Lies, Damned Lies, and Medical Science

[blr_p]

Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are doctors—to a striking extent—still drawing upon misinformation in their everyday practice? Dr. John Ioannidis has spent his career challenging his peers by exposing their bad science.

Source Article

Accompanying papers
PLoS Medicine : Why Most Published Research Findings Are False
JAMA : Contradicted and Initially Stronger Effects in Highly Cited Clinical Research

Interesting article that talks about the corruption that occurs in the medical research sector. May not be too surprising to those in the field but very eye-opening for those that are not

One thing i learned, how to tell a good doctor from a bad one is the one that takes the time to talk to you and gets to know your history vs one that is pressed for time and just dishes out drugs.

The latter is what you want to avoid especially if you have to care for the elderly.

 

[Superbad]

Agree the one dishing out drugs are generally not required by the body but they are given anyways because the pharma companies give them indirect cuts with their sales.
So even though you might think the a certain doc charges you less it aint necessary because he gets it other way round with referrals, tests etc.

 

[medpal]

Its a different way Indian Medical field works than those of west.

Considering Surgical field, there is a lot of different variety of diagnoses and patients that teams working in Public hospitals have so much in their hands that they dont have time to compile data and provide conclusions. Also a hindering fact is we dont have enough infrastructure to collect, preserve, organize, audit and collaborate the data.

Now on to the medical field and science of prescribing drugs.

Western scenario is different to us in epidemiology, in a sense they are more sufferring from Allergic, Life Style based diseases than to us, here in India vector born diseases rule the roost more that the lifestyle diseases, even though later are catching up.

Almost every one in medical field knows that drug studies can be cooked up, can be sponsored, so there are very very less number of physicians who derive their prescription based on those studies.

There cant be assumed that every one in medical field is a saint, and every one is at fault.

Now a days the governments are being governed by larger Corporations and conglomerates (like revealed by Nira Radia Tapes) same way the pharmaceutical multinational giants govern the FDA and such authoratative policies and force so many circumventions which we dont even know of.

A drug to be considered worthy of recommended for prescription requires a lot of research, than a lot of laboratory studies, than lot of animal studies, than a multiple layers of human studies after a long term duration if found safe, can be approved for prescription. This takes atleast 10-12 years of gestation period, but greedy corporations push a drug within 6-7 years which is the reason for failures or recall of drugs.

In India research is at nascent stage, but prescription from a large medical (so called as they are not qualified in modern science of medicine) force who are unqualified / partially qualified or qualified in related subjects and practice as medical expert they release rampant prescription of drugs without considering proper dosage, duration and science behind it so what happens is the developing resistance to the drugs. (you must have heard about Indian Superbug of ICU)

So drug companies are forced to research new drugs, which take time to develop, they try to earn quick benefit by releasing drugs early and get early profits, which is wrongly shared with some leading practitioners (which is very wrong).

So as it happens in every field, medical field is also suffering from few rotten bugs, but the process of cleaning is on, strong and will be effective.

Now few thoughts as a medical practitioner based in India:
Here patients demand cure from symptoms not from disease, patients want to be mobile, problem free fast and early, they want to rejoin work so that loss of lively hood is less.

Patients often skip medicines after few days / skip followup consultations when first course of medicines relieve them of symptoms ultimately rendering them vulnerable to further attacks.

Few doctors want to earn quick bucks, and get lured by cash for prescription schemes and start prescribing substandard drugs.

Believe me not every thing is wrong, but not every thing is right too. Every one who is doing right thing is trying their best to judge the disease and give their patients a best chance to beat the diseases.

 

[chiron]

^^ that's some nice insight.

I've know many relatives/acquaintances complain about how private hospitals tend to make people go for loads of(possibly unnecessary) tests to bloat the medical bill. But since it is a matter of health people don't think of the huge financial burden and end up going for them anyway. Any inputs regarding that?

 

[medpal]

@Chiron, its really difficult to tell a doctor or hospital will advise unnecessary tests to a patient. Yes its case with big referral corporates hospitals in big metros where they do repetitive tests to check the progress.

When a patients is critically ill / multiple doctors are seeing the patients for multiple disorders than it becomes chaos for patient and relatives as every doctor will advise particular set of investigations to rule out a diagnosis / disease.

