One of the advantages of having been a blogger for over 17 years is that you start to get a sense of history and perspective. You see the same things (or similar things) pop up over and over again. Indeed, that’s one reason why I frequently say about antivaccine conspiracy theories in the age of COVID-19 that “everything old is new again” and “there is nothing new under the sun in antivaxland” (e.g., misusing and misrepresenting VAERS); none of the conspiracy theories that have popped up since COVID-19 hit and shocked and surprised my colleagues are new. I don’t want to dwell on that, because the current topic is more general (although certainly COVID-19 cranks are involved). I’m referring to attacks on evidence-based medicine (EBM) as an “illusion” or somehow hopelessly compromised, for whatever reason (most commonly, corruption by big pharma).
These articles seem to pop up every few years. Sometimes these articles make good points, sometimes not (more often it’s a mixture of both good and bad points and a failure to deal reasonably with the messiness of evidence-based medicine), but regardless of the quality of the article, such articles are always embraced by enemies of evidence-based medicine, which is how I became aware of an article published earlier this month in The BMJ by Jon Jureidini and Leemon B. McHenry entitled The illusion of evidence-based medicine. Where did I find out about it? In the comments of my blog and in an article by Dr. Robert “inventor of mRNA vaccines” Malone on antivax leader Robert F. Kennedy, Jr.’s website entitled How Politics Corrupted Evidence-Based Medicine — And How to Fix It, which turned out to be a reprint of the same article on his Substack under the title The illusion of evidence-based medicine, with the subtitle How the government stopped worrying and learned to love propaganda.
Interestingly, RFK Jr. didn’t include the tagline, which was an obvious nod to one of my favorite movies of all time Stanley Kubrick’s classic 1964 Cold War dark comedy Dr. Strangelove, or: How I Learned to Stop Worrying and Love the Bomb. Lest you fail to make the connection, Dr. Malone even included a photo of Peter Sellers as the eponymous Dr. Strangelove, the wheelchair-bound former Nazi scientist who in the film was the President’s scientific advisor pontificating about the Soviet doomsday device. (He also slipped up and the President as “Mein Führer!” with a Nazi salute.) Of course, I love to invoke Dr. Strangelove for other reasons, mainly the obsession of one of its other characters, Gen. Jack D. Ripper, with “purity of essence.”
Whenever I see articles like this one in The BMJ, I like to start with what the crank says about the article and then look at the article itself. Often—but not always—there is a disconnect. Often, the article is fairly reasonable, but the crank uses it to condemn all of evidence-based medicine and, by doing so, claim that their pseudoscience and conspiracy theories must be correct. Also, before I begin, far be it from me to dismiss criticism of evidence-based medicine. The problems with evidence-based medicine were the reason that Steve Novella and others came up with the concept of science-based medicine; to “fill in the holes,” so to speak, in evidence-based medicine, in particular its reliance on methodolatry and randomized controlled clinical trials über alles—sorry, given the Dr. Strangelove reference, I couldn’t resist—and its dismissal of incredibly low to zero prior plausibility based on basic science for modalities like homeopathy.
So let’s start with how Dr. Malone views this paper:
In 1990, a paradigm shift occurred in the development of new medicines and treatments. An idea so big, that it was supposed to encompass the whole of medicine. It was to start initially at the level of pre-clinical and clinical trials and work all the way through the system to the care and management of individual patients. This new concept for how medicine would be developed and conducted is called evidence-based medicine (EBM). Evidence-based medicine was to provide a more rigorous foundation for medicine, one based on science and the scientific method. Truly, this was to be a revolution in medicine – a non-biased way of conducting medical research and treating patients.Evidence-based medicine Evidence-based medicine is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” The aim of EBM is to integrate the experience of the clinician, the values of the patient, and the best available scientific information to guide decision-making about clinical management.So, what the hell happened?
First of all, evidence-based medicine was not a “new concept” three decades ago (which, ironically, was around about the time that—if you believe his account—Dr. Malone was supposedly busily inventing mRNA vaccines). The evidence-based medicine movement did, however, most definitely popularize it, as can be seen by the exponential increase in usage of the term in publications during the 1990s. The way I look at it is that “EBM” was a new term coined to describe and codify a concept that had been discussed since at least the 1960s, if not earlier. It worked, too. Evidence-based medicine is the gold standard of how we as physicians seek to practice medicine and surgery.
That observation aside, I bet that you can guess what, according to Dr. Malone, “happened”:
There is a big flaw in the logic of evidence-based medicine as the basis for the practice of medicine as we know it, a practice based on science; one that determines care down to the level of the individual patient. This flaw is nestled in the heart and soul of evidence-based medicine, which (as we have seen over the last two years) is not free of politics. It is naive to think that data and the process of licensure of new drugs is free from bias and conflicts of interest. In fact, this couldn’t be any farther from the truth. The COVID-19 crisis of 2020 to 2022 has exposed for all to see how evidence based medicine has been corrupted by the governments, hospitalists, academia, big pharma, tech and social media. They have leveraged the processes and rationale of evidence-based medicine to corrupt the entire medical enterprise.
This brings us back to the BMJ editorial, which Dr. Malone likes so much because it accuses the pharmaceutical industry of corrupting evidence-based medicine:
The advent of evidence based medicine was a paradigm shift intended to provide a solid scientific foundation for medicine. The validity of this new paradigm, however, depends on reliable data from clinical trials, most of which are conducted by the pharmaceutical industry and reported in the names of senior academics. The release into the public domain of previously confidential pharmaceutical industry documents has given the medical community valuable insight into the degree to which industry sponsored clinical trials are misrepresented.1234 Until this problem is corrected, evidence based medicine will remain an illusion.
The first four references are to articles about the promotion of gabapentin by Pfizer, cardiovascular risks from COX-2 inhibitors (e.g., Vioxx, a favorite among those attacking science- and evidence-based medicine), the H1N1 influenza vaccine Pandemrix (which was linked—although not definitively—with narcolepsy in Scandinavian countries), and study 329 of paroxetine in adolescents. I’m fairly familiar with the Pandemrix story and wasn’t particularly impressed that the article cited by Jureidini and McHenry was by Peter Doshi, a man who, as I’ve described, is at the very least antivaccine-adjacent if not outright antivaccine, and who can always be counted on to exaggerate harms and minimize benefits of any vaccine, going at least as far back as influenza vaccines in the mid-2000s. (He’s even spoken at at least one antivaccine conference and, more recently, has appeared on a panel with outright COVID-19 conspiracy theorists.) In the article cited, Doshi basically regurgitates the plaintiff’s side of a lawsuit over Pandemrix. As I’ve discussed before, though, the true situation is more complex, and it’s not even totally clear that Pandemrix can be causally linked to the narcolepsy cases. In any event, blog buddy Skeptical Raptor deconstructed Doshi’s article right after it was published, so that I don’t have to do it now. Similarly, the case of Vioxx and other COX-2 inhibitors was actually an example of the system working, albeit imperfectly. As Steve Novella once put it:
It does appear that the company dragged their heels on some of the data with Vioxx, and if this is found to be the case legally they should pay the price. But let’s review what happened. After Vioxx was on the market scientists continued to study its effects. The company supported this research, even though there was no requirement for them to do so. Eventually the data became clear that there was an increase in heart attacks among Vioxx users who were at high risk, and the company withdrew Vioxx from the market. If there were some big Pharma/FDA conspiracy, why would that have happened at all? Wouldn’t they have just kept the whole thing hushed up?
