New BMJ editorial: “How Medicine is Broken, and How We Can Fix It”

Well documented problems exist in the funding and prioritisation of research, the conduct of trials, the withholding of results, the dissemination of evidence, and its implementation with patients. Here we briefly examine six domains where the academy could call for simple practical improvements that would address legitimate concerns.

Publication bias—We conduct trials to detect modest differences, and spend vast amounts of money specifically to exclude bias, yet we allow that bias to flood back in through selective publication.3 4 Eminent bodies writing reports will not fix this, but practical action will. We need new funding for simple systematic work to audit which trials are unreported, to highlight the best and worst performers, and to shine a light on withheld studies.5

Independent trials—A recent cohort study found that 97% of head to head trials sponsored by industry give results that favour the sponsor’s drug.6 Doctors and patients are right to want independent trials. On statins and oseltamivir, there are two clear opportunities, and here we declare our own conflicts. With colleagues, one of us (CH) first proposed a trial of oseltamivir in a pandemic in 2009; the other (BG) first proposed a trial of statins examining side effects over a year ago. In both cases we could have the answer by now.

Cost of trials—Replication will be possible only if the cost of conducting trials is radically reduced. Much of this cost is driven by disproportionate regulation around trials of routinely used treatments.7 The National Institute for Health and Care Excellence’s guidance on cholesterol argues for head to head trials in low risk populations; this would require over 100 000 participants, followed up for a decade. Such trials can practically be delivered only by reducing the expensive and disproportionate regulatory burden,7 embedding them in everyday clinical care and gathering follow-up data from existing electronic health records.8

Better evidence—Treatments are routinely approved after trials with only surrogate outcomes.9 Drugs are then extensively promoted, at the moment of approval, when evidence on real world outcomes is paradoxically at its weakest. We could encourage better evidence by, for example, compelling companies to follow-up all phase III trial participants until real world benefits emerge, considering routine randomisation for newly approved drugs when benefits are unclear, and bartering with either patent extension or choice of the start date for market exclusivity. These suggestions would come at minimal cost and deliver more comprehensive data on treatment effects.

Shared decision making—Concern over statins has recently been reawakened by the introduction of a financial incentive for general practitioners to prescribe the drugs to low risk patients. This is ill judged because patients’ informed choices vary widely.10 11 An incentive to prescribe a treatment that many adequately informed patients do not want undermines informed decision making and inflicts avoidable reputational harm on the profession. If instead we incentivise shared decision making then—for the same financial outlay—best practice will be recognised, rewarded, and laid down in the everyday templates of what doctors do.12

Declare conflicts of interest—Declaration of conflicts of interest is currently chaotic, inconsistent, and incomplete. We clearly need a central system of declarations, ideally maintained by the General Medical Council.13 Conflicts, however, become particularly salient when evidence is unclear: when decisions about which treatment works best are made on the basis of a speculative, superficially plausible narrative about a drug’s mechanism of action, or on the interpretation of weak, confounded, observational data when randomised trials are feasible. If we are able to generate better evidence and ensure that we see the complete evidence, then competing interests—although they must always be declared—will become less salient.

New BMJ editorial: “How Medicine is Broken, and How We Can Fix It”:

By Ben Goldacre

 

More proof that cats are out to destroy us.

Exposure to cats in childhood increases the chance of suffering from serious mental health problems like schizophrenia…The parasite Toxoplasma gondii, which is thought to be the cause, is carried in the intestines of cats.

This Childhood Pet Increases Risk of Serious Mental Illness

By Jeremy Dean at PsyBlog

Can't have a post like this without the Louis Wain cats.
Can’t have a post like this without the Louis Wain cats.

Read more:

Is childhood cat ownership a risk factor for schizophrenia later in life?
Estimating the population attributable fraction for schizophrenia when Toxoplasma gondii is assumed absent in human populations

 


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Alcohol’s Unexpected Effect on Memory and Learning

Alcohol’s Unexpected Effect on Memory and Learning:

Alcohol can actually help some areas of the brain learn and remember.

