Monday, January 25, 2016

The New England Journal of Medicine promotes research secrecy

Charles Murray comments: "NEJM editors: Bullshit. If your data can't be shared, along with coding documentation, you've got something to hide"

Another Facebook commenter: "My favorite line: "other researches might "even use the data to try to disprove what the original investigators had posited." This is so stunning I have no words to express it.

NEJM and JAMA are the two most prestigious American medical journals so what they do and say is widely noted.  But both journals still publish a lot of rubbish.  See e.g. here, here, here, and here.

So I was not totally surprised at the latest NEJM article excerpted below. They advocate abandoning one of the basic  safeguards of science:  data transparency.  Science exists on  trust.  If a scientist reports a set of findings, other scientists will always believe what he says.  But, with various levels of self-awareness, scientists will sometimes misrepresent their findings. And that is no mean problem.  Around two thirds of research findings reported in leading journals have been found to be "unreplicable".  In other words, other researchers doing  the same thing fail to confirm the original finding. So two thirds of what is reported is apparently wrong.

Not all the erroneous findings are conscious and deliberate fraud.  Most commonly, the problem is that the author takes a rosy view of what is in his data.  There is something in his data that suits his preconceptions so he reports that and ignores other information in his data that is contrary to his expectations.

So to be sure that his data has been fully and dispassionately analysed, a scientist has long been held responsible for making his data available to other analysts.  It's a basic safeguard.  And if a scientist refuses to make his raw data available that basically tells you all you need to know: His work is faulty and he knows it is faulty.

So, now that we know how serious the unreplicability problem is, some journals are taking steps to circumvent it -- such as asking authors to pre-register their hypotheses to defeat data dredging.  But NEJM is doing the opposite.  They want to make it harder to check on the soundness of a research report!  That is so amazing that I am inclined to apply the usual suspicion:  I am inclined to suspect that the authors of the article (Dan L. Longo  and Jeffrey M. Drazen) have things in their own research past that they don't want to see the light of day.

And the reasons they give for what they advocate are so specious as to border on the hilarious.  They fear, for instance, that other scientists might "use the data to try to disprove what the original investigators had posited".  But why fear that?  That possibility is what data openness is all about.

And there is no doubt that closer scrutiny of many findings WILL "disprove what the original investigators had posited".  I have only once requested raw data from another researcher  -- a request that was refused -- but that was mainly because there was very often enough information in the statistics provided to show that the conclusions did not follow from the data.  I did and reported that often in my 20 years as an active social science researcher  and I still do it often on my blogs. I pointed to an example of it just yesterday.

So NEJM is in the position of defending crap science.

But why?  Are there any non-personal motives involved?  I suspect that it might have something to do with the battering Warmists have taken over their refusal to release their data.  And the reason for Warmist secrecy is plain.  The classic case was Michael Mann's "hockeystick" picture of climate history.  When he did inadvertently let  details of his data and methods leak out, skeptics showed that his procedures were so faulty that just putting random numbers through Mann's computer program would produce a "hockeystick".  Since we in fact live in a era of exceptional temperature stability (with year to year temperature averages differing by only hundredths of one degree), the Warmist claim that we live in an era of dangerous warming was always going to need heroic lies to support it.

And academics do generally support Warmism (It gives them a golden shower of research grants) so I think our medical authors may be wading in to give some skin of defensibility for the chronic Warmist secrecy

The aerial view of the concept of data sharing is beautiful. What could be better than having high-quality information carefully reexamined for the possibility that new nuggets of useful data are lying there, previously unseen? The potential for leveraging existing results for even more benefit pays appropriate increased tribute to the patients who put themselves at risk to generate the data. The moral imperative to honor their collective sacrifice is the trump card that takes this trick.

However, many of us who have actually conducted clinical research, managed clinical studies and data collection and analysis, and curated data sets have concerns about the details. 

The first concern is that someone not involved in the generation and collection of the data may not understand the choices made in defining the parameters. Special problems arise if data are to be combined from independent studies and considered comparable. How heterogeneous were the study populations? Were the eligibility criteria the same? Can it be assumed that the differences in study populations, data collection and analysis, and treatments, both protocol-specified and unspecified, can be ignored?

A second concern held by some is that a new class of research person will emerge — people who had nothing to do with the design and execution of the study but use another group’s data for their own ends, possibly stealing from the research productivity planned by the data gatherers, or even use the data to try to disprove what the original investigators had posited. There is concern among some front-line researchers that the system will be taken over by what some researchers have characterized as "research parasites."

More HERE  


Assimilation Nation No More -- The American pot that no longer melts?

America has always been a melting pot. We are a nation founded by people from all over the world who came here seeking a better life for themselves and their families. So why is immigration such a hot-button issue?

To be sure, it has often been steeped in bitter controversy at various points throughout our history. Certain ethnic groups have bravely borne the brunt of suspicion and hostility — and proven their ability to become good, patriotic Americans. But today, the issue seems to have taken on a harder edge. Why?

I think it’s because something fundamental has changed at the heart of what it means to be an immigrant. For the first two centuries or so of our history, individuals found success in the United States through assimilation, while simultaneously maintaining their heritage. Today, however, that is less and less the case.

And this is no accident. As Mike Gonzalez documents in his book, "A Race for the Future: How Conservatives Can Break the Liberal Monopoly on Hispanic Americans," for at least the last four decades, the federal government has been inflaming the balkanization of our country by encouraging immigrants to view themselves more as aggrieved ethnic groups than as aspiring Americans.

This flies in the face of what our nation’s Founders said was crucial for the success of the American experiment: for us to become one people dedicated to the principles enshrined in the Declaration of Independence. Mr. Gonzalez writes: "E Pluribus Unum, the official motto in the Great Seal of the United States, demonstrated this urge for unity. In Latin it means ‘Out of many, one,’ and it has been through the centuries a reminder of the imperative of uniting different groups."

