17 October 2010

Science, the public and medicine

Sandwalk alerts his readers to the following video which is plugging an ID work:

Actually, I agree with much of the beginning of the video; a evolution, as scientists understand it, precludes a directed process by which a deity could intentionally create beings designed to worship it. The people in this video clearly don’t understand this process and end up making ridiculous statements toward the end…and no, that evolution happened in more or less the way that scientists say that it did is accepted science.

Sandwalk points us to yet another article in which a non-scientists expresses hurt feelings over the fact that scientists don’t take their criticisms seriously. Yes, non-scientists can criticize all they want, but they have no right to be taken seriously. It would help if they got the science right prior to making their criticisms.

Nature
If you’ve seen one tree, you’ve seen them all. Maybe not. Seriously, surf to this article to see some awesome variety of trees; here is but one to tease you:

Medicine
Here is a case study that highlights:
1. Why diagnosis is so darned hard
2. Why what you did years ago can come back to haunt you today
3. How the body can keep a fungus at bay for decades only to fall prey to it when the defenses go down.

I simply love the the Vital Signs feature in Discover Magazine. In the November 2010 issue there is an article called Reckless Medicine (by Jeanne Lenzer and Shannon Brownlee which talks about how science is often NOT used in medicine.

Along the same lines is this article:

[...]Last spring, I sat in on one of the team’s weekly meetings on the medical school’s campus, which is plunked crazily across a series of sharp hills. The building in which we met, like most at the school, had the look of a barracks and was festooned with political graffiti. But the group convened in a spacious conference room that would have been at home at a Silicon Valley start-up. Sprawled around a large table were Tatsioni and eight other youngish Greek researchers and physicians who, in contrast to the pasty younger staff frequently seen in U.S. hospitals, looked like the casually glamorous cast of a television medical drama. The professor, a dapper and soft-spoken man named John Ioannidis, loosely presided.

One of the researchers, a biostatistician named Georgia Salanti, fired up a laptop and projector and started to take the group through a study she and a few colleagues were completing that asked this question: were drug companies manipulating published research to make their drugs look good? Salanti ticked off data that seemed to indicate they were, but the other team members almost immediately started interrupting. One noted that Salanti’s study didn’t address the fact that drug-company research wasn’t measuring critically important “hard” outcomes for patients, such as survival versus death, and instead tended to measure “softer” outcomes, such as self-reported symptoms (“my chest doesn’t hurt as much today”). Another pointed out that Salanti’s study ignored the fact that when drug-company data seemed to show patients’ health improving, the data often failed to show that the drug was responsible, or that the improvement was more than marginal.

Salanti remained poised, as if the grilling were par for the course, and gamely acknowledged that the suggestions were all good—but a single study can’t prove everything, she said. Just as I was getting the sense that the data in drug studies were endlessly malleable, Ioannidis, who had mostly been listening, delivered what felt like a coup de grâce: wasn’t it possible, he asked, that drug companies were carefully selecting the topics of their studies—for example, comparing their new drugs against those already known to be inferior to others on the market—so that they were ahead of the game even before the data juggling began? “Maybe sometimes it’s the questions that are biased, not the answers,” he said, flashing a friendly smile. Everyone nodded. Though the results of drug studies often make newspaper headlines, you have to wonder whether they prove anything at all. Indeed, given the breadth of the potential problems raised at the meeting, can any medical-research studies be trusted? [...]

To get funding and tenured positions, and often merely to stay afloat, researchers have to get their work published in well-regarded journals, where rejection rates can climb above 90 percent. Not surprisingly, the studies that tend to make the grade are those with eye-catching findings. But while coming up with eye-catching theories is relatively easy, getting reality to bear them out is another matter. The great majority collapse under the weight of contradictory data when studied rigorously. Imagine, though, that five different research teams test an interesting theory that’s making the rounds, and four of the groups correctly prove the idea false, while the one less cautious group incorrectly “proves” it true through some combination of error, fluke, and clever selection of data. Guess whose findings your doctor ends up reading about in the journal, and you end up hearing about on the evening news? Researchers can sometimes win attention by refuting a prominent finding, which can help to at least raise doubts about results, but in general it is far more rewarding to add a new insight or exciting-sounding twist to existing research than to retest its basic premises—after all, simply re-proving someone else’s results is unlikely to get you published, and attempting to undermine the work of respected colleagues can have ugly professional repercussions. [...]

Now I am NOT going to say that such research is worthless but there are some problems.
Here are some statistical problems:
1. Confidence intervals are often set at 95 percent. This means that right off the bat, 5 percent of the studies will “show” an effect that really isn’t there.
2. People often don’t understand what the studies say. Here is but one example: (from the November 2010 Discovery Article “Reckless Medicine”):

For example, when an ad for the anticholesterol drug Lipitor trumpets a one third reduction in the risk of heart attack or stroke, that is a relative risk, devoid of meaning without context. Only by knowing how many patients have to be treated to achieve a given benefit and how many will be harmed can doctors determine whether they are doing their patients any good….[...] in the best-case scenario, 50 men at risk for a heart attack would have to be treated with statins like Lipitor for five years to prevent a single heart attack or stroke.

In other words, 98 percent of these men would receive no benefit at all (but which ones?)

If this seems strange, consider the data presented in another way: if I could find a drug that would cut my risk of a heart attack by one third, should I take it? Well, “it depends”: according to an online calculator, I have about a 3 percent chance of getting a heart attack (or dying from from heart disease in the last 10 years) and this medicine would reduce it to 2 percent. Well, what side effects would this drug have? On the other hand, if someone has a 30 percent chance, a 1/3 reduction of risk could be substantial and perhaps worth the risk of side effects.

Religions and atheism

How outspoken should atheists be? I see no reason why we shouldn’t challenge widely held but unsupportable ideas. But remember that, in general, people deserve respect even if their ideas don’t. I know that I sometimes forget this.

Politics

The tea party people often conflate the Constitution with their own ideas on how America should be:

[...] But near the end she veered into stranger—and more revealing—territory. O’Donnell once told voters that her “No. 1” qualification for the Senate is an eight-day course she took at a conservative think tank in 2002. Now she was revisiting its subject: the Constitution.

The Founders’ masterpiece, O’Donnell said, isn’t just a legal document; it’s a “covenant” based on “divine principles.” For decades, she continued, the agents of “anti-Americanism” who dominate “the D.C. cocktail crowd” have disrespected the hallowed document. But now, finally, in the “darker days” of the Obama administration, “the Constitution is making a comeback.” Like the “chosen people of Israel,” who “cycle[d] through periods of blessing and suffering,” the Tea Party has rediscovered America’s version of “the Hebrew Scriptures” and led the country into “a season of constitutional repentance.” Going forward, O’Donnell declared, Republicans must champion the “American values” enshrined in our sacred text. “There are more of us than there are of them,” she concluded.
[...]

There is much more there.

On the whole, Americans are remarkably uninformed:

Economy: Paul Krugman points out that this current government is NOT a big spending government; the problem is more with the fact that we are underperforming with respect to what our GDP should be.

2010 election It appears that the expected value of the number of expected House pickups by the Republicans is 50; but the confidence interval is very, very wide. In other words, there is a ton of variance in the expected value (either way).