corrupted is one thing, assuming regulatory bodies ACROSS the world are all corrupted at the very same time is just very close to being a ridiculous claim.