How do we know what is true? None of us has the time or the inclination to test everything for ourselves. We rely on trusted experts to tell us. Few doubt that the heart pumps blood to our lungs and other tissues, although few have seen our hearts do that. We know that William Harvey discovered that fact in 1628, and it is now universally accepted as true and foundational to all cardiology. Even fewer know how the nerves cause the heart to beat, how arrhythmias are diagnosed, or how plaques can cause heart attacks. We rely on cardiologists to know all that, and within cardiology are sub-specialties (e.g., heart transplant specialists, sports cardiology, etc.). There are dozens of medical specialties, each with several sub-specialties. There are even specialists in cutting across categories, and assuring that the latest innovations become available to patients; this is called “translational medicine.” In this era of specialization, few know much outside of their specialty, and as patients, we must, at some point, rely on the experts for our knowledge about disease, diagnosis, and treatment.
Medical science became probabilistic in the 20th Century. All medical institutions agreed that statistics are the only way to reject hypotheses, judge superiority or inferiority, infer causality, and to analyze and reduce errors. Statistics are difficult to understand and are non-intuitive, even for many doctors. As sophisticated statistical techniques were adopted by the medical institutions and their publications, lay people, who did not have their arcane knowledge, were increasingly left out of the truth community.
The Dunning-Kruger Effect is a cognitive bias on the part of incompetent people overestimating how much they know. In medicine, a little knowledge is a dangerous thing. When I started writing my novel, Thaw’s Hammer, about a killer virus, I thought I knew enough about the subject to write a credible novel. Four years later, I knew how much I didn’t know. I grew to admire the experts who had to understand the biochemistry of the replicative apparatus, the interactions with host cells, and the immune system. Viruses are the most numerous and diverse forms of life on Earth. Anyone who thinks they understand them is wrong. The experts differ from lay people in knowing they don’t completely understand them. Still, an expert understands a lot more than any lay person who thinks he knows more. I know enough to reject any advice from a Jenny McCarthy or a Joe Rogan in favor of advice from the CDC.
Overconfidence in subjective assessments, when contrary to scientific consensus, is also influenced by alignment with political and religious social groups. The Dunning-Kruger Effect is particularly strong on the issues of vaccination (particularly Covid-19 vaccination), genetically modified foods, and homeopathic medicines (see link below).
Knowledge is progressive and cumulative. Newton said, “If I have seen farther, it is because I have stood on the shoulders of giants.” Opposing this kind of humility, are people who think, based on a few facts or “alternate facts,” that they have arrived at the truth hidden from the rest of us. What they are really doing is inhabiting what Rauch calls an “epistemic (knowledge) bubble.” They are only allowing into their knowledge bubble those data, and persons, that confirm their biases. They take studies out of context and fail to rigorously analyze studies they agree with while finding reasons to disqualify studies that don’t agree with their preconceived notions. They reject the methods of analysis developed by the institutions they reject. They are usually smart and think that they are fully capable of judging the data for themselves. This takes a certain kind of narcissism – as if the whole world is full of “sheeple” and only they know the real truth. They are also lazy – it would be too much work to learn and evaluate the whole body of knowledge.
Fundamentalism has been around in religion at least since the Protestant Reformation. But it emerges in all other areas of human knowledge – politics (as populism), law (as originalism/ anti-stare decisis), and folk/Internet medicine. It is usually short-lived: the fundamentalists of one generation eventually give way to the acceptance of an orthodoxy and hermeneutics for interpretation of texts. Fundamentalism substitutes personal authority for institutional authority. Personal knowledge is acquired rapidly and doesn’t require input from others. Because personal ego is at stake, it excludes all information that doesn’t confirm. Institutional knowledge, on the other hand, builds on a foundation of knowledge of the “truth community,” and includes conflicting data. The conflicting data create new hypotheses and the opportunity for knowledge to expand. If enough conflicting data accumulate, they may cause what Thomas Kuhn called a “paradigm shift.”
Google is a wonderful thing. Knowledge is potentially at our fingertips, but information out of context can mislead. Instead of knowledge, we can be left with information that only confirms what we think we know. Social media ideally expose us to all sides of any issue. But if we are not open to all sides, social media can only reinforce the knowledge bubble we have built around our pre-determined beliefs. Without challenges to what we think we know, there is no progress.
Part 3: Distrust of Institutions and What We Can Do to preserve the Constitution of Medical Knowledge
Written by
Tall_Allen
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This is such a very important series of articles. Unfortunately as Dr. Google has taken an active role in healthcare, we often see confusion between authority and authoritative. The role of money often determines who's voice is heard. Which hypotheses are deemed worthy of study is often based on the potential to profit and not all questions receive the same financial attention.
In the area of fertility there were a myriad of studies comparing expensive gonadotropins against placebo. Yet there were no side to side comparisons with generic metformin which was safer and usually free. Those of us with prostate cancer would love to see side by side comparisons of different treatment modalities. However, financial factors and incentives can limit the possibility of carrying out statistically valid research that addresses a clinically relevant hypotheses.
Comparing the outcome between studies is fraught with risk as well. When looking at studies we must also ask if the study applies to cases like mine or are the results being overgeneralized to a wider group than the initial study.
Medical training increasingly includes research development and analysis as part of that training. But as Allen mention, we must not forget the pitfalls and limitations and that ultimately we are treating individuals and not subjects.
One of the roles of government and NGOs is to provide resources for medical research when there is no profit potential for private industry. NIH/NCI, DoD, the Cancer Moonshot, and PCF all provide research funding in the US. Still, bringing a new drug through all development and trials can cost billions. In recent years, there are increasingly public/private partnerships.