 

[blr_p]

Considering Surgical field, there is a lot of different variety of diagnoses and patients that teams working in Public hospitals have so much in their hands that they dont have time to compile data and provide conclusions. Also a hindering fact is we dont have enough infrastructure to collect, preserve, organize, audit and collaborate the data.

How do doctors learn about treatments then ? speak to colleagues

Now on to the medical field and science of prescribing drugs.

Western scenario is different to us in epidemiology, in a sense they are more sufferring from Allergic, Life Style based diseases than to us, here in India vector born diseases rule the roost more that the lifestyle diseases, even though later are catching up.

Ok, but lifestyle is more likely to play a role in older people than vector borne diseases. That i think is the main reason you see more lifestyle diseases abroad then over here, they are much more older ppl there when compared to the many young as in India.

There cant be assumed that every one in medical field is a saint, and every one is at fault.

Right, the idea is help make an informed choice.

Now a days the governments are being governed by larger Corporations and conglomerates (like revealed by Nira Radia Tapes) same way the pharmaceutical multinational giants govern the FDA and such authoratative policies and force so many circumventions which we dont even know of.

This is mostly to do with conflict of interest, tranparency and disclosure.

Almost every one in medical field knows that drug studies can be cooked up, can be sponsored, so there are very very less number of physicians who derive their prescription based on those studies.

A drug to be considered worthy of recommended for prescription requires a lot of research, than a lot of laboratory studies, than lot of animal studies, than a multiple layers of human studies after a long term duration if found safe, can be approved for prescription. This takes atleast 10-12 years of gestation period, but greedy corporations push a drug within 6-7 years which is the reason for failures or recall of drugs.

Right, and the article does mention this...

Still, Ioannidis anticipated that the community might shrug off his findings: sure, a lot of dubious research makes it into journals, but we researchers and physicians know to ignore it and focus on the good stuff, so what’s the big deal?

The other paper headed off that claim. He zoomed in on 49 of the most highly regarded research findings in medicine over the previous 13 years, as judged by the science community’s two standard measures: the papers had appeared in the journals most widely cited in research articles, and the 49 articles themselves were the most widely cited articles in these journals. These were articles that helped lead to the widespread popularity of treatments such as the use of hormone-replacement therapy for menopausal women, vitamin E to reduce the risk of heart disease, coronary stents to ward off heart attacks, and daily low-dose aspirin to control blood pressure and prevent heart attacks and strokes.

Ioannidis was putting his contentions to the test not against run-of-the-mill research, or even merely well-accepted research, but against the absolute tip of the research pyramid. Of the 49 articles, 45 claimed to have uncovered effective interventions. Thirty-four of these claims had been retested, and 14 of these, or 41 percent, had been convincingly shown to be wrong or significantly exaggerated. If between a third and a half of the most acclaimed research in medicine was proving untrustworthy, the scope and impact of the problem were undeniable. That article was published in the Journal of the American Medical Association.

This is the problem, it gets worse...

But even for medicine’s most influential studies, the evidence sometimes remains surprisingly narrow. Of those 45 super-cited studies that Ioannidis focused on, 11 had never been retested. Perhaps worse, Ioannidis found that even when a research error is outed, it typically persists for years or even decades. He looked at three prominent health studies from the 1980s and 1990s that were each later soundly refuted, and discovered that researchers continued to cite the original results as correct more often than as flawed—in one case for at least 12 years after the results were discredited.

Ioannidis tells me he makes a point of having several clinicians on his team. “Researchers and physicians often don’t understand each other; they speak different languages,” he says. Knowing that some of his researchers are spending more than half their time seeing patients makes him feel the team is better positioned to bridge that gap; their experience informs the team’s research with firsthand knowledge, and helps the team shape its papers in a way more likely to hit home with physicians. It’s not that he envisions doctors making all their decisions based solely on solid evidence—there’s simply too much complexity in patient treatment to pin down every situation with a great study. “Doctors need to rely on instinct and judgment to make choices,” he says. “But these choices should be as informed as possible by the evidence. And if the evidence isn’t good, doctors should know that, too. And so should patients.”

