Evidence based medicine is broken

By Des Spence
BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g22 (Published 3 January 2014)
Cite this as: BMJ 2014;348:g22

Evidence based medicine (EBM) wrong footed the drug industry for a while in the 1990s. We could fend off the army of pharmaceutical representatives because often their promotional material was devoid of evidence. But the drug industry came to realise that EBM was an opportunity rather than a threat. Research, especially when published in a prestigious journal, was worth more than thousands of sales representatives. Today EBM is a loaded gun at clinicians’ heads. “You better do as the evidence says,” it hisses, leaving no room for discretion or judgment. EBM is now the problem, fueling overdiagnosis and overtreatment.

The entire article is here.

Submitting a manuscript for peer review - integrity, integrity, integrity.

Sean P. Murphy, Christopher Bulman, Behnam Shariati and Laura Hausmann-on behalf of the ISN Publications Committee
J Neurochem. 2013 Dec 26. doi: 10.1111/j.1471-4159.2013.12644.x.

Abstract

Publication of a flawed manuscript has significant consequences for the progress of science. When this proves to be intentional, science is brought into disrepute and this puts even more pressure on the shrinking resources that society is prepared to invest in research. All scientific journals, including the Journal of Neurochemistry, have witnessed a marked increase in the number of corrections and retractions of published papers over the last 10 years, and uncovered a depressingly large number of fabrications amongst submitted manuscripts. The increase in number of 'spoiled' manuscripts reflects not only the improved methods that journals employ to detect plagiarism in its many forms, but also suggests a measurable change in the behavior of authors. The increased policing of submissions by reviewers, editors and publishers expends time and money. The sanctions imposed by journal editors on authors found guilty of malpractice are transparent and severe.

Never let the truth stand in the way of a good story 
Mark Twain

While imagination is the source of vibrant fiction, the ‘stories’ we offer in manuscripts submitted for publication have to be faithful. With the beginning of a New Year, it seems appropriate to re-state current Journal of Neurochemistry policies on submissions and, on behalf of the International Society for Neurochemistry, to demand integrity from authors offering manuscripts for scientific review. While the comments here are directed specifically at corresponding authors, the contract entered into with the submission of any manuscript also demands integrity from reviewers, editors and publishers, who
have to be seen to act impartially and promptly in reaching their decisions.

The entire article is here.

How the brain heals emotional wounds: the functional neuroanatomy of forgiveness

Ricciardi E, Rota G, Sani L, Gentili C, Gaglianese A, Guazzelli M and Pietrini P (2013)
How the brain heals emotional wounds: the functional neuroanatomy of forgiveness.
Front. Hum. Neurosci. 7:839. doi: 10.3389/fnhum.2013.00839

In life, everyone goes through hurtful events caused by significant others: a deceiving friend, a betraying partner, or an unjustly blaming parent. In response to painful emotions, individuals may react with anger, hostility, and the desire for revenge. As an alternative, they may decide to forgive the wrongdoer and relinquish resentment. In the present study, we examined the brain correlates of forgiveness using functional Magnetic Resonance Imaging (fMRI). Healthy participants were induced to imagine social scenarios that described emotionally hurtful events followed by the indication to either forgive the imagined offenders, or harbor a grudge toward them. Subjects rated their imaginative skills, levels of anger, frustration, and/or relief when imagining negative events as well as following forgiveness. Forgiveness was associated with positive emotional states as compared to unforgiveness. Granting forgiveness was associated with activations in a brain network involved in theory of mind, empathy, and the regulation of affect through cognition, which comprised the precuneus, right inferior parietal regions, and the dorsolateral prefrontal cortex. Our results uncovered the neuronal basis of reappraisal-driven forgiveness, and extend extant data on emotional regulation to the resolution of anger and resentment following negative interpersonal events.

The entire article is here.

Calling All Female Brains: Stop the 'Neurosexism'

Research now finds sex-linked differences in the neural connections. So what? The media's rush to pop-psychologize the findings fuels retro gender stereotypes that only raise the obstacles to workplace advancement.

