Key Concepts for Informed Health Choices: a framework for helping people learn how to assess treatment claims and make informed choices.

Woolie

Woolie

Senior Member
Key Concepts for Informed Health Choices: a framework for helping people learn how to assess treatment claims and make informed choices.

Chalmers I, Oxman AD, Austvoll-Dahlgren A, et al. BMJ Evidence-Based Medicine 2018; 23:29–33.

http://ebm.bmj.com/content/ebmed/23/1/29.full.pdf. (full text is free)

A list of some of the key concepts:
Recognising an unreliable basis for a claim
Treatments can harm.
Anecdotes are unreliable evidence.
Association is not the same as causation.
Common practice is not always evidence-based.
Newer is not necessarily better.
Expert opinion is not always right.
Beware of conflicting interests.
More is not necessarily better.
Earlier is not necessarily better.
Hope may lead to unrealistic expectations.
Explanations about how treatments work can be wrong.
Dramatic treatment effects are rare.
Understanding whether comparisons are fair and reliable
Comparisons are needed to identify treatment effects.
Comparison groups should be similar.
Peoples’ outcomes should be analysed in their original groups.
Comparison groups should be treated equally.
People should not know which treatment they get.
Peoples’ outcomes should be assessed similarly.
All should be followed up.
Consider all the relevant fair comparisons.
Reviews of fair comparisons should be systematic.
Peer review and publication does not guarantee reliable information.
All fair comparisons and outcomes should be reported.
Subgroup analyses may be misleading.
Relative measures of effects can be misleading.
Average measures of effects can be misleading.
Fair comparisons with few people or outcome events can be misleading.
Confidence intervals should be reported.
Do not confuse ‘statistical significance’ with‘importance’.
Do not confuse ‘no evidence of a difference’ with ‘evidence of no difference
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Woolie said:
Key Concepts for Informed Health Choices: a framework for helping people learn how to assess treatment claims and make informed choices.

Chalmers I, Oxman AD, Austvoll-Dahlgren A, et al. BMJ Evidence-Based Medicine 2018; 23:29–33.

http://ebm.bmj.com/content/ebmed/23/1/29.full.pdf. (full text is free)

A list of some of the key concepts:
Click to expand...

It all seems very sensible and plausible. So why is Chalmers associated with the Norwegian centre where courses are run by Larun and Brurberg, who write Cochrane reviews that make all these mistakes?
 
The irony seems palpable:

'Our survey shows that information on the policies and processes used by research funding agencies to reduce waste and support methodological research and research infrastructure is generally not transparent or readily available. It appears that the processes of governance do not, in general, hold accountable the funding agencies we have surveyed for assessing whether and how they address the questions raised by the reduce research waste framework.'
 
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So what is really going on here?

Is it that Chalmers, like Taverne, has unwittingly spawned a Frankenstein's monster of an organisation that propagates the opposite of what is intended, or is this a group of people who genuinely do not understand that they are prime examples of their own bêtes noirs?

I am reminded of the chap in Edinburgh (?Macleod) who gave his inaugural lecture on bad science, and of course of Ben Goldacre.

Is this in fact a new psychiatric disease idiotruncumoptosis (having a beam in one's own eye) potentially resistant to all forms of psychotherapy?
 
Jonathan Edwards said:
Is it that Chalmers, like Taverne, has unwittingly spawned a Frankenstein's monster of an organisation that propagates the opposite of what is intended, or is this a group of people who genuinely do not understand that they are prime examples of their own bêtes noirs?
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Or is it people wanting to be seen promoting best practice, so their other endeavours will be presumed, by association, conforming to that best practice?
 
Jonathan Edwards said:
So the question is: did @Woolie know that one of the authors of this piece was also on a GET Cochrane review supporting the BPS approach? Was that the reason for posting?
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I smelt hypocrisy right away. Especially give that it was recommended on twitter by some of the worst offenders. What they say seems reasonable - even useful to put it all together - but we know some of these authors do not follow their own advice.
 
Mimicry is a survival strategy employed by many animals. It seems that humans may employ what could be called virtue mimicry (giving the impression of embracing certain virtues, when in reality doing no such thing). Or maybe I'm just overthinking this and reinventing hypocrisy... but a case could be made for this being a deliberate strategy.

Richard Horton also came across as big on hypocrisy. I'm guessing it helps to be seen on twitter showing compassion with poor African children while helping PACE authors exploit hundred thousands of patients with pseudoscience.
 
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strategist said:
Mimicry is a survival strategy employed many animals. It seems that humans may employ what could be called virtue mimicry (giving the impression of embracing certain virtues, when in reality doing no such thing). Or maybe I'm just overthinking this and reinventing hypocrisy... but a case could be made for this being a deliberate strategy.
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No, I don't feel you are overthinking this at all, you are spot on. It's part of the hiding in plain sight strategy some people do - whether they do it consciously, or is just second nature, is another matter. But I think it is more than hypocrisy, because there is an objective behind it.
 