In India research is at nascent stage, but prescription from a large medical (so called as they are not qualified in modern science of medicine) force who are unqualified / partially qualified or qualified in related subjects and practice as medical expert they release rampant prescription of drugs without considering proper dosage, duration and science behind it so what happens is the developing resistance to the drugs. (you must have heard about Indian Superbug of ICU)

Yes,the debate about rampant prescription of anti-biotics leading to an incurable bug. Damn evolution

So drug companies are forced to research new drugs, which take time to develop, they try to earn quick benefit by releasing drugs early and get early profits, which is wrongly shared with some leading practitioners (which is very wrong).

That's just one of the problems, see the corollaries section in the PLos paper for more details.

Corollary 1: The smaller the studies conducted in a scientific field, the less likely the research findings are to be true.

Corollary 2: The smaller the effect sizes in a scientific field, the less likely the research findings are to be true.

Corollary 3: The greater the number and the lesser the selection of tested relationships in a scientific field, the less likely the research findings are to be true.

Corollary 4: The greater the flexibility in designs, definitions, outcomes, and analytical modes in a scientific field, the less likely the research findings are to be true.

Corollary 5: The greater the financial and other interests and prejudices in a scientific field, the less likely the research findings are to be true.

Corollary 6: The hotter a scientific field (with more scientific teams involved), the less likely the research findings are to be true.

So as it happens in every field, medical field is also suffering from few rotten bugs, but the process of cleaning is on, strong and will be effective.

Disagree

Ionnadis worries that the field of medical research is so pervasively flawed, and so riddled with conflicts of interest, that it might be chronically resistant to change—or even to publicly admitting that there’s a problem.

his bigger worry, he says, is that while his fellow researchers seem to be getting the message, he hasn’t necessarily forced anyone to do a better job. He fears he won’t in the end have done much to improve anyone’s health. “There may not be fierce objections to what I’m saying,” he explains. “But it’s difficult to change the way that everyday doctors, patients, and healthy people think and behave.”

Now few thoughts as a medical practitioner based in India:
Here patients demand cure from symptoms not from disease, patients want to be mobile, problem free fast and early, they want to rejoin work so that loss of lively hood is less.

Patients often skip medicines after few days / skip followup consultations when first course of medicines relieve them of symptoms ultimately rendering them vulnerable to further attacks.

Agree

Few doctors want to earn quick bucks, and get lured by cash for prescription schemes and start prescribing substandard drugs.

Believe me not every thing is wrong, but not every thing is right too. Every one who is doing right thing is trying their best to judge the disease and give their patients a best chance to beat the diseases.

So the best thing is for the consumer to be informed and to lean how to know how to select the most objective source of information, whether it be a newspaper, a magazine, a discussion show or advice from a consultant

 

[medpal]

How do doctors learn about treatments then ? speak to colleagues

We learn from textbooks (these are different from journals, surgical workshops, conferences where authors present their experiences of years together, peer reviewed studies which are accepted worldwide unanimously, and not to forget teachers in our colleges and hospitals (medical education is different in a way to other branches is that true knowledge arrives from examining and evaluating patients only, thats why classroom teaching takes backseat from second year onwards)

Ok, but lifestyle is more likely to play a role in older people than vector borne diseases. That i think is the main reason you see more lifestyle diseases abroad then over here, they are much more older ppl there when compared to the many young as in India.

It depends a lot on demography, here we quite a lot of respiratory failures due to infective diseases while there more due to asthmatic attacks. Few inherant genetic qualities alos play a part.

You must have heard there were a lot of deaths here in Gujarat due to Swine Flu than most parts of India, thats also a point to ponder upon, so much needs to be looked into it.

Right, the idea is help make an informed choice.

How can you presume this doctor will be good or bad before even consulting him / her. You have to rely on previous experiences of your relatives/ friends. Even after consulting a particular doctor you can go to someone else. Its a consumer driven society now a days no need to feel bad about it.

On a lighter note, when I started my practice, my patients used to ask are you going to operate, are you going to do it here in this hospital only? Some were candid enough to tell you look younger and we cant have trust on you . later people started trusting me as my hairline receded early :lol:

This is mostly to do with conflict of interest, tranparency and disclosure.

Thats why almost every research study have to mention conflict of interest and source of support before publication.