The UK government makes a huge contribution to the Pharma. R&D but still the process of why drugs are priced expensively the way they are is not transparent. I have seen the the generic statement 'drugs cost a lot to bring to market' before and as a lawyer I am a bit sceptical and would much prefer total transparency. ncbi.nlm.nih.gov/pmc/articl.... "Physicians and the public deserve to be in a position to make informed choices about drug and device risks and benefits. Strong, evidence-based practice requires that objective, unbiased research be available to inform individual clinical decisions, systematic reviews, meta-analyses, and expert guideline recommendations. Industry has used seeding trials, publication planning, messaging, and ghostwriting, as well as selective publication and reporting of trial outcomes, to distort the medical literature and undermine clinical trial research, explicitly by obscuring information that is relevant to patients and physicians. Policies that promote transparency in the clinical trial research process through improved and expanded disclosure of investigator contributions and funding, comprehensive publicly available trial registration, and independent analysis of clinical trial data have the potential to address, at least partially, these subversive practices. These policies will improve accountability among industry and investigators for clinical trial research practice, minimizing the impact of marketing objectives while strengthening the science, which will in turn protect both the integrity of the medical literature and the public's health."
I would not equate interest in all kinds of medical knowledge as "religious fundamentalism." I am not against science or the scientific method. I simple state that money has tainted the science. There are plenty of instances of "medical science" in this country gone wrong in the name of profits. Results of studies by the FDA or skewed to the benefit of big pharma.
" I know enough to reject any advice from [fill in the blank] in favor of advice from the CDC. "
That means you know enough to both reject the use of masking as an ineffective strategy and to accept the use of masking as effective strategy.
Did enough conflicting data accumulate to cause “paradigm shifts” that made so many shifts in masking policy all science-based? I think not. (Perhaps enough newly-imported N-95s accumulated.)
Much of the "Distrust of Institutions" arises not so much because institutions like the CDC are completely wedded to objectivity and to the scientific method, and the untrusting people all reject science. Rather it is because these are POLITICAL institutions that can use the science of RCTs when it serves their politically-influenced policy goals or they can ignore, manipulate or distort the science of RCTs when it does NOT serve their policy goals.
To have blind trust in the honesty and integrity of a political institution is like having blind trust in the honesty and integrity of a politician.
Here's an analysis of a CDC "scientific" study on masking, a study used by "experts" to further public health messaging. [Spoiler alert: it is not a study that you could call a "large, well-done, and confirmed randomized clinical trial that constitutes truth in medical science."]
At 14:40 we hear a good analysis of why trust in institutions like the CDC is in decline: they are doing it to themselves by doing, and then touting, BAD science.
I am a hater of scamming grifters. They are about to destroy US Democracy as we know it.
I'm not interested in their conspiracy theories.
Men of science don't talk like carnival barkers, just like real patriots don't storm the capital because they lost an election.
No science, no patriotism, not going to waste time listening to grifters talking about either. Like I said I shut off 3 seconds in before hearing what he was going to say.
💯 At some point, we have to agree that youtube is not a vehicle for medical science. There is no entertaining substitute for hard facts backed up by clinical research and very dry statistics. Youtube videos are not peer-reviewed - anyone can call themselves an expert.
Are you suggesting any points being made are invalidated simply by virtue of appearing on youtube? That seems odd.
It's rather like saying because there is so much crap on TV, there is little if any possibility that one could ever find anything scientifically valid within a news program or documentary.
If you look at Prasad's work going back to 2011, you will see OTHER people calling him an expert, not just he calling himself one. You may disagree with any (or many!) of his conclusions or positions, but it would be positively ANTI-science to disagree with his claim that there needs to be rigorous attention to randomized controlled trials to make sure they are ethical, well-designed, and do not make claims that are not truly and fully backed by the data.
Right. Youtube is not a medium for conveying peer-reviewed medical information. How would one do that?
I'm not commenting on his expertise. I'm saying that if he has a valid point to make to the scientific community, the appropriate medium for that is a journal response. Such responses are printed all the time. If he can't get published in a legitimate journal, perhaps he doesn't have anything legitimate to say.
The very fact that he chooses youtube as his medium says he is addressing and taking advantage of the ignorance of an uninformed audience.
It does not say that at all. You are claiming he can either use scientific journals as a medium OR he can use youtube as a medium, as if they are mutually exclusive. That's nonsensical.
The first medium is used to communicate exclusively with the scientific community, with some lag time, while the second medium (and other mass media) can be used to communicate instantly and less formally with all who are interested (whether of that scientific community, or mere lay people).
This notion that when an expert tries to communicate with lay people, in language that they can understand and in a place that they can access, then he MUST be "taking advantage of their ignorance" is absurd. Maybe he is, and maybe he isn't.
Do the spokespeople of the CDC not communicate with lay people via mass media, without use of dry stats? I do not understand how the CDC by your own view would not be "taking advantage of the ignorance of an uninformed audience."
Or perhaps you are saying the CDC is not even TRYING to convey peer-reviewed medical information, via mass media, translated into a language and style that makes it more understandable. Perhaps peer-reviewed medical information is for expert eyes only, always and everywhere, and the CDC is telling us "just follow orders, this is all over your head." But if that is the case, why is the mass media (not just youtube) flooded with "official" and "CDC" versions of supposed science fact that is clearly derived from lab studies, observational/epidemiological studies, cohort studies, etc. but NOT from large RCTs?
