So what does a good teacher do?
Create tension--but just the right amount--Donald Norman, American Scientist
Vinay is funny. And I mean “ha, ha” funny. His wit and enthusiasm make for good listening and serve up the perfect medium for critical thought and inquiry. He is an important voice in medicine and has established himself as a valuable resource and member over on #medtwitter. I discovered his powerful twitter threads years ago and was lucky to hear him speak at a Lown Conference. The podcast came later and was promptly in the queue for my long running sessions. When you run your own analytics company, you need to multi-task and I found the time listening to podcasts while ticking off the miles to be a winning combination. When his publisher sent me a copy of his book, Malignant: How Bad Policy and Bad Evidence Harm People with Cancer, I had my trifecta and I continue to gift the book to the emerging scientists and physicians in my data literacy workshops.
I think I have established my appreciation for his work, which for me—a non-clinician—consists of critically reviewing the clinical literature and learning to hold a tension. Previously the only disagreement I had with his clearly articulated views was his unrelenting ban on medical writers. He pokes fun at their obsequious nod to the pharmaceutical companies that employ many of them. I was annoyed until I realized I 100% agreed with his assertion of the servile nature of their employment. Marketing messages, unfounded statements regarding safety and efficacy, and a profound tendency toward asymmetric information are nontrivial drivers of misleading information and bad science.
True disclosure. I was a medical writer for many years. Although now that I think about it, I wasn’t a particular good one. Not for the reasons you might think. In the beginning I worked earnestly shoulder to shoulder with leading voices in HIV research. What followed until I left the profession was a series of firings for resisting inclusion of less than robust data, questioning data quality, and an unrelated or quasi-related creepy feeling when asked to make a clinician’s predilection to porn disappear from his hotel folio.
My point here is to demonstrate the process of accepting a tension and learning to think critically in order to accept the insights that are usually tossed out with the bathwater. I focused on the writing instead and became not only a science journalist but a member of the National Press Club in Washington DC.
I suggest you listen to the Plenary Session podcast if you appreciate critical thinking and actionable measures to improve your clinical and data literacy. Case in point. I thought Dr Prasad and I were on opposite sides of the SARS-CoV-2 opening of the schools debate. Until I allowed myself to be uncomfortable. And to be willing to listen.
In February, Vinay interviewed John P.A. Ioannidis, MD, Dsc. Again, I learned of John at the Lown Conference. The fact that there was a group of journalists, physicians, and scientists gathering to discuss over-medicalization and spurious messaging masquerading as science was revelatory. And my mind was blown. An independent thinker not hesitant to thumb his nose at profiteering and bad science, Hundreds of thousands of zombie randomized trial circulate among us, Why Most Published Research Findings Are False, and his often misquoted thoughts on the science behind SARS-CoV-2 strategies, Infection fatality rate of COVID-19 inferred from seroprevalence data.
In the podcast, there are two important documents mentioned—Great Barrington Declaration and John Snow Memorandum. The tensions in both are obvious and carefully summarized here by Vinay Prasad, Op-Ed: Great Barrington vs John Snow is a False Choice. They are worth your time. Hold those tensions and be the better for it.
In equal measure, limitations of both calls to action are important and should be regarded in real time—not limited to the rear view mirror.
First the Great Barrington Declaration:
Limitations to the statement are its lack of guidance as to who exactly the vulnerable are, how they should shield themselves, and the fact that it lumps together very different things -- such as bars and schools. Open bars can be replaced with drinking beers in the backyard with a friend seated at a distance with little loss of pleasure, but education, particularly for the poor, is one of the few ladders left in American society for a better life, a place to feed children, and a vehicle for detecting abuse. Another limitation is its lack of acknowledgement that in moments of explosive spread, temporary measures likely need to be taken to prevent, for example, hospitals from overflowing. Surely, policy responses must depend on the specifics of the time and place.
In response to the declaration we have the John Snow Memorandum:
Limitations to the Snow memorandum include: How exactly will one create social programs to minimize the harms, and what exactly will those programs look like? What will you do in places like the U.S. where even basic economic stimulus talks have stalled? Millions of people are entering poverty in this country, and many more may face starvation globally. How precisely and quickly will you help them? Those who criticize the Barrington authors for not providing a plan to protect the vulnerable from the virus, must criticize the Snow authors for not explaining how they will shield the vulnerable from the harms of restrictions. Additionally, calling for contact tracing is easy, but practically, this faces severe limitations in a nation like the U.S. when many individuals contacted are reluctant to share information. Here too the Snow memorandum falls short on specifics.
So how do we do better? Keep your ear to the street. METRICS International Forum is a great place to start. The task of “reimaginging science in the 21st century” is an open invitation.
You can RSVP or learn more here Meta-Research Innovation Center at Stanford (METRICS)
Related articles from Data & Donuts:
Quality Care Requires High Quality Evidence
data journalism, bath water, and babies
Future is here—just not equally distributed
medical education, biting hand that pays?
“values” based vs. value-based healthcare
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