Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

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

researchgate.net

Post reply on HN
Print view View original

31–40 of 136 posts

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

#31

Post by SkyPuncher »

ethanbond wrote: post #22
hospitalJail wrote: post #17

I'd love the idea of science based medicine. There are a few issues: >HIPPA has made it basically impossible to do science in Medicine without being part of the establishment >The medical cartels hate change, its bad for business, they actively lobby against change and competition. They want authority based medicine. >The scientist responsible for the discovery and treatment of an issue, can't even legally practice.…

What exactly is HIPAA’s role here? With or without HIPAA, medical institutions don’t want to share their data, especially not the ones with good data because they do their own research.

As someone more familiar with HIPAA than the average lay person (but far from an expert).

There's a lot that HIPAA does to both restrict access to data and ensure that's it's shared freely among institutions. It's kind of this weird open-secret system that works because people get fired for even minor offense.

I don't know what life was like before HIPAA, but after HIPAA it creates a lot of risk aversion. These seems to come out in two ways:

* Risk of identifiable information leaking via a published report. Anonymizing data is much harder than most people anticipate.

* Internal auditing and appropriate use. "Opening" a patient's record has to either be (1) for their care (2) an explicitly permitted use from the patient (research). That means while an institution must be a steward of their patient's data, they cannot simply use it however they want. This isn't much different AWS's handling of customer databases. While AWS keeps all of the data on their servers, they don't really have access to it.

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

#32

Post by bedobi »

dekhn wrote: post #14
bedobi wrote: post #12

Earlier quoted context omitted.

as someone currently suffering from something I statistically have no real justification for getting fixed, I'm grateful I have a Dr who's going to fix it statistics be damned

but if you got better, how would you know it was the doctor and not just random chance? base rate fallacy applies

In my case, I've been suffering from disc herniation induced sciatica for 5 months

When I say suffering, I mean it - I haven't been able to stand, sit, lie down, walk, do anything without constant and extreme pain. For months on end now.

There is a gold standard study called SPORT that proves more or less beyond all doubt that, in the long run, there is no difference in outcomes for patients who get disc herniations surgically removed vs those who don't. Disc herniations eventually heal themselves, all surgery does is fix them sooner than they otherwise would have.

So the tax-funded public health care system in Sweden and other similar countries do not surgically remove disc herniations other than in extreme cases. (loss of bowel control etc)

Thankfully, in the States, I'm able to have the surgery, so I will.

I couldn't care less if in the long run there is no difference in the aggreggate - I don't want to wait another year or two or more for the herniation to heal itself.

I'm not a statistic, I'm a human being lol.

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

#33

Post by jvanderbot »

ethanbond wrote: post #22
hospitalJail wrote: post #17

I'd love the idea of science based medicine. There are a few issues: >HIPPA has made it basically impossible to do science in Medicine without being part of the establishment >The medical cartels hate change, its bad for business, they actively lobby against change and competition. They want authority based medicine. >The scientist responsible for the discovery and treatment of an issue, can't even legally practice.…

What exactly is HIPAA’s role here? With or without HIPAA, medical institutions don’t want to share their data, especially not the ones with good data because they do their own research.

not op: but possibly ... The free exchange of information would make publicly funded data-driven discoveries more feasible. (?)

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

#35

Post by SkyPuncher »

spondylosaurus wrote: post #28
chimeracoder wrote: post #25

Earlier quoted context omitted.

> What exactly is HIPAA’s role here? With or without HIPAA, medical institutions don’t want to share their data, especially not the ones with good data because they do their own research. I agree that OP's thesis doesn't make much sense. HIPAA provides a legal framework for institutions to share data without liability[0]. It doesn't apply at all to non-"institutional" actors (in the way that OP seems to be using the…

As a rule of thumb, I find it's usually safe to dismiss criticism of HIPAA from anyone who misspells it as HIPPA. Not knowing that it's an acronym for Health Insurance Portability and Accountability Act (emphasis on portability there, as you pointed out!) tends to be a sign that you don't know what the hell HIPAA is or is for. "HIPPA," on the other hand, is an ever-convenient boogeyman you can invoke in all kinds of…

Being pedantic. Calling people out on HIPAA/HIPPA is like the warn out slight-of-hand trick you pull at a party and everyone pretends to laugh.

I've never seen anyone who actually understands HIPAA get caught up on this. It's a common typo/misspelling.

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

#36

Post by Fomite »

hospitalJail wrote: post #17

I'd love the idea of science based medicine. There are a few issues: >HIPPA has made it basically impossible to do science in Medicine without being part of the establishment >The medical cartels hate change, its bad for business, they actively lobby against change and competition. They want authority based medicine. >The scientist responsible for the discovery and treatment of an issue, can't even legally practice.…

"HIPPA has made it basically impossible to do science in Medicine without being part of the establishment"

I was able to get access to, and use, HIPPA data as a graduate student working in a field most of the "establishment" dismisses as either useless or confusing.

"The scientist responsible for the discovery and treatment of an issue, can't even legally practice."

I work with a half-dozen practicing physician-scientists.

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

#37

Post by kspacewalk2 »

pella wrote: post #26

(2020) Will COVID-19 be evidence-based medicine’s nemesis? https://journals.plos.org/plosmedicine/article?id=10.1371/jo... "It is surely time to turn to a more fit-for-purpose scientific paradigm. Complex adaptive systems theory proposes that precise quantification of particular cause-effect relationships is both impossible (because such relationships are not constant and cannot be meaningfully isolated) and unnecess…

Sounds extremely susceptible to quackery and hand-waving appeals to authority.

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

#38

Post by SkyPuncher »

jvanderbot wrote: post #33
ethanbond wrote: post #22

Earlier quoted context omitted.

What exactly is HIPAA’s role here? With or without HIPAA, medical institutions don’t want to share their data, especially not the ones with good data because they do their own research.

not op: but possibly ... The free exchange of information would make publicly funded data-driven discoveries more feasible. (?)

That's what standards like FIHR and HL7 do. While interchange is a problem, permissible use is a significantly higher bar.

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

#39

Post by bjornsing »

The main flaw in EBM is that it inverts the scientific method: It’s no longer about hypotheses and falsification. Instead it’s about “scientifically proven facts” (aka “evidence”). Sadly this aligns much better with our dogmatic instinctive understanding of knowledge as a set of agreed truths.

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

#40

Post by Gatsky »

jbandela1 wrote: post #15

Evidence Based Medicine is one of those things that is a good thing, but was pushed so hard by its proponents that it ended up overemphasizing a particular kind of study as the only real way to know things in medicine. Yes, absolutely, medicine should be evidence based. Yes, large randomized, double blind, placebo controlled studies provide a lot of information. However, there are limitations with these kinds of stud…

The biggest issue, IMHO, is that clinical trials are often unethical. This is both in theory and especially in practice. I say this as a physician and clinical trial investigator.

EBM deals with this by saying ‘there is no viable alternative’, a remarkable statement of epistemological nihilism that enables much low quality snd pointless research.

Post reply on HN