“When I tell friends outside medicine that many papers published in medical journals are misleading because of methodological weaknesses they are rightly shocked. ... Why are errors so common? Put simply, much poor research arises because researchers feel compelled for career reasons to carry out research that they are ill equipped to perform, and nobody stops them.” Altman D. (The scandal of poor medical research. BMJ 308, 283-4)

 “We need less research, better research, and research done for the right reasons.“ Altman D. (The scandal of poor medical research. BMJ 308, 283-4)

”Most research in health care is not done by professional researchers, but by health-care practitioners. This is very unusual; agricultural research is not done by farmers, and building research is not done by bricklayers. ... health-care research is often done by people who have little training in how to do it and who have to do their research while, at the same time, carrying on a busy clinical practice. ... When researchers begin to read the research literature in their chosen field, one of the first things they will discover is that knowledge of statistics is essential. There is no skill more ubiquitous in health-care research.“  Bland M, foreword to Peat J, Barton B. Medical statistics: a guide to data analysis and critical appraisal. Blackwell Publishing, BMJ Books, 2005.

Most treatments are not sufficiently effective for you to tell whether or not they work based solely on clinical experience. You need statistical analysis! Consider the question of whether or not to anticoagulate patients with atrial fibrillation and normal heart valves. Such patients are predisposed to emboli. Although anticoagulation with warfarin prevents strokes due to emboli, it can cause serious side effects (bleeding). So what do you do if you have a patient with atrial fibrillation and normal heart valves?

I remember distinctly how Dr. Kanu  Chatterjee, one ofthe greatest  cardiologists to have ever practiced medicine, answered this question in 1987. I was among the medical residents congregated around him at University of California, San Francisco Medical Center waiting for pearls of wisdom. He took a deep breath and said: “What you do is you anticoagulate all your patients with atrial fibrillation until one of them bleeds into his head. Then you don’t anticoagulate any of your patients until one of them has a stroke. Then you go back to anticoagulating all of them.”

Dr. Chatterjee was admitting with an honesty and humility often missing in clinical medicine that it was not clear whether the benefits of anticoagulation out-weighed the risks. He was also capturing the tendency of physicians to base their decisions, in the absence of definitive evidence, on their most recent experience. Fifteen years later, a pooled analysis of six randomized clinical trials demonstrated that anticoagulation with warfarin was superior to aspirin for patients with atrial fibrillation and normal heart valves

Katz M.H.: Study Design and Statistical Analysis A Practical Guide for Clinicians. 2006

“Most of the cheats in science are MDs”  

Linus Pauling, who won the Nobel Prize twice www.whale.to/a/lies_stat_q.html 

Biologists who intend to cheat take cover under ‘biologic variability’ to explain away the lack of reproducibility of an experiment. Scientists in other branches of science do not have this luxury and are therefore more careful to avoid misconduct. (J Acad Ethics (2008) 6:211–228)

“Scientists aren’t saints. Although few falsify results, the field is so competitive that many misbehave in other ways.” Goodstein D. (2002): Scientific Misconduct. Academe: Magazine of the AAUP 88(1) http://www.aaup.org/AAUP/pubsres/academe/2002/JF/Feat/good.htm
“Scientific research is becoming increasingly complex, and it seems that it is no longer possible for many research workers to understand … the principles of experimental design and statistical analysis in addition to their own discipline. … Better training and the establishment of a research environment in which individuals can collaborate with their colleagues and with specialists [i.e. interdisciplinary teams] rather than compete with them should improve the over-all quality of research and result in the better use of scarce research resources.”  Festing M.F.W. Understanding variation.  Scand. J. Lab. Anim. Sci. 1996; 23(1):19-25
“I fully agree with you about the significance and educational value of methodology as well as history and philosophy of science. So many people today - and even professional scientists - seem to me like someone who has seen thousands of trees but has never seen a forest. A knowledge of the historical and philosophical background gives that kind of independence from prejudices of his generation from which most scientists are suffering. This independence created by philosophical insight is - in my opinion - the mark of distinction between a mere artisan or specialist and a real seeker after truth.”   Einstein A. to Thorton R. A., unpublished letter dated Dec. 7, 1944 (EA 6-574). Einstein Archive, Hebrew University, Jerusalem. Quoted in Don Howard, "Albert Einstein as a Philosopher of Science," Physics Today, Dec. 2005 

Sir, I have found you an argument; but I am not obliged to find you an understanding.“  (1784, p. 545, vol. IV, The Life of Samuel Johnson (1791) by James Boswell.)

 

 

 

 

 

 

 

 

 

 


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