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Sunday
Feb212016

RS 153 - Dr. Vinay Prasad on "Why so much of what we 'know' about medicine is wrong"

Release date: February 21, 2016

Vinay Prasad MD, MPH

We like to think of doctors as experts, whose recommendations are backed up by solid evidence. So why does it keep happening that a widely used medical intervention -- like estrogen replacement therapy, or heart stents -- turns out to be useless, or even harmful? This episode features Dr. Vinay Prasad, author of "Ending Medical Reversal: Improving Outcomes, Saving Lives," who talks with Julia about why medical research is so often fatally flawed, and what we can do about it.

Vinay's Pick: "Capital in the Twenty-First Century" by Thomas Piketty

Podcast edited by Brent Silk

 

Full Transcripts 

 

Reader Comments (10)

Thanks for this wonderful episode. My favorite example of a medical practice which has been shown not to work, and has a long lag time before being dropped: Freudian psychiatry.
February 22, 2016 | Unregistered CommenterBrian Lemaire
Good one!

Maybe Dr Prasad will "reverse" his Picketty pick after a little research. That book has serious errors. Here is one refutation of "Capital in the Twenty-First Century". http://philmagness.com/?p=809

Thanks Julia!!
February 22, 2016 | Unregistered CommenterJim
For the love of the FSM, *please* stop using 'double click' nonliterally!!!
February 22, 2016 | Unregistered CommenterXE
Jim wrote:

"maybe Dr Prasad will "reverse" his Picketty pick after a little research. "

The growth in inequality is well-documented from many different sources, so attempts to discredit Piketty don't serve much purpose. Whether the errors noted by Magness are actual errors or are actually serious, I do not know. My guess is that you don't either, you just like the conclusions.
February 22, 2016 | Unregistered CommenterGreg Esres
Greg wrote:

" My guess is that you don't either, you just like the conclusions."

Keep guessing!
February 23, 2016 | Unregistered CommenterJim
Julia

Another excellent program with Vinay Prasad. Medicine, dealing with the quality of life and ultimately with death, draws to it enormous resources both material and human. As a group, our American doctors are the smart kids who undergo a formal training that's as or more demanding than almost any other. I've always loved medical instruments because the culture agrees that they are put to an important use, so the cost of careful design and construction is warranted. They can serve as both a standard and inspiration for equivalents in other endeavors.

Physicians like Prasad, Atul Gawande (New Yorker articles & several books), Siddhartha Mukherjee (Emperor of All Maladies), and Jerome Groopman (How Doctors Think) inform us of the accomplishments and the limitations of science, which help us make more knowing and more deliberate decisions about those medical interventions we seek and those we avoid, and also to apply what we learn about medicine to other areas and activities in which we are interested.

I was amused by Dr. Prasad's selection of Picketty on Capital because Prasad attended the Pritzker School of Medicine at the University of Chicago. I had just looked at the Wiki page on the family. Here's the link> https://en.wikipedia.org/wiki/Pritzker_family. Their gifts are impressive, but if it is not shocking the information about the distribution of the family's retained wealth should be sobering.
February 23, 2016 | Unregistered CommenterBrian Burke
Julia

Another excellent program with Vinay Prasad. Medicine, dealing with the quality of life and ultimately with death, draws to it enormous resources both material and human. As a group, our American doctors are the smart kids who undergo a formal training that's as or more demanding than almost any other. I've always loved medical instruments because the culture agrees that they are put to an important use, so the cost of careful design and construction is warranted. They can serve as both a standard and inspiration for equivalents in other endeavors.

Physicians like Prasad, Atul Gawande (New Yorker articles & several books), Siddhartha Mukherjee (Emperor of All Maladies), and Jerome Groopman (How Doctors Think) inform us of the accomplishments and the limitations of science, which help us make more knowing and more deliberate decisions about those medical interventions we seek and those we avoid, and also to apply what we learn about medicine to other areas and activities in which we are interested.

