Wednesday, October 27, 2010

The Crumbly Edifice of Modern Medicine

Many sites involved with the difficulties of our modern world are focused on our current economic situation.  But there are other problem areas within the modern edifice.

From a recent Atlantic article by David H. Freedman  Lies, Damned Lies, and Medical Science
[Dr. John Ioannidis is] what’s known as a meta-researcher, and he’s become one of the world’s foremost experts on the credibility of medical research. He and his team have shown, again and again, and in many different ways, that much of what biomedical researchers conclude in published studies—conclusions that doctors keep in mind when they prescribe antibiotics or blood-pressure medication, or when they advise us to consume more fiber or less meat, or when they recommend surgery for heart disease or back pain—is misleading, exaggerated, and often flat-out wrong. He charges that as much as 90 percent of the published medical information that doctors rely on is flawed
Ioannidis laid out a detailed mathematical proof that, assuming modest levels of researcher bias, typically imperfect research techniques, and the well-known tendency to focus on exciting rather than highly plausible theories, researchers will come up with wrong findings most of the time.
Simply put, if you’re attracted to ideas that have a good chance of being wrong, and if you’re motivated to prove them right, and if you have a little wiggle room in how you assemble the evidence, you’ll probably succeed in proving wrong theories right.
His model predicted, in different fields of medical research, rates of wrongness roughly corresponding to the observed rates at which findings were later convincingly refuted: 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.
The article spelled out his belief that researchers were frequently manipulating data analyses, chasing career-advancing findings rather than good science, and even using the peer-review process—in which journals ask researchers to help decide which studies to publish—to suppress opposing views.
Itshould be recalled that many (most?) of the great medical discoveries where had a strong element of luck mixed with inspiration in their discovery.

In Accidental Medical Discoveries Accidental Medical Discoveries, Robert W. Winters MD lays out 30 important modern medical discoveries found through serendipity rather than directly targeted research.  Inne example a Royal Air Force doctor (RAF) eye doctor remembering that a shard of plastic lodged in the eye of a pilot evoked no reaction uses this plastic for making artificial lenses to replace cataracts an RAF eye doctor remembering that a shard of plastic lodged in the eye of a pilot evoked no reaction uses this plastic for making artificial lenses to replace cataracts.

And an example from a Morton A. Meyer’s .Happy Accidents: Serendipity in Modern Medical Breakthroughs:

So when we look to science as a the cure all for our current problems of global warming, or peak oil it is best to considers M.A. Meyers summation from Happy Accidents:
At the Johns Hopkins Hospital in 1947, two allergists gave a new antihistamine,
Dramamine, to a patient suffering from hives. Some weeks later, she was pleased to
report to her doctors that the car sickness she had suffered from all her life had disappeared.
The reality is different. Progress has resulted only after many false starts and despite widespread misconceptions held over long periods of time. A large number of significant discoveries in medicine arose, and entirely new domains of knowledge and practice were opened up, not as a result of painstaking experimentation but rather from chance and even outright error. This is true for many of the common drugs and procedures that we rely on today, notably many antibiotics, anesthetics, chemotherapy drugs, anticoagulant drugs, and antidepressants.

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