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Understanding Medical Research

Some of you may be familiar with MOOCs, massive open online courses. They’ve been around for awhile now and are wonderful for an introduction, and some depth, to learning new things. Coursera is one of the largest and oldest providers of MOOCs. I’ve been using them for years. They’re free, for the most part, with the option to get a certificate from the institution for usually $50.

There are thousands of courses offered by hundreds of institutions including the top schools in the USA and Europe. For example, the last course I did was a finance course taught by Robert Shiller, a Nobel Winner in economics, who has been at Yale for many years. Most of the courses are not very rigorous but if you’re not pursuing a degree, then it’s fine. They basically open the door to a new topic or area which then can lead to further independent study.

With that being said, this morning I got an email for this course

Quite timely, I would say. Seeing as many are at home trying not to climb walls, this would be a nice diversion and an opportunity to learn something of value. There’s no need to pay for it, just select the full course without a certificate of completion. It’s from Yale, so the quality of instruction should be good.

One of the things I like about them is they are self-pacing. I tend to do them quickly, but there’s no need for that. This particular course is 7 weeks long. On average each week takes about 3-4 hours to complete. I’ll be doing this course so I’d be happy to communicate with anyone who decides to do it as well.

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A possibly related article - regarding SARS-CoV-2 antigen and COVID-19 disease research reports.

(Reuters, February 19, 2020):

Speed Science - The risks of swiftly spreading coronavirus research

While speedy scientific analysis is highly useful if it’s good, flawed or misleading science can sow panic and may make a disease epidemic worse by prompting false policy moves or encouraging risky behaviour.

A Reuters analysis found that at least 153 studies - including epidemiological papers, genetic analyses and clinical reports - examining every aspect of the disease, now called COVID-19 - have been posted or published since the start of the outbreak. These involved 675 researchers from around the globe.

One scientific post suggests links between the new coronavirus and HIV, a second says it may have passed to people via snakes, while a third claims it is a pathogen from outer space.

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(STAT, February 3, 2020):

Quick retraction of a faulty coronavirus paper was a good moment for science

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A well known paper about subjects surrounding the veracity of reports (published August 30, 2005):

“Why Most Published Research Findings Are False”, John P. A. Ioannidis

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(Physics Org, July 5, 2018):

Beware those scientific studies - most are wrong, researcher warns

a known but persistent problem in the research world: too few studies have large enough samples to support generalized conclusions. But pressure on researchers, competition between journals and the media’s insatiable appetite for new studies announcing revolutionary breakthroughs has meant such articles continue to be published.

when studies are replicated, they rarely come up with the same results. Only a third of the 100 studies published in three top psychology journals could be successfully replicated in a large 2015 test. Medicine, epidemiology, population science and nutritional studies fare no better, Ioannidis said, when attempts are made to replicate them. “Across biomedical science and beyond, scientists do not get trained sufficiently on statistics and on methodology,” Ioannidis said. Too many studies are based solely on a few individuals, making it difficult to draw wider conclusions because the samplings have so little hope of being representative.

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An excerpted section of seeming (COVID-19 information) relevance from the below-linked article.

(The Atlantic, April 29, 2020):
Why the Coronavirus Is So Confusing -
A guide to making sense of a problem that is now too big for any one person to fully comprehend

Expertise is not just about knowledge, but also about the capacity to spot errors. Ginn couldn’t see them in his own work; Bergstrom could. The rest of us are more likely to fall in the former group than the latter. We hunger for information, but lack the know-how to evaluate it or the sources that provide it. “This is the epistemological crisis of the moment: There’s a lot of expertise around, but fewer tools than ever to distinguish it from everything else,” says Zeynep Tufekci, a sociologist at the University of North Carolina and an Atlantic contributing writer. “Pure credentialism doesn’t always work. People have self-published a lot of terrible pieces on Medium, but some of the best early ones that explained stuff to laypeople were from tech guys.”

Bergstrom agrees that experts shouldn’t be dismissive gatekeepers. “There’s a lot of talent out there, and we need all hands on deck,” he says. For example, David Yu, a hockey analyst, created a tool that shows how predictions from the most influential COVID-19 model in the U.S. have changed over time. “Looking at that thing for … an hour helped me see things I hadn’t seen for 3 weeks,” Bergstrom says.

A lack of expertise becomes problematic when it’s combined with extreme overconfidence, and with society’s tendency to reward projected confidence over humility. “When scientists offer caveats instead of absolutes,” Gralinski says, “that uncertainty we’re trained to acknowledge makes it sound like no one knows what’s going on, and creates opportunities for people who present as skeptics.” Science itself isn’t free from that dynamic, either. Through flawed mechanisms like the Nobel Prize, the scientific world elevates individuals for work that is usually done by teams, and perpetuates the myth of the lone genius. Through attention, the media reward voices that are outspoken but not necessarily correct. Those voices are disproportionately male.