Today, though, a victim mentality prevails — one that affects even those who have been American all their lives. Ask yourself: Are there many Americans nowadays who love their country so much that they are willing to make the ultimate sacrifice for it?

Former Reagan speechwriter Peggy Noonan thinks there are, and I agree. But she also fears that their numbers are steadily diminishing. As she once observed in a speech to the Heritage Foundation: "We are living in the beginning of what I believe is post-patriotic America. The ties that bind still exist, but they are growing frayed and tired and attenuated."

She went on to indict our educational system for no longer fostering a sense of patriotism:

"Nobody is really teaching our children to love their country. They still pick it up from their parents, from here and there, but in general, we have dropped the ball. The schools, most of them, do not encourage patriotic feeling. Small things — so many of them do not teach the Pledge of Allegiance. Bigger things — they do not celebrate Washington’s Birthday and draw pictures of him and hear stories about him as they did when we were kids.

"There is no Washington’s Birthday; there is Presidents' Day, which my 11-year-old son was once under the impression was a celebration of Bill Clinton’s birthday. Beyond that the teaching of history has changed and has been altered all out of shape. My son is instructed far more in the sins of racism than in the virtues of an Abe Lincoln.

"There is a school in Washington — and I almost moved there so my son could attend — that actually had pictures of Washington or Lincoln on the wall. On the walls of my son’s classroom they had a big portrait of [Mexican artist] Frida Kahlo."

We sometimes hear it said that our diversity is our strength. Actually, our strength lies in our historical excellence at forging one nation out of such a wide array of people. We’re different, but we’re united in the essentials.

At least we used to be. The question that lies before us is how to regain the wisdom of our Founders on the nagging question of immigration, and find a way to restore the ideal of "E Pluribus Unum."

More HERE  


One Hospital Tells You What You Will Have To Pay -- Before The Surgery

Don’t take our word for it. You can try this out yourself. Just google Surgery Center of Oklahoma and here is what you will find. For Achilles tendon repair, you will pay $5,730. That’s not an estimate with a huge variance around it. It’s a package price that includes doctor, nurse, anesthesia, room, drugs, supplies – everything.

For rotator cuff repair, the price is $8,260.  For carpal tunnel release, it’s $2,750. All these prices are posted online for everyone to see. 

The center is owned by Dr. Keith Smith, an Oklahoma anesthesiologist who started posting prices about the same time the Affordable Care Act (Obamacare) was enacted. Since then he has adjusted his prices (downward!) five times.

As Steven Brill so eloquently explained on 60 Minutes and in his book, America’s Bitter Pill, the average patient has no idea what anything is going to cost when he enters a hospital and no idea what he is being billed for when he leaves. Based on what payers actually pay, there is a three to one difference in spending for essentially the same services among the 306 hospital referral regions across the country. Within those regions, the differences are even greater. At the hospital level, there is a twelve to one difference across the country in what payers pay for an MRI scan of lower limb joints!

How refreshing, therefore, to find a hospital that quotes package prices in advance and is willing to compete for patients based on price and quality. Why are they doing it? For the simplest reason of all: to attract patients.
Recommended by Forbes

Five years ago, Dr. Smith was frustrated. His surgery center had the best surgeons, the best outcomes and the lowest prices (sometimes by as much as 80 percent). His lobby should have been packed. Patients should have been beating down his door. But they weren’t. In fact, the patient flow was stagnant. He was outperforming his competitors, yet no one knew it. So, Dr. Smith started posting his prices online, while at the same time calling his center "free market-loving, price-displaying and state-of-the-art."

So what happened? Nothing happened. At least not initially. Nothing? Nothing.

Like other cities around the country, Oklahoma City is a place where employers routinely complain about health care costs. But not one of them bothered to notice that they could improve outcomes and cut their costs in half by choosing Dr. Smith’s center instead of the alternatives.

In fact, it took two whole years before the employers realized a huge opportunity was located right in their own backyard. It began with Jay Kempton, a third-party administrator whose company contracts with many of the local banks.

Fast forward to today. Not only are Kempton’s clients using Dr. Smith’s surgery center, but so is Oklahoma County and soon (if not already) Oklahoma State employees will be using it as well. The Alaska Teachers Union has offered to fly teachers and an escort all the way to Oklahoma for their surgeries. Canadians are also customers, choosing to travel to Dr. Smith’s surgery center rather than endure lengthy waits for free care back home.

There is more good news. Dr. Smith is no longer alone. Other surgery centers around the country are also posting prices, including Monticello Community Surgery Center in Charlottesville, Virginia, Ocean Surgery Center in Torrance, California, Orthopedic Surgery Center of Clearwater, Florida, and newer centers in Ohio and South Carolina.

 Here is something surprising. The prices that these centers are posting are all competitive with each other. Some of Monticello’s prices in Charlottesville are lower than Dr. Smith’s Oklahoma City prices, while others are higher – just like the price differentials you’d expect to find between grocery stores in the same town. But all of these prices are lower than the expected costs at nearby large hospital systems. The centers seem to be aware that they are all within a quick plane ride of each other and therefore they are all potential competitors for the medical tourist market.

Then again, maybe that’s not surprising. That’s the way markets are supposed to work.

More HERE  


For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCH,  POLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated) and Coral reef compendium. (Updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten. I also put up occasional updates on my Personal blog and each day I gather together my most substantial current writings on A WESTERN HEART.

List of backup or "mirror" sites here or  here -- for when blogspot is "down" or failing to  update.  Email me  here (Hotmail address). My Home Pages are here (Academic) or  here (Pictorial) or  here  (Personal)


No comments: