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.
Love your comments. Thank you very much. Very insightful comments about large studies and meta studies. Also agree that doctors don't read studies (and many of them can't or won't). I don't read animal studies. What am I missing there?
The converse of your large studies comment is that if you can see an effect in a small study (e.g., studies involving natural remedies, such as turmeric. tend to be small), you don't need a large study.
Right, small studies that are powered enough will reveal important observations. Animals are not easily influenced so the studies using animals are much cleaner and more useful.
I loosely compare doctors to auto mechanics. How many auto mechanics (even the better ones) read research papers about car deisgn and car technology? Or car safety? Not many. Lack of time is not the primary reason. Lack of curiosity, ability, and motivation are the real reasons.
I teach math and science to high school students. Most of the students who aspire to become doctors are typically average+. Rarely top of the class.
The reason doctors treat only symptoms rather than underlying causes is because that is all they are taught in med school. The medical industry, and big pharma in particular, does not want doctors to fix/eliminate the root causes of diseases. They want you to be chronically sick (but not die) so that they can sell you their drugs for the rest of your life.
Incurious? More than I would like to admit, but still the minority.
Unscientific? I'd like to think not.
I think that critical appraisal of studies is a skill. It atrophies when underused.
A variety of factors lead docs to their conformist, stale, and depersonalized practice patterns that too often seek refuge in annointed guidlines.
Risk aversion/fear- fear of "experts", accreditors, medical boards, who dominate care directions. Fear of malpractice, leads to guideline driven, high cost practice which is conformist, stale, and depersonalized.
Laziness/uncreative/box checking- a core issue in many industries including medicine.
Susceptibility to the parasitized mindset that seeks patients and approval in the dominant fads and trends and/or marries social justice and medical practice.
Laziness
Fear
Speaking for myself, as a surgical specialist, I use an ever-evolving bullshit meter heuristic. Experienced physicians know that too much of the literature is dubious. I consider myself a skeptical "late adopter" of new technologies and meds most of the time. Time and experience also make clear that guidelines can be helpful but are commonly tainted and ocasssionaly downright worthless.
COVID helped remind those with eyes open that medicine is subject to the shortcomings afflicting humanity generally and that we must remain open-minded, skeptical, and fierce patient advocates.
“ 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…
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.
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
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.
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.
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?
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.
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.
Love your comments. Thank you very much. Very insightful comments about large studies and meta studies. Also agree that doctors don't read studies (and many of them can't or won't). I don't read animal studies. What am I missing there?
The converse of your large studies comment is that if you can see an effect in a small study (e.g., studies involving natural remedies, such as turmeric. tend to be small), you don't need a large study.
Right, small studies that are powered enough will reveal important observations. Animals are not easily influenced so the studies using animals are much cleaner and more useful.
I loosely compare doctors to auto mechanics. How many auto mechanics (even the better ones) read research papers about car deisgn and car technology? Or car safety? Not many. Lack of time is not the primary reason. Lack of curiosity, ability, and motivation are the real reasons.
I teach math and science to high school students. Most of the students who aspire to become doctors are typically average+. Rarely top of the class.
The reason doctors treat only symptoms rather than underlying causes is because that is all they are taught in med school. The medical industry, and big pharma in particular, does not want doctors to fix/eliminate the root causes of diseases. They want you to be chronically sick (but not die) so that they can sell you their drugs for the rest of your life.
“They don’t have time due to managed care. And they are often incurious and unscientific.” - all the above. 🎯
Ouch!
No time? Yes!
Incurious? More than I would like to admit, but still the minority.
Unscientific? I'd like to think not.
I think that critical appraisal of studies is a skill. It atrophies when underused.
A variety of factors lead docs to their conformist, stale, and depersonalized practice patterns that too often seek refuge in annointed guidlines.
Risk aversion/fear- fear of "experts", accreditors, medical boards, who dominate care directions. Fear of malpractice, leads to guideline driven, high cost practice which is conformist, stale, and depersonalized.
Laziness/uncreative/box checking- a core issue in many industries including medicine.
Susceptibility to the parasitized mindset that seeks patients and approval in the dominant fads and trends and/or marries social justice and medical practice.
Laziness
Fear
Speaking for myself, as a surgical specialist, I use an ever-evolving bullshit meter heuristic. Experienced physicians know that too much of the literature is dubious. I consider myself a skeptical "late adopter" of new technologies and meds most of the time. Time and experience also make clear that guidelines can be helpful but are commonly tainted and ocasssionaly downright worthless.
COVID helped remind those with eyes open that medicine is subject to the shortcomings afflicting humanity generally and that we must remain open-minded, skeptical, and fierce patient advocates.
“ 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
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.
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
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.
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.
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.
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?
Vinay you are such a boss. I say this a lot, just want to keep saying it.
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.
Booommm!
I'm not of this world as there's to many liars and cheats running it.Great article once again. Awesome
How do personalities get into Medicine?
Thank you Dr. Prasad. You make EBM concepts accessible to everyone.