By Rosalind C. Barnett and Caryl Rivers
WeNews commentators
Originally posted Friday, December 13, 2013

The news media are at it again; suggesting that a new study proves the old gender stereotypes about women being good at intuition and social skills and men being better at understanding systems and action.

A team of researchers at the University of Pennsylvania used high-tech imaging on the brains of 428 males and 521 females aged 8 to 22 and found neural pathway differences between men and women. (The study was published in the Proceedings of National Academy of Sciences.)

As the Guardian explained it, "Women's brains are suited to social skills and memory, men's to perception and coordination."

The entire article is here.

The Meaning of Disgust: A Refutation

Strohminger, N. (in press). The Meaning of Disgust: A Refutation. Emotion Review

Abstract

Recently, McGinn (2011) has proposed a new theory of disgust.  This theory makes empirical claims as to the history and function of disgust, yet does not take into account contemporary scientific research on the subject.  This essay evaluates his theory for its merits as an account of disgust, and as a piece of scholarship more generally, and finds it lacking.

Introduction

In disgust research, there is shit, and then there is bullshit.  McGinn's (2011) theory belongs to the latter category.

The entire article is here.  And yes, there is some humor here.

Scientists, Practitioners Don't See Eye to Eye On Repressed Memory

Science Daily
Originally published December 13, 2013

Skepticism about repressed traumatic memories has increased over time, but new research shows that psychology researchers and practitioners still tend to hold different beliefs about whether such memories occur and whether they can be accurately retrieved.

The findings are published in Psychological Science, a journal of the Association for Psychological Science.

"Whether repressed memories are accurate or not, and whether they should be pursued by therapists, or not, is probably the single most practically important topic in clinical psychology since the days of Freud and the hypnotists who came before him," says researcher Lawrence Patihis of the University of California, Irvine.

According to Patihis, the new findings suggest that there remains a "serious split in the field of psychology in beliefs about how memory works."

The entire article is here.

Psychologists strike a blow for reproducibility

By Ed Yong
Nature
Originally published November 26, 2013

A large international group set up to test the reliability of psychology experiments has successfully reproduced the results of 10 out of 13 past experiments. The consortium also found that two effects could not be reproduced.

Psychology has been buffeted in recent years by mounting concern over the reliability of its results, after repeated failures to replicate classic studies. A failure to replicate could mean that the original study was flawed, the new experiment was poorly done or the effect under scrutiny varies between settings or groups of people.

The entire story is here.

It's time for psychologists to put their house in order

By Keith Laws
The Guardian
Originally published February 27, 2013

Here is an excerpt:

Psychologists find significant statistical support for their hypotheses more frequently than any other science, and this is not a new phenomenon. More than 30 years ago, it was reported that psychology researchers are eight times as likely to submit manuscripts for publication when the results are positive rather than negative.

Unpublished, "failed" replications and negative findings stay in the file-drawer and therefore remain unknown to future investigators, who may independently replicate the null-finding (each also unpublished) - until by chance, a spuriously significant effect turns up.

It is this study that is published. Such findings typically emerge with large effect sizes (usually being tested with small samples), and then shrivel as time passes and replications fail to document the purported phenomenon. If the unreliability of the effect is eventually recognised, it occurs with little fanfare.

The entire story is here.

Evidence-Based Medicine and the Practicing Clinician

Finlay A. McAlister, Ian Graham, Gerald W. Karr, Andreas Laupacis
Journal of General Internal Medicine
Volume 14, Issue 4, pages 236–242, April 1999 (and still relevant today)

Abstract

OBJECTIVE: To assess the attitudes of practicing general internists toward evidence-based medicine (EBM—defined as the process of systematically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions) and their perceived barriers to its use.

DESIGN: Cross-sectional, self-administered mail questionnaire conducted between June and October 1997.

PARTICIPANTS: Questionnaires were sent to all 521 physician members of the Canadian Society of Internal Medicine with Canadian mailing addresses; 296 (60%) of 495 eligible physicians responded. Exclusion of two incomplete surveys resulted in a final sample size of 294.