Prasad's biggest complaint is that little if any of this expert CDC science is actually backed by large RCTs. As such, it should be presented in CDC press releases as hypothesis rather than as scientific fact. Shouldn't you be on the same page with him, whenever the CDC happens to present a very good guess as if it was already proven?
Between Prasad and the CDC, I think the only way to know which was trying to "take advantage" would be to look at the study in question: was it good science that supported all the claims subsequently made in the popular media, or was it flawed in numerous ways that made it fail to live up to the standards and highest levels of evidence that you are touting here as what establishes "medical truth?"
Yes, it is either/or. Either he wants to influence his peers or he doesn't. If he does, where is the peer-reviewed journal response? Maybe he did one, but all you posted was a youtube video.
The CDC's job is to protect the public health. They have the top virologists and epidemiologists in the world working there. They don't debate one another with youtube videos. If he has a legitimate critique, and he might have, why is he using a medium to reach you and not them? It is clearly just grandstanding - and it worked (at least for you).
CDC deals with medical emergencies, such as response to Covid19. The fact that we got vaccines, and now treatments in record time for a disease that killed more than a million people in the US is a tribute to their hard work.
"why is he using a medium to reach you and not them?"
Your comment makes no sense. Since I am not "them" I do not receive the communications that might be directed to them. I receive the one directed to me. Why is he directing one to me? Because it is in direct response to the one the CDC directed to me via the mass media press release.
He is commenting to ME on the quality of the science he sees in the CDC's communication with ME. To presume he has no contact with fellow scientists via channels other than youtube, is, well,,, presumptuous. Why would you presume that? Because a self-admitted dummy like me can't track down these communications, let alone translate them into something I can understand?
I appreciate that the CDC's job is to protect the public health. I followed their suggestions to mask and isolate and vaccinate. After I recently tested positive and quarantined, I then voluntarily masked when going out in public. I did this because I do ASSUME there is some risk reduction for others if I do so.
What exactly is that risk reduction, based on the results of GOOD and large RCTs? We don't know. It is now a "thought crime" to admit that we do not truly know the exact level of risk reduction for different types of masks under different environmental conditions in different social settings. That scientific truth has not (and likely cannot) be arrived at. So we have been proceeding on the basis of hypothesis, not scientific fact. Why is it so terrible to admit that?
The issue is not an objection to the CDC's job to protect the public health, or to their recommendations to mask and vaccinate. It is an objection to whether the CDC should distort, obfuscate and pursue bad science or non-science in this effort, and then ALSO claim that it is the final arbiter of "scientific truth." Doing the first (the job of politics) necessarily disqualifies you from being the second (the job of science).
Sorry, but no matter how much "hard work" an institution engages in does not change that.
To have our top scientific institutional experts be dishonest or not fully forthcoming or not scientifically critical, because being dishonest or not fully forthcoming or not scientifically critical at a particular moment in time is what BEST serves to protect the public health, is fine with me. I actually don't have a problem with it. I only have a problem with pretending that's not what's happening.
To pretend it is not what is happening seems to me to be anti-science and anti-truth and, frankly, Orwellian. This coming from a double-vaxed and boosted, fully masked, socially-distanced Trump-hating non-Republican. Just trying to call it like I see it.
I said I was posting "an analysis of a CDC study." Where is there a claim of "evidence of medical science" in that statement?
An analysis is a "detailed examination of the elements or structure of something." I believe that happened in the video. If you disagree, please explain.
If we are to know enough to reject any advice from a youtube video in favor of advice from the CDC, where are we getting our "evidence of medical science" when we receive that CDC advice? YOU may be getting it directly from the CDC, but the vast majority of Americans are getting from the mass media platforms of TV, newspapers or... yes, youtube.
If I get CDC advice distilled through an interpreter of science and delivered to me over the youtube platform, should I know enough to reject any advice from a youtube video, and thus ignore the CDC because youtube is not a medium for conveying peer-reviewed medical information? Which platform can I trust for delivery of peer-reviewed medical information that the CDC wants me to see, to protect me? ONLY the CDC website? Or can I trust media outlets that the CDC uses, like the NYT or CNN.
Well, you posted it on a thread about medical evidence, so please don't be disingenuous. It is actually an apt point to make because I think many patients believe the information they see on youtube (and shouldn't).
I wanted to further discuss this. Marshall McLuhan said "The medium is the message," and he was right. Youtube and podcasts are their own media, but are mostly for the entertainment of non-experts. Can you imagine a researcher citing a video as his reference for a study (other than a study about how patients become misinformed)? Here is what happens when patients used social media to become informed:
" Of 200 total articles, 32.5% (n = 65) contained misinformation and 30.5% (n = 61) contained harmful information. Among articles containing misinformation, 76.9% (50 of 65) contained harmful information. The median number of engagements for articles with misinformation was greater than factual articles (median [interquartile range] = 2300 [1200-4700] vs 1600 [819-4700], P = .05). The median number of engagements for articles with harmful information was statistically significantly greater than safe articles (median [interquartile range] = 2300 [1400-4700] vs 1500 [810-4700], P = .007)."
When I read a research paper, if I am unfamiliar with what the author is saying, I check the reference he provides. That's what I do in all of my articles as well. I explain what the study said and provide a reference so if you want to check my accuracy, you can. How can that be done in a youtube video?
