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Announcing the Science-Based Medicine Blog

Science-Based Medicine is a new daily science blog dedicated to promoting the highest standards and traditions of science in medicine and health care. The mission of this blog is to scientifically examine medical and health topics of interest to the public. This includes reviewing newly published studies, examining dubious products and claims, providing much needed scientific balance to the often credulous health reporting, and exploring issues related to the regulation of scientific quality in medicine.

The philosophy of this blog, at its core, is simple: Safe and effective health care is critical to to everyone’s quality of life; so much so that it is generally considered a basic human right. The best method for determining which interventions and health products are safe and effective is, without question, good science. Therefore it is in everyone’s best interest for health care to be systematically evaluated by the best science available.

Too often the nature of science itself is misunderstood or misrepresented to the public. Science is not an arcane and privileged discipline. By its very nature it is meant to be transparent and public. Science is nothing more than a systematic and careful use of evidence and logic to evaluate factual claims. And good science possesses certain virtues that are not unique to science but generic to all intellectual endeavors: fairly accounting for all available evidence, using valid and internally consistent logic, using unambiguous concepts and language, proper use of statistics, being quantitatively precise and accurate, and above all being honest.

And yet there are numerous and powerful influences in society that strongly appose the scientific basis of medicine. Driven by some combination of ideology or the desire for profit they wish to eliminate standards of science in health care, or (often under the guise of “health care freedom”) create a double standard in which unscientific methods and products can thrive unchecked. Others simply lack the training or knowledge to achieve minimal standards of quality for scientific medicine. And even the best traditions of scientific medicine can benefit from more critical analysis.

Within the practice of medicine there is already a recognition of the need to raise the standards of evidence and the availability of the best evidence to the practitioner and the consumer – formalized in the movement known as evidence-based medicine (EBM). EBM is a vital and positive influence on the practice of medicine, but it has its limitations. Most relevant to this blog is the focus on clinical trial results to the exclusion of scientific plausibility. The focus on trial results (which, in the EBM lexicon, is what is meant by “evidence”) has its utility, but fails to properly deal with medical modalities that lie outside the scientific paradigm, or for which the scientific plausibility ranges from very little to nonexistent.

All of science describes the same reality, and therefore it must (if it is functioning properly) all be mutually compatible. Collectively, science builds one cumulative model of the natural world. This means we can make rational judgments about what is likely to be true based upon what is already well established. This does not necessarily equate to rejecting new ideas out-of-hand, but rather to adjusting the threshold of evidence required to establish a new claim based upon the prior scientific plausibility of the new claim. Failure to do so leads to conclusions and recommendations that are not reliable, and therefore medical practices that are not reliably safe and effective.

This is why the authors of this blog strongly advocate for science based medicine – the use of the best scientific evidence available, in the light of our cumulative scientific knowledge from all relevant disciplines, in evaluating health claims, practices, and products. The authors are all medically trained and have spent years writing for the public about science and medicine, tirelessly advocating for high scientific standards in health care. Together, and with contributions from other medical science writers, they will turn a critical eye toward all issues relating to science and medicine. They hope to make the Science Based Medicine blog a vital resource for consumers, providers, regulators, the media, and anyone interested in quality health care.

Posted in: Science and Medicine

Leave a Comment (33) ↓

33 thoughts on “Announcing the Science-Based Medicine Blog

  1. darwiny says:

    Please review the claims made by http://www.quantumtouch.com I have family members who forgo science-based medicine in favor of this placebotator.

  2. slashnull says:

    I think this blog will be a great resource, I always appreciate the health related stories on neurologica and having a dedicated blog about this topic will be fantastic. Good luck!

  3. Tatarize says:

    Wow. A Science/Medicine blog. This is the best thing since colloidal silver!

  4. JS says:

    This sounds great! Good on you guys!

  5. Wicked Lad says:

    Welcome to the pajamahedin, Steve! I’ve been gobbling up episodes of The Skeptics’ Guide to the Universe podcast and getting a lot out of it. I look forward to your blog entries on realityscience-based medicine.

  6. Hank Fox says:

    I look forward to reading this blog.

    One worry nags at my mind: In your goal of presenting some needed opposition to herbalists and pseudo-medical quackery, I hope you won’t become a blind cheerleader for corporate or governmental arguments about the complete safety of this or that.

    For instance, if I were to read that mercury amalgam is unquestionably safe for dental patients, or that genetically modified food crops are the totally-harmless savior of starving humanity, I’d probably stop reading.

    It seems to me that corporate arguments for the harmlessness of certain products usually hinge on a deliberately mistaken interpretation of “innocent until proven guilty.”

