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tehllama posted:Your point doesn't really have anything to do with Discendo Vox erroneously claiming that somehow pediatricians don't have the same level of ability to interpret scientific papers as any undergraduate in a STEM field. The standard for evaluating scientific papers to make care decisions should be, and is, higher than the undergraduate level. Clinicians are trained to think they can evaluate scientific papers, but a bare minimum of literacy is inadequate to keep them from misunderstanding and overrating statements outside their fields of immediate knowledge. How many pediatricians can diagnose a Heywood case?
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Nov 9, 2014 17:55
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Discendo Vox posted:The standard for evaluating scientific papers to make care decisions should be, and is, higher than the undergraduate level. Clinicians are trained to think they can evaluate scientific papers, but a bare minimum of literacy is inadequate to keep them from misunderstanding and overrating statements outside their fields of immediate knowledge. How many pediatricians can diagnose a Heywood case? Their field of knowledge being medicine as it applies to children. If they are not qualified to comment on whether "realigning a spine" to cure viral diseases in children is woo or not then literally no one is.
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Nov 9, 2014 17:58
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Discendo Vox posted:The standard for evaluating scientific papers to make care decisions should be, and is, higher than the undergraduate level. Clinicians are trained to think they can evaluate scientific papers, but a bare minimum of literacy is inadequate to keep them from misunderstanding and overrating statements outside their fields of immediate knowledge. How many pediatricians can diagnose a Heywood case?  Aren't you an ethics major, and therefore a nonscientist? So any paper you read indicating as such would be outside your field and therefore you ability to interpret it. If such a study even existed, which you haven't provided any evidence of.
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Nov 9, 2014 17:59
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tehllama posted:Yeah this is pretty much just factually wrong. I think it would be more accurate to say that, even if they are trained to, their job doesn't involve actually doing so (whereas a scientist has no choice but to interpret scientific literature as part of his job). So a doctor can more easily get away with making unscientific decisions than a scientist.
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Nov 9, 2014 18:00
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Ytlaya posted:I think it would be more accurate to say that, even if they are trained to, their job doesn't involve actually doing so (whereas a scientist has no choice but to interpret scientific literature as part of his job). So a doctor can more easily get away with making unscientific decisions than a scientist. True, but that's kinda of like saying that you don't have to know algebra because you work as a cook. While technically true, if you are unable to do at least basic stuff (like balance a checkbook/show that chiropractors are wack) then you are kinda still nonfunctional.
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Nov 9, 2014 18:07
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Ytlaya posted:I think it would be more accurate to say that, even if they are trained to, their job doesn't involve actually doing so (whereas a scientist has no choice but to interpret scientific literature as part of his job). So a doctor can more easily get away with making unscientific decisions than a scientist. The day to day of a good physician in any field involves staying up to date on the latest therapies, which comes in the form of reading papers and attending relevant CME's. There are physicians that don't but the majority do. I agree it is less critical to their job than that of a research scientist but it isn't unimportant.
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Nov 9, 2014 18:07
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tehllama posted:
I'm a bioethics and comm sci major, and yes, there are a lot of papers outside my immediate area of expertise that I can't fully vet-so I don't tend to make clinical care decisions based on those papers!  Even so, I have way more relevant training in evaluating publications than a clinician receives.Ytlaya posted:I think it would be more accurate to say that, even if they are trained to, their job doesn't involve actually doing so (whereas a scientist has no choice but to interpret scientific literature as part of his job). So a doctor can more easily get away with making unscientific decisions than a scientist. This is a major, structural part of the problem. Another factor is that the minimal litracy training that's now a part of the medical curriculum is a relatively recent invention. There are also the problems of direct interaction between industry (or in this case, "industry", although alt med groups can be surprisingly organized) and clinicians. tehllama posted:The day to day of a good physician in any field involves staying up to date on the latest therapies, which comes in the form of reading papers and attending relevant CME's. There are physicians that don't but the majority do. I agree it is less critical to their job than that of a research scientist but it isn't unimportant. The current CME structure is massively compromised and poorly complied with. Clinicians can attempt to stay up to date with "the latest therapies", but that has a number of problematic connotations, including a)what sources are provided to them for this information, b) how they select this information, and c)their ability to critically evaluate this information. Each of these parts of the learning process are targeted and exploited by those seeking to move physicians to particular therapies, medically legitimate or not. CME would work a lot better if it was practice-specific, meaningfully enforced, and not heavily subsidized by industry. The system, such as it currently is, doesn't actually work. Editorial boards aren't a substitute for individual reader evaluation, and clinicians can't actually independently evaluate those articles- they don't have the training. One way to look at this is in terms of variance. Most physicians will realize the problems with the chiro paper, but because they don't have the necessary/relevant literacy, more of them will be convinced by it when compared with people specializing in immediately relevant fields. DreamShipWrecked posted:True, but that's kinda of like saying that you don't have to know algebra because you work as a cook. While technically true, if you are unable to do at least basic stuff (like balance a checkbook/show that chiropractors are wack) then you are kinda still nonfunctional. A key issue here is that, over time, the incentives have heightened the literacy requirement to the point where it's not tenable across all areas. Nowadays, the cooks are being offered recipes by vendors where the serving sizes are written in topology expressions. Discendo Vox fucked around with this message at 18:18 on Nov 9, 2014 |
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Nov 9, 2014 18:14
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Vox is pretty impressively wrong about everything and his argument that "no really there are valid arguments to banning assisted suicide its v complex guys I just can't provide any evidence" was greatDiscendo Vox posted:Even so, I have way more relevant training in evaluating publications than a clinician receives. Lol a loving commsci undergrad is seriously arguing he's better at papers than a doctor.