As for the other two, the article about the promotion of gabapentin consisted almost entirely of exhibits filed by plaintiffs in a lawsuit against Pfizer for using educational venues to promote off-label use of gabapentin. This actually doesn’t show that evidence-based medicine is somehow broken or corrupted; rather, it suggests that pharmaceutical companies do promote off-label use of drugs, which are often evidence-based. Remember, off-label use is not synonymous with unproven; rather, off-label use happens in medicine all the time because clinical trials can show that FDA-approved drugs have efficacy for other indications not included in the FDA approval. Drug companies aren’t allowed to promote off-label uses for the obvious reason that, if they were, they would have no incentive to submit new data to the FDA to seek formal approval for new indications for their drug. One could imagine a case where a pharmaceutical company won approval for a drug for one indication and then started marketing it for all sorts of indications, whether evidence-based or not. Finally, the article about study 329 demonstrated how a study by GlaxoSmithKline of paroxetine in adolescents claimed that “paroxetine is generally well tolerated and effective for major depression in adolescents,” a claim contradicted by internal company documents were examined.
Whenever I discuss pharmaceutical company chicanery in a way that doesn’t conclude that all pharmaceutical companies are pure evil, inevitably the charge of “pharma shill” will be aimed a me. My usual response is to point out that, if I were a pharma shill, I’d be the worst one ever, given that I’ve only ever had one small grant from a pharmaceutical company (which never really went anywhere) and have been studying repurposing a drug for amyotrophic lateral sclerosis (ALS) to use to treat breast cancer without big pharma support. In any event, we who promote science- and evidence-based medicine are far from oblivious to the misdeeds of pharmaceutical companies. We also often note the disconnect between how often quacks promote pharmaceutical products like ivermectin or hydroxychloroquine without evidence (off-label uses that pharmaceutical companies could have promoted to make lots of money), while damning pharmaceutical drugs that actually work.
But let’s see what Jureidini and McHenry have to say further:
The philosophy of critical rationalism, advanced by the philosopher Karl Popper, famously advocated for the integrity of science and its role in an open, democratic society. A science of real integrity would be one in which practitioners are careful not to cling to cherished hypotheses and take seriously the outcome of the most stringent experiments.5 This ideal is, however, threatened by corporations, in which financial interests trump the common good. Medicine is largely dominated by a small number of very large pharmaceutical companies that compete for market share, but are effectively united in their efforts to expanding that market. The short term stimulus to biomedical research because of privatisation has been celebrated by free market champions, but the unintended, long term consequences for medicine have been severe. Scientific progress is thwarted by the ownership of data and knowledge because industry suppresses negative trial results, fails to report adverse events, and does not share raw data with the academic research community. Patients die because of the adverse impact of commercial interests on the research agenda, universities, and regulators.
Whenever someone invokes the name of Karl Popper while attacking evidence-based medicine, my skeptical antennae start twitching fiercely. It’s not that they will necessarily be mistaken but that they almost always go on a rant right after doing that, and this passage is no exception. I also can’t help but note that The BMJ seems a bit lax in its peer review. Jureidini and McHenry make a number of factual claims here, but nowhere do they back up those claims with references. I will say right here that they aren’t wrong about free market champions promoting privatization and laxer standards of evidence. I myself have bemoaned that very tendency among libertarians who falsely claim that the FDA is “killing people” by being too stringent in its requirements for evidence and too slow to approve new medicines. Their solution? Loosen standards and let the “free market” work its magic, of course! Of course, the factual claims made by Jureidini and McHenry are likely at least partially true, but some references would have been nice.
But what does any of this have to do with evidence-based medicine? Obviously, evidence-based medicine is based on randomized controlled clinical trials (preferably placebo-controlled and blinded, at least when it’s ethical to do so). Also, the people who produce evidence-based medicine guidelines are generally academics based in medical schools and academic medical centers. So:
The pharmaceutical industry’s responsibility to its shareholders means that priority must be given to their hierarchical power structures, product loyalty, and public relations propaganda over scientific integrity. Although universities have always been elite institutions prone to influence through endowments, they have long laid claim to being guardians of truth and the moral conscience of society. But in the face of inadequate government funding, they have adopted a neo-liberal market approach, actively seeking pharmaceutical funding on commercial terms. As a result, university departments become instruments of industry: through company control of the research agenda and ghostwriting of medical journal articles and continuing medical education, academics become agents for the promotion of commercial products.6 When scandals involving industry-academe partnership are exposed in the mainstream media, trust in academic institutions is weakened and the vision of an open society is betrayed.
That reference, by the way, is a book from 2003. One thing I’ve noticed about this paper is that a lot of the references seem to be quite old. Again, I’m not saying that there aren’t problems related to business influence in academia. It’s a problem that goes beyond just medicine and biomedical research. You’d think, though, that someone arguing that evidence-based medicine is hopelessly corrupted by pharma influence could actually cite a clear and compelling example of how a single evidence-based set of guidelines was actually corrupted by—you know—big pharma influence, preferably more recently than two decades ago. None of the first four citations did that, because none of the examples were actually of pharmaceutical companies successfully corrupting evidence-based guidelines. Moreover, although it is true that the FDA often doesn’t see the raw data from clinical trials, it absolutely has the power to demand to see it when deemed appropriate.
I will, however, agree with Jureidini and McHenry’s decrying of “key opinion leaders” (KOLs). These are often physicians who have received funding (often a lot of funding) from pharmaceutical companies, either to support their research or to be part of a company’s speaker bureau.
So what are the proposed solutions? The authors argue:
Our proposals for reforms include: liberation of regulators from drug company funding; taxation imposed on pharmaceutical companies to allow public funding of independent trials; and, perhaps most importantly, anonymised individual patient level trial data posted, along with study protocols, on suitably accessible websites so that third parties, self-nominated or commissioned by health technology agencies, could rigorously evaluate the methodology and trial results. With the necessary changes to trial consent forms, participants could require trialists to make the data freely available. The open and transparent publication of data are in keeping with our moral obligation to trial participants—real people who have been involved in risky treatment and have a right to expect that the results of their participation will be used in keeping with principles of scientific rigour. Industry concerns about privacy and intellectual property rights should not hold sway.
First, I actually agree that public funding of independent clinical trials of new pharmaceutical candidates would be optimal, but I also realize that politically it’s a nonstarter, both due to expense and due to the current political climate. Again, when there are free market libertarians arguing that the current process for accelerated approval of new drugs should be accelerated still more, or even that FDA should be in essence neutered—or at least reduced in authority to its pre-Kefauver-Harris Amendments power to require safety data but not efficacy data before approving drugs—proposing a huge increase in the FDA budget or the creation of a government entity to run clinical trials just isn’t happening, at least not in the US. That’s not to say that there’s not more that can be done; for instance, actual enforcement of the law requiring that all clinical trial results be published expeditiously after completion of the trial would be a good start.