Code: 
https://twitter.com/EricTopol/status/1161003716448624640


(Not sure whether this deserves its own thread.)

Edit:
Maynard, Matt/ Oxman, Andrew/ Pullin, Nicola et al (2019), Key concepts for making informed choices, Nature, vol 572 (15 Aug 2019),
https://www.nature.com/magazine-assets/d41586-019-02407-9/d41586-019-02407-9.pdf

Andrew Oxman is mentioned as an advisor in the e-mail exchange on the Cochrane review between Atle Fretheim and David Tovey
see https://www.s4me.info/threads/cochr...developments-2018-19.10030/page-4#post-179971
 
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MSEsperanza said:


Code: 
https://twitter.com/EricTopol/status/1161003716448624640


(Not sure whether this deserves its own thread.)

Edit:
Maynard, Matt/ Oxman, Andrew/ Pullin, Nicola et al (2019), Key concepts for making informed choices, Nature, vol 572 (15 Aug 2019),
https://www.nature.com/magazine-assets/d41586-019-02407-9/d41586-019-02407-9.pdf

Andrew Oxman is mentioned as an advisor in the e-mail exchange on the Cochrane review between Atle Fretheim and David Tovey
see https://www.s4me.info/threads/cochr...developments-2018-19.10030/page-4#post-179971
Click to expand...

A quick look at this list suggests every single thing produced as part of the psychosocial model of ME fails on every single point. PACE particularly excels, along with others in the series of bad acronym trials. Literally. Every. Single. Point. It's even missing several things that those trials did because they are so evidently fraudulent that it's expected no one would actually try them. And yet here we are.

Somehow I guess this will be exempted. Somehow.

I will still put forward that I would very much this framework to apply to all research on ME. One day, when we are taken off the blacklist anyway.
 
Jonathan Edwards said:
So the question is: did @Woolie know that one of the authors of this piece was also on a GET Cochrane review supporting the BPS approach? Was that the reason for posting?
Click to expand...
Oh, the irony.

Here's the full list of authors:
Iain Chalmers, Andrew D Oxman, Astrid Austvoll-Dahlgren, Selena Ryan-Vig, Sarah Pannell, Nelson Sewankambo, Daniel Semakula, Allen Nsangi, Loai Albarqouni, Paul Glasziou, Kamal Mahtani, David Nunan, Carl Heneghan, Douglas Badenoch

I was looking at David Nunan's publications, because he is on the 2021 Cochrane ME/CFS Exercise Therapy Review. And I saw this publication and thought, super, maybe this guy will be ok, because he's familiar with all of the sources of bias. And I thought, oh, that list of things to be aware of is pretty good, I'll post it on S4ME. And in the process, I see we already have a thread on it.
 
From the description of the paper in google scholar:

Many claims about the effects of treatments, though well intentioned, are wrong. Indeed, they are sometimes deliberately misleading to serve interests other than the well-being of patients and the public. People need to know how to spot unreliable treatment claims so that they can protect themselves and others from harm. The ability to assess the trustworthiness of treatment claims is often lacking. Acquiring this ability depends on being familiar with, and correctly applying, some key concepts, for example, that’ association is not the same as causation.’
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The Informed Health Choices (IHC) Project has identified 36 such concepts and shown that people can be taught to use them in decision making. A randomised trial in Uganda, for example, showed that primary school children with poor reading skills could be taught to apply 12 of the IHC Key Concepts.
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So, apparently Ugandan primary school children with poor reading skills were taught to apply key concepts - these ones:
  • Treatments can harm.*†

  • Anecdotes are unreliable evidence.*†

  • Association is not the same as causation.†

  • Common practice is not always evidence-based.*†

  • Newer is not necessarily better.*

  • Expert opinion is not always right.*†

  • Beware of conflicting interests.*
  • Comparisons are needed to identify treatment effects.*†

  • Comparison groups should be similar.*
  • People should not know which treatment they get.*

  • Consider all the relevant fair comparisons.*†
  • Fair comparisons with few people or outcome events can be misleading.*
Oh, for a Ugandan primary school child with poor reading skills when you need one.


So, David Nunan was the person on the 2021 Cochrane review I was really hoping would be good. Maybe he will be. But looking at this, and all of the Cochrane reviews he has done, he's very much associated with Cochrane.
 
Chalmers: the Godfather

Astrid Austvoll-Dahlgren: Norwegian Institute of Public Health
Andrew Oxman: Tovey/Fretheim exchange
Allen Nsangi: working with Oxman at Oslo
Paul Glasziou: author on previous exercise review with Larun
Loai Albarqouni: works with Glasziou - a successor to Hilda.
David Nunan: on the new review

Nelson Sewankambo: Ugandan physician
Daniel Semakula: Ugandan physician
Douglas Badenoch: Evidence based health care (National Elf Service)
Kamal Mahtani and Carl Heneghan: Oxford Centre for Evidence Based Medicine
Selena Ryan-Vig: Cochrane educator
Sarah Pannell: school biology teacher involved in public education in medicine
 
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