I took a look at your pastebin post. There are a lot of criticisms there of various kinds of bad practices, but not all of them have anything to do with whether the medicines actually work. For instance, the patent issue; while that's a fair issue in its own right, whether large pharmaceutical companies can prevent people from making generic equivalents by using patents does not affect whether the drug works or not. Or direct to consumer advertising; again, it may be a bad idea, but it doesn't have anything to do with whether the drugs actually work.
Many of the other criticisms here are fairly hypothetical. Yes, there are places where the system isn't ideal, where there's potential for the wrong incentives. There are places where it would be nice to do research that covered a broader spectrum. But that doesn't mean that it's all invalid. We live in an imperfect world. We should try to fight those cases when we can, try to get better results, but you shouldn't write off the entire industry merely because it's imperfect.
Here's another example. In the software industry, I see bad practices all the time. People not writing unit tests, not doing full regression tests, writing sloppy code that doesn't handle all of the error conditions, and so on. And yet, somehow, we manage to get by. Software generally works, it does what it says, it improves whatever it was setting out to improve. Sure, there are some big expensive failures you can point to. Sure, it would be nice if we did a better job at this, and should try to continue to fight for higher quality software. But just because there is some software imperfectly written doesn't mean that you should just write off the software industry.
> But does SBM actually address any of the criticism? Not a single point of it, because there is no defense; in fact, it's all coming from high-level 'insiders' in the medical community -- JAMA, NEJM, the IOM, etc.
Really? I just decided to take a look at SBM; I wasn't familiar with it before this thread, but decided to take a look at it. Here's an article on reducing prescriptions for elderly patients, because they may do more harm than good: http://www.sciencebasedmedicine.org/index.php/how-do-we-avoi... (addressing one of your concerns about differences in how medications effect the elderly). Or here's an example where they do address one of the concerns that you mention; they demonstrate that doctors actually are more skeptical of research funded by the pharmaceutical industry: http://www.sciencebasedmedicine.org/index.php/news-flash-doc....
> Instead they just spin it in order to trick people who are predisposed to have faith in modern medicine. (And I use the term faith, because if you're familiar with these issues then it's unmistakably clear that this is really what it is.)
You know, I do tend to be skeptical of pharmaceutical remedies, and so try to minimize them myself. But to say that you have to have faith to buy into modern medicine is a bit of a stretch. How do you explain ever increasing life expectancies? Clearly, there is something going right in modern medicine.
> What science-based medicine does (again, the blog, not the concept) is really no different than what the evangelical megachurches do, it's just dressed up in different language.
Citing actual scientific studies, which may be flawed in certain ways, is the same as merely preaching mythology from a 2000 year old book based on no science whatsoever? Remember, "science" is not some binary thing, where if there's one flaw, it's all false. It's a process, by which we attempt to come up with better models of the world, and try to reduce bias in the process. Sometimes there will still be some bias; you won't necessarily be able to eliminate it all. But that doesn't mean it's worthless.
There are definitely a lot of ways in which I wish that pharmaceutical research would be improved; but the fact that there are people now who are living perfectly normal lives while HIV positive with anti-retroviral therapies, when just 10 or 20 years ago they would have died of the same disease, leads me to believe that it's not all bad. I wish those drugs were cheaper, that they weren't so tied up with patents, and so on; but you know, I wish I had a pony too. To equate the research and development that went into such life-saving measures as equivalent to an evangelical megachurch is quite frankly ridiculous.
"not all of them have anything to do with whether the medicines actually work."
That's because in general I'm only interested in systemic problems, not specific case studies. There are entire books written about just anti-depressants, or statins, or whatever, which you can easily find on Amazon.
"How do you explain ever increasing life expectancies?"
Of the 30-year increase in life expectancy over the last 100 years, 25 years has come from better public health (e.g. sanitation), and another 1.5 years has come from preventive care like vaccination.
Source: Bunker JP, Frazier HS, Mosteller F. Improving health: measuring effects of medical care. Milbank Quarterly 1994;72:225-58.
lambda asked the same question I had, which is, simply: what is the point you're trying to make? You're making a lot of side comments about minor points, but I'm not sure what your thesis is.
