Book list! (And medical school advice)
Medical makes a holiday
On October 24, 2010 08:41
Southern net
Summary: Time of professional career much is disclosing Greek doctor John Yaoanidisi the mistake of person of the same trades and deceit. He discovers, the most thing that expresses on medical magazine is misdirect, exaggerated, full of prunes even. So, why are doctors still using these erroneous information in routine?
Time of professional career much is disclosing Greek doctor John Yaoanidisi the mistake of person of the same trades and deceit. He discovers, the most thing that expresses on medical magazine is misdirect, exaggerated, full of prunes even. So, why are doctors still using these erroneous information in routine?
2001, a message is in Greek each hospital travels to come, surgeon to accumulate operation time, a lot of hapless Albanias are emigrant by by accident examine is appendicitis. In Aiaonina the teaching hospital of university college of medical, the Si Aoni of Pallas · tower that just became a doctor is commenting with the colleague this hearsay, after a professor hears their conversation, ask she is willing to confirm whether this hearsay is belonged to solid. She accepted this one challenge, below the help of this professor and other staff, write finally into to study a report formally, the report shows, no matter as a result of what reason, the odds that does not have sicken from the appendix that excises on Albania patient body is 3 times of the patient Greeker. "Find the journal that is willing to publish this report very hard, but we still try to let it be able to publish. " prove later, this investigation is test actually. The professor that to the tower so Si Aoni puts forward that to challenge plans to select young doctor and M.d. composition group, capture a different common and the problem that has controversy sex extremely.
Last year spring, I attended the week regular meeting of this group. Dasiaoni and additionally 8 young Greek student are surrounded sit beside one magnify table, john Yaoanidisi moderates.
An investigator, the biology statistician that is called tall to treat Ya · Sa Landi opens notebook computer and epidiascope, begin to introduce she and a few tasks that the colleague is studying: Whether is pharmacy company operating published research, is the drug that allows them thereby looked like more effective? The data that Sa Landi collects appears to show, fact as expected such. Other group member raised question immediately almost. One person points out, sa Landi‘s research did not consider this be related is solid -- , the research of pharmacy company was not measured the most crucial " hard " result, for instance disease suffers from live and dead scale, dedicated instead at " soft " result, for instance the symptom of subjective description (" my bosom is painful today reduced. " ) another person points out, sa Landi‘s research ignored this fact -- , when the data when pharmacy company shows disease suffers from healthy state to improve it seems that, data often cannot show those who bring to this improves is medicaments.
Sa Landi remain calm, be opposite such interrogation it seems that be accustomed to sth, it is the answer says only, research can‘t confirm all problems. Begin a feeling in me, when the data that medicaments studies has infinite plasticity, professor Yaoanidisi that listens attentively to beside all the time put forward crucial hypothesis: Whether to have this kind is likely, the research task that pharmacy company took care to choose them beforehand -- , for example, the medicaments that takes them and the inferior medicaments on those foregone markets undertake contrast -- , come so, from at the beginning can they ensure be far ahead? "Probably occasionally, jaundiced is not the answer however problem, " he is smiling to say. Everybody is nodding. Although the result of medicaments research often becomes press head, but you must suspect, they can prove what thing really. In fact, considering the numerous and potential question that raises this on the conference, letting person suspicion whether still what medicine studies deserve credit.
This problem accompanies professional career of Yaoanidisi all the time. He has been the world authority of domain of medical research reliability. He and his group again and again, with a variety of different means prooves, the conclusion that investigator of medicine of many living things reachs in publication paper -- , when doctors are opening antibiotic or depressor; When perhaps suggesting the public has fiber to eat the meat less more; Perhaps pass an operation to treat heart disease when their proposal patient or when backache, counts verdict -- , it is exaggerated, misdirect is full of prunes even. He points out even, amounting to the publication medicine information of 90% is wrong. His job gets acknowledgement generally of medical bound; Publish on the top class journal of this domain; He still is the gold-lettered signboard of a lot of seminars. All health that everything what place of the everyone that involves medical field considering his research, doctor does and we hear suggest, yaoanidisi is probable the scientist that is the living the most influential force on the world. And the mistake that he worries about medicine to research a field affects face such extensive, was full of use conflict, will defy reform for a long time probably, reject to admit existence problem publicly even.
Ai Ao Ni Yacheng is town of a college, the distance is great the archaic theater of that bethel and time this fane has only a paragraph short car Cheng. Allegedly, in ancient time, magic power crosses an emperor oak to flamen people the order that transmits them. Today, bethel relics also has an oak to forecast future for tourist. "I always take the learned man that call in to here, they can ask oak a same question almost, " Yaoanidisi says, "‘ my research funds whether get approving? ‘ " to funds clinging the reliability that weakened medical research greatly.