While it’s true that alcohol is generally bad for conscious memory, it can boost unconscious memory.

This may help explain why alcohol — and other drugs — can be so habit-forming.

Or to put it another way, previous ethanol experience enhances synaptic plasticity of NMDA receptors in the ventral tegmental area.

Read more at Jeremy Dean’s PsyBlog

Original study here


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“Stop bragging. It annoys people.” –Science

You Call It “Self-Exuberance”; I Call It “Bragging”

[P]eople overestimate the extent to which recipients of their self-promotion will feel proud of and happy for them, and underestimate the extent to which recipients will feel annoyed…Because people tend to promote themselves excessively when trying to make a favorable impression on others, such efforts often backfire, causing targets of self-promotion to view self-promoters as less likeable and as braggarts

More at PSYCHOLOGICAL SCIENCE
Asking about the other person, showing genuine interest, requesting advice, and other tips for staying out of “Braggart’s Jail” HERE

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A ‘Learning’ Attitude Helps Boost Job Search Success

PAFF_060315_LearningAttitudeSuccess_newsfeatureFor most jobseekers, the job hunt is no picnic — disappointment, rejection, and desperation seem to have become hallmarks of the typical job search. It’s common to hear stories of job hunters who have submitted hundreds of applications before getting a single interview.

No one will argue that looking for a new job isn’t stressful, but new research finds that the way people manage and channel this stress could have a big impact on their ultimate success.
Continue reading “A ‘Learning’ Attitude Helps Boost Job Search Success”

One Minute Personality Tests – PsyBlog

The Big Five personality framework is well-validated across cultures and popular with researchers, although it’s not as well known at the Myers Briggs. The five factors of personality that emerge with some consistency are

Extroversion/introversion
Neuroticism
Agreeableness
Conscientiousness
Openness to experience

Looking over this list, you can see why the Big Five hasn’t caught on with HR departments. The terms don’t look value-neutral. If you administer the Myers Briggs and report that someone came out as an INTJ or an ESFP, great! Neither one sounds better or worse than the other. But who wants to tell someone they tested as  neurotic and disagreeable?

One dimension that the Big Five has in common with the more popular Myers Briggs is introversion vs. extroversion.

Psychologist Jeremy Dean has posted one-minute measures of introversion and neuroticism, with more to come.

Try it out!

Are You An Introvert, Extrovert or….? 

How Neurotic Are You? One-Minute Personality Test

 


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BPS Research Digest: 10 hellish psychology studies you’ll be glad not to have participated in

BPS Research Digest: 10 hellish psychology studies you’ll be glad not to have participated in.

And in case you’re wondering why  Zimbardo and Milgram aren’t on that list, BPS has them here:

The 10 most controversial psychology studies ever published

 Frankie Bow’s first novel, THE MUSUBI MURDER , is available at Audible.comAmazon.com, andiTunes.

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People prefer a healthy-looking leader to an intelligent-looking one.

Health was an influential cue across all scenarios, while intelligence only had an effect in half of the presented scenarios. “

Well, at least intelligence wasn’t a negative predictor (The study was done in the Netherlands; I wonder how the same experiment might turn out in the US).

And yes, apparently there is a way to manipulate “intelligent-looking.”

“[H]igh and low apparent intelligence prototypes were created as described in Moore et al. (2011). Briefly, these prototypes were created by regressing ratings of attractiveness, masculinity, health, and perceived age against ratings of perceived intelligence. The faces with the largest positive and negative residuals (i.e., those who were rated as looking much more or less intelligent than predicted by their age, attractiveness, masculinity, and health) were “averaged” using Psychomorph software to create composite high and low perceived intelligence faces…”

Faces manipulated for apparent intelligence and health

Also, if you can figure out a way to make yourself look taller, that helps too.

Frontiers | A face for all seasons: Searching for context-specific leadership traits and discovering a general preference for perceived health | Frontiers in Human Neuroscience.

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