they don’t care about investigating the assumption on which their research rests
That sounds like a problem with the researchers and not with the system. I understand that you want to solve this problem with better incentives, but I don’t actually see how PBM helps with that.
It’s not perfect but it doesn’t have to be perfect to be better than the status quo.
The problem with novel ideas is that we’re often not clever enough to predict all the ways they will go wrong. Therefore, if a novel idea looks only slightly better than status quo, it’s probably going to be worse than the status quo by the time we’ve implemented it. And that’s before we consider switching costs.
I’m also not calling for monoculture and that everything has to be done via PBM.
That’s weird, you criticized cancer research a lot, but it seems that PBM wasn’t intended for that? It’s okay to have partial solutions. But while reading your comments about cancer, I assumed that you did have better ideas.
That’s partly what I meant by “weird tone” in the first comment. From my point of view the system is almost the best thing humans could reasonably make, with any flaws relatively minor and with some solutions presumably on the way. And from your point of view, presumably, it’s fatally flawed and near useless. But you aren’t providing much evidence that would make me change my view at all.
That sounds like a problem with the researchers and not with the system.
I don’t think that the placebo problem is caused by individual researchers being stupid but because of the incentives that the system sets.
Researchers don’t care for investigating the foundations because they can’t get grants for that purpose. On the other hand, they get grants for doing research that might lead to new drugs that make billions in profit.
Therefore, if a novel idea looks only slightly better than status quo, it’s probably going to be worse than the status quo by the time we’ve implemented it.
The solution I outline in my post is to not start by competing with hospitals but by going for treatments that are currently provided by hypnotists and bodyworkers who don’t practice much EBM anyway. It’s a class of people where individual skill between practioners matter a great deal and studies are therefore less likely to generalize than studies that are about giving out pills.
If you take chiropractics, which happens to be a class of body-workers where there are a lot of them it took till 2008 till we had a Cochrane meta-study according to which chiropractics provide a working treatment for lower back pain.
Moving from a system that takes decades to come to that conclusion and not being able to distinguish between skill differences between different chiropractics to a system that can do that in a year is more than just “slightly better”.
But you aren’t providing much evidence that would make me change my view at all.
A lot of the value from changing the system depends on how inadequate you believe the present system to be. It’s inherently difficult to provide evidence about the amount of low hanging fruit that’s out there because by it’s very nature providing you cases like EY’s SAD treatment means that there is only anecdotal evidence for those treatments.
This post from Sarah Constantin might give some indication that there are a lot of how hanging fruit out there that aren’t picked by our current system.
In The legend of healthcare Michael Vassar uses the inability of our system to get doctors to use mirrors to treat phantom limb pain as evidence that we don’t really have a healthcare system. Prediction-based Medicine would make it easy for one provider of mirros treatment to offer his treatment to all the people with phantom limb pain who seek treatment.
Researchers don’t care for investigating the foundations because they can’t get grants for that purpose. On the other hand, they get grants for doing research that might lead to new drugs that make billions in profit.
I don’t see why EBM is to blame or PBM would help.
Cochrane meta-study according to which chiropractics provide a working treatment for lower back pain
Reading the abstract, it doesn’t look all that positive.
more than just “slightly better”.
If you’ll let me be witty, I’ll suggest that your claims are lacking a kind of scientific integrity, a principle of scientific thought that corresponds to a kind of utter honesty—a kind of leaning over backwards. You’re not stating the assumptions that lead you to this conclusion, not explaining possible ways the assumptions could be wrong, and more generally, you don’t seem to try to find possible negative consequences or limitations of PBM. To be honest though, I don’t really want to discuss these possible problems. This thread already has enough going on.
It’s inherently difficult to provide evidence about the amount of low hanging fruit that’s out there
For example, some of these fruit involve wasted money (especially in US). I can agree that they are low hanging, because there are other medical systems providing similar outcomes in similar circumstances, for less money, and I can vaguely imagine that policies could be adopted in US to reduce costs. By the way, cost problems have very little to do with EBM. The talk you linked to also seems less about how EBM is inadequate and more about how doctors are failing to make good use of EBM.