The idea that there are no experts is overly glib. The issue is that modern expertise tends to be deep, but narrow. Even within epidemiology, someone who studies infectious diseases knows more about epidemics than, say, someone who studies nutrition. But pandemics demand both depth and breadth of expertise. To work out if widespread testing is crucial for controlling the pandemic, listen to public-health experts; to work out if widespread testing is possible, listen to supply-chain experts. To determine if antibody tests can tell people if they’re immune to the coronavirus, listen to immunologists; to determine if such testing is actually a good idea, listen to ethicists, anthropologists, and historians of science. No one knows it all, and those who claim to should not be trusted.

In a pandemic, the strongest attractor of trust shouldn’t be confidence, but the recognition of one’s limits, the tendency to point at expertise beyond one’s own, and the willingness to work as part of a whole. “One signature a lot of these armchair epidemiologists have is a grand solution to everything,” Bergstrom says. “Usually we only see that coming from enormous research teams from the best schools, or someone’s basement.”

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Good find…thanks.

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Having worked mostly in smaller groups/companies in my career involved with electronic design - with the latter being an exception, the statement that “enormous research teams” can evidently manage to become every bit as much as misguided as lone wolves makes me chuckle and grin. Mutatis mutandis.

(Or, perhaps), the statement was made in earnest (?) - at which point it might just be my own cynicism. The more that I read it, it seems I (may) initially have misinterpreted the statement’s intended meaning.

So much has already been written about everything that you can’t find out anything about it.
-James Thurber

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(Vox, May 29, 2020):

Scientists are raising questions about a new study suggesting
hydroxychloroquine is deadly -
A growing body of research finds the antimalarial doesn’t help
hospitalized coronavirus patients.

Referenced research paper:

(The Lancet, May 22, 2020):

Hydroxychloroquine or chloroquine with or without a macrolide
for treatment of COVID-19: a multinational registry analysis

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(Science Magazine, June 2, 2020):

A mysterious company’s coronavirus papers in top medical journals
may be unraveling

Today, The Lancet issued an Expression of Concern (EOC) saying “important scientific questions have been raised about data” in the paper and noting that “an independent audit of the provenance and validity of the data has been commissioned by the authors not affiliated with Surgisphere and is ongoing, with results expected very shortly.”

Hours earlier, The New England Journal of Medicine ( NEJM ) issued its own EOC about a second study using Surgisphere data, published on 1 May. The paper reported that taking certain blood pressure drugs including angiotensin-converting enzyme (ACE) inhibitors didn’t appear to increase the risk of death among COVID-19 patients, as some researchers had suggested. (Several studies analyzing other groups of COVID-19 patients support the NEJM results.) “Recently, substantive concerns have been raised about the quality of the information in that database,” an NEJM statement noted. “We have asked the authors to provide evidence that the data are reliable.”

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(The Guardian, June 3, 2020):

Governments and WHO changed Covid-19 policy
based on suspect data from tiny US company

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Are many people using this in the US?

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(JAMA, May 28, 2020):

Some interesting relevant background reported (May 15) by the New York Times: https://www.nytimes.com/2020/05/15/us/politics/teva-antitrust-hydroxychloroquine-settlement.html

Here’s The Guardian’s recent take on some gung-ho (medical degreed) promoters: https://www.theguardian.com/us-news/2020/may/24/hydroxychloroquine-trump-us-doctors-coronavirus

Here is The Washington Post’s (more) recent take on pro-prescribing ephemera: https://www.washingtonpost.com/health/2020/05/29/trump-fueled-promotion-unproved-coronavirus-drug-generated-spike-prescriptions-study-finds

The Hill’s (more) recent take on what they seem to indicate is the current practice: https://thehill.com/changing-america/well-being/prevention-cures/500163-us-hospitals-slash-use-of-hydroxychloroquine-the

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(Vox, June 4, 2020):

A major study on Covid-19 and hydroxychloroquine has been retracted -
There’s little evidence that hydroxychloroquine helps Covid-19 patients,
but there were problems with the study suggesting it’s actively deadly.

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(New York Times, June 1, 2020):

How You Should Read Coronavirus Studies, or Any Science Paper -
Published scientific research, like any piece of writing, is a peculiar literary genre.

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(New York Times, June 15, 2020):

The Pandemic Claims New Victims: Prestigious Medical Journals -
Two major study retractions in one month have left researchers wondering
if the peer review process is broken.

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This has been some time coming. The number of retractions has been steadily climbing for quite some time. As the amount of money has increased, the standards of both scientists and the journals, has decreased. It’s quite sad as it’s becoming more difficult to trust.