Evidence based medicine? Is there another kind? In response to Vinay Prasad's "Evidence based medicine: misunderstood and in decline" ...
Heard of evidence based aeronautics or electronics?
As an outsider to medicine, one of the most shocking discoveries for me was how little of medical practice is based on understanding disease mechanisms.
Medical researchers squandered billions and decades on research but admit they are still completely ignorant about the root cause of asthma, autism, autoimmunity, allergies or even COVID severity. One of the reasons is them ignoring mechanistic studies and focusing almost completely on association/correlation based epidemiological studies. One of the explanations offered is that the human body is complex. But the problem is researchers have been ignoring mechanisms that have been known for 50-100 years. Applying those mechanisms, determining root cause of asthma, autism, autoimmunity, allergies or even COVID severity is easy.
Vinay Prasad wrote:
Prasad writes:
if RCTs are available, EBM will prioritize those results
Randomized Controlled Trials (RCT) are used in “Evidence based medicine (EBM)”. RCTs do not require the investigators to understand drug/disease mechanisms.
It is very easy to fool RCT enthusiasts like Vinay Prasad who BLINDLY trust RCTs. Bill Gates and Pharma corrupted researchers have repeatedly demonstrated that with ivermectin and hydroxychloroquine (HCQ) studies. In HCQ trials, they used near fatal HCQ doses to kill seriously ill patients in the trial. This made HCQ look dangerous/ineffective. For ivermectin, they delayed the medicine until a median of 5 days after symptom onset thus defeating the idea of early treatment.
Table.1
Pfizer’s fraudulent mRNA vaccine RCT is in court.
In all cases, they successfully fooled Vinay Prasad and most others.
even smart doctors can be mislead by lower levels of evidence.
Describes himself.
‘cuz physics.’
Prasad needs to understand that physics is more important than RCTs. Very difficult to cook physics. Easy to cook RCTs as repeatedly demonstrated.
With the 737 MAX, Boeing and the FAA tried to cook physics. They were quickly caught as they killed 346 people.
A new generation of doctors has entered the scene, and they have hopelessly confused advocacy and evidence. Huge belief structures in their mind know the ‘right’ thing to do, even when there is no evidence at all.
Quacks.
The battles over masking
Physics dictates that masks can help a little. They can filter large particles/droplets. But mainly they impede free airflow. So even CO2 accumulates behind a mask. If it can impede CO2 flow, it can impede viruses, aerosols. But Prasad cites RCTs to claim masks are useless. None of these RCTs required eye protection. So even if the masks worked 100%, people can get infected through their eyes. This is like concluding front door locks do not prevent burglaries because the back doors were left open in the RCT.
So masks+eye protection, used VOLUNTARILY (ABSOLUTELY NO MANDATES), for short periods of time (while say caring for the infected), may offer protection. Long term use is unhealthy due to CO2 accumulation as Del Bigtree demonstrated.
Physics beats RCT.
So EBM has nothing to do with real evidence and is just more Pharma, Bill Gates corrupted tobacco science that maims and kills.
Yes, when I attempted to teach Chemistry to medical students I found they were good at rote learning but in general had disappointing IQ and deductive reasoning skills. I saved the life of one young aspiring medico when she approached a flask of ether with a Bunsen Burner.
Notre Dame University started admitting first year students into my Chemistry and Physics classes with zero high school qualifications so they could charge huge fees to students hoping to take a fast route to Medicine. Too many Epidemiologists and not enough Single Cell Scientists these days.
They both matter. Mechanisms can be misleading too. Example:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9282120/
Masks could catch aerosols, evaporate the water, and make viruses effecitvely smaller and easier to breath deep into the lungs. And while masks may reduce inhalation of aerosols, they may also reduce exhalation of aerosols. So mechanisms are not a clear face mask argument to me. Humidification is another potential beneficial mechanism. The main potential benefit of masks is not reduction in infection, but reduction in severity, but reducing initial viral dose. This was never tested, and not even suggested by mask promoters, which is pathetic and just shows how disconnected discussion is. They missed their best argument.
In other words, there is always the possibility to realize something about mechanisms we did not think about before. And it's not like gravity. It's interactions with biological systems and there will always be things we don't expect.
Another physics speculation: The better your filter material, the harder it is to breathe through, the more air is thus redirected along poorly fitted edges. A paradoxical effect.
Vinay is far better than most, but he does need to get woke about a lot still.