You asked "Which platform can I trust for delivery of peer-reviewed medical information that the CDC wants me to see, to protect me? ONLY the CDC website? Or can I trust media outlets that the CDC uses, like the NYT or CNN." Yes the CDC only states as fact, factual information. When there are no facts available yet, they say that too. I think they are very good about that. Your mistrust of the best institution we have for providing the most current virology and epidemiology information is misplaced. You (and I) don't know enough to doubt the opinions of those world-class experts. Until you do, that is the best source. If you believe that CDC is part of a vast conspiracy to keep you from the truth, that is just an "epistemic bubble" of your own creation.
Well, I posted it in direct response to your comment about Joe Rogan and the CDC, because the intro of the video references them both right off the bat, in an overly-demonstrative way. (He is extra snarky in this intro, which his fans may find funny but others may interpret as sneering and off-putting.)
Understand this: Joe Rogan has NEVER, EVER postured himself as some kind of medical expert. He has followed up numerous of his own comments with something to the effect of, "... but don't listen to me, I'm just a dumb comedian."
What you hear your favorite comedian, or politician, or musician, or actor or athlete say about medical issues should never be the basis of medical decision, or considered a foundation for medical knowledge. But everybody already KNOWS that.
Do people let what they hear from noteworthy non-experts INFLUENCE a decision? Sure. The only way to fix that is to ban celebrities from any discussion of medical issues (unless of course their opinions and comments align with the wishes of public health authorities).
But my point is simple: true things can appear on youtube, and false things can appear in studies... yes, even in RCTs! Suppose I found a true thing on youtube and a false thing in a CDC study. In an Orwellian definition of truth, the thing on youtube that is true CANNOT be true, by definition, and the thing appearing on the CDC website CANNOT be false, by definition. Ever.
That is implicit in the idea of rejecting ANY advice from a Joe Blow in favor of advice from the CDC, because you frame it as an absolute. It means Joe Blow could NEVER give advice that is better-informed scientifically than the advice of the CDC. But it only has to happen once for it not to be "never."
And it happened at the beginning of the pandemic. Unless you think the head of the Chinese Center for Disease Control and Prevention has less access to "good science" than the head of the CDC. But maybe all the studies that Chinese scientists were doing were only distributed via mass media platforms and none appeared in journals?
The point is that peer-reviewed journals are part of an ongoing INSTITUTION for evaluating knowledge claims. It isn't that institutions don't make errors - they certainly do! But it is very much to the point that they also correct and retract, and their truth claims depend on a community of experts and not on any one person. It is the institution that ferrets out errors and corrects them. Youtubers and podcasters have no such institution. If Joe Rogen misinforms, it is up to him whether he wants to correct himself, and that is only if he catches his error.
In a health crisis, there is no time for prospective randomized blinded clinical trials. They will come. But they are called upon to help write policy for HHS. They go with the best data they have--not perfect, but hardly a hypothesis. And yes, it may change over time.
Exactly... in a crisis you go with the best data you have. Then, you admit that is what you are doing because there is no choice but to do that. Or do you not admit it?
If we go back to any early data on masking, here is what we are doing: we are assuming that a mask, ANY mask, will reduce risk by SOME unknown degree. Pretty simple, and not something a reasonable person can argue with as a fair hypothesis.
What the health authority says, in chronological order, instead consists of:
If we went "with the best data we had" then we would have heard #3 right away, because it is the most reasonable hypothesis even before RCTs could possibly prove or disprove anything (which they still probably can't, wrt the exact degree of risk reduction under a wide range of conditions).
My point is simply that the three statements we heard were a function of political considerations more than a function of data changing over time. We should not confuse political/policy authority with authority that establishes scientific truth, as they are inherently in conflict.
If I’m reading you correctly (and I’m not meaning to misinterpret by design), you’re calling out the changing CDC advice as pointing to something untrustworthy, or evidence of something politically-motivated, or bad science, or … something, and with apologies, I’m not 100% clear. However:
— is it possible that the understanding wrt use of masks changed as we gather more data, as it was less of an urgent need to prioritize front-line medical staff, and in general as the science evolved and course-corrected?
— I’ve never quite understood, just what was the political agenda that was behind the seemingly conflicting CDC statements?
— do you believe that policy authority is always in conflict with authority establishing scientific truth? The use of “inherently” seems to imply this; again, I’m not meaning to put words into anyone’s mouth.
Thanks for taking a second. I do want to understand your points more clearly.
" is it possible that the understanding wrt use of masks changed as we gather more data "
No. The science was getting well established in Asia. If you pretended that science did not exist or you ignored it, only then could you answer "yes."
"as it was less of an urgent need to prioritize front-line medical staff, and in general as the science evolved and course-corrected"
I think what course-corrected was the actual supply of N95s and surgical masks. If you look at Asia, those countries were prepared because of their prior experiences. Our institutions were almost entirely UN-prepared, even though they had access to all the data from the past few decades of the Asian experiences. Why unprepared? Because they are political institutions of a huge bureaucratic government mired in partisan bickering and boondoggles.
" just what was the political agenda that was behind the seemingly conflicting CDC statements?"
I am not saying there was any agenda in the normal use of the word. What I am saying, the way a political institution CAN work (and often does) is that policy is arrived at first, and then studies are sought out that will give it scientific support. Or, as I believe was the case here, studies that exist that would NOT give support are NOT sought out.
"do you believe that policy authority is always in conflict with authority establishing scientific truth? The use of 'inherently' seems to imply this"
What I mean is an inherent POTENTIAL for conflict is always there. To remove that potential, science would always come first, and ALL policy would be arrived at on the basis of that science. Of course, the policy has to be funded where it needs funding, and should be legal and constitutional and all that. But the point is, policy is driven by good and complete science that is not consciously cherry-picked to arrive at pre-desired outcomes, as I outlined above.
