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Monicen  2yr ago (doyourownresearch.substack.com)   2751 thread views

Deconstructing Evidence-Based Medicine... from the inside out.

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Man, this would be really bad if there was any evidence at all whatsoever other than one paper about statistics that makes no specific testable claims, and also didn't require the reader to ignore 200 years of history.

There are arguments to be made re. drug getting soft-pedaled in trials vis. effectiveness; believing they are soft-pedaled re. harm requires a level of alternate reality living that is frankly impressive.

I currently hold a similar position wrt. efficacy vs. active harm. The claims of drugs being actively harmful to the population seem like they mostly come from Gøtzsche's work. I do not know whether or by how much he may have exaggerated these claims. In the meantime, here's all the references on harm I could find from this post:

On BIA 10-2474:

Butler, D., & Callaway, E. (2016, January 21). Scientists in the dark after French clinical trial proves fatal. Nature, 529(7586), 263–264. https://doi.org/10.1038/nature.2016.19189

On fialuridine:

Honkoop, P. Scholte, H. R., de Man, R. A., & Schalm, S. W. (1997). Mitochondrial injury: Lessons from the fialuridine trial. Drug Safety, 17(1), 1–7. https://doi.org/10.2165/00002018-199717010-00001

On TGN1412:

Attarwala, H. (2010). TGN1412: From discovery to disaster. Journal of Young Pharmacists, 2(3), 332–336. https://doi.org/10.4103/0975-1483.66810

Wadman, M. (2006, March 23). London's disastrous drug trial has serious side effects for research. Nature, 440(7083), 388–389. https://doi.org/10.1038/440388a

The bulk of Peter C. Gøtzsche's claims (which probably contain several more references):

Gøtzsche, P. C. (2013). Deadly medicines and organized crime: How big pharma has corrupted healthcare. CRC Press. https://doi.org/10.1201/9780429084034

I have personal reasons to distrust the medical establishment, but trying to read this subject article is difficult. Can you summarize the thrust of the argument?

As I understand it, the main idea is that the (U.S.) pharmaceutical industry has been covering up hundreds of thousands of deaths and other adverse effects in their drug trials, using bogus statistical analysis to fool everyone about the efficacy of their drugs, and colluding with government agencies to disallow any alternatives. Thus, we should be immensely distrustful of any and all "evidence-based" medical information, and we should spread this idea in order to convince people to rebuild the medical establishment from the ground up. (I don't personally endorse this argument.)

I don't follow him that closely so maybe he has, but I haven't seen Marinos himself make anywhere near so strong a claim as "covering up hundreds of thousands of deaths, using bogus statistical analysis to fool everyone".

I think his thesis in all this has been "if you judge many accepted findings by the same standards by which plausibly-for-other-reasons-disfavored findings have been dismissed, a lot of it wouldn't hold up".

ie Beware Isolated Demand For Rigor

I don't follow him that closely so maybe he has, but I haven't seen Marinos himself make anywhere near so strong a claim as "covering up hundreds of thousands of deaths, using bogus statistical analysis to fool everyone".

Reading this post, it would appear that Marinos is trying to endorse this viewpoint. He uncritically refers to Gøtzsche "explaining how prescription drugs are the third leading cause of death", which would add up to hundreds of thousands of deaths annually when applied to mainstream leading-cause-of-death tables. Marinos doesn't really add much additional analysis in this post, likely because it was adapted from a Twitter thread. Also, Marinos quotes an author that blames "evidence-based medicine" practitioners for propagating lies that line the pharmaceutical industry's pockets, and he himself blames government agencies for making policy decisions based on "evidence-based medicine" during the COVID-19 pandemic; I'd assume that the pharmacetical companies (and those colluding with them) are to be interpreted as the ultimate liars. Marinos only seems to back off slightly from the accusations in his conclusion.

So Ivermectin Guy is basing his rant on one single source who seems to be an axe-grinder about the medical profession, mostly because it fits in with his biases about Big Pharma and Big Medicine hiding, downplaying or lying about the efficacy of the Miracle Covid Cure Ivermectin?

Colour me surprised at the methodology on display here.

The claims of hidden deaths in particular seem to come entirely from Gøtzsche. The rest of the sources mainly discuss the replication crisis in medical efficacy, alongside their various preferred solutions. Marinos blames the authorities and medical profession for making decisions based on flawed research to further their own ends, against the interest of the public. Personally, I think that Marinos takes his claims of conspiracy much farther than the evidence would justify; if a reader holds Scott's evaluation of orthodox medical information as generally trustworthy (modulo regulatory friction preventing effective drugs from being sold and preventing promising drugs from being tested, and new drugs' efficacy relative to their predecessors being oversold), this post in particular isn't going to change their mind, since beyond the standard replication-crisis stuff it's mostly an appeal to heterodox authorities such as Gøtzsche and Charlton.