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Nov 9, 2014 18:23
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Discendo Vox posted:I'm a bioethics and comm sci major, and yes, there are a lot of papers outside my immediate area of expertise that I can't fully vet-so I don't tend to make clinical care decisions based on those papers! Oh dear, this is a level of hubris and ignorance that I don't think anyone is going to be able to correct over an Internet forum.
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Nov 9, 2014 18:27
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tehllama posted:The day to day of a good physician in any field involves staying up to date on the latest therapies, which comes in the form of reading papers and attending relevant CME's. There are physicians that don't but the majority do. I agree it is less critical to their job than that of a research scientist but it isn't unimportant. Key word bolded. I can definitely tell you that, at least in psychiatry, a very large portion, if not most, of psychiatrists carry with them a large number of unscientific biases as a result of their personal experience (such as some random SSRI being superior to all others or another being better at giving you "energy"). I would assume that the same is true for other physicians; it's just worse with psychiatrists since they happen to work in a field where our knowledge is changing drastically and fast. There isn't really anything preventing a physician from acting on his/her biases, where at least scientists have peer review* and the review of the editors of the journals they submit their work to. *Although there's also a big problem in the scientific community where this is concerned. Given how limited funding is, most scientists aren't exactly going to choose to spend their valuable time and grant money just trying to verify some other scientists' results. This has also resulted in the vast majority of research in the field of genetics (for example) focusing on relatively few genes, simply because it's easier to get grants to research genes that are already well known. A graduate student in the lab I work at actually wrote a paper about what he called the "ignorome"; the set of genes that are strongly expressed but with very little research done on them (the paper he did - which is really cool and interesting - actually shows up as the first google result for "ignorome"). edit: Specifically, as he mentions in his paper, "the top 5% of genes absorb 70% of the relevant literature". It's really nuts.
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Nov 9, 2014 18:29
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Actually, Discendo Vox brings up some very good points, they're just totally out of left field. Clinicians as a population are embarrassingly bad at evaluating scientific literature, but it's irrelevant in this discussion, because this isn't "critical evaluation of the science," it's "common loving sense with a basic medical education."