Go up century at the beginning of 90 time, when haing Buddha university holds the position of a researcher, ni Di agreement A this the problem that encountered group of medicine of this indulge in wilful persecution for the first time. At that time, he is interested to the diagnosis of rare disease, because lack data of case of illness, bring about doctors to rely on intuition and experience only. But, he notices, other doctor also relies on same method, even if when facing the common disease such as cancer, heart disease, also be such. Where is the hard data of those diagnostic decisions that can you support them? The research that publishs on the journal is not little, but among them much is very unscientific, mostly the basis observation to a few case of illness. New " evidential foundation medicine " motion begins to accumulate power, yaoanidisi is determined to devote into among them. He is mixed above all Dafusi the famous investigator of the university cooperates, accepted Yaohanhuopujinsi later the position of university and institute of American country sanitation.
Yaoanidisi is having the sth used to one‘s own advantage of unusual: Be in Greek on he is the mathematical talent with famed far and near when high school. His parents also is a doctor. He has an opportunity to rise maths and medical knowledge union now, the field that uses strict statistical analysis method to a flaw 100. "I think at that time, the judgement of doctors basically is right, I need to confirm this one conclusion only, " he says, "What we must do is only systematically reappraise evidence, trust it tells our conclusion, next, all metropolises become perfect. All metropolises become perfect..
But result and his desire is completely contrary. Consulting when medical journal, he discovers what many various conclusion are overthrown by new discovery again later. Of course, of medicine " fluky " be not what secret, make top news even occasionally, for instance, in recent years large research discovery, what examination of mammary X mating plate, colonic lens and antigen determine to be when examination cancer and did not think once upon a time like us is reliable in that way; Again for instance, prozac, zoloft, wait to be fought commonly usedly with Paxil depressed medicine is by the proof below most circumstance and more not more effective than comforting an agent; Again for instance, we just are informed, completely evasive sunshine can increase cancered risk instead; Again for instance, the proposal that waters in great quantities when violent campaign just was discovered the likelihood brings deadly consequence; Again for instance, last year in April, we are informed to take fish oil, campaign again, solve enigma and helpless at resisting senile and gawkish disease. Whether can use mobile phone cause brain tumor? Everyday is Morpheus exceeds 8 hours still ill health benignantly after all? Take A to be able to be Si Pi spirit lengthened after all or shorten everyday life? Whether does art of fixed and hemal rehabilitate compare remedy more conduce to cleared heart blood-vessel jamming? The research conclusion of these problems sufferred the person of the same trade examines research refute.
It is besides these top news, yaoanidisi is more open-eyed study conclusion at the medicine that is overthrown affect the range is so wide. "Contrast randomly experiment " contract disease cent to become two groups, one group takes experiment medicaments, another group is taken comfort an agent, contrast next two groups of results. The conclusion of method of this kind of experiment is considered as the evidence that cannot dispute all the time. But the conclusion that such reaching also is proved to be a mistake occasionally. Yaoanidisi scratch one‘s head over, begin to search these to excogitate complex matter. Before long, he discovers each segment makes mistake possibly: From the query of investigator, to the method that they study, to the choice that disease has, to measurement technique, to the method that analyses data, to the means that presents a result, to the way that research publishs on medical journal, make mistake possibly entirely.
This showed more tremendous, the obstacle of deep administrative levels. Yaoanidisi thinks, he knows the crux of the problem. "These research contain bias, sometimes bias clearly, discover very hard sometimes, but very existence. " investigator people having takinging some kind to expect when beginning a test, result, got expectant result as expected! We think normally, the course that studies scientificly is objective, severe exacting, be callosity even, can distinguish absolutely fact and bogus fact, what even if that is you,expect. But in fact, it is very easy to should affect a result, no matter be in cold blood involuntary still ground. "The each pace of this process has the space of screwy result, " Yaoanidisi says, "Here is put in an interest conflict, it forces investigator to reach the conclusion that is helpful for them obtaining research funds. It forces investigator to reach the conclusion that is helpful for them obtaining research funds..
Only perhaps a few investigator is affected by bias, but the tremendous effect that their screwy conclusion studies to having disproportionate to what publish. To acquire funds and lifelong position, investigator people the article must be published on famous journal, and the disallowance of this kind of advanced journal is led be as high as 90% . Imagine not hard so, those results that capture people eyeball easily often are chosen more easily. But, reach a conspicuous conclusion is not difficult, the test that should allow it to pass a fact is other one thing however. In rigorous research, the data that most person is contradicted is knockdown. Imagine 5 different research groups to test an interesting theory, 4 groups prove this theory is wrong correctly, and not quite rigorous group, erroneously " proof " academic correct. Guess, can your doctor go up in medical journal finally the research result that who reads? Sometimes, investigator can pay close attention to through confutationing a famous discovery is won, this conduces to pair of primitive conclusion raising doubt at least, but, normally, the redound that proves a new point of view is more, after all, the research that proves someone‘s conclusion is unlikely to let you again gets publishing, and refute wide the point of view that gets valued fellow worker may bring deformed consequence.