Also, although in concept sharing anonymized raw data sounds good (I can even get behind it to some extent), in practice there are a lot of problems. It’s not as though this sort of thing hasn’t been considered and discussed a long time, and, contrary to Jureidini and McHenry’s blithe claim that it would be “easy” to anonymize the data and place it in a publicly accessible repository, open sharing of clinical trials data that way is anything but easy, based on how difficult it is to maintain even non-public usable data repositories:
The key challenge is that preparing and maintaining usable data repositories require a great deal of effort and resources, especially the time of researchers who collected the data and need to describe it in meaningful ways to make the data legible to prospective users while ensuring simultaneous compliance with the open data mandates and any confidentiality, privacy, and internal policies that may apply. This is a time- and labour-intensive process, especially in organisations implementing controlled access to data. Receiving and processing applications for data release, developing agreements and contracts, producing and transferring data, and responding to subsequent requests for clarification involve a broad range of people across the data-sharing organisation . In this sense, open data more resembles new data products than readily available outputs from previous experiments. Research organisations typically have limited resources to handle these requests, which can result in conflict with other demands on staff time, such as ongoing research. In the absence of support from research funders to prepare the datasets, some research units may require applicants to provide funding to cover the necessary staff time, which in effect means spending research money on curation.50 In the absence of funding specifically to curate and release data as open data, researchers continue to share their data with others in different ways.
One of the risks raised by researchers as an impediment to data sharing is the possibility of data misuse or even wilful misinterpretation of the data. In the situation where there is a lack of agreement on what constitutes data reuse and reusability, these concerns are justified. In the absence of robust data descriptors, the data may be analysed incorrectly, and incorrect conclusions may be drawn. Another concern is that the purpose for which data is later reused may be incompatible with the original purpose for which the data was collected. Such purposes may include causes with which the original data creator disagrees or does not wish to be aligned. Researchers also raised concerns that future data users may not give proper credit to the original creators. A further concern is that data may be used to harm future business activities of research organisations, such as allowing others to commercially exploit the data.
This brings me back to Dr. Malone, who, ironically, uses the desire to misuse data to argue for data transparency, although obviously he would not admit that that’s what he’s doing:
US government employees also control the narrative. Take for example the use of the media, CDC and the FDA to control the narrative about early treatment for COVID-19. By now we should all know about the corruption of the early clinical trials of hydroxychloroquine. On the basis of these faked studies, one of the safest drugs in the world was recommended to not be used in an out patient setting – most likely, in order to increase vaccine acceptance. Or how our government used propaganda to control the use of ivermectin by such tactics as calling it unfit for human use and labelling it as a “horse wormer.” All indications are that these efforts by the US government were to dissuade early treatment to stop vaccine hesitancy.
I bet you can guess which “early clinical trial” of hydroxychloroquine to which Dr. Malone is referring. Yes, it’s the Surgisphere trial, which reported serious adverse events associated with hydroxychloroquine but was later found to have been likely impossible based on what was claimed. It was indeed a debacle, but the retraction of that study did not, contrary to what Dr. Malone seems to be implying, mean that hydroxychloroquine actually worked against COVID-19. It doesn’t. Similarly, ivermectin is the new hydroxychloroquine that clinical trials still hasn’t seemed able to kill. It’s actually an interesting example, given that greater data transparency would likely have undercover the incompetently poor design of some studies and the apparent outright fraud of the “positive” randomized trials for the drug. Amusingly, Dr. Malone might not like greater data transparency when it comes to his favored COVID-19 quackery.
That part about misuse or willful misinterpretation of data is also very pertinent. One risk of truly open access to clinical trial data is that cranks will willfully misinterpret it or cherry pick certain parts. If you don’t believe me, just look at how they’ve done exactly this with an actual truly open database, the Vaccine Adverse Events Reporting System (VAERS) database. Jureidini and McHenry’s claim that it would be “easy” to guarantee privacy of clinical trial subjects is a bit clueless too, given the history of antivaxxers doing their damnedest to violate that privacy when they can by combining databases to try to extract personally identifiable information. I’m not saying that what Jureidini and McHenry propose can’t be done. I’m simply saying that they seem oblivious to just how difficult it would be and how easily conspiracy theorists could weaponize the data.
While Jureidini and McHenry make some reasonable points about data transparency, they overreach when they imply that evidence-based medicine is an “illusion” because big pharma has so corrupted it. After all, pharma doesn’t do the only clinical trials of drugs, which often go into further trials after approval by other entities to compare their efficacy and safety to existing treatments.
It’s also no surprise that someone like Dr. Malone would be all over Jureidini and McHenry’s op-ed as slam-dunk evidence that he and the other COVID-19 cranks, contrarians, and antivaxxers were right all along. That is why I conclude by responding to Dr. Malone as I always respond to claims that evidence-based medicine is so hopelessly corrupted as to be wrong:
I also caution Jureidini and McHenry. While it’s true that one can’t control how one’s work is used once it’s published and “out in the wild,” so to speak, be willing to subject it to reevaluation when you see cranks and conspiracy theorists pointing to it enthusiastically as supporting their pseudoscience, quackery, and conspiracy theories, for example:
Let’s just say that, when conspiracy theorists and grifters like the Frontline COVID-19 Critical Care Alliance love you, even if your message was accurate, you might not have delivered it in the most effective manner and very well might have overstated your case by just a bit. Of course, there’s also this statement of Conflicts of Interest:
McHenry and Jureidini are joint authors of The Illusion of Evidence-Based Medicine: Exposing the Crisis of Credibility in Clinical Research (Adelaide: Wakefield Press, 2020). Both authors have been remunerated by Los Angeles law firm, Baum, Hedlund, Aristei and Goldman for a fraction of the work they have done in analysing and critiquing GlaxoSmithKline’s paroxetine Study 329 and Forest Laboratories citalopram Study CIT-MD-18.
So they’ve written a book and served as expert witnesses for plaintiffs suing drug companies. Why am I not surprised. No wonder they’ve written an article that someone like Dr. Malone can so easily use as a reason to invoke Dr. Strangelove about clinical trial science. That doesn’t mean that they don’t make some good points. After all, years ago Ben Goldacre wrote a book called Bad Pharma that argued many of the same things. It just suggests why someone like Dr. Malone would choose to cite their work instead of Dr. Goldacre’s.
81 replies on “Here we go again: Is evidence-based medicine an “illusion”?”
“Everything old is new again.”
You are prophetic, Orac!
I’ve just completed (i.e., co-authored) a book describing the medical resurgence of psilocybin; based on a plethora of empirical and anecdotal evidence. This is undeniable proof that “Something old is new again”.
Here’s the book description:
Mental anguish is a woeful experience that can make our lives miserable. Mother Nature created a mushroom-based compound known as psilocybin that can biochemically alter perception and affect mental anguish. Medical research shows that psilocybin activates the brain, engendering new cognition and awareness. Rediscovering the benefit and its basis in the morality of psilocybin is both enlightening and fascinating. Throughout this book, quotes, personal anecdotes, and medical research disclose the therapeutic use of psilocybin across a wide array of human conditions. Ironically, although psilocybin use dates to antiquity, its contemporary usefulness is still in its relative infancy. Nevertheless, psilocybin-assisted therapy is a life-changing experience for many suffering from mental anguish. Looking into the future, easy-to-read summaries of United States patent-pending applications showcase psilocybin innovation. The authors promote better health and well-being coupled with the moral intention that “If I can change my thoughts with psilocybin, I can try to heal mental anguish.”
So no real data or research eh, just your usual bullshit. No surprise.
“Mental anguish is a woeful experience that can make our lives miserable.”
With insights like that, the book should soon be a #1 Amazon best-seller in the genre “Dystopian Brain Turds”.