A "political" conflict could even come at the level of the academy, where a researcher is less intent on revealing scientific truth than on doing work that gets the results that influential others might want and expect him to get.
Thanks for asking those questions... helped me frame the points I'm trying to make here a bit better, hopefully!
First of all, I do not set public policy; I can only act on personal policy. It has been admitted that the CDC's admittedly clumsy early mask guidance was based largely on the shameful lack of access to PPE by out HCWs at risk.
Secondly, the science did change--both because of changing perception of transmission via droplets vs. aerosols, and (of course) because the infectious agent changed over time. Other than your first statement, which you may view as political (I don't; to me it was a reaction to public health policy, which you may view as political, but I view as science, though probably a "softer" science) the others were purely based on the constantly changing body of clinical knowledge.
I can't agree. That view implies that Asian countries who embraced masking early were just winging it, rather than doing so on the basis of the latest and best science as they saw it. Those countries have CDCs, too.
Sorry--unless it's been translated I'm not familiar with the Chinese literature--I'm sure it's out there.
You may recall that early on, a contrast was made between the presumptive transmission of SARS CoV-2, as NOT being primarily airborne. (The question of transmission via fomites was also open). It was contrasted with bugs that were known to have airborne transmission (flu, measles, etc.). It is altogether possible that there was plenty of literature from the SARS pandemic of 2003, and they were acting on the basis of that knowledge. If there WAS in fact literature from the earlier coronavirus outbreak that was ignored, then that was yet another public health failure. But I don't know that that was the case.
" do not understand how the CDC by your own view would not be "taking advantage of the ignorance of an uninformed audience.""
Did you ever notice that the uninformed who build up belief systems based on self emotional needs as opposed to facts always get around to accusing others of being uninformed?
What I think is that I was quoting TA, and it was HE who was making a blanket accusation others of being uninformed, not me. (Presumably anybody who watches Joe Rogan MUST be, simply by virtue of ingesting that content.) I was simply throwing his accusation back in his face.
You better read more carefully... you are getting things bass ackwards.
"You can call TA many things, but uninformed is not one of them. Yet it seems you are accusing him of that. No?"
No. Emphatically, NO. Please reread the thread.
TA said "The very fact that [Prasad] chooses youtube as his medium says he is addressing and taking advantage of the ignorance of an uninformed audience." All I did was refute that, and say that a person using that platform does NOT define that person as attempting to "take advantage" of less informed listeners.
It does not definitively reveal the person to be doing that any more than the CDC giving a press release to a variety of media outlets means THEY are "taking advantage of the ignorance of an uninformed audience." You and TA may not realize this, but many people access information from BOTH a platform like youtube AND a platform like WaPo.
The use of either, neither or both of these platforms to access information cannot define an individual as "uninformed." Nor can an individual's use of use of either, neither or both of these platforms to disseminate information define him as "taking advantage." Any assertion suggesting that is nonsensical.
I have watched countless "Grand Rounds in Urology" presentations on youtube. By TA's analysis, the fact that these discussions are presented on the youtube platform reveals that GRU and editor E. David Crawford are addressing and taking advantage of the ignorance of an uninformed audience. Otherwise, why chooses youtube as a medium for urologists, medical oncologists, radiation oncologists, and other healthcare providers to keep up-to-date with best practices and current clinical updates for the treatment of urologic diseases?
Until TA proves to me that GRU also communicates via the channels of established scientific journals, by his own logic I will have to make the default assumption that their choice to use the youtube platform means they are trying to take advantage of me. Damn, so many wasted hours!
Perhaps TA should inform GRU and editor E. David Crawford that youtube is not a medium for conveying peer-reviewed medical information, and if there are valid points to make to the scientific community, they should use a more appropriate medium.
And again, as for TA being uninformed, he is clearly BY FAR the most informed person on this forum. I do not consider myself among the most informed. His knowledge is beyond impressive, and he has been of great help to me, as he has to countless others.
You believe that because TA has a level of knowledge beyond impressive, and he has been of great help to countless men, that nobody should ever dare disagree with one of his statements. Goodie for you. Again, that is called an appeal to authority.
When I think he is wrong on the basis of his logic one out of 1000 times, why wouldn't I say so, that one time? As a matter of respect? When as a young man I would debate my father (100x smarter than I) and would on rare occasion challenge him on a point of logic, he never appeared to take that as a sign of disrespect. Don't dis' my Dad.
Ideally, the audience for GRU is doctors. At it's best, it is doctors presenting their best information to other doctors. They would ideally present details of their evidence and include citations to peer-reviewed journal articles. This mimics the presentations given at conferences, ideally. I stress the word ideally because they don't always live up to that ideal. I've seen a few but stopped watching it when they started violating those ideals and now seem to pander to patients, much as PCRI does. Presentations at conferences are almost always backed up by publication in peer-reviewed journals.
Well, certainly not from this guy. There are guys who wind up on youtube who actually use and dispense well-sourced information. Two off the top of my head--the electrophysiologist John Mandrola and the nephrologist F. Perry Wilson.
So when someone posts a point-by-point critique of the scientific weaknesses of a study, and you shut off 3 seconds in before hearing what he has to say yet are willing to call him a "charlatan" on the basis of that 3 seconds, you have pretty much established yourself as a hater of science and a lover of ad hominem.
