Tag Archives: research

Surrogate end points in clinical research: Hazardous

Surrogate end points in clinical research: hazardous to your health. – PubMed – NCBI – Obstet Gynecol. 2005 May

Surrogate end points in clinical research pose real danger.

A surrogate end point is an outcome measure, commonly a laboratory test, that substitutes for a clinical event of true importance.

Resistance to activated protein C, for example, has been used as a surrogate for venous thrombosis in women using oral contraceptives.

Other examples of inappropriate surrogate end points in contraception include the  Continue reading

Unexpected mechanism behind chronic nerve pain

Unexpected mechanism behind chronic nerve pain | News | News | Karolinska Institutet

It has long been assumed that chronic nerve pain is caused by hypersensitivity in the neurons that transmit pain.

Researchers at Karolinska Institutet in Sweden now show that another kind of neuron that normally allows us to feel pleasant touch sensation, can switch function and instead signal pain after nerve damage.

The results, which are presented in the journal Science, can eventually lead to more effective pain treatments.  Continue reading

Cells carry ‘memory’ of injury

Cells carry ‘memory’ of injury, which could reveal why chronic pain persists | EurekAlert! Science News – May-2016

A new study from King’s College London offers clues as to why chronic pain can persist, even when the injury that caused it has gone.

Although still in its infancy, this research could explain how small and seemingly innocuous injuries leave molecular ‘footprints’ which add up to more lasting damage, and ultimately chronic pain.

While chronic pain can have many different causes, the outcome is often the same: an overly sensitive nervous system which responds much more than it normally would Continue reading

Individual differences make pain personal

Individual differences in pain: understanding the mosaic that makes pain personal: PAIN – Fillingim, Roger B. – Pain: April 2017

In Brief: The experience of pain is characterized by tremendous interindividual variability, which is driven by multiple biopsychosocial factors.

This review article discusses individual differences in pain, including the roles of demographic, genetic, and psychosocial factors and their interactions

The public can only access the first page of this report as a JPEG picture, but if you enlarge it you can read the text (even though it seems to have been intentionally blurred).  Continue reading

Quackery infiltrating scientific journals like BMJ

Quackery infiltrates The BMJ – Science-Based MedicineDavid Gorski – May 22, 2017  

Is LACK of EVIDENCE the same as/equate to QUAKERY?

We here have long lamented the creeping infiltration of quackery into medical academia in which modalities once considered quackery, such as

  • acupuncture,
  • reiki, naturopathy,
  • homeopathy, and
  • various other dubious treatments,

have found their way into what should be bastions of science-based medicine (SBM).   Continue reading

Online Statistics Primer for Clinical Trials

Welcome to STAT 509: Clinical Trials –  Pennsylvania State University

Though this is an actual course, I found it useful as a quick reference when I wanted to understand some aspect of statistics being using in a study. Below, I’ve listed direct links to the 19 chapters/topics of statistics used in clinical trials.

This course is a survey of statistical methods and study design issues related to the testing of medical treatments.

The Prison of Evidence Based Medicine

Deconstructing the evidence-based discourse in health sciences: truth, power and fascism – Int Journal of Evidence-Based Healthcare – 2006

This is an interesting critique of the ever-increasing focus on evidence-based medicine (EBM) in healthcare.

I agree that, while this seems purely scientific, the narrow focus on EBN actually undermines the human factor, which may lead to many more creative and compassionate approaches to practicing medicine.

EBM ignores all individual variation and, with what we know of genetics and biochemistry by now, this is a very UN-scientific approach. It also ignores the values and beliefs held by patients that are most critical to “healing”.  Continue reading

Embrace Uncertainty and Cut the Hype

Want More Trust in Medical Science? Embrace Uncertainty and Cut the Hype – John Mandrola, MD – April 2017

…in this week of righteous celebration of science, certainty will be favored over uncertainty, as will acceptance over skepticism.

This, I believe, is a core reason science has a trust problem. An old mentor warned me of the danger of hubris. Hubris, he said, was the doctor’s greatest enemy.

I see a lot of overconfidence in medical science.  Continue reading

Standards to Foster Research Integrity

Top Scientists Revamp Standards To Foster Integrity In Research: Shots – Health News : NPR -April 11, 2017 – Heard on Morning Edition

It’s been 25 years since the National Academy of Sciences set its standards for appropriate scientific conduct, and the world of science has changed dramatically in that time. So now the academies of science, engineering and medicine have updated their standards.

The report published Tuesday, “Fostering Integrity in Research,” shines a spotlight on how the research enterprise as a whole creates incentives that can be detrimental to good research.  Continue reading

Baloney Detection Kit

The Baloney Detection Kit: Carl Sagan’s Rules for Bullshit-Busting and Critical Thinking – Brain Pickings – Maria Popova

Carl Sagan (November 9, 1934–December 20, 1996) was many things.