The basis of ‘evidence based…’ is that evidence should guide us, the best evidence at the time. Whether it’s science, medicine or economics, we have all come a long way. But the scientific process is even improving. I would be interested in seeing a comparison of industry funded trials with other trials, or a comparison of trials conducted in the post-vioxx period with those pre-vioxx. Even vaccine testing has continually changed, learning from past successes – and failures (https://www.science.org/doi/epdf/10.1126/science.abf0357).
In spite of the ‘earned’ criticism of the pharma industry, we are living in the most evidence-based age yet. The past 2 years have been an extreme ‘stress test’ for the medical/pharmacological system, with heightened examination of every data point.
Strange that the COVID-19 deniers hate Eric Topol. He is one of the few who has actually done what they are trying to do – to expose a clinical trial, and leading to the removal of an approved pharmaceutical.
“Again, when there are free market libertarians arguing that the current process for accelerated approval of new drugs should be accelerated still more, or even that FDA should be in essence neutered—or at least reduced in authority to its pre-Kefauver-Harris Amendments power to require safety data but not efficacy data before approving drugs—proposing a huge increase in the FDA budget or the creation of a government entity to run clinical trials just isn’t happening, at least not in the US.” If the FDA is captured, why not both? Minimize or even get rid of the FDA and use the money to fund full disclosure of trial data and independent testing?
Labarge won’t be happy until the Cuyahoga River burns once more.
Why do you think that FDA is captured ? Some evidence could be useful.
He put a lot of evidence in the post. Look up zero grams trans fat or Purdue pharma. Or ask yourself why European regulators, while no don’t influenced by pharma, are more cautious wrt to Covid jabs. Why did it want 75 years to answer a FOIA about its safety determination?
£john labargeThey did not get 75, after all. Did something come out from the raw data. Reaso nn was that they had better things do than publish 75000npages of private medical data.
European regulators have, of couurse, accepted covid vaccines
“If the FDA is captured, why not both? Minimize or even get rid of the FDA …’
Because, labarge, unlike libertarians who are either unwilling or unable to engage in critical thinking or education in general, the rest fo us realize it’s better to have people who know what they are doing examine the data and design the experiments than to have clowns like you simply making shit up.
That’s pretty incoherent. No one said that we shouldn’t have people in the field look at the data. A captured agency doing so provides little value as its conclusions are predetermined.
“That’s pretty incoherent.”
Not really. Your plan would remove the people with the skills to do it. Who would take over? Your libertarian friends, people who are the most authoritarian, least moral, and most poorly educated scum around? No matter, your imagined “capture” BS of the FDA seems to be your latest fake hobby horse you’re gonna ride since evidence isn’t on your size
Supporting evidence needed.
It’s not as if we don’t have experience with unregulated pharmaceutical industry. That’s why the FDA was created. It’s not perfect, but a free-for-all is worse.
Marketing isn’t actually oversight.
Some might argue deception by a powerful organization is worse than free for all.
A. Pharmaceutical companies are powerful organizations. You want them with no oversight.
B. Government has more tools – and more easy to use tools – to control and pull back an agency than a company.
C. Again, we tried the no-regulation approach. It worked very, very badly.
It seems to me there’s a fairly common communication problem here: a nuanced frame gets lost in the cacophony of our overloaded mediaspheres, so in order to get any attention at all, arguments present themselves under hyperbolic banners.
There can actually be some benefit in this, as the hyperbole may make the direction of the claim easier to grasp and engage. But this means that the inflated claim must be seen as part of a dialogic process in which it’s strengths and weaknesses are tested, and which typically/hopefully eventually arrives at a more nuanced understanding. Often, this involves something like recognizing a claim made in fairly universal terms is only valid as outlined in a more limited domain. Anyway, this is my take on how to approach “theory” in the humanities (not that everyone in that area would agree with me). When someone like Jean Baudrillard writes “the gulf war did not exist”, it gets your attention, and after you object that this thesis is obviously cuckoo, you read the argument, still think its cuckoo, but then maybe bat it around in your head for a while and finally conclude that OK there’s a sense in which that makes some sense.
“Evidence based medicine is an illusion,” strikes me as a fairly similar claim, albeit one where the hyperbole is easier to decode and reconcile with reality than Baudrillard. :- ) When you read the specific complaints the authors make as Orac quotes here, and the solutions they offer, you see, as Orac does, that they’re not unreasonable at all — other than a number of proposals being non-starters in the realpolitik we inhabit, which is also true of the majority of policy proposals made by sbm advocates at the SBM blog. It would certainly be fair to say that “The illusion of evidence-based medicine” is just a horribly inaccurate frame to describe what McHenry and Jureidini are talking about.
Unlike Orac, I don’t put too much weight in how cranks like Malone exploit an article like this. That’s just what they do: exploit anything and everything they can twist to their purposes, and they’re ‘good’ enough at it that it doesn’t really matter how accommodating or not the source seems to be. They can cherrypick, take quotes out of context, make up their own hyperbolic summary statements, yadda yadda. I doubt anything Ben Goldacre said in Bad Pharma or elsewhere would prevent the likes of Malone from doing a similar number with that book, and I’d guess the reason Malone was riffing off McHenry and Jureidini is simply that their article is new.
Instead, I see the crank exploitation as (a fairly small) part of a larger problem. The process an offering like “The illusion of evidence-based medicine” enters or starts takes place in a quite different arena than the one where wacky academic theory in the humanities gets batted around. There the players are expected to actually read the material, spend some time thinking about it, and to come up with some kind of attempt at a well-considered contribution to the debate. In contrast, The illusion of evidence-based medicine” is getting discussed on the Internet. Which I mean snarkily, as a way of saying online commentary is largely a fun-house mirror version of the public sphere, in which everyone dishes out hot-takes before the comment threads get old — i.e. within less than 24 hours usually — based on no more than a quick skim of the article, or just the headline, summary sub-head and pull quotes, or just a precis ‘secondary source’… (Confession: i haven’t read the whole text at BMJ. Now, I’m not really opining on evidence based med or issues therein, but still…) Even if you filter out the willful malicious distortions of cranks and trolls, you still wind up with noisy superficial flame-wars that tend to go off in a totally different direction from the original argument.
An example of this that pops into my head is “defund the police”. It’s a hyperbolic, attention-getting slogan. If you actually take the time to look into the history of police reform, the policing issues in poor largely-minority communities, the reasons that slogan became prominent, and what activists are actually proposing — it’s not crazy at all. Highly debatable still, sure, but nowhere near as outre as you might think. (W. Kamau Bell did an excellent explication of this in the “Policing the Police” episode of his CNN show, which unfortunately is not available online, but you can find some clips and interviews with him about it, and a forum at The Commonwealth Club, etc.) But if even so much as 1% of the commentary on the subject — including Joe Biden’s “No! Fund the police!” exclamations — is informed by ANY of that, I’d be surprised.