Right, and the article does mention this...

This is the problem, it gets worse...

Medical Science is an evolving science, you keep looking for new avenues, but never a treatment option be it medical or surgical is derived from a small study done at a single centre. People are so much compelled to publish a paper, sometime we feel laughing to many of them.

So that portion of PLOS article must be concerning about decreasing quality of medical research articles.

Yes,the debate about rampant prescription of anti-biotics leading to an incurable bug. Damn evolution
That's just one of the problems, see the corollaries section in the PLos paper for more details.

Corollary 1: The smaller the studies conducted in a scientific field, the less likely the research findings are to be true.

Corollary 2: The smaller the effect sizes in a scientific field, the less likely the research findings are to be true.

Corollary 3: The greater the number and the lesser the selection of tested relationships in a scientific field, the less likely the research findings are to be true.

Corollary 4: The greater the flexibility in designs, definitions, outcomes, and analytical modes in a scientific field, the less likely the research findings are to be true.

Corollary 5: The greater the financial and other interests and prejudices in a scientific field, the less likely the research findings are to be true.

Corollary 6: The hotter a scientific field (with more scientific teams involved), the less likely the research findings are to be true.

Thats why the studies which gain more weightage are done at multiple centres simultaneously, double blind, randomized, peer reviewed, most likely retrospective. Thereafter the findings are put to test at other centres which approve of them with their methods or disapprove them. When conclusive long term evidence is found the treatment method is accepted as the textbook method.

Thats when majority of doctors will try to implement that in their day to day practice.

Disagree

only time will tell we both being expecting good things to come out of it

Agree
So the best thing is for the consumer to be informed and to lean how to know how to select the most objective source of information, whether it be a newspaper, a magazine, a discussion show or advice from a consultant

Rightly said.
As we now start to encounter a new set of questions from learned patients about choice of treatment method and its successful outcomes.
Its always nice to have good cross questioning, right now for the time being I am seeing less patients of this variety, but my colleagues and seniors in metros must be getting such patients.
Such patients will force us to sharpen our skill set and it will be ultimately beneficial to all.

 

[6pack]

@medpal, i always wanted to know what are those unnamed drugs that many docs forcibly give to their patients every visit for 100 bucks or so. I mean the green, white and yellow tabs without any manufacturer names on them and sold in plastic pouches. are these anti biotics or just vitamins? the white one looks like crocin to me.

 

[kippu]

i just pop any white pill which comes into my hands when i fall ill just to give my body a placebo effect

 

[blr_p]

We learn from textbooks (these are different from journals, surgical workshops, conferences where authors present their experiences of years together, peer reviewed studies which are accepted worldwide unanimously, and not to forget teachers in our colleges and hospitals (medical education is different in a way to other branches is that true knowledge arrives from examining and evaluating patients only, thats why classroom teaching takes backseat from second year onwards)

Couple of problems with the bolded bit.

- “Even when the evidence shows that a particular research idea is wrong, if you have thousands of scientists who have invested their careers in it, they’ll continue to publish papers on it,” he says. “It’s like an epidemic, in the sense that they’re infected with these wrong ideas, and they’re spreading it to other researchers through journals.”

Though scientists and science journalists are constantly talking up the value of the peer-review process, researchers admit among themselves that biased, erroneous, and even blatantly fraudulent studies easily slip through it.

Nature, the grande dame of science journals, stated in a 2006 editorial, “Scientists understand that peer review per se provides only a minimal assurance of quality, and that the public conception of peer review as a stamp of authentication is far from the truth.”

What’s more, the peer-review process often pressures researchers to shy away from striking out in genuinely new directions, and instead to build on the findings of their colleagues (that is, their potential reviewers) in ways that only seem like breakthroughs—as with the exciting-sounding gene linkages (autism genes identified!) and nutritional findings (olive oil lowers blood pressure!) that are really just dubious and conflicting variations on a theme.

- Most journal editors don’t even claim to protect against the problems that plague these studies. University and government research overseers rarely step in to directly enforce research quality, and when they do, the science community goes ballistic over the outside interference. The ultimate protection against research error and bias is supposed to come from the way scientists constantly retest each other’s results—except they don’t. Only the most prominent findings are likely to be put to the test, because there’s likely to be publication payoff in firming up the proof, or contradicting it.