But above all, he endures as our era’s greatest patron saint of reason and common sense, a master of the vital balance between skepticism and openness.

In The Demon-Haunted World: Science as a Candle in the Dark (public library) — the same indispensable volume that gave us Sagan’s timeless meditation on science and spirituality, published mere months before his death in 1996 — Sagan shares his secret to upholding the rites of reason, even in the face of society’s most shameless untruths and outrageous propaganda.

In a chapter titled “The Fine Art of Baloney Detection,” Sagan reflects on the many types of deception to which we’re susceptible — from psychics to religious zealotry to paid product endorsements by scientists, which he held in especially low regard, noting that they “betray contempt for the intelligence of their customers” and “introduce an insidious corruption of popular attitudes about scientific objectivity.” (Cue in PBS’s Joe Hanson on how to read science news.)

Through their training, scientists are equipped with what Sagan calls a “baloney detection kit” — a set of cognitive tools and techniques that fortify the mind against penetration by falsehoods:

The kit is brought out as a matter of course whenever new ideas are offered for consideration. If the new idea survives examination by the tools in our kit, we grant it warm, although tentative, acceptance. If you’re so inclined, if you don’t want to buy baloney even when it’s reassuring to do so, there are precautions that can be taken; there’s a tried-and-true, consumer-tested method.

But the kit, Sagan argues, isn’t merely a tool of science — rather, it contains invaluable tools of healthy skepticism that apply just as elegantly, and just as necessarily, to everyday life.

By adopting the kit, we can all shield ourselves against clueless guile and deliberate manipulation.

Sagan shares nine of these tools:

  1. Wherever possible there must be independent confirmation of the “facts.”
  2. Encourage substantive debate on the evidence by knowledgeable proponents of all points of view.
  3. Arguments from authority carry little weight — “authorities” have made mistakes in the past. They will do so again in the future. Perhaps a better way to say it is that in science there are no authorities; at most, there are experts.
  4. Spin more than one hypothesis. If there’s something to be explained, think of all the different ways in which it could be explained. Then think of tests by which you might systematically disprove each of the alternatives. What survives, the hypothesis that resists disproof in this Darwinian selection among “multiple working hypotheses,” has a much better chance of being the right answer than if you had simply run with the first idea that caught your fancy.
  5. Try not to get overly attached to a hypothesis just because it’s yours. It’s only a way station in the pursuit of knowledge. Ask yourself why you like the idea. Compare it fairly with the alternatives. See if you can find reasons for rejecting it. If you don’t, others will.
  6. Quantify. If whatever it is you’re explaining has some measure, some numerical quantity attached to it, you’ll be much better able to discriminate among competing hypotheses. What is vague and qualitative is open to many explanations. Of course there are truths to be sought in the many qualitative issues we are obliged to confront, but finding them is more challenging.
  7. If there’s a chain of argument, every link in the chain must work (including the premise) — not just most of them.
  8. Occam’s Razor. This convenient rule-of-thumb urges us when faced with two hypotheses that explain the data equally well to choose the simpler.
  9. Always ask whether the hypothesis can be, at least in principle, falsified.

Propositions that are untestable, unfalsifiable are not worth much.

Consider the grand idea that our Universe and everything in it is just an elementary particle — an electron, say — in a much bigger Cosmos. But if we can never acquire information from outside our Universe, is not the idea incapable of disproof? You must be able to check assertions out.

Inveterate skeptics must be given the chance to follow your reasoning, to duplicate your experiments and see if they get the same result.

Sagan writes:

In addition to teaching us what to do when evaluating a claim to knowledge, any good baloney detection kit must also teach us what not to do.

He admonishes against the twenty most common and perilous ones — many rooted in our chronic discomfort with ambiguity with examples of each in action:

  1. ad hominem
  2. argument from authority
  3. argument from adverse consequences
  4. appeal to ignorance
  5. special pleading,
  6. begging the question, also called assuming the answer
  7. observational selection, also called the enumeration of favorable circumstances
  8. statistics of small numbers
  9. misunderstanding of the nature of statistics
  10. inconsistency
  11. non sequitur
  12. post hoc, ergo propter hoc
  13. meaningless question
  14. excluded middle, or false dichotomy
  15. short-term vs. long-term
  16. slippery slope,
  17. confusion of correlation and causation
  18. straw man
  19. suppressed evidence, or half-truths
  20. weasel words

Like all tools, the baloney detection kit can be misused, applied out of context, or even employed as a rote alternative to thinking. But applied judiciously, it can make all the difference in the world — not least in evaluating our own arguments before we present them to others.