Recently, I read a few medical and science books. Two books that I read were written by Ben Goldacre, a very vocal idealist bright scientist from UK, titled Bad Science and Bad Pharma. The other book was a textbook of pharmacoepidemiology written by group of experts in the field. All of those books gather excellence evidences which criticise how we practice medicine today in term of industry interference and lost research data or inadequate drug study, though the last book doesn't say it straight forwardly.
When I read the books, I find how all of those problems in developed countries are too sophisticated and too advance to happen in my country. Problems like unpublished research data, inadequte reporting, or unnoticed long term adverse events of drugs are far beyond our ability as a country. Those problems are like fairy tale in the country where drugs are mostly still inaccessible and unaffordable. Today's most talked issue among physicians in developed countries, statin's long term side effect in geriatric patients, are somehow irrelevent with circumstances in my country where high cholesterol are still underdiagnosed and therefore undertreatment (following this sentence, I should have provided you with evidence, but there wasn't any data of how many people predicted to have high cholesterol and how many of them receive treatment. We'll talk about it later). To have such a long term side effect of expensive drug is luxurious for our people. Look how ironic this world can be.
Now let's talk about research. It's funny how Goldacre are resentful by many unpublished research data (most of them showed no significant benefit of new drugs, he's arguing that they intentionally unpublished to hide the findings thus it will favor the pharmaceutical industry), while researchers in my countries are struggling to publish their findings. Most of researchs in my country went unpublished as they were rejected by journal's editor. So that's just there hiding peacefully in the laptop. There was a moment when I was presenting my literature review on a med student championship, one of the judges, asked me why didn't I pick study from my own country while there is one Randomized Controlled Trial (RCT) that he aware had been conducted on my topic. Well, I've searched using all the available med research database, but there wasn't such study I find conducted in my country. This is a publication bias, not becuase it is unpublished but because it's insearchable. In that championsip, I decided to use a systematic review which (not so) surprisingly, doesn't contain RCT that the judge was talking about. Not even mention in the excluded studies.
According to Goldacre, many of product sellers in UK cherry picks research to back up their product selling. Cherry pick is an act where someone is selectively choose some studies which support their arguments, whereas studies can result in vary outcome. Thus, the best evidence isn't some researchs, it's a research that contains every previous studies (published or unpublished, in favor or against, significant or insignificant), it's systemmatic review and meta analysis.
In country where there are lack studies conducted in a year, and less academic journals and none of them are linked to Pubmed (biggest database of online medical studies), we have our own problem. We have data scarcity. We are unfindable. None of product sellers can cherry pick studies, which is good but devastating at the same time if we realize how lacking we are in science. We have a lot of intelligence talented scientist, some are brighters than those in developed world. However, they are forced to unscience and unsmart theirselves because of how my country treat them. There is no sufficient fund allocated for research, and if there's any only few of the research proposals selected and therefore the rest of them struglling to find their own funding, even some of them use their own fortune. Eventually, they have to choose, to stay in the country and taking regular less interesting job or to stay in the country and live as idealist scientist and live poorly or they can also choose to get out of the country and pursuing life of science abroad.
This toxic conditions leave my country in their biggest intellectual crisis. We keep arguing without evidence, we decide things without sufficient knowledge, we think we are the smartest because no one can prove we are wrong while the truth is we know nothing about our implausibility.
When I read the books, I find how all of those problems in developed countries are too sophisticated and too advance to happen in my country. Problems like unpublished research data, inadequte reporting, or unnoticed long term adverse events of drugs are far beyond our ability as a country. Those problems are like fairy tale in the country where drugs are mostly still inaccessible and unaffordable. Today's most talked issue among physicians in developed countries, statin's long term side effect in geriatric patients, are somehow irrelevent with circumstances in my country where high cholesterol are still underdiagnosed and therefore undertreatment (following this sentence, I should have provided you with evidence, but there wasn't any data of how many people predicted to have high cholesterol and how many of them receive treatment. We'll talk about it later). To have such a long term side effect of expensive drug is luxurious for our people. Look how ironic this world can be.
Now let's talk about research. It's funny how Goldacre are resentful by many unpublished research data (most of them showed no significant benefit of new drugs, he's arguing that they intentionally unpublished to hide the findings thus it will favor the pharmaceutical industry), while researchers in my countries are struggling to publish their findings. Most of researchs in my country went unpublished as they were rejected by journal's editor. So that's just there hiding peacefully in the laptop. There was a moment when I was presenting my literature review on a med student championship, one of the judges, asked me why didn't I pick study from my own country while there is one Randomized Controlled Trial (RCT) that he aware had been conducted on my topic. Well, I've searched using all the available med research database, but there wasn't such study I find conducted in my country. This is a publication bias, not becuase it is unpublished but because it's insearchable. In that championsip, I decided to use a systematic review which (not so) surprisingly, doesn't contain RCT that the judge was talking about. Not even mention in the excluded studies.
According to Goldacre, many of product sellers in UK cherry picks research to back up their product selling. Cherry pick is an act where someone is selectively choose some studies which support their arguments, whereas studies can result in vary outcome. Thus, the best evidence isn't some researchs, it's a research that contains every previous studies (published or unpublished, in favor or against, significant or insignificant), it's systemmatic review and meta analysis.
In country where there are lack studies conducted in a year, and less academic journals and none of them are linked to Pubmed (biggest database of online medical studies), we have our own problem. We have data scarcity. We are unfindable. None of product sellers can cherry pick studies, which is good but devastating at the same time if we realize how lacking we are in science. We have a lot of intelligence talented scientist, some are brighters than those in developed world. However, they are forced to unscience and unsmart theirselves because of how my country treat them. There is no sufficient fund allocated for research, and if there's any only few of the research proposals selected and therefore the rest of them struglling to find their own funding, even some of them use their own fortune. Eventually, they have to choose, to stay in the country and taking regular less interesting job or to stay in the country and live as idealist scientist and live poorly or they can also choose to get out of the country and pursuing life of science abroad.
This toxic conditions leave my country in their biggest intellectual crisis. We keep arguing without evidence, we decide things without sufficient knowledge, we think we are the smartest because no one can prove we are wrong while the truth is we know nothing about our implausibility.
No comments:
Post a Comment