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Nov 9, 2014 18:32
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disheveled posted:Actually, Discendo Vox brings up some very good points, they're just totally out of left field. Clinicians as a population are embarrassingly bad at evaluating scientific literature To expound on this subject for people who disagree with this, medical school is just job training for how to be a doctor. It's not the same type of education as a Ph.D. where you learn how to do research and are expected to read scientific literature to stay on top of what's going on in your field. silence_kit fucked around with this message at 18:53 on Nov 9, 2014 |
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Nov 9, 2014 18:50
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Spangly A posted:Vox is pretty impressively wrong about everything and his argument that "no really there are valid arguments to banning assisted suicide its v complex guys I just can't provide any evidence" was great I cited to Ezekiel Emanuel, who's the main authority writing on that subject in bioethics. Spangly A posted:Lol a loving commsci undergrad is seriously arguing he's better at papers than a doctor. I'm a PhD student specializing in problems of scientific miscommunication among and between scientists and other professions. disheveled posted:Actually, Discendo Vox brings up some very good points, they're just totally out of left field. Clinicians as a population are embarrassingly bad at evaluating scientific literature, but it's irrelevant in this discussion, because this isn't "critical evaluation of the science," it's "common loving sense with a basic medical education." I'd like the points to be irrelevant, but my belief is that the low level of literacy means that clinicians are more susceptible to even the trashiest sources. Importantly, DSHEA alt med groups are getting better and better at dressing up their products/beliefs in the language and trappings of the scientific literature. The very OP of this thread is a prominent example of this sort of phenomenon. silence_kit posted:Medical school is just job training for how to be a doctor. It's not the same type of education as a Ph.D. where you learn how to do research and are expected to read scientific literature to stay on top of what's going on in your field. tehllama's earlier post was right- physicians are, in fact, supposed to stay on top of best practices, both from a top-down and a bottom-up perspective (the details of the top-down part, how this is enforced at the institution level, are outside my areas of research- something to get into after tenure, since I see it as a potential avenue for change). The difficulty is that they realistically can't, and often don't even try. Discendo Vox fucked around with this message at 19:17 on Nov 9, 2014 |
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Nov 9, 2014 18:51
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I'd like to point out that a doctor published this paper and received over 120 citations. The objective of the paper is "to develop a mathematical model for the determination of total areas under curves from various metabolic studies." The results: "In Tai's Model, the total area under a curve is computed by dividing the area under the curve between two designated values on the X-axis (abscissas) into small segments (rectangles and triangles) whose areas can be accurately calculated from their respective geometrical formulas." 
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Nov 9, 2014 19:22
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silence_kit posted:To expound on this subject for people who disagree with this, medical school is just job training for how to be a doctor. It's not the same type of education as a Ph.D. where you learn how to do research and are expected to read scientific literature to stay on top of what's going on in your field. This is partially true, but and MD is also a masters of science based on human physiology. They don't really learn how to do research per se, other then some 6 months of research internships,( at my alma mater anyway) but reading of scientific literature to stay on top of what's going on in your field is mandatory for every doc and quite a lot of training is spend on how to do this correctly. Every doctor in training has periodic presentations for the faculty where they have to give a comprehensive review of the current literature on a certain issue, for instance the level of evidence for treating appendicitis with antibiotics (surprisingly effective). Sure there are complete idiots with a MD, but i'd still give more weight to a Doc's reading on a published trial then that of an unrelated Msc or PhD. Present company excluded, of-course.
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Nov 9, 2014 19:27
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IAMNOTADOCTOR posted:This is partially true, but and MD is also a masters of science based on human physiology. They don't really learn how to do research per se, other then some 6 months of research internships,( at my alma mater anyway) but reading of scientific literature to stay on top of what's going on in your field is mandatory for every doc and quite a lot of training is spend on how to do this correctly. Every doctor in training has periodic presentations for the faculty where they have to give a comprehensive review of the current literature on a certain issue, for instance the level of evidence for treating appendicitis with antibiotics (surprisingly effective). That's a decent point, but there are defects in this system as well. Although it's nominally a requirement under the LCME standards, not all MD programs have the same degree of rigor in their research requirements (after all, not all medical schools are really research-driven institutions). This actually gives me the chance to share an example of the sort of problem I've witnessed in these curricula- I got to sit in on a couple of the presentations you mention, and what transpired was that the faculty also didn't catch the problems in the literature when the students repeated them. The problems can be self-perpetuating in this way; I understand there are some observational studies in the pipe to capture this, but there are obviously big method challenges for that sort of research at the best of times- envision researchers observing students reporting on research.
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Nov 9, 2014 19:41
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QuarkJets posted:I'd like to point out that a doctor published this paper and received over 120 citations. Please, please tell me that's a joke site. Or the author was trolling them or something . The 120 citations were just people pointing out how stupid that is for someone to write, right? Right ?
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Nov 9, 2014 20:08
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eNeMeE posted:Please, please tell me that's a joke site. Or the author was trolling them or something . I have always been too afraid to look and just like to pretend this is the case.
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Nov 9, 2014 20:14
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eNeMeE posted:Please, please tell me that's a joke site. Or the author was trolling them or something . No. It's a completely for-real paper, published in a real and peer-reviewed diabetes journal. You can find the paper on google scholar and pubmed. Some of the citations are great, with titles such as "Tai's formula is the trapezoidal rule", which presumably just mocks the original paper.