> That's because in general I'm only interested in systemic problems, not specific case studies. There are entire books written about just anti-depressants, or statins, or whatever, which you can easily find on Amazon.
What is the point that you are trying to prove? Are you merely trying to demonstrate that there are certain systemic problems? If so, then congrats, you've won, there are some systemic problems. I don't think there has ever been a wide-scale system involving humans that hasn't had a certain amount of cheating, lying, corruption, and the like. If someone tried to claim to me that there was an entire multi-trillion dollar industry that did not involve some amount of cheating, lying, and corruption, I would laugh in their face.
Are you trying to argue that the pharmaceutical industry has a net negative value; that it it something that causes more harm than good? Because that's going to be a lot harder to prove, and a bunch of little anecdotes does not make a good argument.
You seem to be fairly concerned with certain people, who discuss science based medicine, and say that they are corrupt because they advocate for modern pharmaceuticals and criticize certain alternative medicine. Your evidence seems to be that they do not talk about all of the corruption and problems that you would like them to talk about. Do you have anything more than that?
> Of the 30-year increase in life expectancy over the last 100 years, 25 years has come from better public health (e.g. sanitation), and another 1.5 years has come from preventive care like vaccination.
>
> Source: Bunker JP, Frazier HS, Mosteller F. Improving health: measuring effects of medical care. Milbank Quarterly 1994;72:225-58.
Hmm. That's an 18 year old source, talking about life expectancy, which is a trailing indicator. So, 25 years of life expectancy from better public health (like sanitation and nutrition) is an amazing thing. And you say that 1.5 years come from preventative care like vaccination, and dismiss the other 3.5 years. Now, 3.5 years may not sound like much out of about 75. But think about it for a bit. 3.5 years is averaged across the whole population. Not everyone has a condition that is treatable; many people die of old age, accidents, murder, suicide, and things that modern medicine has not yet made much progress in. Those 3.5 years don't really affect any of those folks. So lets say that 1 in 10 people have a treatable condition (I'm pulling this number out of my ass, by the way; this is just a hypothetical, and the numbers may differ, in which case you would scale the reasoning appropriately). That means that those 1 in 10 people have gained 35 years of their life from medicine. Look around at your family and closest friends. How much would you trade for 35 more years with one of them?
So, you are discounting 18 years of medical progress, as well as treating a few years of life expectancy gained as no big deal. And of course, any talk of life expectancy also ignores quality of life issues; curing something that would have been crippling but not deadly doesn't substantially affect life expectancy, but does affect quality of life.
It sounds like you are trying to argue against the value of modern medicine, which is going to be a tough thing to convince people of, given all of the demonstrable benefits it has. I can understand discussing specific criticisms, and trying to figure out how we can improve it, and that saying "all medicine is scientific progress and is great" is fallacious, but trying to prove that modern medicine has a net negative value because of a few issues of systemic corruption is not the way to do it.
I was arguing against the following statement: "But it's an exaggeration [...] to say that the enterprises that develop new drugs for prescribed medical treatment are corrupt in general beyond what Goldacre claims with specific evidence."
Or, more generally, reminding people why it is that our infrastructure is falling apart and why the federal government is at risk of collapse in the next few years, which are both in large part due to the massive amounts of fraud in the medical system. At least a third of all medical spending is waste and fraud, and that's not even counting the damages from all the needless harm it inflicts on people. Even just fixing some of the low-hanging fruit would leave us with enough money to provide healthcare to all Americans, as well as build an entire nationwide highspeed rail network every single year.
> Your evidence seems to be that they do not talk about all of the corruption and problems that you would like them to talk about.
It's mostly the intellectual dishonesty in virtually every single post that bothers me. The entire point of the blog is to 'prove' that alternative medicine is inferior to mainstream medicine because it isn't supported by science. They do this by looking at all the ways alternative medicine isn't supported by science, while completely sweeping under the rug all of the ways that mainstream medicine isn't supported by science. My concern isn't that the authors aren't mentioning specific issues, but rather that they're going out of their way to mislead their readers about the issues and the state of medicine more generally.
> That's an 18 year old source, talking about life expectancy, which is a trailing indicator.
It's the most recent data available. The fact that a lot of the data about the medical system is 20+ years old is in fact one of the biggest problems.
