Saturday, May 13, 2017
"...medicine is quick to adopt practices based on shaky evidence but slow to drop them once they’ve been blown up by solid proof."
When Evidence Says No, but Doctors Say Yes - The Atlantic: "When you visit a doctor, you probably assume the treatment you receive is backed by evidence from medical research. Surely, the drug you’re prescribed or the surgery you’ll undergo wouldn’t be so common if it didn’t work, right?
For all the truly wondrous developments of modern medicine—imaging technologies that enable precision surgery, routine organ transplants, care that transforms premature infants into perfectly healthy kids, and remarkable chemotherapy treatments, to name a few—it is distressingly ordinary for patients to get treatments that research has shown are ineffective or even dangerous.
Sometimes doctors simply haven’t kept up with the science. Other times doctors know the state of play perfectly well but continue to deliver these treatments because it’s profitable—or even because they’re popular and patients demand them. Some procedures are implemented based on studies that did not prove whether they really worked in the first place. Others were initially supported by evidence but then were contradicted by better evidence, and yet these procedures have remained the standards of care for years, or decades.
Even if a drug you take was studied in thousands of people and shown truly to save lives, chances are it won’t do that for you. The good news is, it probably won’t harm you, either. Some of the most widely prescribed medications do little of anything meaningful, good or bad, for most people who take them.
In a 2013 study, a dozen doctors from around the country examined all 363 articles published in The New England Journal of Medicine over a decade—2001 through 2010—that tested a current clinical practice, from the use of antibiotics to treat people with persistent Lyme disease symptoms (didn’t help) to the use of specialized sponges for preventing infections in patients having colorectal surgery (caused more infections). Their results, published in the Mayo Clinic Proceedings, found 146 studies that proved or strongly suggested that a current standard practice either had no benefit at all or was inferior to the practice it replaced; 138 articles supported the efficacy of an existing practice, and the remaining 79 were deemed inconclusive. (There was, naturally, plenty of disagreement with the authors’ conclusions.)
Some of the contradicted practices possibly affect millions of people daily: Intensive medication to keep blood pressure very low in diabetic patients caused more side effects and was no better at preventing heart attacks or death than more mild treatments that allowed for a somewhat higher blood pressure. Other practices challenged by the study are less common—like the use of a genetic test to determine if a popular blood thinner is right for a particular patient—but gaining in popularity despite mounting contrary evidence. Some examples defy intuition: CPR is no more effective with rescue breathing than if chest compressions are used alone; and breast-cancer survivors who are told not to lift weights with swollen limbs actually should lift weights, because it improves their symptoms.
A separate but similarly themed study in 2012 funded by the Australian Department of Health and Ageing, which sought to reduce spending on needless procedures, looked across the same decade and identified 156 active medical practices that are probably unsafe or ineffective. The list goes on: A brand new review of 48 separate studies—comprising more than 13,000 clinicians—looked at how doctors perceive disease-screening tests and found that they tend to underestimate the potential harms of screening and overestimate the potential benefits; an editorial inAmerican Family Physician,co-written by one of the journal’s editors, noted that a “striking feature” of recent research is how much of it contradicts traditional medical opinion...
A 2007 Journal of the American Medical Association paper coauthored by John Ioannidis—a Stanford University medical researcher and statistician who rose to prominence exposing poor-quality medical science—found that it took 10 years for large swaths of the medical community to stop referencing popular practices after their efficacy was unequivocally vanquished by science. According to Vinay Prasad, an oncologist and one of the authors of the Mayo Clinic Proceedings paper, medicine is quick to adopt practices based on shaky evidence but slow to drop them once they’ve been blown up by solid proof...
In 2007, after a seminal study, the COURAGE trial, showed that stents did not prevent heart attacks or death in stable patients, a trio of doctors at the University of California, San Francisco, conducted 90-minute focus groups with cardiologists to answer that question. They presented the cardiologists with fictional scenarios of patients who had at least one narrowed artery but no symptoms and asked them if they would recommend a stent. Almost to a person, the cardiologists, including those whose incomes were not tied to tests and procedures, gave the same answers: They said that they were aware of the data but would still send the patient for a stent.
The rationalizations in each focus group followed four themes: (1) Cardiologists recalled stories of people dying suddenly—including the highly publicized case of jogging guru Jim Fixx—and feared they would regret it if a patient did not get a stent and then dropped dead. The study authors concluded that cardiologists were being influenced by the “availability heuristic,” a term coined by Nobel laureate psychologists Amos Tversky and Daniel Kahneman for the human instinct to base an important decision on an easily recalled, dramatic example, even if that example is irrelevant or incredibly rare. (2) Cardiologists believed that a stent would relieve patient anxiety. (3) Cardiologists felt they could better defend themselves in a lawsuit if a patient did get a stent and then died, rather than if they didn’t get a stent and died. “In California,” one said, “if this person had an event within two years, the doctor who didn’t [intervene] would be successfully sued.” And there was one more powerful and ubiquitous reason: (4) Despite the data, cardiologists couldn’t believe that stents did not help: Stenting just made so much sense. A patient has chest pain, a doctor sees a blockage, how can opening the blockage not make a difference?"
