Bench to bedside in a bad way (on the virtue of clinical trials)
Andrew Gelman recently wrote about Columbia surgery professor’s research missconduct. I haven’t looked into the details but it seems like the retracted papers were all about lab research with no true clinical relevancy. In that context, this part of the post stuck out:
Can you imagine, you come to this guy with cancer of the spleen and he might be pushing some unproven treatment supported by faked evidence? Scary.
I can’t tell whether this was supposed to be a joke or if Gelman truly believes that faking mouse experiments directly leads to using unproven treatments, but in case it’s the latter I have to say that the logic is stretched. Yes, the kind of person who has no qualms about fake data is probably not all that rigorous about the evidence for surgical procedures, but for all we know he could be a master surgeon with excellent technique and great outcomes who also happens to have been a bad judge of character and trusted a bad actor. I suspect it’s the latter: the kind of multi-tasking surgery “superstar” that the professor in question seems to be tends to spend a lot more time in the the operating room (or, for another kind of a superstar, the board room), than the lab.
Now, if he were a medical oncologist or any other kind of doctor that gives cancer treatment then maybe things would have been more dubious — that kind of research tends to jump to clinic too quickly and without merit. But unless you’re transplanting pig’s hearts and working on other large animals, the lab is so far removed from the operating room that it is extremely unlikely any such evidence could be used to back up actual surgical treatment.
Incidentally, that last link is to Siddharta Mukherjee’s abomination of an article titled “The Improvisational Oncologist” (subtitle: “In an era of rapidly proliferating, precisely targeted treatments, every cancer case has to be played by ear.") from the May 2016 edition of The New York Times Magazine (it’s a gift link so feel free to read it; caveat lector) and it describes actual scientific and medical malpractice of bringing half-baked — though, admittedly, not faked — ideas from the lab into clinic. Gelman didn’t comment on his blog back then, but he did praise Mukherjee the following year for a New York Times opinion piece “A Failure to Heal” (another gift link there) that is about — wait for it — clinical trials that show the treatment that you thought would work doesn’t. These kinds of trials tend to be called “negative” but there’s nothing negative about them! They bring positive value to the world. Maybe our improvisational oncologist learn something in those 18 months that separate the two texts?
To be clear, what Mukherjee artfully called “improvisational oncology” was (lab) bench to (hospital) bedside medicine, which is distinct from bench to bedside research: the concept of bringing laboratory findings to clinical practice quickly, but still with some semblance of a clinical trial that includes a pre-specified protocol, informed consent and regulatory oversight. You know, all the stuff that decreases the odds of laboratory malfeasance endangering patient care. I say decreases the odds and not prevents them completely because we do have a case of a bad actor completely destroying an entire field of clinical research (Alzheimer’s disease). Can you imagine the damage that kind of shenanigans would do if we didn’t have clinical trials standing between the lab and the commercial drug market?
COI statement: I am involved in a [course about clinical trials][6 and think they are the best thing that has happened to medicine since a cloth merchant wanted to take a closer look at some garments so there is some bias involved, but then again say what you’ll do and do as you say is both a major tenet of clinical trialists and good general practice.
File under “headlines of note”, from Scott Sumner.
On a semi-related note, the NBA season is starting tonight and I look forward to the Wizards’ home game tomorrow night, even if it ends up being the devastating loss from the Celtics that everyone expects will happen.
I have to say there was a moment as the K-poptometrist and I stared deeply into each others’ eyes (him to assess my astigmatism, me because my head was in a cage) where I momentarily forgot that I am quite happily partnered with my girlfriend and in my head was like, wait, Dr Lee… what are we? Then he told me that I should be on the lookout for impending presbyopia due to my age, which brought me back to earth.
File under “footnotes of note”, from Rachel Kwon.
There’s no space in Bangkok left untouched, no discarded patch of land underneath a tangle of elevated roadways, no plot too harsh and uninviting, that doesn’t have at least four or five vendors pitching something, be it food, motor parts, lottery tickets, keys made on order, outdoor tailors, and haircuts. No placid backdrop your eyes can rest on to give your senses and brain a break.
File this one under “paragraphs of note”. Chris Arnade at his best.
I wanted the world to stop, and I wouldn’t stop until it did.
File this one under “sentences of note”. The entire essay is almost too good of a cautionary tale to be true, but who cares if it’s “true” as long as it’s good.
Not sure where I first saw the suggestion that one should never use typographic enhancements like bold or italic text to emphasize the written word, but the latest Daring Fireball post and the style guide that led to it are a good reminded for why it is indeed a good idea not to use them.
Busy day today, but there is always time for a few good links:
Adam Mastroianni nails it:
When people revile a degree from Harvard’s Extension School and revere a degree from Harvard College, they’re saying that the value of an education doesn’t come from the fact that you got educated. It comes from the fact that you got picked.
Alas, it is a paid post, and the more I encounter those the less I think of Substack and — this is not rational, I know — people who use it to blog. Because that is all Substack is: a blog with an optional, easy to implement paywall. I am not a fan.
Blogosphere's end
Venkatesh Rao, while retiring the Ribbonfarm blog, makes a serious prediction:
I do think that the end really is here for the blogosphere though. This time it really is different. I’ve weathered many ups and downs in the blogosphere over my 17 years in it, but now it feels like the end of the blogging era. And what has emerged to take its place is not the blogosphere (and really shouldn’t try to be), even though parts of it have tried to claim the word.
I don’t think there is any single heir to the blog, or to the public social media landscape it dominated, anymore than there was a single heir to the Roman empire when it collapsed. And this is as things should be. Emerging media should emerge into their own identities, not attempt to perpetuate the legacies of sundowning media, or fight over baggage. And of course, many architectural elements of the blog will live on in newer media, just as many patterns we live with today originated in the Roman empire. Chronological feeds, and RSS-like protocols are part of our collective technological vocabulary. So at least in a technological sense, nothing is dying per se. But in a cultural sense, we are definitely witnessing the end of an era.
A few people beg to differ, of course, but there is a generational gap here and my kids may be viewing blogs the same way I saw Bulletin Board Systems, and note that some of those are still around! But maybe not; this post’s main home is, after all, on a blog. Which yesterday had 3 orders of magnitude fewer visitors than a single social media post (about which I will write more soon here, not on X). So it goes…
Happy to be able to cross-post to Threads, but now that I’ve been fiddling with micro.blog settings I see that Bluesky crossposting stopped working for me around 2 months ago. It’s like playing whack-a-mole.