Thursday, August 12, 2010

Evidence Based Research

Evidence Based Research is essentially a fancy word for 'scientific research'. The quality of research is judged against the rigorousness of the design of research.

Weak research but nonetheless valid research is 'anecdotal'. For example "Henry, I note when I point this longish object here at that object over there and press this red button here the object over there disappears."

To improve on this research John might well repeat the experiment numerous times and point the longish object at different objects and conclude rather reliably that longish object with red button cause other objects to disappear.

If he wanted to prove that longish objects with red button cause other objects to disappear he might randomly pick up longish objects with red buttons and try his experiment. Randomization is contrasted with selection in which quite frankly he might indeed know which longish objects with red buttons cause things to appear and by selecting those with a hole in the end opposite the red button to those without get the result he wanted. If he said then my experiment says longish objects with red buttons caused things to disappear all sorts of people would be confused because when they tried to 'repeat' his experiment half their longish objects, those without the hole in the end, wouldn't make things disappear. That's why having an experiment repeated by others, especially others without an initial invested interest, makes for better science.

Finally there is the aspect of 'controlling' an experiment. In this case we point the longish shaped object with the hole in the end and press the red button at every other object on the horizon and then wait. Quite surprising to us might be the observation then that all the objects on the horizon disappeared regardless of whether we pointed the longish object with the red button and hole at them. We have thereby controlled this experiment by having a 'control' group, the objects we didn't point the longish object with the red button and hole at.

If we wanted to blind the experiment we'd put a blind fold on the operator and see if the objects he pointed the object at indeed disappeared. If they didn't we could conclude the object's disappearance had nothing to do with the experiment but rather that the operator was disappearing the objects by supreme mentalist powers and trying to sell us longish objects with red buttons and holes so that he would become rich and we'd falsely believe we had similar powers and a useful disappearing tool.

Finally if we wanted to double blind the experiment we'd blindfold the operator and not let the observer see where the operator pointed the longish object with the red button and hole. This way we'd control the observer, believing in the object, mentally causing things to disappear with his great mentalist powers that he may not even be aware of.

At it's simplest this last might represent a multi center (more than one experimenter), randomized, double blind trial.

Statistically the number of round holed red buttoned longish objects should be over 30 and the number of disappeared objects should be over 30.

Now this is where 'evidence based research' or science begins. It's the basis of all airplane travel, all automobiles, the kitchen toaster, all pharmaceuticals, the air conditioner, gps, telephones, the internet and just about everything that is part of the modern world. Science is also about very smart bombs but that's a separate issue.

More people than at any other time in the world are being fed and clothed and living longer lives than ever before. Science has profoundly altered positively the very nature of our existence. Much of our free time is a product of science. Historically people lived shorter lives, except in early biblical accounts and then only a very few of the very wealthy and privileged because books until very recently weren't wasted on commoners. The evidence of fossils and archeology is that people had horrible illness and lived with all manner of disability. It was painful.

Even a report of the Cree before the Hudson Bay Company arrived with their famous blankets described existence as 'cold'. Mosquitos and bugs were so bad on the west coast only a hundred years ago that the First Nations people rolled in mud and kept the bugs from biting themselves by being filthy muddy all summer. The open fires in tee pees and such caused early death from chronic lung disease. Smoking the tobacco and peace pipe didn't help and may well have contributed to the early spread of TB. Indoor plumbing, showers and toilets are a product of science.

When I go to an "alternative health food store" I immediately note that the owner calls his product "food'. Then he 'lies' and says that it is 'medicine' and makes all manner of claims for his product which at first by the nature of labeling results in these products not being required to be 'effective'. Food is not required to be 'effective'. It's not scientifically required to do what it says it would do. Chips and chocolate bars 'entertain' but they're not very 'nutritious' and rarely contribute to robust health. Indeed they're contributing to the epidemic of obesity that has devastated America these days. Similarly 'health foods' are 'entertaining'. They are usually consumed by the rich with large amounts of disposable incomes and hypochondriacs. The very same people then have to insist that these things are 'beneficial' because otherwise they'd appear as idiots for spending more money on 'fake medicine' than really sick people spend on 'real' medicine.

"Alternative medicine" itself, in contrast to mere 'health foods' but sometimes found in the same counters, is commonly older 'medicines' which were shown to be of benefit 'anecdotally' and increasingly today are being subjected to scientific studies by medical researchers and pharmacologists, the same people who bring you pharmaceuticals of proven benefit with clearly researched pros and cons. These 'alternative medicines' are of benefit and in medicine are called 'alternative' because they represent 'adjunctives', ie medicines that help other medicines work or may be 'palliatives', medicines that don't cure but reduce the damage of disease. As an example 'ginkgo biloba' is an alternative medicine which makes other medications more potent in some cases whereas it counteracts the effects of others. It has generally been used to treat early memory loss but can also make some pharmaceutical antidepressants more potent.

Many things work 'anecdotally'. We are 'self healing' systems. Salamanders grow tails. We grow skin back. Our bodies heal. Mostly medicine assists the healing process. For instance, Penicillin assists the white blood cells which are already fighting off bacteria.

The 'health food stores' and the 'alternative medicine' purveyors would be just great in the best of all worlds. The trouble is they continue to make claims by 'cutting off the heads of others' . It's like people who say bicycles are better than cars. They say that ambulances should be replaced by bicyclists pulling stretchers. They have the bicycles and patents on the stretchers. It's a great idea. So then people ban ambulances. Not only that car accident victims on the side of the road are told to wait for a year or two while a bicyclist comes to rescue them.

And yearly thousands, tens of thousands or more people die from 'health foods' and 'alternative medicines' because they 'trusted' the 'claims' which are mostly 'slick marketing'. There is 'no proof'.

As a scientist I can't help but look at people spending millions on 'health food' and 'alternative medicine 'and not think that they're like a whole bunch of international commuters standing on runways with their latest brooms jumping up and down and expecting to fly because their broom is marketted with the slickest of marketting.

In contrast I love flying Air Canada, Northwest, Alaska Airlines, Delta and even United when it's not smashing my luggage. Sure I'd like to travel with a horse and buggy. Hell, I'd rather drive my Harley. But there's not a road across the Atlantic or Pacific and few would visit Australia were it not for planes.

Yet I go to parties and invariably I meet "Storm" (see Tim Minshin) and I have to listen to Storm telling everyone about her latest quack cure for her neurosis. And I am delighted to hear the 'eye of neut' is wonderful. I just get my back up when I hear that doctors and scientists should be using 'eye of neut' for all that ails their patients. I get upset when I hear these things because I think the guy with the broom shop is knocking WestJet because no one seems to note that the weakest argument of all is 'chopping off the heads of others to make yourself look taller'.

So if 'natural' food was so good, then we'd see most Africans having better health than Canadians. If 'alternative medicines' were so effective people would not fly from all over the world to Mayo Clinic they'd fly to Haiti to try the herbs.

I like science. I am suspicious naturally of business because 'business' is all about 'conflict of interest' , politics and my product versus your product. Business uses science and in fact 'sells' science.There's a business of science and a business of health food and a business of alternative medicine. It's in the business that one has to look. And just because we all like indoor plumbing and have toilets doesn't mean it's a conspiracy.

Big business doesn't necessarily mean 'bad business'. It's important to separate science from business. Alot of business is just about whose got the bigger gun. Science is not that. Evidence based research is not business yet it's being used by business for nefarious ends. That's a different story though.

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