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Nov 9, 2014 20:16
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Discendo Vox posted:
Then I apologise and retract the insult, but now I'm not seeing an issue where Drs can't read papers properly at Ph.D level. Regulate clinicians better and let the med board deal with any nutjobs is surely the better solution than further barriers to entry for med students?
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Nov 9, 2014 20:18
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Spangly A posted:Then I apologise and retract the insult, but now I'm not seeing an issue where Drs can't read papers properly at Ph.D level. Regulate clinicians better and let the med board deal with any nutjobs is surely the better solution than further barriers to entry for med students? Except the Med Board is increasingly having their hands tied by groups pushing for deregulation of the medical industry a'la chiropractors and natural health nuts that insist thr medical industry is a farce and they are just proped up by big pharma. These same groups have an ever increasing body count they leave in their wake.
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Nov 9, 2014 20:48
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CommieGIR posted:Except the Med Board is increasingly having their hands tied by groups pushing for deregulation of the medical industry a'la chiropractors and natural health nuts that insist thr medical industry is a farce and they are just proped up by big pharma. I agree, I'm making the point that this is clearly not on the Drs trying to do their job, but the libertarian nutjobs happy to recklessly endanger and kill children so they can scream about FREEDOMS. e; It's pretty hard to be free when you're in a wheelchair from polio, not that these wankers would ever know.
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Nov 9, 2014 20:57
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Spangly A posted:Then I apologise and retract the insult, but now I'm not seeing an issue where Drs can't read papers properly at Ph.D level. Regulate clinicians better and let the med board deal with any nutjobs is surely the better solution than further barriers to entry for med students? In the short and medium term the answer isn't clear- in the long term the answer is likely to be an intermediary authority that vets research and promulgates best practices top-down on an active, rather than passive or reactive, basis. This would also have the effect, with major benefits and major drawbacks, of severely limiting individual clinical discretion in diagnosis and treatment. My limited understanding is that such systems already sort of function in this role at the institution level- this would be moving that current process to the state and national level.
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Nov 9, 2014 21:09
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I have posted about my favorite "doctor" in this and other threads before: anti-vac chiropractor/alternative healthcare provider Dr. James Winer, who has a local radio show which airs like 70 hours a week here. http://drwiner.com/ Here is his "Children's Healthcare" section: http://drwiner.com/services/children-s-healthcare  Here is the good doctor's take on ebola (not pictured, elsewhere he stated that the hydrogen peroxide should be administered via IV):  Today he posted this gem: 
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Nov 10, 2014 16:13
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QuarkJets posted:I'd like to point out that a doctor published this paper and received over 120 citations. iirc, She actually then published a response to the people pointing out that she was a moron, in which she attempted to argue that her paper was totally something novel and those people just didn't understand the technical subtleties.
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Nov 10, 2014 16:42
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I suppose it is novel in a sense, since she's using a combination of rectangles and triangles instead of trapezoids for some stupid reason (therefore it's totally not the trapezoidal rule, guys)
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Nov 10, 2014 18:54
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QuarkJets posted:I suppose it is novel in a sense, since she's using a combination of rectangles and triangles instead of trapezoids for some stupid reason (therefore it's totally not the trapezoidal rule, guys) I'm guessing it's because the area of a trapezoid is too difficult for the author to calculate.
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Nov 10, 2014 19:15
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Gregor Samsa posted:iirc, She actually then published a response to the people pointing out that she was a moron, in which she attempted to argue that her paper was totally something novel and those people just didn't understand the technical subtleties. If that's true, then that's really bad. I don't think that the fact that she published a paper on the trapezoidal rule is that bad. Medical researchers aren't really educated in math to the same level as engineers and physicists and there's nothing wrong with that if they really don't need that level of math to do their research. I'm sure that there have been theoretical physicists who are convinced that they've invented some new math thing only to find later that some math guy 50 years ago already did it. This sort of thing happens a fair amount, I think. Although admittedly, claiming that you have invented a technique in math that is covered in freshman calculus is a pretty extreme example. silence_kit fucked around with this message at 23:30 on Nov 10, 2014 |
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Nov 10, 2014 22:33
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silence_kit posted:If that's true, then that's really bad. For what it's worth she appears to be a nutritionist with an Ed D, not an MD or a PhD. I think the fact that it passed the editors of a journal is somewhat more damning. e: Though you would think an MS in nutrition would at least include collegiate level calculus. tehllama fucked around with this message at 22:56 on Nov 10, 2014 |
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Nov 10, 2014 22:49
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silence_kit posted:I'm sure that there have been theoretical physicists who are convinced that they've invented some new math thing only to find later that some math guy 50 years ago already did it. This sort of thing happens a fair amount, I think. Although admittedly, claiming that you have invented a technique in math that is covered in freshman calculus is a pretty extreme example. I'm planning to develop a quantitative measure of this phenomenon in a couple years (tentatively, "scientific redundancy"). The problem is that a lot of the SNA statistical tools I need to capture it at the systems level haven't been invented yet.