I too am a hater of scamming grifters. I'm not interested in conspiracy theories. But I don't identify con men and liars on the basis of MY tribal affiliation. Or theirs. I do it based on the content of their speech first, and then on my perception of their motives and intentions, based on actually LISTENING to that speech. (Just so you know, Vinay Prasad belongs to YOUR political tribe, and I do NOT happen to belong to the opposition tribe.)
You are the perfect living example of what Prasad predicts (at 14:40 of the video that you refuse to listen to) as a likely path for the scientific fields in this country: the scientific community will increasingly split along ideological and political grounds so that we have a Two-Science paradigm. There will be one set of scientists for "us" and one set for "them" and each will cherry-pick the data to establish THEIR scientific truth. The end of scientific consensus.
Guys like Prasad will of course be excommunicated from their tribe by the likes of you because they dare to question or analyze the scientific basis of the policies and messaging sent down from on high by their own tribe's Top Experts (who are nearly all creatures of politics first, scientists second). Even daring ask (scientific!) questions like "Is this really true?" or "Is this actually good science?" establishes him as giving aid and comfort to The Enemy (who then claim him as one of their own even if he is nothing of the sort).
There is one element of your posts I can agree with: LoL.
Here's what you are actually saying: those who do not toe the party line (of Our Tribe) can easily be identified, by that and that alone, as sneering grifters, demagogues, quacks, and haters of democracy, etc.
Never mind if one publishes in peer-reviewed journals and publishes books that are well-reviewed by reviewers from The Lancet, Nature, Dana Farber, Queen's University, Harvard Medical School... he dared question the scientific bona fides of a CDC study!
Prolly some footage of him at the Capitol on Jan 6 will turn up soon, the traitor. In the meantime, start working on your "Hang Vinay Prasad!" chants, and get on down to the the University of California at San Francisco (what?!) where he won the 2017 Craig Okada Award for best teacher in the Hematology Oncology Fellowship program, the 2018 faculty mentorship award from the internal medicine residency, the 2019 J. David Bristow award from the graduating medical students, and the 2020 excellence in research and scholarship mentoring as awarded by the internal medicine residents.
Sorry, but what you see as "sneering" is not what everyone sees. (Although for those who belong to a certain political tribe it can probably ONLY be seen as "sneering.") It might be seen as an attempt by a non-comedian to be humorous.
But what exactly does sneering "give away?" That it is impossible for there to be any valid observations following the intro? How does THAT work?
The self satisfied sneering snickering confidence of a conspiracy theorist who's opinions are based upon emotional needs as opposed to facts.
Like the traitors who are now being sentenced for attempting subvert the votes of others when they attacked Congress in January, or people who use contrived religious beliefs to justify endangering others with their diseases in the armed forces or in nursing homes, or to justify hate speach and anger towards others based upon their skin color or sexual preferences.
You can just smell the stink of the intolerance and anger. Never a reliable source of accurate information.
When you see one of those Adolf Hitler speaches, you can pick that up in seconds... and you don't even need to understand German. You know where the speaker is heading... and it isn't fact based science. LoL
Just my opinion. But I'm not interested in listening to anyone who who needs to buttress their beliefs with anger and hatred.
So tell me, why do you feel the need to defend that guy. Why post that content instead of some links to peer reviewed research? Why?
I have my own theory. But how do you justify it in your head?
I have watched many hours of Prasad's online critiques of RCTs for cancer meds (including VISION and ENACT for PC, among others). I do not perceive the hatred that you do, so consider that you may be projecting that on to him. And if a presenter appears angry or mocking at times, couldn't that just be because he has contempt for the quality of the science he is reviewing?
(I don't see it that differently than a film reviewer mocking a poorly made film... one cannot say that defines him as "hateful" simply because he hates what he perceives as bad film making, and you happen to love the filmmaker in question.)
I did not post specifically to "defend that guy" but as a response to a specific statement by TA: "I know enough to reject ANY advice from a Joe Rogan in favor of advice from the CDC." So this video happens to be the perfect counterpoint to that, sneering or not.
I put "any" in bold, because that means if Joe Rogan ever happens to cite a well-designed RCT as the sound basis of his advice, and the CDC gives advice based on lower levels of evidence, then TA will favor the lower-level evidence over the higher-level evidence. Which is the exact opposite of what TA has just suggested we do!
This is known as an appeal to authority.
TA has first claimed we must ALWAYS accept the medical truth of the higher-level evidence over the lower-level evidence.
Immediately after this, he is claiming the most important thing is not the distal source of a claim, the actual levels evidence being used as the foundational basis for making a claim or "giving advice," but rather the most important things are 1) the hierarchical status of the proximal source of the claim, and 2) the nature of the platform on which this claim is delivered.
So what he is saying is, always accept claims from the higher authority even if those claims turn out to not have a foundation of scientific truth as defined by RCTs, and never accept claims from the lesser authority even if those claims DO have a foundation of scientific truth as defined by RCTs.
That seems like an odd position to take. I'm not sure why you would find it odd that I find it odd.
And the CDC gets paid to tell people what they DON'T want to hear. So?
You are in effects saying, based on the hierarchical authority of the source, the things you want to hear can NEVER be true and the things you DON'T want to hear MUST ALWAYS be true.
It's a little like claiming everything Dad says MUST be true and everything your kid brother says CANNOT be true. You believe this? Because that is quite different from supposing MOST of what Dad says is probably true and MOST of what your kid brother says probably is not true.