You must have heard there were a lot of deaths here in Gujarat due to Swine Flu than most parts of India, thats also a point to ponder upon, so much needs to be looked into it.

No, did not hear about it, do ppl of Gujurat travel much more than others so more chances of picking up infectious diseases from elsewhere ?

How can you presume this doctor will be good or bad before even consulting him / her.

Not possible to do before but after one may do so.

Some were candid enough to tell you look younger and we cant have trust on you . later people started trusting me as my hairline receded early :lol:

There's a paradox here. If they're young maybe they're not experienced enough like they would be if they were old. And if they are old they might not be uptodate or keep themselves informed about latest devlopments. So its not clear cut to say whether younger is necessarily better than older or vice-versa.

Medical Science is an evolving science, you keep looking for new avenues, but never a treatment option be it medical or surgical is derived from a small study done at a single centre. People are so much compelled to publish a paper, sometime we feel laughing to many of them.

The article says..

- 80 percent of non-randomized studies (by far the most common type) turn out to be wrong, as do
- 25 percent of supposedly gold-standard randomized trials, and
- as much as 10 percent of the platinum-standard large randomized trials.

Thats why the studies which gain more weightage are done at multiple centres simultaneously, double blind, randomized, peer reviewed, most likely retrospective. Thereafter the findings are put to test at other centres which approve of them with their methods or disapprove them. When conclusive long term evidence is found the treatment method is accepted as the textbook method.

Thats when majority of doctors will try to implement that in their day to day practice.

How do you reconcile that you can only rely on research that has been tested for many years, maybe a decade with the fact that medical science is also evolving ?

Many times there is the temptation to say this is a newer drug, has less side-effects, targets the problem better than old etc.

only time will tell we both being expecting good things to come out of it

If both doctor & patient are aware it will happen sooner.

As we now start to encounter a new set of questions from learned patients about choice of treatment method and its successful outcomes.
Its always nice to have good cross questioning, right now for the time being I am seeing less patients of this variety, but my colleagues and seniors in metros must be getting such patients.
Such patients will force us to sharpen our skill set and it will be ultimately beneficial to all.

Well, this is the second point about spotting a good consultant in any field, one that will openly accept questions rather than get irritated about it. If you can get all your questions answered to your satisfaction without being embarassed then that's another factor to consider when accepting any advice.

There is one classic problem that arises very often, one consultant says x & y is required say operations or medications and another says there is no need :huh:

How do you resolve that, you need to ask yet another, cannot make a decison unless there are an odd number of votes.

 

[logistopath]

@medpal, i always wanted to know what are those unnamed drugs that many docs forcibly give to their patients every visit for 100 bucks or so. I mean the green, white and yellow tabs without any manufacturer names on them and sold in plastic pouches. are these anti biotics or just vitamins? the white one looks like crocin to me.

Difficult to say unless you ask the doctor himself personally. These might be generic drugs, manufactured by smaller pharma companies. Such companies cannot spend much on advertising and employing MRs, so they rather distribute these drugs directly to the physicians, who pass them on to patients.

 

[medpal]

@medpal, i always wanted to know what are those unnamed drugs that many docs forcibly give to their patients every visit for 100 bucks or so. I mean the green, white and yellow tabs without any manufacturer names on them and sold in plastic pouches. are these anti biotics or just vitamins? the white one looks like crocin to me.

Those are generic medicines, means they sell by their content name not a brand name, usually its available in loose box packing and family physicians depend upon them to treat their patients. Majority of time they are supportive medicines like for fever, cold, pain, acidity, itching etc. Antibiotics even generic have their individual tablet / capsule packaging so as to identify dosage / content / expiry date.

Couple of problems with the bolded bit.

Even in your quoted stats, the non reliable figure drops from 80% to 25% in good studies.
Generally we depend upon those good studies to count for results, than we also search for the correlating studies which emphasise the points raised and also counter argument.

In finding a better drug or a newer drug nothing works better than ones own personal clinic experience, ie if I start using a fancy new drug for a specific ailment, and patients come back unsatisfied I have to revert back to older molecule to maintain satisfaction of patient and quality of my service. But on a personal front I am not enthusiastic about using newer drug straight away. We also interact with seniors in local forums to check about their feedback for a particular drug / treatment option.