    Unless a product or process can be PROVEN harmful, in other words, it’s “innocent.” Which means that large amounts of evidence must be mounted before said product can be seriously questioned, or taken off the market.

    The flaw in that interpretation is that “innocent until proven guilty” is an idea based in the desire in law to do no harm to a human suspect. Applying that same HUMAN right to inanimate products or lucrative corporate practices can turn the original intent of the thing on its head, menacing those same humans it was formulated to protect.

    Some things really are dangerous, and when human safety comes up against corporate profits, the scales should automatically tip – heavily – in the direction of safety. Even if we can’t change the big socioeconomic picture which the product under scrutiny is a part of, we should be able to at least TALK about the thing critically and honestly without worrying about the cost or feasibility of taking it off the market.

    If the air in post-9/11 New York City was medically dangerous, for instance, city residents should have been told that by SOMEBODY. Somebody who should have said “These are the facts; react to them as you choose.”

    So: I look forward to reading this blog. But I’m also hoping you dare occasionally to tell us (insert grin here) that Monsanto is sometimes guilty of dangerous, duplicitous greed, or that the head of the ADA (or the EPA, or the U.S. Army, etc.) really can be a lying sack of shit.

  7. Whiskyjack says:

    Welcome guys. Really looking forward to this blog. Very nice topic to focus on.

  8. David Gorski says:

    For instance, if I were to read that mercury amalgam is unquestionably safe for dental patients

    Sorry, but that’s a very bad example that I can’t allow to go unchallenged.

    Mercury amalgam is safe for dental patients. The anti-amalgam types are largely pseudoscientists pushing replacement of these amalgams with more expensive newer compounds or the use of chelation therapy to “detoxify” nonexistent mercury toxicity.

  9. Welcome to the science-based blogsphere (though some of you have been there for a while).

    Looking very much forward to your future posts.

  10. Harriet Hall says:

    Is mercury amalgam “unquestionably safe”? I’m open to questioning anything, and “safe” is a relative term. If you look hard enough you can find potential dangers in anything. What matters is the risk/benefit ratio, and whether a better alternative exists. This is a science based medicine blog, and science can’t say something is “safe” because that’s a value judgment. Science can say that the evidence doesn’t show that people with mercury amalgam fillings have greater morbidity or mortality.

  11. Dr Hall, the reason most herbalists would give regarding the use of “whole herbs” over purified single constituents is that the multicomponent nature of the former provides pharmacological synergy. However, scientific demonstration of this principle is quite rare – in fact, when it is shown the results end up in very high-profile journals, such as this PNAS paper from Frank Stermitz and Kim Lewis’ groups on the synergy of berberine with the NorA efflux pump inhibitor, 5′-methoxyhydnocarpin, in Berberis fremontii.

    So, I’m perfectly open to this rationale for the use of whole herbs assuming 1) the data exists and 2) active constituents achieve plasma levels and a duration of action consistent with what has been observed in vitro.

    As an aside, I enthusiastically welcome your joint effort to the sci-med blogosphere. What an outstanding group of professionals whose content I expect with be of equal value to the professionals, patients, and the general public. Welcome!

  12. David Gorski says:

    Harriet, as usual, was more nuanced in her response to Hank than I was. However, what we can say based on science is that the common claims made by anti-amalgam dentists and “holistic” practitioners are without even mildly convincing scientific or clinical data to support them.

  13. PalMD says:

    I’m quite excited about this new site. I have high expectations.

  14. pmoran says:

    I wonder if by this paragraph in the introduction you meant to imply that plausibility is not an evidence-based judgment?

    “Within the practice of medicine there is already a recognition of the need to raise the standards of evidence and the availability of the best evidence to the practitioner and the consumer – formalized in the movement known as evidence-based medicine (EBM). EBM is a vital and positive influence on the practice of medicine, but it has its limitations. Most relevant to this blog is the focus on evidence to the exclusion of scientific plausibility. The focus on evidence has its utility, but fails to properly deal with medical modalities that lie outside the scientific paradigm, or for which the scientific plausibility ranges from very little to nonexistent.”

    I agree that the usual model of EBM faces problems when applied outside its native setting of mainstream medicine. It overwhelmingly favours evidence from clinical trials. This is as it should be — it recognises the large gap in reliability between clinical trials and other kinds of evidence such as the personal judgments of medical practitioners. It also normally deals with matters having neutral or positive prior probability (plausibility).