More generally, I don’t need a list of problems that kind of look easy to solve. I need you to show me why exactly the problems aren’t already solved, how much benefit there would be if we did solve them, and that there exists a concrete and simple plan to solve them without assuming that we live in full communism.
That sounds like a problem with the researchers and not with the system. I understand that you want to solve this problem with better incentives, but I don’t actually see how PBM helps with that.
The problem with novel ideas is that we’re often not clever enough to predict all the ways they will go wrong. Therefore, if a novel idea looks only slightly better than status quo, it’s probably going to be worse than the status quo by the time we’ve implemented it. And that’s before we consider switching costs.
That’s weird, you criticized cancer research a lot, but it seems that PBM wasn’t intended for that? It’s okay to have partial solutions. But while reading your comments about cancer, I assumed that you did have better ideas.
That’s partly what I meant by “weird tone” in the first comment. From my point of view the system is almost the best thing humans could reasonably make, with any flaws relatively minor and with some solutions presumably on the way. And from your point of view, presumably, it’s fatally flawed and near useless. But you aren’t providing much evidence that would make me change my view at all.
I don’t think that the placebo problem is caused by individual researchers being stupid but because of the incentives that the system sets.
Researchers don’t care for investigating the foundations because they can’t get grants for that purpose. On the other hand, they get grants for doing research that might lead to new drugs that make billions in profit.
The solution I outline in my post is to not start by competing with hospitals but by going for treatments that are currently provided by hypnotists and bodyworkers who don’t practice much EBM anyway. It’s a class of people where individual skill between practioners matter a great deal and studies are therefore less likely to generalize than studies that are about giving out pills.
If you take chiropractics, which happens to be a class of body-workers where there are a lot of them it took till 2008 till we had a Cochrane meta-study according to which chiropractics provide a working treatment for lower back pain.
Moving from a system that takes decades to come to that conclusion and not being able to distinguish between skill differences between different chiropractics to a system that can do that in a year is more than just “slightly better”.
A lot of the value from changing the system depends on how inadequate you believe the present system to be. It’s inherently difficult to provide evidence about the amount of low hanging fruit that’s out there because by it’s very nature providing you cases like EY’s SAD treatment means that there is only anecdotal evidence for those treatments.
This post from Sarah Constantin might give some indication that there are a lot of how hanging fruit out there that aren’t picked by our current system.
In The legend of healthcare Michael Vassar uses the inability of our system to get doctors to use mirrors to treat phantom limb pain as evidence that we don’t really have a healthcare system. Prediction-based Medicine would make it easy for one provider of mirros treatment to offer his treatment to all the people with phantom limb pain who seek treatment.
I don’t see why EBM is to blame or PBM would help.
Reading the abstract, it doesn’t look all that positive.
If you’ll let me be witty, I’ll suggest that your claims are lacking a kind of scientific integrity, a principle of scientific thought that corresponds to a kind of utter honesty—a kind of leaning over backwards. You’re not stating the assumptions that lead you to this conclusion, not explaining possible ways the assumptions could be wrong, and more generally, you don’t seem to try to find possible negative consequences or limitations of PBM. To be honest though, I don’t really want to discuss these possible problems. This thread already has enough going on.
For example, some of these fruit involve wasted money (especially in US). I can agree that they are low hanging, because there are other medical systems providing similar outcomes in similar circumstances, for less money, and I can vaguely imagine that policies could be adopted in US to reduce costs. By the way, cost problems have very little to do with EBM. The talk you linked to also seems less about how EBM is inadequate and more about how doctors are failing to make good use of EBM.
More generally, I don’t need a list of problems that kind of look easy to solve. I need you to show me why exactly the problems aren’t already solved, how much benefit there would be if we did solve them, and that there exists a concrete and simple plan to solve them without assuming that we live in full communism.