Monday, 20 November 2017

The fallibility of scientists

Nature has echoed the professional debate about the intrinsic quality of scientists’ work, in a dynamics of self-criticism comparable to what is taking place, in similar terms, in the clinical world. Scientists are also fallible, says the article writer and therefore, should enhance the mechanisms of self-criticism, rather than enrol in self-deception.

John Ioannidis, Meta-Research Innovation Center at Stanford, says scientists should work harder to understand the biases of their human fallibility if they want to overcome the crisis of confidence generated by the poor reproducibility of research results. And to illustrate his words, Ioannidis offers three examples: a) from a selection of one hundred psychology studies, only the results of just over a third of the work could be replicated, b) a group of Amgen researchers only succeeded in reproducing 6 of the results of 53 reference studies in the field of oncology and haematology, and c) the Ioannidis team itself was able to replicate completely only 2 of the 18 gene expression studies based on microarrays (DNA chips).

The Nature article author, Regina Nuzzo, analyzes four trends that lead scientists to self-deception and, to compensate, she proposes four ideas to reduce this phenomenon.

Four Trends in Self-Deception

Myopia of the hypothesis. Often researchers conduct biased reviews of evidence to support the hypothesis of the future project, while ignoring the evidence that goes the other way, and not hearing enough adverse opinions to their original idea.

The adoption of flawed models. There’s a Texan fable about a clumsy shooter who, on a hunting course, got lucky and hit the target; this caused some bettors who thought they had discovered a talented shooter to lose a lot of money. According to Nuzzo, same trends are observed among researchers: being blinded by the observed patterns that inspire them and, on the other hand, not realizing that these patterns may not be supported in a sufficiently consistent way.

Asymmetric attention. When the results go in the desired direction there is an inclination to eagerly take them for good, whereas if the results go in the opposite direction, they are revised and double checked excessively.

The rounding of the story. Once the results of the investigation are obtained, a tendency to create a well rounded story is observed. Matthew Hankins, a statistician at King's College London, has collected more than 500 creative phrases that researchers use in scientific articles to convince readers that the results, while not significant, are valuable.

Four proposals to reduce self-deception

Promote the practice of devil's advocate. Regina Nuzzo suggests devoting time to elaborate hypotheses that are alternative to the original and to contrast the support that the scientific revision offers to each of these alternative hypotheses.

Signing agreements prior to publication. Publishing the plan for the data exploitation and analysis during the previous phase of the work. Richard Horton, editor of the Lancet and Richard Smith, former editor of the British Medical Journal, have been proposing this for some time, and now more than 20 scientific journals are already offering agreements to publish projects protocols, with clear commitments of results publishing, regardless of whether they go in the desired direction or not.

Inviting the opponents to share their opinion. Scientists who are in positions contrary to the hypotheses are the best actors in detecting self-deception: approach myopia, errors in the detection of models, asymmetric attention, confusing scripts, etc.

Blind data analysis. The focus of ​​this proposal is for scientists to analyze data that only computers know if they are the ones that correspond to the actual results or not. This should be done as a mechanism to avoid unconscious bias in the analysis phase, due to the pressure that scientists have to obtain certain results.

Large investments and research expectations have boosted competitiveness among professionals and between institutions, to the extremes that have triggered alarms, which has led many leaders and scientific editors to believe that the time has come to look after biases and to increase the reproducibility of results.

Jordi Varela

Monday, 13 November 2017

Measuring the value of anti-cancer drugs

Cristina Roure

Anti-cancer drugs, especially palliative drugs, are toxic, costly and sometimes of little benefit, as a result their value to the patient and society are often questionable. It’s also true that significant improvements in the survival rates are threatened by the difficulty in accessing them, due to their unsustainable cost.

Monday, 6 November 2017

Precision medicine in the elderly care

Marco Inzitari

One of the challenges launched by President Barack Obama ($215 million for 2016) is the "Precision Medicine Initiative" a concept that goes against the treatment focused on the "average-patient". According to this initiative, as a first step, cancer treatments should be oriented to the specific genetics of the patient. For this reason, we often refer to the future of oncology as a "precision medicine". As another example, to continue with oncology, the Watson Intelligent System (IBM) will provide support to oncologists for informed and well fitted decision-making, analyzing patients' medical records and looking for possible evidence-based options.

Monday, 30 October 2017

Prediabetes epidemic in sight

Prediabetes is a terminology that, recently, is used when a person is detected with higher than normal levels of blood glucose, but there is no pathology. Prediabetes could be understood as a disposition to develop diabetes in the future, a disease that, in turn, represents a condition that puts one at risk of serious affections such as nephropathy, retinopathy or cardiovascular disorders, among others. Due to this chain of risks, and with a healthy intention to reduce morbidity and mortality, the American Diabetes Association (ADA) led a study to consider that glycosylated haemoglobin (HbA1c) is a test that can be done without any preparation or need for fasting and see if it can become a new criterion for detecting prediabetes. The concern arises when, according to this diagnostic extension, it’s estimated that in millions of pre-diabetics would show up: in China 493, in the US 86 and in Spain 6, to cite three countries from which I have data.

Monday, 23 October 2017

The Patient Revolution according to Victor Montori

In 2016, Victor Montori, a professor of medicine and diabetes doctor at the Mayo Clinic, launched The Patient Revolution, a foundation whose mission is to help make truly patient-centred treatment a reality. In his new book, Why We Revolt, Montori argues that “industrial medicine” has corrupted the mission of medicine to the point where doctors are now incapable of caring for the people who place their trust in them (for further information about the author in this same blog, search for “Montori, V." entries in the tags [top-right-hand column].

Monday, 16 October 2017

The face as a mirror... of the pocket!

Pedro Rey

As this is my first post on this blog, let me introduce myself. I am a researcher into behavioural economics, a field that uses ideas from psychology to enrich the study of economic problems. More specifically, at present we are working on a project that – as I will explain at the end of this piece, and for various reasons – may have interesting implications in the field of medicine.

Our research aims to answer a simple question: what is the relationship between how much consumers like the products they buy and how much they are willing to pay for them?

Monday, 9 October 2017

An extensive model for complex chronic patients

The emergent phenomenon of multi-chronicity and geriatric fragility is analyzed from all points of view: demographic, epidemiological, the use of resources and the economic impact, to mention only the most outstanding. Now familiar with the tendency, we’re facing the challenge of finding out how to provide appropriate services to patients who, due to the precariousness of their health, or their social circumstances, or both, suffer instability and become frequent and directionless visitors.

This group of complex patients, although not too large, is stressing the rigidities of health systems in three ways: a) the saturation of hospital emergency services consuming ambulances and observation beds is unable to give effective responses to the needs of these people, b) lack of coordination of transfers between levels, especially between the hospital and primary care, and c) poly-medication due to prescription fragmentation.