Of course, the easy critique is to call for the hyperbole to be dropped, to just come up with headlines/summaries/rubrics/slogans that more accurately reflect the actual nuance of the argument. I say “easy” because I’m sympathetic to the dilemma posed by our messed-up public sphere, which, like it or not is the only real public sphere we have. On one hand, the Scylla of hyperbole, on the other the Charybdis of obscurity. For example, my own perspective on “defund the police” is informed by the fact I hail from greater Minneapolis, and I’ve continued to follow the news from there despite having moved away. The Minneapolis PD has been a cess-pool of brutality and racism for just about forever, but the last city government aligned with that under a “law and order” rubric ended in the 1970s. So for four decades, Democratic (mainly progressive) mayors have appointed reform minded police chiefs, who have done their best to clean up the department, and for four decades these reform efforts have failed, due to the city charger and state laws that grant the PD a functional autonomy and result in the de facto authority structure being the police union, which in turn is dominated by a right-wing reactionary culture. All you really need to know about the MPD is that Derek Chauvin was the training officer for the two rookie cops who followed his lead in the death of George Floyd. Which is why, after four decades of failed “fix the MPD” rhetoric, activists concluded the only way to fix policing in the city was to divert funds away from the MPD toward a new Department of Public Safety that would have a reframed mission (prevention over punishment) and more oversight by the city council. That made news, got everyone’s attention, in a way another rehash of calls for ‘politically realistic reform’ would not… and then crashed on the fear-driven, hot-button, reductionist campaign the right ran against it, exacerbating and inflating legitimate concerns.
How many people would be paying attention to McHenry and Jureidini if they had titled their editorial “Addressing reliability issues in evidence based medicine”? BMJ might have gone with that for an editorial, but a book publisher? I’m sure Goldacre could have come up with a more sober and nuanced title than Bad Pharma, but had he wanted to, I’d guess his press would have cautioned, “Look, neither you nor we want this thing to just come out and disappear.”
In the last analysis, I don’t mean to endorse McHenry and Jureidini’s framing, or even let them off the hook. I mainly just want to address the larger ‘damned if you do, damned if you don’t’ situation. In the time it’s taken me to write this, I’ve come up with a framing title that IMO has plenty of “pop” without suggesting the whole terrain of ebm is an “illusion” [to quickly identify what’s wrong with that I’ll go with “Nirvana Fallacy”]: “Countering Corruptions Within Evidence Based Medicine”. I will admit that this language is intentionally manipulative, and ‘click-baity’ based on conflating different definitions of the word “corruption”: 1) (intentional, malicious) “dishonest behavior by powerful people”, ‘The Warren G. Harding administration was rife with corruption’ ; 2) (systemic byproduct) “a departure from what is pure or correct”, ‘The hard drive crash caused corruption of a crucial file in the OS’. I take the argument in the BMJ editorial to be more the second type than the first, and if that’s not apparent enough from the text, I’d suggest clarifying editorial changes. This would, I hope, effectively bridge any too-hot-take expectations generated from the title into the more nuanced and reasonable argument for anyone who takes the time to read in at least part way. While my proposed frame and title would address some of Orac’s concerns, again I have no illusions it would hamper the likes of Malone from distorting and exploiting it. Cranks gonna keep cranking.
Speaking of reading in a ways, I see I have gone on here. If you’ve gotten this far, I do thank you for spending that much of your attention resources on my musings. Cheers.
You know, your likening the “illusion of evidence-based medicine” to “defund the police” is actually not bad, but doesn’t make the argument to me that you think it does. I’m sympathetic as hell to reforming police to eliminate brutality and reduce systemic racism, and every time I heard “defund the police” I cringed even though I knew what the slogan was trying to say. And of course the slogan was incredibly easy for those opposed to doing anything to change the status quo to address the problems were able to weaponize the phrase to portray Black Lives Matter as naive or police-hating cranks who don’t care if crime runs rampant after the police are “defunded.”
The point is this. Just like the case for “defund the police,” in the case of the “illusion” of evidence-based medicine, there are pithy slogans that can be useful without being so easily weaponized.
My argument is that there are systemic pressures toward hyperbole for voices aiming to engage a general audience, and that this too often results in negative consequences. While I do agree that “there are pithy slogans that can be useful without being so easily weaponized” I added the emphasis there because I think it’s naive to imagine those alternative ‘punchy’ frames would be immune to weaponization. Of course, I think advocates for good causes should try to do better, I’m just sympathetic to the difficulty of crafting a message that will get through that Scylla-Charybdis strait.
(I did finally read a suggested alternative slogan to “defund the police” that struck me as an improvement: “rethink the police.” But that was only recently, and I’m not aware of any good alternatives being proposed as the issue was rising. )
I can’t help but wondering, Orac, if you have done the critical thinking trick of imagining the shoe being on the other foot. You’re not exactly immune to strong statements that get weaponized by your opponents (albeit in a different way than Malone does with the BMJ editorial). Couldn’t it be said that McHenry and Jureidini are delivering some serious respectful insolence to the institutional establishment of EBM, and suggesting they dial down to “Reforms needed to empower evidence-based medicine” per DB’s (tongue-in-cheek?) amounts to tone trolling? That’s a rhetorical question in the sense that the answer is ‘yes, it could’, but I phrased it as a question not to be snide, but because I’m not sure that it would be fair. After all, I recently wrote a long comment on your other not-at-all secret blog arguing your take on antivax rhetoric wasn’t pointed and punchy (or insolent, if you will) enough, and suggesting how to add more sting to the language. Coming up with an effective rhetorical strategy is a very tricky business, with pitfalls in every direction, only compounded if you’re encumbered by nasty little restraints like sticking to the truth.
Back to McHenry and Jureidini… I was wondering today how that “illusion” hyperbole dovetailed with the fact they’ve worked with the plaintiffs bar. I’m not sure that “analysing and critiquing” studies = being “expert witnesses” at trial, but let’s say they were trying to position themselves to serve as such in other litigation against pharma firms. After a bit of thought, I concluded that if that was the case, then the whole “EBM is an illusion” frame would likely be shooting themselves in the foot. It’s too all embracing. As i understand it, you win in court — civil or criminal — by establishing the defendent as an outlier, a bad apple, not by condemning the whoie tree…
Re: your last point.
I’m not sure that that is the case here given that their entire argument is that the main reason that “EBM is an illusion” is because of the depredations of big pharma.
As for the constraints of “sticking to the truth” when coming up with pithy slogans and phrases, that’s part of the problem. Jureidini and McHenry make a lot of fact claims, but back up almost none of them. Had I been the peer reviewer of this piece I would have demanded references to back up each and every fact claim. It’s very sloppy of The BMJ not to have done that.
I have read some Jureidini. He seems more concerned about upholding a medical ethos of care than upholding the truth for the sake of the truth. That’s the vibe I got reading him on MbP.
@sadmar we may not agree re safety of covid-vaccines or the corruption at play in our Pharma regulators, but your comment was extremely insightful nonetheless.
Jesus H Christ, Sadmar!
Couldn’t you have just posted a meme or something?
Your comment was almost as long as Orac’s post.
Im joking… your comment was very well reasoned and hit the nail on the head.
“They want it hot, they want it now”
It’s nothing really new other than the fact that the way the newer generations have been brought up makes it extremely available.
As a 42-year-old dad with four kids ranging in the ages from 18 to 10 years old, I get it. I just signed up for Snapchat last month so that I could communicate more effectively with my kids!
The point is you have to change with the times. I grew up and had to go look up articles, walk-through library, Check out the journal from the University library, read it and return it, that was back in the late 90s… Even into the early 2000 we were able to use Medline, This was a big change, it only got better from there as far as accessibility to information.
To switch gears, back to what you were saying, there was another commentor in a few of the previous threads that focused in on the psychological aspect of the conversation. This is also nothing new but is very critical in understanding information, I don’t want to use the term “warfare” but it’s not a poor description of the psychological aspect of media.