MAIN RESULTS: Mean age of respondents was 46 years, 80% were male, and 52% worked in large urban medical centers. Participants reported using EBM in their clinical practice always (33, 11%), often (173, 59%), sometimes (80, 27%), or rarely/never (8, 3%). There were no significant differences in demographics, training, or practice types or locales on univariate or multivariate analyses between those who reported using EBM often or always and those who did not. Both groups reported high usage of traditional (non-EBM) information sources: clinical experience (93%), review articles (73%), the opinion of colleagues (61%), and textbooks (45%). Only a minority used EBM-related information sources such as primary research studies (45%), clinical practice guidelines (27%), or Cochrane Collaboration Reviews (5%) on a regular basis. Barriers to the use of EBM cited by respondents included lack of relevant evidence (26%), newness of the concept (25%), impracticality for use in day-to-day practice (14%), and negative impact on traditional medical skills and “the art of medicine” (11%). Less than half of respondents were confident in basic skills of EBM such as conducting a literature search (46%) or evaluating the methodology of published studies (34%). However, respondents demonstrated a high level of interest in further education about these tasks.

CONCLUSIONS: The likelihood that physicians will incorporate EBM into their practice cannot be predicted by any demographic or practice-related factors. Even those physicians who are most enthusiastic about EBM rely more on traditional information sources than EBM-related sources. The most important barriers to increased use of EBM by practicing clinicians appear to be lack of knowledge and familiarity with the basic skills, rather than skepticism about the concept.

The entire study is here.

Thanks to Ed Zuckerman for this research article.

Pushing the Intuitions behind Moral Internalism

Derek Leben and Kristine Wilckens

Introduction 

Moral Internalism claims that there is a necessary connection between judging that some action is morally right/wrong and being motivated to perform/avoid that action. For instance, if I sincerely believe that it is morally wrong to eat animals, then I would be automatically motivated not to eat animals. If I sincerely believe that it is morally required for me to take care of my children, then I would be automatically motivated to take care of my children. This claim is called ‘Internalism’ (or more technically, ‘Motivational Judgment Internalism’) because in such cases, the motivation is internal to the evaluative judgment. There are different types of Moral Internalism, but we will here be concerned with the conceptual variety advocated by Hare (1952), which claims that the link between moral judgments and motivation is an a priori conceptual truth.

The fact that Internalism appears intuitively to be true specifically for moral judgments has been extremely important to moral philosophers. In response to the skeptical question: “Why should I care about right and wrong?” some ethicists have argued that the question is nonsensical, since by making judgments about right and wrong, one is automatically motivated to care about these judgments. In response to the question: “What kind of judgments are moral judgments?” philosophers going back to Hume have argued that beliefs like ‘my car is black’ or ‘today is Tuesday’ can never in themselves motivate or direct anyone to perform some action, but only in conjunction with an emotion. If one adopts this Humean Theory of Motivation along with Moral Internalism, then, as Hume states, “it is impossible that the distinction betwixt moral good and evil can be made by reason; since that distinction has an influence on our actions, of which reason alone is incapable” (Hume, 1739). In other words, since beliefs are never inherently motivating, moral judgments cannot be normal beliefs about the world. This conclusion is known as (psychological) non-cognitivism, and has obvious consequences for how we engage in moral debate and consideration. 

The entire article is here.

The Pervasive Problem With Placebos in Psychology

By Walter R. Boot, Daniel J. Simons, Cary Stothart, and Cassie Stutts
doi: 10.1177/1745691613491271
Perspectives on Psychological Science July 2013 vol. 8 no. 4 445-454

Abstract

To draw causal conclusions about the efficacy of a psychological intervention, researchers must compare the treatment condition with a control group that accounts for improvements caused by factors other than the treatment. Using an active control helps to control for the possibility that improvement by the experimental group resulted from a placebo effect. Although active control groups are superior to “no-contact” controls, only when the active control group has the same expectation of improvement as the experimental group can we attribute differential improvements to the potency of the treatment. Despite the need to match expectations between treatment and control groups, almost no psychological interventions do so. This failure to control for expectations is not a minor omission—it is a fundamental design flaw that potentially undermines any causal inference. We illustrate these principles with a detailed example from the video-game-training literature showing how the use of an active control group does not eliminate expectation differences. The problem permeates other interventions as well, including those targeting mental health, cognition, and educational achievement. Fortunately, measuring expectations and adopting alternative experimental designs makes it possible to control for placebo effects, thereby increasing confidence in the causal efficacy of psychological interventions.

