e-patient Dave tells patients and docs to wise up on evidence

E-patient Dave (Dave deBronkart, diagnosed two years ago with stage 4 kidney cancer), blogs today under the headline, “e-Patients and doctors both, wise up. If you haven’t already.” If you don’t know about Dave, you should. He’s one of the hottest speakers at health care meetings these days. He begins today’s blog:


“I’ve only been studying healthcare for two years – far less than most people on this blog – and I hesitate to be overly assertive. But I have, finally, reached the point where I feel confident in citing cases where people are simply being unscientific: ignoring evidence. That’s always hazardous, and it becomes insidious when it’s caused by a blind, unquestioning belief in our institutions.”

One of those institutions, he points out, is the peer-review system. He quotes Richard Smith, longtime editor of the British Medical Journal, who wrote in the Journal of Participatory Medicine:

“…evidence on the upside of peer review is sparse, while evidence on the downside is abundant. We struggle to find convincing evidence of its benefit, but we know that it is slow, expensive, largely a lottery, poor at detecting error, ineffective at diagnosing fraud, biased, and prone to abuse. Sadly we also know–from hundreds of systematic reviews of different subjects and from studies of the methodological and statistical standards of published papers–that most of what appears in peer-reviewed journals is scientifically weak.”

Finally, Dave plugged our project, which he calls a “wise-up tool.”

Read his entire column. I’ve only given you a few points from it.

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e-Patient Dave

June 11, 2010 at 2:00 pm

Thanks for the link, Gary.
Y’know, it’s funny – for everyone I know who talks about the value of reliable health information, the intention is to weed out crap by thinking smarter, but it’s relatively rare to see people who are scrutinizing “What do we mean by ‘smart’?”
That’s the metric that underlies informed decision making, at both the individual level and the policy level. That’s where you come in…

Gregory D. Pawelski

June 12, 2010 at 9:34 am

I can empathize with David about peer review standards. Recent disclosures of fraudulent or flawed studies in professional medical journals have called into question the merits of their peer-review system. Passing peer-review is not the scientific equivalent of the Good Housekeeping seal of approval. They do not control the world’s information flow.
Peer review lacks consistent standards. A peer reviewer often spends about four hours reviewing research that may have taken months or years to complete, but the amount of time spent on a review and the expertise of the reviewer can differ greatly.
The power of the internet is amazing. All papers can be viewed on internet websites, not just those that would selectively be handled by so-called peer-reviewed journals. Papers are sent to so-called first rate journals. Get it peer-reviewed. If they are accepted, great. If not, up it goes on the internet. And the information gets out there even more quickly and effectively than it would have been had the journal done the right thing and publish what are very good and important papers.
Release of news about medical findings is among the most tightly managed in the country. Journals control when the public learns about findings by setting dates when the research can be published (if they allow them published at all). They impose severe restrictions on what authors can say publicly, even before they submit a manuscript, and they have penalized authors for infractions by refusing to publish their papers.
Journal Editors are the “gatekeepers” of information (only information that they allow). What’s that saying, “if peer-review were a drug, it would never be marketed.” Peer-review is nothing but a form of vetting (whether it be anger, jealousy, or whatever). Reviewers are in fact often competitors of the authors of the papers they scrutinize, raising potential conflicts of interest.
Such problems are far more embarrassing for journals because of their claims for the superiority of their system of editing. Journal Editors do not routinely examine authors’ scientific notebooks, they rely on peer reviewers’ criticisms.
Then there is the problem with respected cancer journals publishing articles that identify safer and more effective treatment regimens, yet few oncologists are incorporating these synergistic methods into their clinical practice. Because of this, cancer patients often suffer through chemotherapy sessions that do not integrate all possibilities.
These are the major flaws in the system of peer-reviewed science. All the more reason why journalists should avoid relying on the latest studies for medical news coverage.