How are you title something, the language you use in your discussion, etc. at all actually matters a lot.
TBH, Science is not winning on that front. It’s a very delicate line to skate. (See how I used TBH… lol)
I am sorry to not comment on the original post, Orac did a very nice job discussing this topic and it was an enjoyable Friday evening read
On the topic of “open data”: my spouse used to work at a company specializing in the publishing of data for various governments, from visitor logs at government buildings to descriptions of towed vehicles in a specific city. And even with these really quite small datasets it was complex enough that it required an entire company to make these websites work.
All of the data from a clinical trial? Hoo boy that is a lot of data. Like, not quite Google/Facebook/NSA amounts of data, but still huge datasets. Maintaining that, in compliance with HIPAA and 21 CFR 210 and 21 CFR 211 (data integrity) would be a bear of a project.
Not impossible! Just a lot of work, taking a lot of server space, and therefore costing a lot of money. Who is going to pony up that cash? The logistics of this are far more reasonable than the absurd “autopsy everyone” thing from a few days ago, but far too often projects like this are suggested by people who don’t think through the logistics, and then when the project gets bogged down in those logistics the original proposers just wander off.
And just a side note: all of those data sets would need to be reviewed, cleaned and audited before they went up if they’re going to be useful. (“Cleaning” meaning identifying obvious outliers and cross-checking that the data had been entered correctly and it wasn’t a typo or transposition or something.)
After all anti-vaxxers are still having coniptions over a typo in one of the HPV data sets, even after it has been explained to them that it was a typo.
On top of ‘it’s difficult to successfully anonymize data’, there’s also the fact that the more useful you want the data to be, often the more difficult it become to anonymize (after all, searching for common factors underlying clusters of conditions will require a lot of other factors to be included, and the more other factors such as age/location/economic status are included, the easier it is to pin down any particular record to a small number of people).
And on top of that, there’s the fact that anti-vaccine people have in the past demonstrated that they don’t necessarily care about perfect accuracy, and there have been cases of getting ‘unanonymized data’ wrong and ruining some unrelated person’s life, with said person soon enough becoming another part of the conspiracy theory. These people find patterns where none necessarily exist, after all, and one of the defining features of a ‘conspiracy theory’ is the inability to accept that the theory is wrong… so sometimes just having the data available is giving folks like Qanon cranks other targets. Which, admittedly, they’d probably find even if the data weren’t available, they’d just have a harder time convincing anybody who wasn’t already deep in the rabbit hole about what they were saying.
So like what’s the budget of the FDA and what would it take to stand up an independent non-crony able- system instead. I thin the libertarians are more right on this (I’m definitely mostly libertarian – it’s my starting place at least) but suffers from the blind spot you mention. The problem with the FDA and government in general Pharma teams up with it is it creates monopolies. Regulatory capture creates a power monopoly that resists innovation and quality to the point of being just safe enough to not cause too much political damage (until it happens and it will happen eventually). This is what all of us pharma skeptics see and react to be it vaccines or statins or whatever doctors prescribe. There is always the question of whether it’s as safe as it could be given the systems we have in place and the demonstrated failures of those systems. We should accept the reality that the FDA is not only not perfect, but pretty dang bad; the CDC hopelessly anti-science and captured and that if 2 jabs are good more is better because of $$ and politics, not necessarily health. It’s getting harder and harder to trust anyone associated with the medical establishment from where I sit.
Why do you think your new system is noncronyable ? How do you quarantee that ? You may want to check how much clinial tirals cost. It is much more than FDA’s budget
‘I’m definitely mostly libertarian – it’s my starting place at least”
that explains your lack of knowledge.
John, you seem to have forgotten the first letter of the FDA.
“Pharma” has nothing to do with the food side of the FDA.
But the FDA, with the CDC and USDA, are changed with, and spend a lot of time and energy on, making sure our food is reasonably safe.
For example, CDC investigates an outbreak of listeria that is tracked back to ice cream from a specific manufacturer. FDA investigates and, depending on their findings, issues a Warning Letter with specific corrections and consequences for not making those corrections. (If it were, say, spinach or raw meat then it would be USDA.)
In your efforts to tear down the systems you see as terrible (FDA, CDC) you would leave the whole country vulnerable to dangerous or deadly food.
There is room for reform and improvement, but wholesale elimination is more damaging than you realize.
I have not. Look up zero grams trans fat. The FDA approved lying on food labels. Their food pyramid is a joke.
So where DO you sit? With your head up your ass I’d guess. I know that’s mean, but you just beg for meaness with your ridiculous and unsupported assumptions; ie, ignorance.
Uh, John, the FDA has never had anything to do with the food pyramid (which was phased out in 2011). The food pyramid (and My Plate, the current recommendation) are created by USDA.
The FDA exists because the public demanded it because they were being poisoned by the food they bought, the food they were sold by companies that did not care if their product was safe, only if it had a good profit margin.
You’re mad about the difference between 0.6g trans fat and zero. OK, that’s a fact-based complaint. But you know what? Without the FDA there would be no label on your food at all! No calories, no ingredients, no allergy warnings. Nothing.
Again, maybe acquaint yourself with what the various federal agencies actually do before demanding their elimination.
I’m not sure that pro-vaxxers care about perfect accuracy either. Are you? Seems like there is a Pfizer whistle blower that shares my concern.
Already discussed in extensive detail here – perhaps you should use the search box.
More of the usual gaslighting. “We also often note the disconnect between how often quacks promote pharmaceutical products like ivermectin or hydroxychloroquine without evidence”
One has to be deliberately obtuse to be unaware of the evidence supporting these drugs. Your use of the pejoratives “quack” and “crank” are self-parody at this point. There is more evidence supporting ivermectin as early treatment and prophylaxis than there is to support the use of experimental gene therapy products masquerading as “vaccines” or other therapies still under patent. Yet here we are. Kinda weird how—where covid treatments are concerned—there is a positive correlation between profit and acceptable narrative, and a negative correlation with actual evidence. I’m sure it’s just coincidence.
What evidence do you mean ? Orac haas said multiple times, that eveidence is based on lopw quality, or fraudulent trials. Not to mention publication bias: clinical trials.gov has 88 ivermectin trials, 31 completed and 10 reported results
“There is more evidence supporting ivermectin as early treatment and prophylaxis than there is to support the use of experimental gene therapy products masquerading as “vaccines” or other therapies still under patent.”
You clowns make it very easy for people to realize two things: you have no effing clue what you’re talking about and nobody should ever take you seriously.
Whether there is evidence or not I don’t know. It seems like several studies (who funded them and how were they done with what dosage etc are still things I’d need to read) stating the drugs are not effective. I can’t say that I know that those studies are the perfect ones and the ones that had positive takes are the bad ones. What I can say that is somewhat relevant to this post, is that it took an awful long time to get these large studies on these repurposed drugs to happen in comparison to how long it took to whip out a mRNA vaccine that has cardio vascular side effects the extent of which aren’t yet fully understood. I think this points to bias in what evidence gets considered when and goes to the point being made in the BMJ article.