I was amused by Dr. Prasad's selection of Picketty on Capital because Prasad attended the Pritzker School of Medicine at the University of Chicago. I had just looked at the Wiki page on the family. Here's the link> https://en.wikipedia.org/wiki/Pritzker_family. Their gifts are impressive, but if it is not shocking the information about the distribution of the family's retained wealth should be sobering.
February 23, 2016 | Unregistered CommenterBrian Burke
What a betrayal of the patients and of the Hippocratic Oath, namely "First, do no harm."
I've been harping on this for a while. Had this exchange with Dr. Steven Novella and fellow skeptics in 2009, under a blog post on inductive reasoning.
http://www.skepticblog.org/2009/04/13/inductive-reasoning-in-science/

Max: I often hear how scientists are thrilled when new observations challenge the prevailing theory, because it means they made a new discovery.
But you know who’s not thrilled? Decisionmakers who have already based decisions and policies on the prevailing theory, women who developed breast cancer or heart disease after being placed on hormone replacement therapy, and anyone else with a stake in the prevailing theory.
For example, take safety standards. Last time I checked, there was no evidence that the powerful magnetic fields used in MRI damage tissues, but common sense says that extreme doses of anything are unhealthy. I’m sure that X-rays were deemed safe when first invented. What’s the chance that science is wrong about MRI, and common sense is right? Can you put a number on it?
Given that every scientific theory is a work in progress, at what point is there enough confidence to base major decisions on it? When even the most reductionist discipline of Physics has no clue what 95% of the universe is made of, what hope is there for the study of complex systems like climate, economy, and the human body and mind?

Steven Novella: Max – there will always be uncertainty in medicine. And no data can prove a risk of zero for anything. However, statistics can be used to analyse data and conclude, for example, that there is a probability of X that the risk of a particular negative outcome is smaller than Y. There is a very high probability that any risk from MRI scan is very small.
Also, in medicine we do not deal so much with absolute risk but with relative risk or risk vs benefit.
So to answer your question directly, there is no magic threshold of confidence, but for many question we can say that we have sufficient confidence on which to base policy. Other question are currently unknown or controversial, and there is everything in between.

Max: Dr. Novella, if you know about black swans, then you know my concern. When scientists or economists estimate risks, how can they take into account the possibility of the unexpected? Before black swans were discovered, what was the probability that all swans are white? Even now, what is the probability that there are no green mammals other than the acouchi? Induction says the probability is high. My intuition says it’s low. How much money would you bet on it?
“The Week” magazine had a contest for readers to come up with a headline about a new study that discovered something really obvious.
The winner: “New study finds that most new studies are overturned by future studies.”
February 24, 2016 | Unregistered CommenterMax
Now we're told that GMOs are safe because traditional plant breeding is a sort of genetic modification, and because biochemists are smart and they know what they're doing, so there's no need for clinical trials. Monsanto said, “There are not currently any human clinical trials used to test the safety of GM crops... As long as the introduced gene protein is determined safe and the GM and non-GM crops are alike in all respects, the GM crop is said to be substantially equivalent, or “equal to,” their conventional counterparts and are not expected to pose any health risks. Experts in the field of food safety are satisfied that this approach is sufficient and reliable to assure the GM crops are as safe their conventional counterparts. This expert community does not see a need and thus does not recommend long-term tests in humans in order to establish food safety."
http://www.monsanto.com/newsviews/pages/food-safety.aspx

There's that mechanistic reasoning Dr. Prasad was talking about: Experts understand the chemistry so well, they don't see a need for empirical tests.
February 24, 2016 | Unregistered CommenterMax
Thank you. I've thought about this topic for a long time. It's puzzled me that, for example, tonsillectomies seemed much more common when I was young than they are now. I kept hoping he would mention that specific procedure. But maybe it's in the book. :) Definitely I will check out more of these podcasts.
April 1, 2016 | Unregistered CommenterSteve M

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