You and I can agree that Donald Trump is a poor source of truth. Let's suppose it is established, by a source the two of us agree is a reliable arbiter, that 99 of 100 of his claims are false (perhaps a bit generous). That also establishes by definition that 1 of 100 are true. You are the person that says his 100th claim is also false, while I am the person that admits the 100th is true. Gee, sorry... but which of us is factually correct?
Let's suppose our reliable arbiter finds that 99 of 100 of CDC claims are true. That also establishes by definition that 1 of 100 are false. You (and TA?) are the person that says their 100th claim is also true, while Vinay Prasad is the person that charges the 100th is false. I guess that makes him a bad guy.
Why is Prasad only talking about the one false claim, and not about the 99 true ones? Because that's what he sees as his job. The standards for a truth-teller are far higher than for those of a liar. To truly be considered honest, a truth-teller must tell truth 100 out of 100 times. Being "mostly honest" doesn't cut it if you expect to be a standard bearer of scientific truth.
It doesn't appear that you are actually reading my posts. You are certainly not addressing any of the points I am making, or trying to answer any of the questions I am asking.
Would you care to re-read my posts and try addressing some of the points I am making, or try to answer some of the questions I am asking? If not, why not?
At the very least, please explain why asking questions like "Is this actually good science?" or "Does this study have serious flaws?" or "Are the conclusions of this study valid?" would establish one as a demagogue? How would you know if Prasad is using rational argument or not if you refuse to listen to him?
By definition, a demagogue avoids rational argument. The only way to know if an argument is rational is to hear it. So I am very confused as to how one can put his hands over his ears and then be so very sure he knows exactly what is being said. It seems an odd approach to reality.
Absolutely. Also boo hooed MRNA vaccines. Instead stood behind live virus Novavax. Then when Novavax was approved started to bad mouth it as well. He had to keep his "show" going.
He has points, but his method of delivery is what calls it into question. I appreciate the people on this site is they sift through the myriad of articles to identify studies and eliminate the information that is not science based. I wanted to cling to treatments I might be able to control, but it's both a waste of time and money. Finding effective treatments for this disease that's so individual demands rigorous review and I'm thankful for guidance and identifying those plans that are scientific based.
Sorry--Prasad is a tool. He's been outed in multiple venues as being vaccine-skeptic-adjacent, if not antivaccine himself. You may believe what you will, but damning the CDC because this guy doesn't like the CDC--well, it's a big mistake.
Of course damning the CDC just because some guy doesn't like the CDC would be a big mistake. That's why that's not what I am doing. I am listening to his point-by-point critique of a particular study, and trying to decide if his points are valid. (He says he used to LIKE the CDC, but he has never liked bad science, and prefers the CDC not do bad science.)
You seem certain Prasad CANNOT HAVE any valid points by virtue of being "outed." (Which simply means he is not staying in line with the tribal authorities.) This means you do not need to listen to anything he actually says, but retain the ability to judge the content of his speech as "false."
You may believe what you will, but damning a guy's speech without actually listening to any of it -- well, it's a big mistake.
Let's take a look at one of his tweets: "I am the biggest advocate of adult vaccination, and took the first opportunity I could get to get mRNA, but I am stunned that so many smart people are so eager to embrace EUA for 12 to 15 without closer scrutiny of the data."
Does that sound anti-science or anti-vax to you? It sounds to me like someone saying SHOW ME THE SCIENCE. And after you show it to me, I will tell you if I think it is GOOD science.
I'm sorry if you have a problem with people asking the questions, "is this good science?" or "where are the RCTs to declare this as medical fact?" Actually, I am sorry FOR you if you have that problem.
I have listened to Prasad for quite some time. He is very selective with his sources. I can forgive his snark (I can be plenty snarky myself). What I like less is his cherry-picking of research. I've decided he's not an honest broker of information--sorry.
But of course, he CAN cherry-pick research, because he is not claiming to be THE arbiter of ultimate scientific truth. Rather, he seems more to be a de-bunker of OTHERS who suggest THEIR research is "truth." His main use of the cherry-picking of research then is to critique the cherry-picking of research done by others to establish their conclusions.
If he sees his job as questioning the soundness of the scientific conclusions of others, how could he NOT be cherry-picking research? He is using only the studies that would serve to undermine the conclusions under discussion.
You know what my spell-checker does? It cherry-picks the dictionary for only the words I type to find the ones it thinks I mispelled. So sure, Prasad ignores a lot of data. He wants only data that damages conclusions and undermines soundness of the specific research he is reviewing. He is not there to pat researchers on the back for all the many things they got right, but only to nail them for possible mistakes. A dirty job, for sure.
One can question the soundness of a particular study, methodology or conclusions. And as a gadfly he is entitled. But anyone who comes to their own conclusions based on someone else's cherry-picked data set(s) is doing themselves a disservice. Peer review is supposed to filter out biased conclusions. It ain't perfect, but it's an attempt at a balanced view.
If you care to bring up the specifics of any of his critiques, and why they are flawed or to be doubted, I am happy to hear them. Before the pandemic, most doctors who didn't like his tone or disagreed with some of his specific conclusions still praised him for rigorous research.
I kind of wish he spent less time on COVID, as that has ruined him for many. Prior to that, he was all about the idea that the only drugs worth prescribing are those that have been rigorously validated in clinical trials... and that many trials turn out NOT to be so rigorous. Wouldn't you think of such a person with such a job as a guy TA might respect, if not even like?