Go up century 90 time end, yaoanidisi was in Ai Ao Niya university to establish a group, begin to disclose the problem in numerous medicine paper, point out bring about certain research to reach the means of misdirect conclusion. Other investigator also begins to notice the appears often mistake on medical literature. But, yaoanidisi hopes to get a more comprehensive verdict, analyse with solid data, clear logic and perfect statistic for credential. This job postpone again and again, the Xijinuosi that returns Aegean to go up till him isle, over, old academic tradition let him obtain inspiration. He says, "A forever theme in ancient Greek literature is, you must seek the truth, no matter what the truth is. " 2005, he published two challenges medicine to research fundamental thesis.
He chose to be published on PLoS Medical of journal of a network among them. This journal acceptance publishs the article with any argumentation rigorous methods, and do not read conclusion whether " interesting " . In the paper, yaoanidisi proved with mathematical method, technology of slight investigator bias, typical not perfect research, increase the liability that pays attention to interesting theory, this a series of elements are brought about, below most circumstance, investigator can get a wrong verdict.
Say simply, if you by wrong odds greater spot place is attracted; If you hope to prove they are correct; If you are gathering evidence from time to tome the mobile space of little, so your theory probable proof mistake is correct. His mode is fatidical, the field researchs in different medicine, wrong odds and the odds that study conclusion refutes later are identical: The blame of 80% contrasts randomly research is confirmed to be a mistake as a result; Contrast randomly the scale that studies an error is 25% , and scale of mistake of large and random research is 10% . Yaoanidisi points out, investigator for funds and future often operate data analysis, use a person of the same trade to examine even -- , professional journal asks investigator help to judge what research to give publish -- , suppress is contrary viewpoint. Doug Aerteman of director of center of Oxford medicine statistic says, "You can oppugn the detail of a few computation in Yaohanwen, but the radical point of view that refutes him very hard. But the radical point of view that refutes him very hard..
Yaoanidisi estimates, medical scope is potential discover sniff to his: Of course, a lot of doubtful research appear on medical journal, but our investigator and doctors know to ignore them, pay close attention to good thing only, so, what do this have alleged? Another his paper lets this kind of view lose the ground of base oneself upon thoroughly. He analysed the past 13 years li of medicine domain most 49 discovery that suffer admiration. It is according to science two standards of the bound measure a way of course: Study the paper is published on the journal that is cited the most extensively by scientific research article; And itself of these 49 articles also is cited widely in these journals. Be the popularity that these articles brought about method of a few treatment, treat the turn of life to be asked for integratedly with hormonal substitution method for instance; Reduce heart disease risk with vitamin E; Prevent heart disease with coronary artery bracket; Take aspirin to control blood pressure, precaution everyday heart disease and apoplectic. In 49 articles 45 claimed to find effective remedial method, 34 allege therapeutics has gotten confirming. And have 14 among them (41% ) research conclusion is refuted strongly by, its conclusion or be mistake or be by exceeding and exaggerated. If say those who be as high as 41% is wide,the research that gets recognition is proved suspect, so the seriousness of the problem is apparent undeniable. This article of Yaoanidisi is published in " magazine of American medicine society " on.
The research that has a problem apparently is full of authoritative publication, more do not raise common paper. Consider the verdict that dietetics studies the in a steady stream that reach is constant. In these research, investigator undertakes a few years dogging investigating to thousands of person continuously, their food below the record (include health care to taste food) change with health. "Next, investigator begins to quiz, ‘ is vitamin E able what? Where is vitamin C, D and A? Quantity of heat, protein and absorbed change adiposely what to result bring about? What change does cholesterol level have? Who suffers from went up the cancer of which kinds of type? ‘ they pass all questions, begin to discover all sorts of connection, conclude finally -- , the risk that vitamin X can reduce Y cancer, perhaps say some kind of food can reduce the risk that contracts some disease. " this year spring, inside brief a week, following and healthy report appeared on Google news: "Take Oumijia - 3 fatty acid are helpless at heart disease person " : "The person that fruit, vegetable reduces smoking has cancer risk " : "Soja may alleviate the Morpheus problem of senile woman " with etc a few similar news.