What ultimately matters is the quality of service you provide, satisfaction of patient achieved, safety and efficacy of treatment method achieved, for all these high lever of personal vigilance is what matters. Also your own inner conscience that you are doing wrong to gain small and quick benefits.

No, did not hear about it, do ppl of Gujurat travel much more than others so more chances of picking up infectious diseases from elsewhere ?

no people of Gujarat dont travel much, but their suceptibility to the Respiratory Ailment is more than other areas.

Not possible to do before but after one may do so.

Thats what I said, after consultation you can judge the response to your own queries and trust you derive from interaction which is important.

There's a paradox here. If they're young maybe they're not experienced enough like they would be if they were old. And if they are old they might not be uptodate or keep themselves informed about latest devlopments. So its not clear cut to say whether younger is necessarily better than older or vice-versa.

So its a double edged weapon, patient can use it suit themselves.

The article says..
How do you reconcile that you can only rely on research that has been tested for many years, maybe a decade with the fact that medical science is also evolving ?

Many times there is the temptation to say this is a newer drug, has less side-effects, targets the problem better than old etc.

I think I answered it earlier, even temptation to use newer drug will have to satisfy patient in outcome than only a doctor can continue with further progress otherwise patient will ask questions or change the doctor.

If both doctor & patient are aware it will happen sooner.

Fully agreed

Well, this is the second point about spotting a good consultant in any field, one that will openly accept questions rather than get irritated about it. If you can get all your questions answered to your satisfaction without being embarassed then that's another factor to consider when accepting any advice.

If a doctor gets embarrassed by patients queries and refuses to answer or does not answer well, most likely you wont get treatment from that doctor isnt it?

There is one classic problem that arises very often, one consultant says x & y is required say operations or medications and another says there is no need :huh:

How do you resolve that, you need to ask yet another, cannot make a decision unless there are an odd number of votes.

As there are multiple options for a particular disease, some consultants go aggressive in operative advise and some go conservative. Its a difference of opinion, Its bound to stay with many opinions.

For my field, earlier there used to be so many tonsil removal surgeries, now a days because of better hugiene, lifestyle and better drugs the number of surgeries have gone down too much. So a pediatrician will say surgery is not necessary and an ENT surgeon will say its must, thats where a trustable opinion counts, which you judge by answers of doctor and also their approach while suggesting the treatment option.

 

[sharktale1212]

I think this will make an interesting read: Need Vitamin D Supplements? Depends Which Newspaper You Read - NYTimes.com

 

[phoenix844884]

@medpal - Thank you for your insightful inputs. Doctors become villains very easily, but no one sees the long hard work we put into getting where we are.

@blr_p - Dude, no offense, but any controversial topic and you are right there splitting people's words and lines and responding to everything. Relax, life's too short to take so much stress. I sure hope you enjoy it and don't do it for the heck of it. With that being said, you have posted some great thoughtful stuff over the months I have been reading your posts.

 

[blr_p]

@medpal - Thank you for your insightful inputs. Doctors become villains very easily, but no one sees the long hard work we put into getting where we are.

The villain is the corruption thats seeped into medical research. Do yourself a favour and read the article, given you're a resident in Chicago and the Atlantic is a 100+ year old American publication you might get the gist. You might not be too surprised though.

This is isn't your run of the mill alarmist fodder, the protaganist is from Harvard, is well respected and travels extensively around the globe talking about his research. The charge is of being less scientific in a field that is very scientific. It's aimed more at laypeople than doctors though the papers of which the article was based upon were published in medical journals, one of which is open source. You're defnitely aware of JAMA.

@blr_p - Dude, no offense, but any controversial topic and you are right there splitting people's words and lines and responding to everything. Relax, life's too short to take so much stress. I sure hope you enjoy it and don't do it for the heck of it. With that being said, you have posted some great thoughtful stuff over the months I have been reading your posts.

