This is a great framework of our journey through medical research. I would argue that depending on the topic and their area of research/interest, even the most "pragmatist" and "enlightened" doc can fall in any one of the earlier stages. It is very few that are experts on ALL the "pieces of beauty" out there. Humility and curiosity are key. Sadly, those qualities don't "move the meat" in overbooked clinics and ERs.
Yes I agree, it can certainly be a very fluid situation and we can all slip backwards!
Sadly you are also right that there is little reward for the humility and curiosity necessary to provide the best evidence based care to out patients. Hence little incentive for many to step out any further than "Stage 1".
I generally agree with the framework, very interesting way of medical sociological reflection.
That being sad, "most research findings are false" is not the same claim as "most research is wrong". Even if both apply, the main claim that most of published articles aren't "the truth" is a different and less nihilist claim, which was kind of theorized in Ioannidis' model.
I guess one of the best known "nihilists" would be John Ioannidis. Knowing that results are often not duplicated. That is probably a valuable observation (if you accept the premise). The political problem is that his ideas are often used as an excuse to reject ALL biomedical research, which has helped get us to the state in which we now find ourselves.
Getting past that is so important, but usually not sexy enough to grab headlines.
i saw that you were reading richard mcelreath on twitter. the thing about most of the issues with the sorry state of affairs is that most of the problems are 1. already known and 2. being worked on by very smart people 3. they put their solutions out for free on the internet. it's just up to doctors to want to get better, and find them, just like you are! in that line, i think you'd like this https://arxiv.org/abs/2406.19673
This is a great framework of our journey through medical research. I would argue that depending on the topic and their area of research/interest, even the most "pragmatist" and "enlightened" doc can fall in any one of the earlier stages. It is very few that are experts on ALL the "pieces of beauty" out there. Humility and curiosity are key. Sadly, those qualities don't "move the meat" in overbooked clinics and ERs.
Yes I agree, it can certainly be a very fluid situation and we can all slip backwards!
Sadly you are also right that there is little reward for the humility and curiosity necessary to provide the best evidence based care to out patients. Hence little incentive for many to step out any further than "Stage 1".
I generally agree with the framework, very interesting way of medical sociological reflection.
That being sad, "most research findings are false" is not the same claim as "most research is wrong". Even if both apply, the main claim that most of published articles aren't "the truth" is a different and less nihilist claim, which was kind of theorized in Ioannidis' model.
Great point, I agree - more compatible with the desired outcome of embracing a higher amount of uncertainty too.
I guess one of the best known "nihilists" would be John Ioannidis. Knowing that results are often not duplicated. That is probably a valuable observation (if you accept the premise). The political problem is that his ideas are often used as an excuse to reject ALL biomedical research, which has helped get us to the state in which we now find ourselves.
Getting past that is so important, but usually not sexy enough to grab headlines.
Yeah I think Johns work is provocative and important for helping people understand the vast limitations of most of the literature.
That said, when you publish an article literally stating most research is wrong, nihilism is a pretty natural next step...
i saw that you were reading richard mcelreath on twitter. the thing about most of the issues with the sorry state of affairs is that most of the problems are 1. already known and 2. being worked on by very smart people 3. they put their solutions out for free on the internet. it's just up to doctors to want to get better, and find them, just like you are! in that line, i think you'd like this https://arxiv.org/abs/2406.19673