The entire article is here.

The Crisis in Social Psychology: Paul Bloom on Bloggingheads.tv

Paul Bloom interviews Joseph Simmons about the crisis in social psychology.  They discuss the experimental method, the ability to replicate studies, false positives, and studies with "sexy findings".



The entire web site is here.

No Faith in Science

By Jerry A. Coyne
Slate.com
Originally published November 14, 2013

A common tactic of those who claim that science and religion are compatible is to argue that science, like religion, rests on faith: faith in the accuracy of what we observe, in the laws of nature, or in the value of reason. Daniel Sarewitz, director of a science policy center at Arizona State University and an occasional Slate contributor, wrote this about the Higgs boson in the pages of Nature, one of the world’s most prestigious science journals: “For those who cannot follow the mathematics, belief in the Higgs is an act of faith, not of rationality.”

Such statements imply that science and religion are not that different because both seek the truth and use faith to find it. Indeed, science is often described as a kind of religion.

But that’s wrong, for the “faith” we have in science is completely different from the faith believers have in God and the dogmas of their creed.

The entire article is here.

Psyching Us Out: The Promises of ‘Priming’

By GARY GUTTING
The New York Times - Opinionator
Originally published October 31, 2013

Reports of psychological experiments are journalistic favorites.  This is especially true of experiments revealing the often surprising effects of “priming” on human behavior. Priming occurs when a seemingly trivial alteration in an experimental situation produces major changes in the behavior of the subjects.

The classic priming experiment was one in which college students had been asked to form various sentences from a given set of words.  Those in one group were given words that included several associated with older people (like bingo, gray and Florida).  Those in a second group were given words with no such associations.  After the linguistic exercise, each participant was instructed to leave the building by walking down a hallway.  Without letting the participants know what was going on, the experimenters timed their walks down the hall.  They found that those in the group given words associated with old people walked significantly slower than those in the other group.  The first group had been primed to walk more slowly.

The entire story is here.

Episode 35: Does Reading Harry Potter Make You Moral?

Very Bad Wizards Podcast

Special guest Will Wilkinson joins the podcast to talk about whether fiction makes us better people, and to discuss his recent Daily Beast article that trashed Dave's profession and livelihood. Also, Dave and Tamler try to make sense of Ancient Greek justice in a myth about incest, adultery, daughter-killing, husband-killing, matricide, cannibalism, and trash talking to disembodied heads.

The podcast is here.

Trouble at the lab

Scientists like to think of science as self-correcting. To an alarming degree, it is not

The Economist
Originally posted October 19, 2013

“I SEE a train wreck looming,” warned Daniel Kahneman, an eminent psychologist, in an open letter last year. The premonition concerned research on a phenomenon known as “priming”. Priming studies suggest that decisions can be influenced by apparently irrelevant actions or events that took place just before the cusp of choice. They have been a boom area in psychology over the past decade, and some of their insights have already made it out of the lab and into the toolkits of policy wonks keen on “nudging” the populace.

Dr Kahneman and a growing number of his colleagues fear that a lot of this priming research is poorly founded. Over the past few years various researchers have made systematic attempts to replicate some of the more widely cited priming experiments. Many of these replications have failed. In April, for instance, a paper in PLoS ONE, a journal, reported that nine separate experiments had not managed to reproduce the results of a famous study from 1998 purporting to show that thinking about a professor before taking an intelligence test leads to a higher score than imagining a football hooligan.

The entire article is here.