The research that is aimed at the by a definite date of 10 thousand person 5 years when discovers, those people that take vitamin X suffer from the danger of Y cancer to reduce, you perhaps can think, this is the good reason that takes more vitamin X. Doctors often also communicate similar proposal to their patient. But, this kind of research often contradicts each other. Whether can vitamin A, D and E prevent cancer? Is edible adipose what effect to have to heart health with carbohydrate? Fat can you cause loss of life after all or lengthen? To these a few problems, all sorts of research get the verdict that gives mutual contradiction repeatedly. In the dietetics discovery that how we contradict in these is the choice made? Yaoanidisi offerred a simple means: Give entirely negligence.
His explanation says, above all, in any large databases that involve a variety of nutrition elements and healthy element, will appear a few clear connection, but in fact they are a kind of accidental coincidence only, and be not real healthy curative effect -- , this resembles combing a chain of the letter that arranges randomly, allege an important information is concealed in the word that appears accidentally. But, although a certain research discovered the true and healthy action of certain nutriment, you gain how many benefit unlikelily also through a large number of taking, because we are absorbed daily,plant by tens of thousands nutriment, they resemble the network of an interaction, change among them some is planted of the element absorb a quantity to be met for certain dimple arises in the network, and they are too complex, far from these institutes can discover. Although changed some kind of element to bring alleged curative effect really, also have very large possibility, the long-term health that it can not give you brings how old profit, because this kind considers to be able to last a few years rarely, see the effect of some kind of element to disease and life truly. They just dog a few health that can measure easily " index " , syrup of cholesterol level, blood pressure, blood is for instance smooth. Healthy expert has confirmed, the change of these index often does not have a relation with long-term and healthy state.
Below unusual situation, study when duration grows to study the object dies, final result often can overturn the conclusion of short-term research. (for instance, although a large number of is opposite fat and individual research will be fat be together with bad healthy connection, but among them the research with the longest duration fails to make proof of ground of person be convinced fat however can shorten life, contrary a few research prove to spend obese person gently to may live longlier it seems that. ) and these problems still eliminated to measure a mistake commonly (for instance people often erroneous report their food) , regular wrong analysis (investigator relies on sophisticated software overly, the kind that these software often cannot understand with them operates result) , still have in addition scarcer but more serious in cold blood con (private investigation discovery, this one phenomenon compares scientists approbatory is more general) .
If, a certain research is evasive afore-mentioned all problems, discovered some kind of thing and long-term and healthy connection really, you still unwarrantable can from which benefit, because study the report is the most terminative,be an average that is a foundation with all research target only if really. Although you belong to those can from which of benefit lucky and individual, the health that also does not expect you appears to be improved apparently, if you have the risk of some kind of disease from inferior become lower how can you experience again get? Yaoanidisi says, "Any useful conclusion survive from inside these research the odds very little that come down. " his gently a word was overruled expend gigantic endowment research, annual and mere it is the United States is thrown in the funds of this respect to reach 100 billion dollar.
Yaoanidisi says, medical research also is same argument. In fact, dietetics research still is not worst. Medicaments research is more impure the corrupt force that economic interest conflicts. Gene and the interesting relation between all sorts of diseases and physiology characteristic ever caused wide attention, even the report says the distance finds the magical treatment that treats all diseases already not far, however these alleged conclusion had been proved flaw 100. Yaoanidisi discovers even, occasionally, although chaos of a collection of illustrative plates of gene of government human body throws a dart,get similar result possibly also. (in recent years, these research appear to be improved somewhat, but the problem that they still still remain whether effectively to discuss after all. ) Vioxx, zelnorm and Baycol are in large and random contrast be decided after the experiment safe and effective, the result is overall finally because invalid or insecure be banned to use.
Yaoanidisi says, "The conclusion of these research often very exaggerative, you do not need to know detail even, can eliminate them immediately. " but, just is these special exaggerated conclusion (large contrast to pray secretly what the experiment proves to come from sealed object even the life that can save heart surgery patient, and another research reachs completely opposite conclusion) help these research be able to be on the journal publish, enter the life of the doctor‘s diagnosis and people finally. "Although evidence shows the conclusion of a certain research is wrong, but if thousands of scientist throws their professional career,go in, they still can continue to publish relevant paper. " Yaoanidisi says, "This is pestilential like, in some sense, they are affected by these wrong think of a way, catch other student through academic journal again next. Catch other student through academic journal again next..
What perhaps a few doctors notice their patient does not resemble expecting to the reaction of certain treatment is good in that way, however, anecdotical evidence obedience became the usual practice of this industry already at considering to discover. More important is, the working effect of doctors never gets examining in authentic research. Yaoanidisi says, wrong therapeutics and healthy information did not cause too serious consequence, main reason depends on, most medicine intervenes and suggest not to involve life-and-death case, the purpose just lets healthy state of the person be improved a little, won‘t let us have huge gains but also won‘t create too big risk. Compile: Eaves
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