19 Comments

I read papers for a living, as a health researcher. Life is short and reading papers is hard and time consuming. So I use simple heuristics to determine if I’m going to study a paper or not.

Very large studies that promote drugs are a red flag. If an effect is large enough to be clear, it should work in a small study. Large drug company studies are virtually always manipulated if not outright fraudulent.

I also prefer animal studies as they are much clearer as to result.

I pretty much avoid meta studies as their conclusions are whatever their investigators want. But they are useful for their citations.

In my experience, doctors don’t read studies. They don’t have time due to managed care. And they are often incurious and unscientific.

Expand full comment

“ Not everyone is good at critical appraisal of medical literature. If you aren’t good, it is never too late to work to improve ones skillset before commenting widely.”

Can it be improved? As a fairly recent (within 10 years) med school graduate, I can attest that there was a lot of effort made by the schools to teach critical appraisal of literature… and then Covid happened and that entire generation of young doctors trained in evidence based medicine completely fell on its face when it came to appraising literature!

Sometimes it’s not about reading skills, it’s about resisting groupthink, and I don’t know if that can be taught in, er, groups…

Gaty.substack.com

Expand full comment

I have sources who violated HIPAA and told me what Topol has.....he's been diagnosed with MeEgoitis. It presents with constant need to get likes, and attaboy's in social media. Another side effect is chronic JOTB, it's like COPD but you just Jump On The Bandwagon - whatever message is popular. Also, TDS tends to be correlated with JOTB.

Expand full comment

The guy in question is full of himself and he most likely will not be affected in the least by your trenchant observations recorded here.

Expand full comment
Apr 12, 2023·edited Apr 13, 2023

In 2016, NIH awarded him a $207 million grant to help lead the Precision Medicine Initiative Cohort Program. Since 2018, shortly after the All of Us Study was funded, there has been no new information, only recruiting.

The All of Us Study, Topol’s translational medicine program specifically states: “Until now, the treatment and prevention of disease has been based on a ‘one-size-fits-all’ approach, with most therapeutics tailored for the ‘average patient’. However, advances in genomic sequencing, mobile health technologies, and increasingly sophisticated informatics are ushering in a new era of precision medicine.” The irony here is that Topol’s own approach toward the pandemic was cookie cutter and ignored vaccinology and adversology. His philosophy of tailored medicine was ignored at a time where it could have been quite consequential.

While he may not take money directly from the vaccine manufacturers he has made plenty of money on stock trades, book writing and likely speaking engagements. Medpage is the most biased clickbait medical “noos letter.” Despite its POM POM cheering more readers than ever are speaking out and criticizing its approach. That tells you something

Expand full comment

I wish there was a way to tag this post for Sam Harris , who platformed Eric Topel and gave him the definitive word on all things Covid at a time when there were so many reasonable questions that should have been addressed with unbiased, unpoliticized, data- driven science. Sam has never revisited the subject or corrected the "misinformation" they so vehemently posited on his podcast. I've been a longtime admirer of much of Sam's work but I'm still mad about this.

Expand full comment

Eric Topol is not dumb. He must know he got it wrong on COVID and vaccines but continues to hope he can fool enough people to save his career. He is a psychopath.

Expand full comment

Vinay you are such a boss. I say this a lot, just want to keep saying it.

Expand full comment

VP, I'm going to go out on a limb here and say I'm not the only physician on here who could use a refresher course on interpreting studies/biostatistics. Maybe I am the only one, but oh well. I would love if you could start a series, written or videoed, that addresses the basics of reading studies: designs, biases, end-point analyses, etc. i regret not taking this stuff more seriously in med school, but I see now how important it is to invest in this. More than just for increasing knowledge, I have a few thousand patients who desperately need their doctor to be a true leader and advocate for them.

You probably don't have the time, so could you at least point me/us to some respectable source material?

Expand full comment
founding

Topol is a tool. I keep pointing that out in these notes. Having personal experience, he will say EXACTLY what he is paid to say. I have yet to meet anyone who I respect who has a single good thing to say about him. How he continues to maintain his Scripps position and his prominence in the medical field speaks volumes to how and why the field is, perhaps irretrievably, broken.

Expand full comment
founding

Booommm!

Expand full comment

How do personalities get into Medicine?

Expand full comment

Thank you Dr. Prasad. You make EBM concepts accessible to everyone.

Expand full comment

I'm not of this world as there's to many liars and cheats running it.Great article once again. Awesome

Expand full comment