The Not-So-Hidden Cause Behind the A.D.H.D. Epidemic

By MAGGIE KOERTH-BAKER
The New York Times
Published: October 15, 2013

Here are two excerpts:

Of the 6.4 million kids who have been given diagnoses of A.D.H.D., a large percentage are unlikely to have any kind of physiological difference that would make them more distractible than the average non-A.D.H.D. kid. It’s also doubtful that biological or environmental changes are making physiological differences more prevalent. Instead, the rapid increase in people with A.D.H.D. probably has more to do with sociological factors — changes in the way we school our children, in the way we interact with doctors and in what we expect from our kids.

Which is not to say that A.D.H.D. is a made-up disorder.

(cut)

This lack of rigor leaves room for plenty of diagnoses that are based on something other than biology. Case in point: The beginning of A.D.H.D. as an “epidemic” corresponds with a couple of important policy changes that incentivized diagnosis. The incorporation of A.D.H.D. under the Individuals With Disabilities Education Act in 1991 — and a subsequent overhaul of the Food and Drug Administration in 1997 that allowed drug companies to more easily market directly to the public — were hugely influential, according to Adam Rafalovich, a sociologist at Pacific University in Oregon.

The entire article is here.

Montreal Statement on Research Integrity in Cross-Boundary Research Collaborations

The Montreal Statement on Research Integrity in Cross-Boundary Research Collaborations was developed as part of the 3rd World Conference on Research Integrity, 5-8 May 2013, in Montréal, as a global guide to the responsible conduct of research. It is not a regulatory document and does not represent the official policies of the countries or organizations that funded or participated in the Conference.

Preamble. 

Research collaborations that cross national, institutional, disciplinary and sector boundaries are important to the advancement of knowledge worldwide. Such collaborations present special challenges for the responsible conduct of research, because they may involve substantial differences in regulatory and legal systems, organizational and funding structures, research cultures, and approaches to training. It is critically important, therefore, that researchers be aware of and able to address such differences, as well as issues related to integrity that might arise in cross-boundary research collaborations. Researchers should adhere to the professional responsibilities set forth in the Singapore Statement on Research Integrity. In addition, the following responsibilities are particularly relevant to collaborating partners at the individual and institutional levels and fundamental to the integrity of collaborative research. Fostering the integrity of collaborative research is the responsibility of all individual and institutional partners.

The entire statement is here.

The ethics of admitting you messed up

By Janet D. Stemwedel | October 14, 2013
The Scientific American Blog
@docfreeride

Here is an excerpt:

Ethically speaking, mistakes are a problem because they cause harm, or because they result from a lapse in an obligation we ought to be honoring, or both. Thus, an ethical response to messing up ought to involving addressing that harm and/or getting back on track with the obligation we fell down on. What does this look like?

1. Acknowledge the harm. This needs to be the very first thing you do. To admit you messed up, you have to recognize the mess, with no qualifications. There it is.

2. Acknowledge the experiential report of the people you have harmed. If you’re serious about sharing a world (which is what ethics is all about), you need to take seriously what the people with whom your sharing that world tell you about how they feel. They have privileged access to their own lived experiences; you need to rely on their testimony of those lived experiences.

The entire article is here.

The potential benefit of the placebo effect in sham-controlled trials: implications for risk-benefit assessments and informed consent

By Remy L Brim and Franklin G Miller
J Med Ethics 2013; 39:703-707 doi:10.1136/medethics-2012-101045

Abstract

There has been considerable debate surrounding the ethics of sham-controlled trials of procedures and interventions. Critics argue that these trials are unethical because participants assigned to the control group have no prospect of benefit from the trial, yet they are exposed to all the risks of the sham intervention. However, the placebo effect associated with sham procedures can often be substantial and has been well documented in the scientific literature. We argue that, in light of the scientific evidence supporting the benefits of sham interventions for pain and Parkinson's disease that stem from the placebo effect, these sham-controlled trials should be considered as offering potential direct benefit to participants. If scientific evidence demonstrates the positive effect of placebo from sham interventions on other conditions, sham-controlled trials of interventions for the treatment of these conditions should be considered to have prospects of benefit as well. This potential benefit should be taken into account by research ethics committees in risk-benefit analyses, and be included in informed consent documents.

The article is here.