Holy cow! @Idw56old – talk about the stone in a glasshouse… No support (ie references) for your statement that could possibly shake the foundations of my doctoral degree or more than two decades of professional investigation of clinical claims of treatments! @johnlabarge – for someone admitting that he doesn’t know and only have been looking at numbers of studies (at least regarding the present comment) you do have a strong opinion on why agencies with experties that are being paid to investigate those claims and studies should be deprived of some sort of resources (in accordance with your other comments on the post). • I usually have strong views on referencing and giving extensive credit/evidence to theories and effects studied in “softer” sciences (such as psychology or economics), but these commenters seem to epitomise the Dunning-Kruger…
@john labarge Start with meta-analyses. They include many studies. Be aware that negative results may remain unpublished (sponsor may even require that).
“ … No support (ie references) for your statement that could possibly shake the foundations of my doctoral degree or more than two decades of professional investigation of clinical claims of treatments!”
No medical degree here, just statistics (doctorate), and I gotta say I don’t really care what your opinion is exilapotekare. Ol’ labarge has a long enough history of lying and ignoring when things are explained to him that continuing do do so is an exercise in tossing away time.
I had a bit of trouble following exilapotekare’s reasoning but I do wonder if they missed the quotation marks at the start of your post. If so, then maybe they assumed that you were on the ‘other side’, as it were.
For the 50,000000,0000,0000th time IVERMECTIN HAS NO PLACE IN COVID TREATMENT. You really are goddamn dense, aren’t you?
Another study for labarge to lie about.
Maybe not. But one thing seems likely: authorities are able to get away with falsifying the evidence for the former.
@john labarge And when authorities have falsified evidence for vaccines ?
Chaos Infusion picked a bad day for this particular ignorance-laced rant. The day before he wrote that, the results of the TOGETHER trial were published. This was a large double-blinded, placebo-controlled trial in Brazil testing the efficacy of ivermectin. The results were underwhelming, to say the least. https://www.nejm.org/doi/full/10.1056/NEJMoa2115869
You can’t expect anywhere as many reads/clicks if your article is titled “Reforms needed to empower evidence-based medicine”.
Instead, call EBM an “illusion”, and watch the trolling pay dividends.
When you think about it, clicks may be all that alties/ contrarians accept as a measure of
reality: if loads of people accept it and share it, it must be correct.
Remember that they often call for debates that will be decided by how the audience reacts or the number of people who side with them rather than what data show. So flamboyant, jump-off-the-page titles may be another method comparable to what they do in debates: distort, gish gallop to conclusions, paint SBM as inadequate or dangerous. They know that their fans will probably not research any further if they take them as meaningful in the first place.
A blatant example of this in the past few days at PRN: the woo-meister includes a print of a study that concluded that Tai Chi did not affect level of risk for heart disease like cholesterol, BP BUT when he discusses it on air, he maintains the EXACT opposite- that the measures were DECREASED. He includes the blurb about the study on his website and says the reverse as if no one would notice or remember because they won’t. Followers already agree with his line of BS which would be that non-medical solutions work better than meds so toss the heart meds and do Tai Chi.
RE clicks and page views: alties like those I survey constantly brag about their numbers of followers, shares, page views etc. I’m sure that Orac and other SBM writers do not get as many and that they also do not live on massive estates or ranches like these dudes. Clicks may translate into money. Yet alties are the ones crying endlessly about how doctors live excessive lives being sent to resorts in exotic locales or having tickets to the opera and extravagant restaurants if they only prescribe the right, new med and do what Pharma dictates.
Right, Bacon goes to Nobu after his jaunt to the Maldives. Twice a year.
“if loads of people accept it and share it, it must be correct.”
I have an interesting real life example. A neighbor is strongly anti-vax and anti-mask. However he is in no way belligerent. He is soft spoken and friendly, and not at all bothered by people he disagrees with. He doesn’t protest or comment on internet sites. He carries a fake “exemption” and uses it, when he can, to go into stores maskless.
When we were talking about it, I happened to ask how he reaches his conclusions about vaccines. The mask issue is easier since he just wants to be left alone so that he can do what he likes. He has no problem with others being vaxxed and masked since he thinks it’s their choice. He knows I am pro-vax and pro-mask.
He’s retired with no local family and mostly keeps to himself. He browses the internet to find things out. He is disinclined to trust politicians (of any stripe) and experts. We are not in the US but the same political divides exist here though to a lesser extent. He has no higher education.
When he comes across something seemingly crazy or said by someone who looks suspicious, he is suspicious and tends to discount the tale. But when he sees the same thing popping up in multiple places he begins to think there’s something to it. For example, he sees lots of talk of aluminum in vaccines and aluminum accumulation associated with Alzheimer’s, so he worries.
I did not ask him which web sites or media sources he visits, or if he just generally searches without discrimination. There was no obvious tie between his opinions on politics and expertise to what he tends to believe about vaccines and other public health measures, but a connection wouldn’t surprise me.
I know others with far more extreme views but I have not discussed these topics with them. Perhaps some day I will. People are interesting.
“Bacon goes to Nobu after his jaunt to the Maldives.”
DB is an oligarch?
“Undisclosed industry payments rampant in drug-trial papers”
Oh well. That must mean homeopathy works, Bill Gates wants to make all women infertile and vaccines are secretly killing or giving cancer to everyone who receives them?
“…vaccines are secretly killing or giving cancer to everyone who receives them?”
Hope not. My wife and I just got our second Pfizer booster last night. I do have a sore knee right now, but I’m gonna lay that off on a four-hour photo hike in a local woods this morning.
Yeah, it’s not good when there are undeclared conflicts of interest – but far worse when the research itself is deeply flawed and even fraudulent. The name Andrew Wakefield comes to mind. More recently, there was fellow antivaxer Brian Hooker:
“The Editor and Publisher (of Translational Neurodegeneration) regretfully retract (Hooker’s 2014) article as there were undeclared competing interests on the part of the author which compromised the peer review process. Furthermore, post-publication peer review raised concerns about the validity of the methods and statistical analysis, therefore the Editors no longer have confidence in the soundness of the findings. We apologise to all affected parties for the inconvenience caused.”
Meanwhile Ed no doubt rejects all pharmaceuticals and medical therapies based on published research, because some authors may not have complied with all journal funding disclosure requirements.
@ Dr Bacon:
I’ve been looking around the woo-esphere and haven’t seen anything about Andy for quite a while. I did read that he and Elle are no longer a thing from her reps. The last flurry of activity from him IIRC was his film, The Act.
It;s possible that he’s on Telegram, Gab or Substack but I don’t look at those : I already see enough flaming idiocy to melt my brains.
“Yeah, it’s not good when there are undeclared conflicts of interest – but far worse when the research itself is deeply flawed and even fraudulent.” Both are equally fatal.
No pharmaceutical company has run a ivermectin trial, so this is irrelevant here.
RCT could be double blinded, that meaning that neither patient or investigator do not know who get drug or placebo.
As contemporary news is rather “entertaining” nowadays, I do not hang much on medicine blogs much anymore. However, I just read the following. I thought it would be “entertaining” to share it, on this very special blog where Medicine and Truth intertwine in the most admirable of ways. Just hot from the shelf from the ethics department of France’s medical board:
Inceste : l’ordre des médecins n’est « pas favorable » à une « obligation de signalement » des médecins
Incest: France’s National Medical Board would not welcome a legal obligation to notify authorities that would be binding on medical doctors.
I just love it. The sheer amount of balls required to take such a position and then blackmail patients about “Not Accepting The Truth” and “Being In Denial” and all this kind of wishy-washy bullshit they gaslight the same kind of people they fail to genuinely protect by notifying authorities in the first place. Despicable.