    Yet clinical trials are also very easily corrupted or faked and liable to statistical flukes. Positive studies may thus not readily carry the day when applied to matters that have an extremely low prior probability (plausibility). They only work for the mainstream because of the sheer intensity of clinical study, with multiple replications of studies and rigorous re-analyses ensuring that the inevitable occasional wrong judgments don’t endure for long.

    But what makes things implausible, or “outside the scientific paradigm”? In the above paragraph you seem to be detaching these concepts from any evidence base. May it not simply be that in considering some matters we are instinctively, almost unconsciously, recruiting types of evidence that don’t normally figure within the medical or scientific mind?

    An example: why is homeopathy implausible? Among other matters, its signature proposition is implausible mainly because never in the whole of human experience or research has dilution of solutions been found to enhance their intrinsic physical, chemical or biological properties (Hormesis is a property of a few biological systems, not the consistent behavior of solutions that homeopathy requires). Thus, dilution doesn’t make our coffee taste stronger and we don’t expect otherwise no matter how much we shake or stir it.

    It seems many don’t take this kind of evidence into consideration. It is not seen as “science”. It does not involve a laboratory, is not done by scientists, and it is not published anywhere. Yet it is as scientifically valid and consistent an observation as that things always fall down, not up.

    This is presumably why so many found “potentisation” implausible well before anyone knew anything about Avogadro’s number.

    As you correctly state good science involves taking into account ALL the relevant evidence but we should not be restricitng oursleves as to what kinds of evidence we consider.

    Peter Moran

  15. Peter – I agree, and well stated. Scientific plausibility is based upon prior scientific knowledge, which is based upon logic and evidence. Science includes evidence, so science based is necessarily evidence based. Plausibility stems more from basic science rather than clinical trials. I should have therefore written “reliance on clinical evidence.”

    My co-authors and I have been vigorously discussing how best to convey the complex relationship among plausibility, basic science, and clinical evidence in the full spectrum of health claims from mainstream science to the absurd fringe. Once we have it tweaked we will likely publish it here as our “mission statement.” Feedback from you and the other commenters will be very helpful in crafting this statement, so thanks.

  16. PalMD says:

    @Darwiny:
    I have a little deconstruction of your query at my place.

  17. darwiny says:

    Thanks for getting on http://www.quantum-touch.com, PalMD! They need exposure, and I need relief from the nutters in my family who buy this snake oil.

  18. isles says:

    I think this blog should be mandatory reading for medical students. A little something to balance out the woo that’s found its way into their curricula.

    Congratulations on an excellent start!

  19. wertys says:

    Looking forward to keeping up with the blog throughout the year !

  20. diggs says:

    I’d like to point out that both Salk and Sabin said that the polio vaccine had nothing to do with the disappearance of the disease, it had simply run it’s course like all epidemics do. Further, the junk science supporting vaccines is supported by fear based propaganda with very little real evidence indicated. If vaccines work so well, why does anyone care if a few people don’t get them? What threat is it to those of you who do? Won’t you be protected from the diseases? I love when people say that those who don’t get vaccinated are a threat to those who do, it proves that people don’t really believe in the vaccines. Has everyone in the medical community forgotten that we have immune systems and the reason that so many of us have weakened immune systems is because we keep plunging our bodies into vats of chemicals? Thimerisol is not the only problem with vaccines; the spread of other diseases through them, the vast amounts of other chemicals, the fact that the diseases in them don’t pass through our immune system in any way that it recognizes, the list goes on and on ending with they simply don’t work. These aren’t rogue scientists saying it, they are from Harvard, Merck, U of C and many other esteemed places. Today we have better nutrition, clean water, sanitary conditions and if you think those things don’t make a difference you are completely mistaken and need to expand your research.

  21. David Gorski says:

    I’d like to point out that you seem to be commenting in the wrong discussion thread. This post has almost nothing to do with vaccines. I suspect you wanted to comment here.

  22. diggs says:

    Why thank you David, I must have hit the wrong link.

  23. TheProbe says:

    What a wonderful idea, a blog dedicated to evidence based medicine. With the media addressing medical issues more and more, and getting it right less and less, there needs to be a sound voice, a resource, where they can find their answers. Hopefully, this blog will be the leader among many.

    Now, for a suggestion. You may wish to line up a few “guest bloggers” to allow you folks some time off. If the rest of the blogosphre is any measure of the attack dog attitude of the anti-science know-nothings, your regular contributers will need periodic R&R to prevent SBSD (scinece blogging stress disorder).

  24. Langis says:

    I have high hopes for this blog and will be following it from now on. We need for resources like this in the world.

  25. Langis says:

    By “for” I meant “more” =)

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