...At the same time, patients and even doctors themselves are sometimes unsure of just how effective common treatments are, or how to appropriately measure and express such things. Graham Walker, an emergency physician in San Francisco, co-runs a website staffed by doctor volunteers called the NNT that helps doctors and patients understand how impactful drugs are—and often are not. “NNT” is an abbreviation for “number needed to treat,” as in: How many patients need to be treated with a drug or procedure for one patient to get the hoped-for benefit? In almost all popular media, the effects of a drug are reported by relative risk reduction. To use a fictional illness, for example, say you hear on the radio that a drug reduces your risk of dying from Hogwart’s disease by 20 percent, which sounds pretty good. Except, that means if 10 in 1,000 people who get Hogwart’s disease normally die from it, and every single patient goes on the drug, eight in 1,000 will die from Hogwart’s disease. So, for every 500 patients who get the drug, one will be spared death by Hogwart’s disease. Hence, the NNT is 500.
That might sound fine, but if the drug’s “NNH”—“number needed to harm”—is, say, 20 and the unwanted side effect is severe, then 25 patients suffer serious harm for each one who is saved. Suddenly, the trade-off looks grim. Now, consider a real and familiar drug: aspirin. For elderly women who take it daily for a year to prevent a first heart attack, aspirin has an estimated NNT of 872 and an NNH of 436. That means if 1,000 elderly women take aspirin daily for a decade, 11 of them will avoid a heart attack; meanwhile, twice that many will suffer a major gastrointestinal bleeding event that would not have occurred if they hadn’t been taking aspirin. As with most drugs, though, aspirin will not cause anything particularly good or bad for the vast majority of people who take it.
That is the theme of the medicine in your cabinet: It likely isn’t significantly harming or helping you.
“Most people struggle with the idea that medicine is all about probability,” says Aron Sousa, an internist and senior associate dean at Michigan State University’s medical school. As to the more common metric, relative risk, “it’s horrible,” Sousa says. “It’s not just drug companies that use it; physicians use it, too. They want their work to look more useful, and they genuinely think patients need to take this [drug], and relative risk is more compelling than NNT. Relative risk is just another way of lying.”"
Women: greater gender in-group bias + heightened anticipatory fear response.
Gender differences in automatic in-group bias: why do women like women more than men like men? - PubMed - NCBI: "Four experiments confirmed that women's automatic in-group bias is remarkably stronger than men's and investigated explanations for this sex difference, derived from potential sources of implicit attitudes (L. A. Rudman, 2004). In Experiment 1, only women (not men) showed cognitive balance among in-group bias, identity, and self-esteem (A. G. Greenwald et al., 2002), revealing that men lack a mechanism that bolsters automatic own group preference. Experiments 2 and 3 found pro-female bias to the extent that participants automatically favored their mothers over their fathers or associated male gender with violence, suggesting that maternal bonding and male intimidation influence gender attitudes. Experiment 4 showed that for sexually experienced men, the more positive their attitude was toward sex, the more they implicitly favored women. In concert, the findings help to explain sex differences in automatic in-group bias and underscore the uniqueness of gender for intergroup relations theorists."
Men and women differ in the way they anticipate an unpleasant emotional experience, research finds -- ScienceDaily: "Men and women differ in the way they anticipate an unpleasant emotional experience, which influences the effectiveness with which that experience is committed to memory, according to new research. In the study, supported by a grant from the Wellcome Trust, women showed heightened neural responses in anticipation of negative experiences, but not positive ones. The neural response during anticipation was related to the success of remembering that event in the future. No neural signature was found during anticipation in either positive or negative experiences in men. Dr Giulia Galli, lead author from the UCL Institute of Cognitive Neuroscience said: "When expecting a negative experience, women might have a higher emotional responsiveness than men, indicated by their brain activity. This is likely to then affect how they remember the negative event." "For example, when watching disturbing scenes in films there are often cues before anything 'bad' happens, such as emotive music. This research suggests that the brain activity in women between the cue and the disturbing scene influences how that scene will be remembered. What matters for memory in men instead is mostly the brain activity while watching the scene... This finding might be relevant for psychiatric disorders such as anxiety, in which there is excessive anticipation of future threat and memory is often biased towards negative experiences."