Splitting words & lines only if you did not follow the reasoning behind them. It's called having a discussion and the learning only comes when there are ppl to interact with. When you can challenge views and see where one stands. I wish more would do it as its pretty standard for a web forum, and discussions go on for a great deal longer. So long as stuff is backed up with sources then a productive discussion can be had.

medpal did not see me as being argumentative at all, look at the way he answered everything that was asked and am grateful he did.

Where i will take your advice however is when dealing with ppl that aren't that knowledgeable about a topic to begin with and cannot substantiate opinions. That just becomes an endless exchange leading nowhere.

 

[chiron]

This is isn't your run of the mill alarmist fodder, the protaganist is from Harvard, is well respected and travels extensively around the globe talking about his research. The charge is of being less scientific in a field that is very scientific. It's aimed more at laypeople than doctors though the papers of which the article was based upon were published in medical journals, one of which is open source. You're defnitely aware of JAMA.

I don't know how scientific something is if the most of conclusions are drawn from empricial data. Besides, I guess the medical field by its nature is limited by the amount of testing that can be done. And regardless, conclusions will be drawn because that is what is expected from someone doing research.

Besides, research on research might give an indication of a trend but it can't do much towards finding culprits(if any) and bringing them to law since wrongdoings would have to be proven on a subjective basis.

In conclusion, I think this discussion is going nowhere

 

[rgsilent]

^^ that's some nice insight.

I've know many relatives/acquaintances complain about how private hospitals tend to make people go for loads of(possibly unnecessary) tests to bloat the medical bill. But since it is a matter of health people don't think of the huge financial burden and end up going for them anyway. Any inputs regarding that?

My dad had gone through a severe bout of malaria a few months back.
The hospital he was admitted to had two doctors treating him. After his malaria was cured internal bleeding started. So the doctor who was mainly treating him suggested a specialist. But the other doc, since he was her senior and the MD of the hospital made us get numerous tests done. He even suggested a CT scan which was not at all necessary as we already found out the source in the initial endoscopy.
Basically he told us to get the CT scan done by a doc who was his very good friend (read him getting a nice cut from it)
So we chucked him off and consulted the specialist and all was solved with a five minute endoscopy and medication.

 

[blr_p]

I don't know how scientific something is if the most of conclusions are drawn from empricial data. Besides, I guess the medical field by its nature is limited by the amount of testing that can be done. And regardless, conclusions will be drawn because that is what is expected from someone doing research.

That means results from drug trials are not scientific no matter how they're conducted ?

I'm not sure if you can say that.

What you can say however is if the test was not properly conducted that it was less scientifc than one that was.

Besides, research on research might give an indication of a trend but it can't do much towards finding culprits(if any) and bringing them to law since wrongdoings would have to be proven on a subjective basis.
In conclusion, I think this discussion is going nowhere

I don't think the aim was to find culprits rather it was to highlight the extent of the problem, to laymen.

If the trend is indicating a detoriating quality in research then questions need to be asked.

 

[chiron]

hehe... happy agruing and merry christmas :bye1:

 

[medpal]

Splitting words & lines only if you did not follow the reasoning behind them. It's called having a discussion and the learning only comes when there are ppl to interact with. When you can challenge views and see where one stands. I wish more would do it as its pretty standard for a web forum, and discussions go on for a great deal longer. So long as stuff is backed up with sources then a productive discussion can be had.

medpal did not see me as being argumentative at all, look at the way he answered everything that was asked and am grateful he did.

Where i will take your advice however is when dealing with ppl that aren't that knowledgeable about a topic to begin with and cannot substantiate opinions. That just becomes an endless exchange leading nowhere.

Till a person understands the subjects, counters the arguments with thoughts, does not stoop to the personal and unthoughtful attacks this is the way to discuss things online. But people tend to indulge into meaning less fights instead.

Thanks for the compliments blr_p. I also never found your posts inflammatory, I always participated where I thought I have some constructive to add to the discussion. Happy to interact with you, learn from you, and also liked your insightful discussion on other topics too.

@phoenix844884 : Its not about who brings up the topic, but about how you put your thoughts into it and find a meaningful way forward for the discussion. Like we can talk about other profession (law / accountants / architects), JOurnalists, Politicians, Actors, Celebrities, people also have a right to talk about medical field. What we can do is enlighten the people we are discussing with about the realities we know and everyone benefits .