Also, I'm not in any way dismissing the contributions of modern medicine. As you say, modern medicine has contributed an enormous amount to society. Which makes it all the more unfortunate that many of its most vocal supporters wildly exaggerate its benefits and stick their heads in the sand when confronted with its problems. Making an intellectually honest argument in favor of modern medicine has to be one of the easiest tasks in the world, so the fact that so many of its supporters can't even do this doesn't say much for the quality of their ideas.
> Trying to prove that modern medicine has a net negative value because of a few issues of systemic corruption is not the way to do it.
I'm not trying to prove that it has net negative value. However, it's definitely not just a 'few' issues with systemic corruption.
I'm a little unclear on what point you're trying to make here. Can you clarify?
> I mean look at my pastebin post: http://pastebin.com/cniysd82
I took a look at your pastebin post. There are a lot of criticisms there of various kinds of bad practices, but not all of them have anything to do with whether the medicines actually work. For instance, the patent issue; while that's a fair issue in its own right, whether large pharmaceutical companies can prevent people from making generic equivalents by using patents does not affect whether the drug works or not. Or direct to consumer advertising; again, it may be a bad idea, but it doesn't have anything to do with whether the drugs actually work.
Many of the other criticisms here are fairly hypothetical. Yes, there are places where the system isn't ideal, where there's potential for the wrong incentives. There are places where it would be nice to do research that covered a broader spectrum. But that doesn't mean that it's all invalid. We live in an imperfect world. We should try to fight those cases when we can, try to get better results, but you shouldn't write off the entire industry merely because it's imperfect.
Here's another example. In the software industry, I see bad practices all the time. People not writing unit tests, not doing full regression tests, writing sloppy code that doesn't handle all of the error conditions, and so on. And yet, somehow, we manage to get by. Software generally works, it does what it says, it improves whatever it was setting out to improve. Sure, there are some big expensive failures you can point to. Sure, it would be nice if we did a better job at this, and should try to continue to fight for higher quality software. But just because there is some software imperfectly written doesn't mean that you should just write off the software industry.
> But does SBM actually address any of the criticism? Not a single point of it, because there is no defense; in fact, it's all coming from high-level 'insiders' in the medical community -- JAMA, NEJM, the IOM, etc.
Really? I just decided to take a look at SBM; I wasn't familiar with it before this thread, but decided to take a look at it. Here's an article on reducing prescriptions for elderly patients, because they may do more harm than good: http://www.sciencebasedmedicine.org/index.php/how-do-we-avoi... (addressing one of your concerns about differences in how medications effect the elderly). Or here's an example where they do address one of the concerns that you mention; they demonstrate that doctors actually are more skeptical of research funded by the pharmaceutical industry: http://www.sciencebasedmedicine.org/index.php/news-flash-doc....
> Instead they just spin it in order to trick people who are predisposed to have faith in modern medicine. (And I use the term faith, because if you're familiar with these issues then it's unmistakably clear that this is really what it is.)
You know, I do tend to be skeptical of pharmaceutical remedies, and so try to minimize them myself. But to say that you have to have faith to buy into modern medicine is a bit of a stretch. How do you explain ever increasing life expectancies? Clearly, there is something going right in modern medicine.
> What science-based medicine does (again, the blog, not the concept) is really no different than what the evangelical megachurches do, it's just dressed up in different language.
Citing actual scientific studies, which may be flawed in certain ways, is the same as merely preaching mythology from a 2000 year old book based on no science whatsoever? Remember, "science" is not some binary thing, where if there's one flaw, it's all false. It's a process, by which we attempt to come up with better models of the world, and try to reduce bias in the process. Sometimes there will still be some bias; you won't necessarily be able to eliminate it all. But that doesn't mean it's worthless.
There are definitely a lot of ways in which I wish that pharmaceutical research would be improved; but the fact that there are people now who are living perfectly normal lives while HIV positive with anti-retroviral therapies, when just 10 or 20 years ago they would have died of the same disease, leads me to believe that it's not all bad. I wish those drugs were cheaper, that they weren't so tied up with patents, and so on; but you know, I wish I had a pony too. To equate the research and development that went into such life-saving measures as equivalent to an evangelical megachurch is quite frankly ridiculous.