Hmm yeah. Problem with advanced statistics is that it's so hard to tell who's bullshitting and who isn't.

As they say, there are three types of liars. Liars, damn liars, and statisticians.

I don't think any amount of statistics would allow for fraud on that scale. At that point, you're either throwing out data as it's being collected, or completely fabricating it when you go to do the analysis.

You call yourself a "rat", so take the beam out of your own eye first. "Rat" as a 'cutesy' nickname for "rationalists" isn't cute, funny or clever. Adopt a less insulting moniker (because the general usage of calling someone a "rat" is meant to be insulting and derogatory) and then come back to finger-wag about "name calling".

  • -13

This seems unnecessarily antagonistic, please don't do this.

I love rationalists and rationalism and use the term rat affectionately. To each their own.

I’d prefer not to give more views to this substack, so is there anyone who can confirm the number of digs at Scott? My bet’s on 2-3.

Zero, unless there's something extremely subtle that I missed. I'd say Scott would agree with this one for the most part.

Thanks. Consider me chastened.

Zero. Scott wasn't mentioned.

Seriously? Ivermectin Guy once again? This is your second time posting something from/about him. Either you are his biggest fan, or you are him operating a sock-puppet account.

biggest fan

My first gut reaction whenever I encounter him after having not for a while is "this guy's so fucking annoying, just stop", and the degree to which I ever read any further is out of a desire to see him slip up badly enough I can dismiss him altogether or see him definitively put in his place by someone who clearly knows better.

The problem is I haven't seen that yet.

Here's hoping I don't get so entangled this or any time that I can't return to not paying attention. There's enough other and more consequential shit where the same general dynamic that his claims point towards is ruining everything, that it would already be several full time jobs' worth of time and misery to attempt to follow it all.

But yes, unless he's been properly owned and continued anyway in purely ego-driven contrarianism-poisoned bad faith, god bless him for not dropping it despite it making him This Fucking Guy? Again?

Scott Enjoyers having a normal one today, I see.

Can't expect anything else when their sacred cow is attacked.

This would explain the total catastrophe of Western medicine as seen by almost everyone with eyes in the last two years.

everyone with eyes

Please refrain from consensus-building language. If you see a shit-show, tell us what you see! But don't insist that only the blind could disagree.

Is there anyone arguing that the last two years was NOT a "shit show"?

I thought pretty much everyone agreed that it was indeed a shitshow, but that the specifics were still being debated. (Happy to be shown I am wrong. Please point me to the person who thinks the pandemic went off in an exceedingly well-ordered manner.)

Otherwise, are you not moderating for an imaginary hypothetical person?

Secondarily, it's a fairly common phrase. You don't really think I was trying to build a consensus, do you? (I wasn't.)

For my own clarification, is it "consensus-building" idioms and expressions that are outlawed, or actual consensus building?

For my own clarification, is it "consensus-building" idioms and expressions that are outlawed, or actual consensus building?

What do you think the difference is, in a text-only medium? If you say words to the effect of "everyone knows" or "everyone agrees," you're almost certainly literally wrong. But if we let everyone get away with saying things that are literally wrong on grounds that "we know what they meant," this creates a bailey in which people can make very strong claims ("everyone with eyes agrees with me") but, when challenged, can retreat to innocuous claims ("it's just an idiom, besides, even if everyone disagrees about the specifics, they at least agree on the general point, I wasn't saying anything controversial!").

This place is called the Motte because we don't want you playing in the bailey.

So either you understand what I'm saying, and you realize that you've been caught with your hand in the cookie jar, and you're going to do better--or, you're still confused, in which case I would tell you, personally, to avoid "consensus-building" idioms, because you do not use them sufficiently artfully to prevent people from thinking you are actually consensus-building.

Reminds me of people who get offended on behalf of a hypothetical person who might theoretically be offended.

"Everyone agrees the Holocaust was bad."

Mod: "Please refrain from consensus building."

This forum is way over moderated. I'm going back to Reddit.

This forum is way over moderated. I'm going back to Reddit.

Thanks for letting us know. Stay safe out there!

You wouldn't have used the phrase if you truly thought that everyone agreed.

Thank you! Exactly.

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