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Listen to Nocturne symphonique (Elegie No. 2) for orchestra Op. 43 by Ferruccio Busoni.

Evidence-based medicine (EBM) grew from the recognition that medical recommendations should become more scientific, Dr. Malcolm Kendrick explains. Unfortunately, several factors confound the endeavor. Kendrick notes life expectancies have begun to decline in the U.S. and U.K. and suggests this may be due, in part, to the unreliable evidence doctors use to treat their patients. Citing prominent voices from the scientific scholarship, he discusses several reasons why our most trusted studies — randomized controlled trials and meta-analyses — are unreliable. “Can EBM be salvaged?” Kendrick asks. “Only if the public and politicians, and of course doctors, wake up to the fact that ‘something has gone fundamentally wrong with one of our greatest human creations,’” he concludes.

Read MoreEvidence-Based Medicine, Part 3: Can It Be Salvaged?

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Peter Mason
December 30th, 2019 at 5:18 am
Commented on: Evidence-Based Medicine, Part 3: Can It Be Salvaged?

I bought into the work of quacks, many of them have written on this site. I find their advice to be better than any i have had from my doctor who funnily enough i have not needed to see since discovering the information out there on the net.

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Gustavo Sandri Heidner
December 30th, 2019 at 3:04 am
Commented on: Evidence-Based Medicine, Part 3: Can It Be Salvaged?

"Dr." Malcolm Kendrick is an MD, not a PhD. He has, therefore, not received training to be a scientist, but rather to be a clinical practitioner. His lack of focus with his criticism can be seen all over the place. First, he complains that clinical trials and meta-analyses do not include "small" data, and later he complains that 50% of the "small" data is trash. Well, which one is it then?

We are living in strange days. Never before have we had so much access to information, and never have people bought so much into the "work" of quacks. I don't know when CF took that turn, but it seems to me that as the months go by, more and more, it is distancing itself from any tether to the truth and delving ever deeper into the realms of fantasy. Soon it might find itself unable to quote from the very science that runs in its veins.

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Michael Eades
December 30th, 2019 at 6:50 am

Mathematician and philosopher Nicholas Naseem Taleb coined the acronym IYI, which stands for 'intellectual yet idiot.' These are the people we've all encountered who have gone to all the right schools, taken all the right degrees, and accumulated all the right academic merit badges. They embody the term intellectual, but once they leave academia, they are unable to function in the real world. By virtue of their diplomas and awards, they end up finding their way into high levels of government (and to some degree business) where they manage to screw up everything they touch. They last a lot longer in government than they do in business. They are intellectuals, but total idiots in terms of any productive function.

Taleb has inspired me to coin my own acronym for similar types of people found all too often in the medical and scientific community: EBYI. Which stands for 'evidence-based yet idiot.' These are the docs (both MD, DO, and PhD) who go around primly scoffing at the diagnoses and, especially, treatments of their peers. Hmph, they snort, I would never do that; I practice only evidence-based medicine.

What's the definition of evidence-based medicine? One assumes it is diagnosis and/or treatment based on evidence. But then what is evidence?

If pressed, most EBYIs would respond that evidence can be found in the medical literature or the current treatment guidelines, which are supposedly based on the latest medical/scientific literature.

But what if the medical/scientific literature is not up to snuff? What then?

David Sackett, the so-called father of evidence-based medicine, famously told his medical students "Half of what you'll learn in medical school will be shown to be either dead wrong or out of date within five years of your graduation; the trouble is that nobody can tell you which half."

Half would be bad enough, but it's even worse than that. John Ioannidis from Stanford, one of the most cited researchers in science, has pointed out in his seminal 2005 paper that most of what is found in the medical and scientific literature is wrong. Others performing detailed statistical analyses on Dr. Ioannidis's work have calculated that roughly 93 percent of published studies are false.

This means that 7 percent of papers published in the medical/scientific literature are science, while 93 percent are science fiction. Going back to Dr. Sackett's talk to his medical students raises the question Which 7 percent are really science and which 93 percent are dead wrong?

Since the practice guidelines are based on the most current scientific literature, odds are they are more science fiction than science.

It's been my unfortunate experience that the EBYIs among us pompously go about their business blindly adhering to these guidelines and the literature that underpins them, while looking down their noses at those, such as Dr. Kendrick and others, who are digging into these studies to try to separate the 7 percent wheat from the 93 percent chaff.

The wreck that is the current medical/scientific situation is at the heart of what CrossFit refers to as The Mess. Seven percent science vs 93 percent science fiction is almost beyond belief. It's a situation that should not be tolerated, yet EBYIs walk among us, primly touting these studies as evidence-based, while 93 percent of them are total BS.

Instead of being castigated, Dr. Kendrick and CrossFit should be applauded for shining a light on this absolutely dreadful and dangerous situation. Only the disinfectant of serious inquiry will ever bring a cure.

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Nima Alinejad
January 2nd, 2020 at 6:13 pm

Michael, remarkably well said!

I still find it mind boggling that folks still find it easier to keep repeating to themselves a mantra that ‘everything is alright’.  Then lash out with anxiety that everything is not alright by calling this a “fantasy” instead.

I applaud CrossFit for continuing to shine light on The Mess.

If religion was the opiate of the masses for Marx, junk-science has become of the opiate of modernity.

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Kyle Laney
January 10th, 2020 at 4:41 am

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Greg Glassman
January 13th, 2020 at 6:04 pm

Gustavo, this makes no sense:

First, he complains that clinical trials and meta-analyses do not include "small" data, and later he complains that 50% of the "small" data is trash. Well, which one is it then?

Try again. What happens when the answer is "both"?

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