Trials We Cannot Trust

[lobelsteve]

https://www.sciencedirect.com/science/article/pii/S1526590023004674

If you want to learn, or if you just cannot sleep.

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[kstarm]

Interesting, I agree that trustworthiness of articles in an important topic. I thought for sure this would be about device companies and the incredible financial incentives behind studies in spinal pain, and this was about CBT and exercise! It turns out everyone has an angle...

 

[drusso]

https://www.sciencedirect.com/science/article/pii/S1526590023004674

If you want to learn, or if you just cannot sleep.

Bravo.

"Our findings have important implications for the application of evidence-based healthcare. RCTs and systematic reviews of RCTs are routinely held up as the reference standard of evidence for ascertaining the effectiveness of interventions and for underpinning clinical recommendations. We have shown here how this cohort of studies has led to substantial impacts on both the results of systematic reviews and the recommendations of CPGs, contributing to overly positive conclusions regarding the effectiveness of adding CBT to physical rehabilitation for spinal pain, with subsequent impacts on clinical decisions."

I've been saying this for years. There's Big Money in therapeutic nihilism. People get paid a lot for doing nothing, saying nothing works, and denying patients treatments. They build careers and livelihoods on it. They get promotions, speaking engagements, sit on prestigious committees, etc. They start professional societies and build social media capital on spreading misinformation about treatments and disorders. They invent new disorders! They get paid large, untrackable consulting fees from legal firms to say, "Opioids don't work," "Discography doesn't work," "PRP is a scam," "SCS is placebo," "pain is imaginary and constructed in the brain," "fibromyalgia is fake," etc.

If you told me that science was just rhetoric, I'd be pissed...

 

[Ducttape]

take home message - old trials may affect meta-analyses or reviews. kind of like GIGO.

doing and adding more specific studies can help neuter effects of these index trials.

I've been saying this for years. There's Big Money in therapeutic nihilism. People get paid a lot for doing nothing, saying nothing works, and denying patients treatments. They build careers and livelihoods on it. They get promotions, speaking engagements, sit on prestigious committees, etc. They start professional societies and build social media capital on spreading misinformation about treatments and disorders. They invent new disorders! They get paid large, untrackable consulting fees from legal firms to say, "Opioids don't work," "Discography doesn't work," "PRP is a scam," "SCS is placebo," "pain is imaginary and constructed in the brain," "fibromyalgia is fake," etc.

If you told me that science was just rhetoric, I'd be pissed...

fine. in that case, if you hold doubts with all researchers, then find and follow only studies where the investigators do not find benefit from their vested interests.


and in your examples, can you even point to legitimate studies done "by the other side" that refute the index studies?

its kind of a balancing. enough device rep and PRP companies claim their studies show benefit.

yet with all of these - opioids, disco, PRP, SCS - we have not made any indent on the epidemic of chronic pain.

ive been waiting decades for studies that show opioids work long term, even if they are from drug companies.

 

[p1at0]

Bravo.

"Our findings have important implications for the application of evidence-based healthcare. RCTs and systematic reviews of RCTs are routinely held up as the reference standard of evidence for ascertaining the effectiveness of interventions and for underpinning clinical recommendations. We have shown here how this cohort of studies has led to substantial impacts on both the results of systematic reviews and the recommendations of CPGs, contributing to overly positive conclusions regarding the effectiveness of adding CBT to physical rehabilitation for spinal pain, with subsequent impacts on clinical decisions."

I've been saying this for years. There's Big Money in therapeutic nihilism. People get paid a lot for doing nothing, saying nothing works, and denying patients treatments. They build careers and livelihoods on it. They get promotions, speaking engagements, sit on prestigious committees, etc. They start professional societies and build social media capital on spreading misinformation about treatments and disorders. They invent new disorders! They get paid large, untrackable consulting fees from legal firms to say, "Opioids don't work," "Discography doesn't work," "PRP is a scam," "SCS is placebo," "pain is imaginary and constructed in the brain," "fibromyalgia is fake," etc.

If you told me that science was just rhetoric, I'd be pissed...

Comment of the decade award. Facts. “This.”

 

[drusso]

take home message - old trials may affect meta-analyses or reviews. kind of like GIGO.

doing and adding more specific studies can help neuter effects of these index trials.


fine. in that case, if you hold doubts with all researchers, then find and follow only studies where the investigators do not find benefit from their vested interests.


and in your examples, can you even point to legitimate studies done "by the other side" that refute the index studies?

its kind of a balancing. enough device rep and PRP companies claim their studies show benefit.

yet with all of these - opioids, disco, PRP, SCS - we have not made any indent on the epidemic of chronic pain.

ive been waiting decades for studies that show opioids work long term, even if they are from drug companies.

You're conflating personalized treatment with population epidemiology.

Did requiring doctors to learn ACLS make an impact on the prevalence of coronary artery disease?

Did orthopedic hardware reduce the rates of hip fractures?

Treating chronic pain doesn't change the incidence of chronic pain.

 

[Ducttape]

if treatments do not make a sizable impact on the incidence of people disabled or at least reporting chronic pain, why continue to advocate?

and your examples are not consistent. ACLS and orthopedic hardware are treatments for a condition, not to prevent a condition.

people who were taught ACLS improved survival and discharge from hospital instead of morgue.

hip replacement surgery has reduced mortality from hip fractures tremendously.

treating chronic pain should reduce the disability and dysfunction related to said chronic pain.

 

[callmeanesthesia]

If you told me that science was just rhetoric, I'd be pissed...

You seem to spend a lot of time pissed off. Maybe you should try some CBT for that…

 

[lobelsteve]

You seem to spend a lot of time pissed off. Maybe you should try some CBT for that…

Only if cbd doesn’t work

 

[drusso]

if treatments do not make a sizable impact on the incidence of people disabled or at least reporting chronic pain, why continue to advocate?

and your examples are not consistent. ACLS and orthopedic hardware are treatments for a condition, not to prevent a condition.

people who were taught ACLS improved survival and discharge from hospital instead of morgue.

hip replacement surgery has reduced mortality from hip fractures tremendously.

treating chronic pain should reduce the disability and dysfunction related to said chronic pain.

You're still wrong. The connections are not as tight as you believe. Treating chronic pain only helps relieve suffering for most. And that is enough. Read your online reviews.

 

[Ducttape]

Show me data that shows we as a society are doing a good job treating chronic pain.


And I'll show you a society that you are not living in.

 

[drusso]

Show me data that shows we as a society are doing a good job treating chronic pain.


And I'll show you a society that you are not living in.

Doctors don't treat society. They treat individual patients one at a time. Based on your diligence, expertise, and skill, your mileage may vary.

 

[CleanUp]

Show me data that shows we as a society are doing a good job treating chronic pain.


And I'll show you a society that you are not living in.

I hear what you’re saying. Honestly I do.

Conceptually I moved from treating chronic pain to focusing on preventing people spiraling into chronic pain, stopping the initiation of opioids, or introducing a palliative approach to help patients accept in a non judgey way that this is their life and their body.