I really don't have the standing by way of education to critique either his public health OR his oncology bona fides. I really didn't listen to him before the pandemic. His blogging during the pandemic certainly raised his profile. I suspect (though I cannot know) that that was precisely the idea.
Thank you for this and for your ongoing, loving attention to this topic and to these people.
Exactly what is your goal with these polemics? You want to set the rules for discussions and contributions to this site? You want to be the arbiter of what is acceptable and not acceptable? Who appointed you Overseer? No really.
I came here to become better informed, not browbeaten and lectured.
I agree with TA about 99% of the time. That being said, a healthy scepticism of the CDC is warranted and needed. The mRNA vaccines may have saved lives early on but the absolute stonewalling of known therapies such as Ivermectin and HCQ is and was unconscionable IMHO.
Why is your skepticism warranted or needed? Do you think you know more about it than their experts. Do you think you know more about prostate cancer than your MO? Ivermectin and HCQ were proven to have no effect. You are deluded by non-experts who spread misinformation.
TA, I realize that is the opinion of many relative to COVID. Thank you for taking the time to respond. I still think the CDC has lost a ton of credibility with the public over the past few years. Guess I am delusional.
It has been conclusively proven that neither HCQ nor ivermectin have any benefit for Covid19. Obviously, you have been misled and deluded, and a perfect example of the epistemic bubble that Rauch describes:
If that is the case TA, why not allow it to be used off label? Why the stonewall? What is wrong with "Right to try?" Are you saying Americas Front Line Doctors are all wrong? There are hundreds of them.
You can use them off label. You can use any FDA-approved drug off label. Just don't expect your insurance to cover the cost or your doctor to administer it.
Yes, I am certainly saying that this group of delusionals, "Americas Front Line Doctors" are all wrong. They seem to be a group of whack-jobs:
They have been demonized by the establishment for sure. I take in all opinions. Even the ones the establishment doesn't want me to know about. Thanks for the banter TA. Much respect.
That is the problem that you "take all opinions." There are facts (although fallible) by virtue of the institution of science. And then there are opinions. They are not the same, if you respect science.
Just so people know where I am coming from on my CDC comments...
February 27, 2020, CDC: “There is no role for these masks in the community.”
February 29, 2020, Surgeon General: “STOP BUYING MASKS! They are NOT effective in preventing general public from catching [COVID]."
March 24, 2020, CDC: “If you are NOT sick: You do not need to wear a facemask unless you are caring for someone who is sick (and they are not able to wear a facemask).”
April 3, 2020, CDC: [We suggest] "cloth face coverings fashioned from household items or made at home from common materials at low cost can be used as an additional, voluntary public health measure."
[NPR headline: "Consider Wearing Cloth Face Coverings In Public"]
[Pres. Trump: “You can do it. You don’t have to do it. I am choosing not to do it.”]
**PLEASE NOTE: At this point, the Trump messaging and the NPR messaging are not all that different! There is no huge tribal split yet. But Trump has now already set the tone for the future, helped by the very soft stance of the CDC and its lack of urgency.
July 14, 2020, CDC: “Cloth face coverings are one of the most powerful weapons we have to slow and stop the spread of the virus – particularly when used universally within a community setting."
[The first study cited in support of this statement was one in which all subjects were wearing SURGICAL or N-95 masks, not cloth masks.]
At some point in March 2020, my wife realized that "science" in China and Korea was different than "science" in the USA. It seemed THEIR science already suggested an N-95 would help slow transmission of this kind of virus, while OUR science did not.
As an RN and EMT, she had access to N-95s that were about to reach their expiration date. She insisted that we and her elderly parents wear them during any close contact with others, which we and they mostly avoided. Her father is diabetic, a stroke survivor, and at extreme high risk.
In the greater interest of public health, the CDC chose to go AGAINST the best available science, to avoid a run on N95s. This is a very understandable position. But if my wife "knew enough to reject any advice from a [Joe Blow] in favor of advice from the CDC," her father might very well be dead. He is alive today.
The CDC was not an example here of the "pursuit of medical truth." Just the opposite. They chose a "medical lie" because that better served the immediate need. And I'm fine with that. But please don't try to tell me that it isn't what happened, and that it is not logical that such an act would justifiably undermine that institution's future credibility. A lie results in loss of credibility almost by definition.
You see, the CDC is looking out for the public health, not for my father-in-law's health. That's my wife's job. And she did it, successfully, by ignoring the advice of the CDC. Don't dis' muh wife!
So you think any doctor knew everything all at once, from the start? Scientific knowledge is cumulative, and subject to error. ith functional institutions, errors are corrected. It seems you have unreasonable expectations. I think they did a great job of alerting the public as knowledge progressed.
Would I have unreasonable expectations if I happened to live in South Korea? They changed masking standards and official recommendations multiple times just in February and March of 2020, incorporating the physical lack of masks into the planning. Scientific knowledge apparently accumulates a lot faster over there. Or perhaps the inertia of a huge bureaucracy is much like that of a big ship, making it hard to turn on a dime?
Even if Korean officials tried telling citizens that cloth masks were just as good as N-95s as late as March, the officials would have been laughed or booed off the stage. See, that population had ALREADY been told that "better" masks were better for respiratory disease prevention than the less-good masks used for dust and pollution. One presumes they were told this on the basis of something resembling "scientific knowledge."
The CDC was not about to tell people to wear masks that did not exist in sufficient quantity. And as I say, I can't fault them for that. My only point is that the advice then given to the US public seems to have been borne of that logistical reality rather than borne of the latest and best scientific knowledge on the planet.
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