Listener-Blue — feminismisahatemovement: it-goes-both-ways: ...: "...what you may not be aware of is the *reason* women get more afraid than men at horror shows. It’s because women are more prone to *anticipate* and have a negative emotional response to the upcoming terrible event. Don’t hate me. Hate science. “But you’re not answering my question… what does Feminism mean?” I’m getting to that. See, science… when it’s done as science actually finds out some pretty crazy shit. Like did you know that men naturally have almost no bias for other men? “Bullshit!” No, seriously. Men lack (or have an exceedingly small amount) of a trait known as “in-group bias”. Pound for pound men just like women more. They like talking to them, like being around them, like spending time with them and care about them and their well being WILDLY more than they do other men. “Okay, so what? Guys are douchenozzles to other guys? Big fucking deal.”
Except women don’t lack that trait. In fact, women have in group bias in *spades*. Women like women more than they like men. A lot more than they like men. For example, if two people are bleeding… one male and one female.. a woman (and a man actually) will almost always be drawn to help the bleeding female rather than the bleeding male. And this isn’t social conditioning that girls are weak. This trait shows up in children kindergarten age. “You’ve made me sit through all this shit why again?”.
Tie the two together. Tie in group bias with heightened anticipatory fear response. Then give them political power. Meet Feminism.
Or, try this: In Canada abused women get three hundred and fifty million a year in services from the Canadian government for domestic abuse shelters, help, and so forth. Men get $0.00. Remember what I said about men not being overly concerned about the welfare of other men? And how women are hyper concerned about the welfare of other women and themselves, especially in relation to dangers perceived or real? So… okay, an instinctual bias towards a specific kind of public policy. That doesn’t mean the fears aren’t real? No, the fears often are very real… but the *response* to those fears is very often disproportionate to what they’re afraid of. And more importantly, in a group with a primary driving force of in group bias… you *never* see the concern for men that you do for women under any circumstances. It not only doesn’t exist, it never will. It’s why a group of Feminists cheering about women dwarfing the number of men in college isn’t met by anyone with a lot of puzzled looks.
“But alright… so Feminism isn’t so much about equality, but how can you be against helping women and seeing that they have equal rights?” I’m not. “But you’re against Feminism.” Feminism isn’t about equal rights. Feminism is an anticipatory response to a perceived fear that has snowballed since its earliest inception driven by women’s in group bias and men’s lack thereof.
And here’s why I’m Anti-Feminist: Because it shows no sign of slowing. There is no “end" game. There is no “equality" that can be reached for the Feminist. Seriously. ever think about that? At what point do the Feminists pack it up and call it a day? What event could occur that would convince Feminists the “patriarchy has been dismantled" and they could go home? Hint: it will never happen. No event would trigger that. Equality can never be reached for the Feminist… so all the Feminist movement can do is attempt to secure more and more and more power and advantage (which is historically all it has ever done if you’re actually intellectually honest about the whole thing). And that’s dangerous as fuck."
"Maybe, just maybe, men are not broken versions of women."
Listener-Blue — The last post makes me wonder..: "What was on my partner’s shopping list of perfect womanly traits when he interviewed me for the position of possible long term relationship? Was he looking for someone needy and demanding? Someone constantly needing reassurance? Was he looking for someone who can be short-tempered and irrational? Someone who gets irritated by the tiniest thing with no warning? Was he looking for someone who is selfish at times, who often doesn’t put him first but who expects him to put her first all the time? Was he willing to put up with all of this so long as I make the dinner and do his washing? So long as I keep house? So long as I behave like a proper little wifey? You know what - he doesn’t give a fuck about that stuff that men supposedly care about. Hell, I don’t even do it. Not like that. He suffers through all the shit and he doesn’t even get the good stuff?! I don’t even iron his fucking shirts for him? What kind of shit ass wife am I? He must not have read the ‘how to find a perfect wife’ manual that men are apparently given in adolescence. Or maybe, just maybe, men are not the shallow evil pigs these idiots make them out to be. Maybe, just maybe, men are capable of loving someone as a whole, just as women are. Maybe, just maybe, he tolerates my bad points because he thinks my good points outweigh them. Maybe, just maybe, he finds comfort in my company, my humour, my intelligence, my personality. Me. And maybe, just maybe, he feels that the minor inconvenience of my worse traits is overshadowed by the stuff that makes us happy together and makes our relationship work. None of which has any fucking thing to do with my ability to cook or clean or bear children. Maybe, just maybe, men are not broken versions of women. And maybe all these women that think they are should go and fuck themselves. Or maybe…. just maybe… the reason they don’t see it is because these women are just broken versions of men, unable to see anything but what they want in life. Unable to see anything but themselves. These women are unable to properly love a man because their checklist of ‘perfect man’ consists of only one thing - find a man who does exactly what I want him to. Oh shit, wait, I think my internalised misogyny just spilled over."
