I am sure I am very easily identifiable for someone lurking on hackernews.

What do you consider a well-known, credible medical professional? A Harvard professor? I happen to have worked with world-renowed clinical researchers, and I have nothing but disrespect for their scientific abilities. I do however, value their clinical teachings very much, and I am thankful for the training they provided in the clinics.

I am frankly not motivated enough to look for papers about it, and I clearly speak from my own experience. I do know that the proportion of research considered as valid is very difficult to estimate, though. If you are interested in "evidence-based medicine", I am sure you know PubMed and related websites. At this point however, I find it extremely difficult to believe any medical paper containing statistics.

Forget "medical professional". Forget my criteria. Just cite someone, anyone, whom YOU believe is well-respected in medicine and whose view on this agrees with you. If you can't find anyone well-respected, then cite the best source you can. My point is, just cite someone. For someone who cares about science it's sure ironic that you're expecting us to trust your judgment with zero backing.

Yeah, so... there is abundant literature on quality assessment. A few samples:

- deficiencies in the reporting methodology https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3554513/

- a bit of incorrect retraction https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3899113/

- a fun one on systematic reviews https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4785311/

- regarding missing data https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748550/

- a paywalled abstract about power https://www.ncbi.nlm.nih.gov/pubmed/26677241

- on sample size calculations https://www.ncbi.nlm.nih.gov/pubmed/25523375

- aaand a fun one on selection bias https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566301/

All found within 10 minutes...

We could go on like that for hours with this sizing contest. I do not expect to convince you. You will, if you put the time and effort into it, find other studies saying the opposite (although being less sexy for publishers, they will be harder to find). If you are somewhat knowledgeable in the field of statistics, please take a look a the numbers, as I am quite sure you will find them appalling (19% of study population missing outcome data and 27.9% underpowered studies, anyone?)

I offer this in the interests of maintaining what I see as a useful, if difficult, discussion, not to be antagonistic:

http://www.jclinepi.com/article/S0895-4356(16)00147-5/abstra...

What the OP is referring to isn't unique to MDs, it's endemic to much biomedical research today. I blame it on lack of tenure protections and science-as-university-income, which in many cases ultimately stems from indirect costs charged to federal grants, or the current grant system.

For me, the concerns mentioned in this thread about scientific research and MD training in particular, bring up bigger issues pertaining to the culture of hierarchy in medicine and its implications for quality of care and competition in service provision and training models.

Interesting, thank you for the link!

I know you're not asking me but here are 2 that back my claims.

http://www.healthy-eating-politics.com/usda-food-pyramid.htm...

http://well.blogs.nytimes.com/2014/11/14/ask-well-how-many-e...

This will get you started https://en.wikipedia.org/wiki/Evidence-based_medicine

Evidence based medicine. An idea that is really less than 50 years old, and still strugging to gain widespread acceptance.

I mentioned once that I was a researcher (not medicine) to someone at a hospital when making smalltalk over the time my wife was in hospital giving birth. She got all excited and started explaining her issues with a research supervisor or something who she didn't agree with on methodology. She said something to the effect of 'what does this old guy know of modern research! Nowadays it's all about evidence based research! I found it right here in this book, how much more evidence does he want!'

I pretty much literally facepalmed; luckily she interpreted that as agreeing with her...

I won't pretend to know about or have any background in medicine, but based on a cursory reading of the article, it seems to be a term for applying the Scientific method to medicine. The idea that we only started doing this 50 years ago is terrifying to say the least.

It seems to me that the problem here is that our industry, built around throwing expensive drugs at problems, paying for results and lobbying governments and insurance companies is ripe for abuse of "science".

That said, "pure" science is about more than published papers: it's about taking the data and observations you have and constructing the most likely theories and explanations around the observed evidence. If we had a capability to separate funding (and emotions) from research we might be able to produce good results given enough open data (which is itself a challenge).

As an uninformed software developer, I think medicine is a field where machine learning based tools will shine: ethical ("hippa") issues aside, we eventually might be able to feed all observed data, from diagnosis to results years after treatment into computer systems which might be able to make sense of the data and allow us to construct conclusions of the data unbiased by personal and business incentives.

Obviously our current eco-policital climate is strewn with roadblocks, but just wanted to put it out there that science doesn't have to lead us down this path if done right.

> The idea that we only started doing this 50 years ago is terrifying to say the least.

It's also a flawed notion. There has been a concerted push in the last 50 years, but applying the scientific method to medicine is considerably older. Koch's Postulates, for example, were published in 1890.

You're talking about applying the scientific method to understanding disease, which is not Evidence-based Medicine.

Evidence-based Medicine is applying the scientific method to the practice of medicine.

Please read the link before spreading misinformation.

I picked one example, but there are others that well predate the term "Evidence Based Medicine". Semmelweis comes to mind. But I've also seen Koch's Postulates used in evaluating the practice of medicine, in addition to the study of disease.

You could ask for clarification before simply assuming I don't know what I'm talking about.

Furthermore, I'd suggest that understanding disease and understanding the practice of medicine are far more entangled than your division suggests.