I have written recently about the faulty premises underlying Obamacare (the innovation and life destroying anticipated consequences of identifying and relying on "evidence -based clinical guidelines") and the damage that the FDA does to innovation in the name of the precautionary principle (which prevents minimal dangers and exerts tremendous opportunity costs while preserving known dangers.) In the past I have noted that much of what the FDA does is destructive to life; for example, by refusing to sanction any treatments not directed against a specific disease, the FDA inhibits basic research into the accretion of errors known as aging that underlies most of the disease that will one day capture us all.
A week ago, in More Lies, Damn Lies, and Statistics, I pointed out that the statistical manipulations which purport to show significance in Social Science research is often shoddy and of limited validity and reliability.
Now, along comes a report by the CDC which questions the validity and reliability of much of the epidemiological research upon which public health policy rests: [HT: Eric Drexler at Metamodern]
Quality of Systematic Reviews of Observational Nontherapeutic Studies
Introduction
High-quality epidemiologic research is essential in reducing chronic diseases. We analyzed the quality of systematic reviews of observational nontherapeutic studies
Methods
We searched several databases for systematic reviews of observational nontherapeutic studies that examined the prevalence of or risk factors for chronic diseases and were published in core clinical journals from 1966 through June 2008. We analyzed the quality of such reviews by using prespecified criteria and internal quality evaluation of the included studies
Results
Of the 145 systematic reviews we found, fewer than half met each quality criterion [Emphasis mine-SW]; 49% reported study flow, 27% assessed gray literature, 2% abstracted sponsorship of individual studies, and none abstracted the disclosure of conflict of interest by the authors of individual studies. Planned, formal internal quality evaluation of included studies was reported in 37% of systematic reviews. The journal of publication, topic of review, sponsorship, and conflict of interest were not associated with better quality. Odds of formal internal quality evaluation (odds ratio [OR], 1.10 per year; 95% confidence interval [CI], 1.02-1.19) and either planned, formal internal quality evaluation or abstraction of quality criteria of included studies (OR, 1.17 per year; 95% CI, 1.08-1.26) increased over time, without positive trends in other quality criteria from 1990 through June 2008. Systematic reviews with internal quality evaluation did not meet other quality criteria more often than those that ignored the quality of included studies.
Conclusion
Collaborative efforts from investigators and journal editors are needed to improve the quality of systematic reviews.
I love the conclusion. However, the results are more important. As I highlighted, fewer than half (of the systematic reviews of epidemiological research) met each quality criterion.
These are the studies that the nanny state uses to tell us what to eat and how to live!!!
The New York Times this week:
Report Questions Need for 2 Diet Supplements
The very high levels of vitamin D that are often recommended by doctors and testing laboratories — and can be achieved only by taking supplements — are unnecessary and could be harmful, an expert committee says. It also concludes that calcium supplements are not needed.
Read the whole thing if you wish. If you have been following along you won't be surprised. The problem is that we know much less, with much greater certainty, than most people realize. In such an environment, the only ethical approach would be to offer people as much information as is available and allow them to decide what level of risk they are comfortable with. Today anyone can become an informed amateur about most topics simply by surfing the web. There is no way to be certain that the information you find is valid and reliable but those who believe they are experts by virtue of their degrees and positions often know less than they think they know.
A hypothetical:
If you are a Psychiatric patient, you could defer to the experts at the FDA, Academic Physicians and Psychiatrists with minimal clinical experience, and trust that the KATIE study has adequately established "evidence -based clinical guidelines". If you were so trusting you would be maintained on older anti-psychotic drugs, like Trilafon, which are very cheap and have known risk profiles due to their long term use. You would be risking developing Tardive Dyskinesia but would no longer be overtly psychotic. Your negative symptoms, social withdrawal, blunted affects, and others, would not be affected by the drugs and your long term course would be toward a minimally functional life. However, were you to defer to a clinical Psychiatrist who has used the older drugs as well as th newer, very expensive drugs, and had accrued clinical expertise in identifying the kinds of patients who respond well to the various drugs available (responses not yet predictable by genetic or other testing) you might be advised to try one of th newer drugs, such as Seroquel, which helps some people avoid the negative symptoms and does not appear to increase the risk of neurological disease (TD.) Further, were you to have experience with both drugs you night notice that the newer drugs preserve your ability to enjoy life, something the older drugs consistently impaired. You would be more willing to stay on the medication and better able to prevent future relapses. However, you would be faced with a risk (similar to the risk of TD with the older drugs) of developing Metabolic Syndrome and possibly Diabetes. I do not think it should be my decision which drug you take; all I can and should do is give you the benefit of my clinical expertise and allow you to decide.
One day when I am old and sick, I want to be able to avail myself of any potential treatment option, even experimental treatments which might accelerate my passing. At what point I would take the risk and how much risk I would tolerate should be my decision, not the decision of some faceless, nameless bureaucrat who is more concerned with his well being than mine (but tells me its for my own good.)
Life in a technological society more closely resembles a naturalistic experiment than people realize. The food we eat is not "natural"; the electric lights we read by are not "natural"; the entertainment we consume is not "natural." I could go on indefinitely in this vein. The point is that we are the first people ever to live the way we live today and tomorrow we will be the first people living the way we will live tomorrow. Once you understand this, the idea of a board of "experts", who know only marginally more than you and far less than the crowds around you, running your life and making fundamental decisions for you, becomes untenable.
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