No notification ? No documentary evidence. No truth. As if they cared anyway in the first place about “Truth”.
Hello, Monsieur F!
That’s incredible. I don’t know French law but are doctors/ professionals required to report other forms of abuse like rape, threats or domestic violence?
Well, there is a legal obligation to notify when the medical doctor is dead sure of incest. But, otherwise… suspicion ? nah… we deal with among doctors. The notion of care is above the law, in essence. (And, also, medical doctors could in the current system be sued by the perpetrator for defamation or analogous in front of the medical boards in case a suspicion is notified. I guess that’s what medical boards are for, in essence…)
If a perpetrator confesses rape to a doctor, that’s medical secrecy. No obligation.
Overall, there seems little obligation. The legal discussion is about whether or not medical secrecy can be opposed to doctors notifying authorities. It’s not much about obligations made to doctors. It’s more about delineating when medical secrecy does not bind the medical practitioner any more, but not an obligation.
There seems to be an obligation to notify, but also seems that there is no sanction prescribed in the law when that obligation is not met. But violating medical secrecy is a crime, with real sanctions.
I noticed somewhere a 45000 fine and 3 years prison maximum sentence for not denouncing rape, child abuse, domestic violence and the like. Except for doctors. Roughly, judges seem to start sanctioning when they judge that silence amounts to complicity. Other than that, it’s up to the conscience of the doctor.
Moreover, medical secrecy is considered binding at a level above of an oath when testifying in front of a judge. Medical secrecy is considered “absolute” (sic). (Same word used for priests and confession of sins, by the way… France is soooo secular….)
Only 5% of such notifications of incest emanate from medical doctors.
So no. No obligations to notify (except formal ones with no or little sanctions attached it) but a right to derogate from medical secrecy under extreme circumstances. A right. Not an obligation.
The amount of legal pedantry on these topics is astounding in the literature.
Did you know that judges here are still asking victims of incest if they withheld consent ? April’s fool ! They are not. Since… April 2021.
If I still were healthy, I’d move to Texas and buy a machine gun or two. That’s civilization.
Aaaaahhh… the modern life of a self-professed MbP victim.
Just encountered a group of french antivaxxers. Made an innocent remark about their weekly demonstration. The antivaxxers started hearing up the conversation. One of them said “I’m a doctor. If you want to talk about medecine, you should learn. Just who do you think you are?”
The usual medical paternalistic bullshit I am just so used of.
The medical world should really clean up their act. This poutinoid attitude towards patients should really stop.
I’ve been wondering about this:
there were early estimates about what level of vaccine coverage would be necessary for herd/ community immunity. There were figures between 80 and 90%.
If you look at Covid maps ( e.g. Mayo Clinic) that show vaccine rates in various locales, you’ll notice that certain regions have levels around/ above 75%.
Also, they have low R rates and positivity measures. We currently see governmental rules being eased in these places.
Is it possible that these places are already approaching herd immunity?
Hows Israel doing? Which jab # directed at the original variant mare they on by now? They should be zero covid with all those jabs…
According to the BBC today, Israel currently has an R rate around 1 and more importantly, a rate of death much below that of the US, UK, Italy, Russia and many other countries over the course of the entire pandemic with only 10K deaths overall.
According to Haaretz, as of 3/31:
“Israel’s coronavirus metrics showed an improvement for the seventh day in a row, according to Health Ministry data on Thursday, with new and serious cases continuing to decline.”
Israel has a Covid-19 case mortality rate of 0.3%, which compares favorably with most other countries.
Interesting. Any increases in mortality otherwise? (like say in 20-29 year olds)
Israel is only about 60% fully-vaxxed you twit. Fewer have received boosters. COME OFF IT. You are completely full of shit. COMPLETELY.
Stop with the Israel nonsense you read in Epoch or whatever hive of bs you peruse. It is either intentionally misinterpreted or OUTRIGHT LIES.
Still with a relatively low level of vaccination, 66% of the population has the “complete initial protocol” (i.e. fully vaccinated but not necessarily had any booster shots).
I’m not sure why you keep imagining that Israel is highly vaccinated, though it does have a slightly higher rate than the USA.
I am glad that you find that ‘interesting’, what ever that means.
And I hope that this leads you to do more research, instead of asking others to do it for you (I guess that’s what the remark ‘Any increases in mortality otherwise’ means). I know that you are not one to be swayed from your argument by something as minor as ‘data’, so I await your findings.
With John, “Interesting” means “I was wrong, so rather than admit it I’ll try to change the subject.”
“ Any increases in mortality otherwise? (like say in 20-29 year olds)?”
It’s more than a little disconcerting john that you’re rooting for an increase in deaths just in the hope of supporting your blithering idiocy.
It’s possible that johnlabarge is concerned about Israel because it was one of the early places to announce boosters, first and second. So perhaps he imagines that they have failed to protect people or even harmed people. It seems to me that the number of concern is the case mortality rate: perhaps the older and at risk people were protected better than in other places. If only 60-something % are fully vaccinated w/o boosters, it could explain why some infections remain. More than one factor is involved in each country’s numbers.
As I wrote previously, look at places with high rates of fully vaccinated in the US, Canada, AUS and UK: NYC comes to mind. High vaccination rates, lower Rt and positivity rates, few people in hospital and low death rates, restrictions being relaxed or eliminated HOWEVER the overall rate for the US is not great because….. other places
In other anti-vax news…
( AoA today) Kim speculates that actor Bruce Willis developed aphasia because of vaccines. Katie Wright ( @katiewr31413491) hints that the Foo Fighters’ drummer died from a similar cause.
What’s next? Vaccines makes actors slap comics? A new CT from Adams: that was staged to increase awareness about alopecia because Pharma has a new drug soon to be announced.
“What’s next? Vaccines make actors slap comics?”
But of course. Violence and aggression have reportedly increased during the pandemic and spiked even as the caseload wanes. Astute observers have linked the onset of acute psychosis with Covid-19 vaccination:
We should demand that everyone accused of violence or who has become psychotic within two months of vaccination receive EEGs and MRIs, to be interpreted by Russell Blaylock.
If you’re opposed, what are you afraid of?
@ Dr Bacon:
Don’t anti-vax trolls at RI often demand that all children should be tested for immunological issues before receiving any childhood vaccine?
And a Covid variant on that theme:
all people should undergo testing for anti-bodies to the virus before receiving a Covid vaccine?
Sure, that will speed things up and be very efficient.
“As of January 2021, 42 cases of psychosis associated with COVID-19 infection have been reported. It has been hypothesized that a COVID-19 triggered cytokine storm may increase the risk of psychosis.”
I’m going to go out on a limb and guess that that number may be an undercount.
90 shots they say? the spikes coming out of that guy’s eyes must be like those meams of bright eyed dumbshittery.
“the coronavirus vaccination gave me artisanism” — (not the guy fetured in the article, apparently)
According to the news over here it was 87 injections. Still he didn’t drop dead.
“I have not. Look up zero grams trans fat. The FDA approved lying on food labels. Their food pyramid is a joke.”
I looked it up, and the first thing I noticed is the food pyramid is produced by the department of agriculture. A swing and miss by John “germ theorists use time time” delabarge. If you want to make dark suggestions of malfeasance, you’ll need to be more obscure so people can’t just look up the facts, and laugh at you.