Thread by Alexandros Marinos

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Deconstructing Evidence-Based Medicine... from the inside out. 🧵

At first, I was shocked with what I was finding. How could anyone not have seen this?

Well, I was wrong. People have DEFINITELY seen it. And have spoken out. In peer-reviewed journals.

Nobody (in power) cares.
Let's start with this excellent paper by Leonid Hanin:
bmcmedresmethodol.biomedcentral.com/articles/10.1186/s12874-017-0399-0
An incredible piece that is extremely readable, and uncovers the whole mess.
"Oh come on, Alex, this is some prof from Idaho with a 23 h-index. Is this your refutation?"

I've not even gotten started yet.
How about Dr Peter Gøtzsche, over 180 THOUSAND citations, h-index 103 (this means over 100 papers with over 100 citations EACH). Is he credentialed enough?

Oh, yeah, he was also a founder and board member of the Cochrane Collaboration.
Here he is explaining why large pharmaceutical companies meet the definition of organized crime:

Here he is explaining how prescription drugs are the third leading cause of death: youtu.be/KpDzB8uYHgY
Naturally, he was kicked out of Cochrane when he started speaking out: undark.org/2019/12/30/peter-gotzsche-cochrane/
"Ok fine. You found the village idiot. We keep him around because he has a funny accent".

Funny you should say that, because I have another dude with a funny accent for you:

456 THOUSAND citations, by some accounts, the most cited living scientist.
"Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true. Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias." journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124
Now, keep in mind, Ioannidis and Gøtzsche are two of the authors of the PRISMA statement, which is the consensus standard for how meta-analyses and systematic reviews should be done.

They are EBM royalty. www.sciencedirect.com/science/article/pii/S0895435609001802
Naturally, all this had been foretold. All the way back in 1998, Charlton and Miles had laid it all out for us. A "science" that is named after the lie that all prior medicine was "not-evidence-based" is a discipline that lives by lies. www.researchgate.net/profile/Andrew-Miles/publication/13574786_The_rise_and_fall_of_EBM/links/5538cfc...
The author wrote a retrospective 11 years later (13 years ago), basically explaining to us what would happen during the pandemic, when even the basic guardrails were thrown out because "EMERGENCY!!!"

The paper is unpaywalled on his blog:
charltonteaching.blogspot.com/2009/08/zombie-science-of-evidence-based.html
In fact, this is not a medical, or for that matter, scientific problem at all. Deming had explained the problem of metrics-driven managerial top-down authoritarianism years ago.

PLEASE watch this video to the end. Don't let his deadpan humor fool you:

Much more material can be found in this book that I will never stop recommending:
press.princeton.edu/books/hardcover/9780691174952/the-tyranny-of-metrics
And that's how we got here.

It's not about the evidence. It never has been.

Incentives rule everything around me.

I hope this thread can serve as a reading list of material for people who have run into the same mess I did a year and a half ago, so they don't have to spend 18 months reconstructing it.

The evidence against evidence-based medicine is as conclusive as it is damning.
Brought to you by... SCIENCE!
ps. how did I forget this? www.bmj.com/content/376/bmj.o702
ps2. this thread is dedicated to John Lykoudis - a name everyone should know.

ps3. Another epic piece, this time on nutrition "science".

I actually consider this an optimistic thread. Whenever I've seen evidence of rot that is *this* clear, this public, the narrative eventually shifts. Maybe it will take a decade. Or maybe it will take longer. But it will shift. The question is "to what?"

Turned this to a substack article, for those who prefer their twitter threads all in one place: doyourownresearch.substack.com/p/deconstructing-evidence-based-medicine
The biggest reason I make these threads, and why I post them on Twitter, is all the additional material that comes up in the responses. In particular this video by @p_parry1 is an excellent complement to this thread.

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