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Nov 10, 2014 23:10
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tehllama posted:e: Though you would think an MS in nutrition would at least include collegiate level calculus. ...what do you think nutritionists study
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Nov 10, 2014 23:11
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SedanChair posted:...what do you think nutritionists study I would think understanding rate of change would be somewhat fundamental to a nutritionist but my background is engineering so I see calculus in everything.
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Nov 10, 2014 23:19
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tehllama posted:e: Though you would think an MS in nutrition would at least include collegiate level calculus. Students in social and life science programs aren't expected to be as proficient in math as students in engineering and physics programs. Even if they are required to take a calculus class, it usually is an easier version than the ones that the other students take. I can totally see taking a not so great calculus class and coming out of it not really understanding the trapezoidal rule. Even though I was taught it in high school calculus and got a top score on the high school AP calculus exam, I didn't really see the point of numerical integration because I was given nice formulas for computing the integrals of various functions. It wasn't until I took college calculus when I got a feel for integration being the limit as you use more shapes in the Riemann sum.
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Nov 10, 2014 23:29
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SedanChair posted:...what do you think nutritionists study "nutritionist" isn't a legally protected title in most of the US, so...nothing. "Dietitians" are a formally accredited profession in the US, although the organization is notoriously compromised by industry.
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Nov 10, 2014 23:36
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silence_kit posted:Students in social and life science programs aren't expected to be as proficient in math as students in engineering and physics programs. Even if they are required to take a calculus class, it usually is an easier version than the ones that the other students take. I absolutely agree, and I just read her replies and its pretty clear she lacks even an elementary understanding of the fundamentals of calculus. She tortuously reaches the conclusion that integration is indeed the limit as our discrete intervals approach zero, but still apparently doesn't understand that her measured numbers are not an exact representation of the actual curve. She appears to have reached her solution by algebra alone, which actually makes it more sympathetic. quote:"nutritionist" isn't a legally protected title in most of the US, so...nothing. "Dietitians" are a formally accredited profession in the US, although the organization is notoriously compromised by industry. It's my understanding that the purpose of pursuing MS's in nutrition science is for pursuing basic science research/industry jobs, not clinical.
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Nov 10, 2014 23:46
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tehllama posted:It's my understanding that the purpose of pursuing MS's in nutrition science is for pursuing basic science research/industry jobs, not clinical. That's usually correct.
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Nov 10, 2014 23:52
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Discendo Vox posted:"nutritionist" isn't a legally protected title in most of the US, so...nothing. "Dietitians" are a formally accredited profession in the US, although the organization is notoriously compromised by industry. Exactly. Yet another discipline with all the rigor of a blog.
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Nov 11, 2014 00:06
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SedanChair posted:Exactly. Yet another discipline with all the rigor of a blog. Unfortunatly, its not only social, medical or biological sciences. Comp sci is also pretty renown for the frivolous publications. One guy got away with 120 randomly created gibberish publications: http://www.nature.com/news/publishers-withdraw-more-than-120-gibberish-papers-1.14763 Medicine again, getting published in some of the open access peer reviewd journals is as simple as aplying: http://www.sciencemag.org/content/342/6154/60.full quote:There are numerous red flags in the papers, with the most obvious in the first data plot. The graph's caption claims that it shows a "dose-dependent" effect on cell growth—the paper's linchpin result—but the data clearly show the opposite. The molecule is tested across a staggering five orders of magnitude of concentrations, all the way down to picomolar levels. And yet, the effect on the cells is modest and identical at every concentration.
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Nov 11, 2014 00:37
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This thread is writing a part of my dissertation for me. Thanks in advance! edit: the real fun begins when these papers get cited.
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Nov 11, 2014 00:40
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SedanChair posted:Exactly. Yet another discipline with all the rigor of a blog. I mean its the same as being a "biologist" or "chemist." Accreditation for a lot of basic science programs are provided as part of a university's accreditation process rather than at the school level.
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Nov 11, 2014 00:44
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