Thu, 15 October 2009 Prof. Ian Harris 0:00:00 Introduction - Richard Saunders 0:01:50 Eran Segev talks to Prof. Ian Harris Comments[22] |
Sorry, Skeptic Zone -- that was way too long, had little to do with skepticism and really dragged. If there were questions that Eran forgot to ask, then he should have plenned it better or there should have been a two-parter episode like the one with Ben Goldacre. That was really dull. I suggest that in future you break up a show if its going to be like that one and hope you go back to the standard you've already maintained.
I totally disagree with gi.
I found it a very interesting interview and was sorry, when it was over.
Any chance on getting Prof. Harris back? Maybe in a debate format? The topics and his challenging views on them are well worth it.
Keep up your good work!
I found it a very interesting interview and was sorry, when it was over.
Any chance on getting Prof. Harris back? Maybe in a debate format? The topics and his challenging views on them are well worth it.
Keep up your good work!
I would hear a discussion between Harris, Dunlop, Crislip, and Novella. I am still crunching this episode through my brain, but my knee jerk reaction is that while Harris is correct in pointing out some flaws in current medical science, his ideas that plausibility of a treatment almost are a certain guarantee that it won't work seemed extreme. While there are many failed ideas, taking Harris's ideas to the logical conclusion would seem to mean that medicine is one big failure. Hum-m-m food for thought
posted by: Nigel St. Whitehall on Sat, 10/17 11:53 AM EDT
Swinging between 'was too long' and 'was fairly interesting'. Would have been better if it was a discussion, most of your interviews are around the 30-40 min mark and this didn't seem to really be on the usual standard. Agree that the 'more questions at the end' were unnecessary.
I liked it, I'm glad it wasn't split up. Then again, I have a long commute. I do agree that a format with another doctor would be nice for some back and fourth.
posted by: Travis Roy on Sun, 10/18 06:22 PM EDT
A fascinating show thanks. This is a reminder to all skeptics that we note should turn off our "skeptic meter" when we walk through the doors of our doctor's surgery. All aspects of daily life can benefit from a rational approach and even mainstream medical practise can sometimes be a target for skepticism not just quackery.
I would have liked an even longer interview, maybe in two parts. The doctor started out sounding very rational, with some thought-provoking points, but seemed to me to veer off into kookiness near then end. His last few statements sounded ideologically driven, and I would have liked to hear him elaborate a bit more.
Prof. Harris's views on life expectancy seem at odds with other's, e.g.: http://www.efmoody.com/estate/lifeexpectancy.html. The points he made weren't really backed up; i.e. he didn't say this study shows that, he more said that he thought. Also saying that better sanitation, better water, were the really good things, seems odd. Surely it was scientists, like Louis Pasteur, who said it sanitation, water, etc. was important.
All in all I would like Prof. Harris to publish his views in a peer reviewed journal that we can study in detail.
All in all I would like Prof. Harris to publish his views in a peer reviewed journal that we can study in detail.
The overall message that science-based medicine needs ongoing careful evaluation and reassessment is certainly a good one. I have no problem with someone making these arguments, even if I do detect a bias in one direction, as they bring about overall improvement. I do think, however, Prof Harris should be more careful in his statements in regards to alternative treatments with no scientific backing. True, receiving no treatment in certain cases might be the better choice, but that does not justify quackery.
My impression, as an anaesthetist who works in both public and private hospitals, who has been involved in a smattering of clinical research, and who is modestly well versed in the content of the clinical (and in particular anaesthesia-related) literature, is that Prof. Harris strayed into areas outside of his clinical expertise. There is no doubting that there are a lot of controversies to be resolved in the practice of clinical medicine. However the Prof came across as if most of what western clinical medicine has to offer is a waste of time or dangerous. But when it came to backing up those claims he was a little too fuzzy on the details to sound convincing! This kind of wide ranging discussion is best had with others also well versed in the field who can specifically address some of the claims made by Prof Harris. Eran did well but was hampered by lack of knowledge and a need to be polite I think.
Some of the controversies in medicine may not be resolved by clinical trials (gasp! horror!). Clinical medicine is the classic human discipline where science overlaps with human imperfection, idealism slaps up hard against pragmatism and practicality, and where one or two trials may not be the alpha and omega of any particular clinical dilemma.
Clinical research does change clinical practice. I can give a recent example in my own field where the findings of a trial lead (in this country anyway) to a nation-wide abandonment of a drug found to have an unacceptable risk-benefit profile. Where a clinical trial does not immediately change practice, one can take the pessimistic view that it is because doctors are ignoring evidence to support their bank balances, and some instances this may be true. But I can tell you that there are many doctors who take the results of clinical trials very seriously. These results are discussed at clinical meetings, and in the literature, and where no widespread changes are implemented, it may just be the case that the trial was flawed, or in some way was not able to be generalised from the trial population. It takes specialists in each field to be commenting on the controversies in their field since they are most likely to be across the ebb and flow of the literature and the debate. I think the Prof himself noted that one person cannot read all the clinical trials released everyday across the medical spectrum since it would require 48 hours of reading every twenty four hours! So I think the Prof needs to take that advice and perhaps stick to evidence in his field of orthopaedic trauma.
One final note....the trial in the NEJM (2002) about sham arthroscopic knee surgery was specifically addressing the area of whether knee washout and debridement of “shaggy” cartilage in patients with osteoarthritis only was of benefit. That is, it didn’t study other reasons for arthroscopic knee surgery such as synovectomy, or surgery on meniscal injuries. So lets be clear that the study did not conclude that all arthroscopic knee surgery is a waste of time, and certainly the orthopaedic surgeons I know are aware that surgery for OA alone is in most cases no longer indicated and don’t do it. So there you go! Even orthopaedic surgeons read the literature from time to time!
Some of the controversies in medicine may not be resolved by clinical trials (gasp! horror!). Clinical medicine is the classic human discipline where science overlaps with human imperfection, idealism slaps up hard against pragmatism and practicality, and where one or two trials may not be the alpha and omega of any particular clinical dilemma.
Clinical research does change clinical practice. I can give a recent example in my own field where the findings of a trial lead (in this country anyway) to a nation-wide abandonment of a drug found to have an unacceptable risk-benefit profile. Where a clinical trial does not immediately change practice, one can take the pessimistic view that it is because doctors are ignoring evidence to support their bank balances, and some instances this may be true. But I can tell you that there are many doctors who take the results of clinical trials very seriously. These results are discussed at clinical meetings, and in the literature, and where no widespread changes are implemented, it may just be the case that the trial was flawed, or in some way was not able to be generalised from the trial population. It takes specialists in each field to be commenting on the controversies in their field since they are most likely to be across the ebb and flow of the literature and the debate. I think the Prof himself noted that one person cannot read all the clinical trials released everyday across the medical spectrum since it would require 48 hours of reading every twenty four hours! So I think the Prof needs to take that advice and perhaps stick to evidence in his field of orthopaedic trauma.
One final note....the trial in the NEJM (2002) about sham arthroscopic knee surgery was specifically addressing the area of whether knee washout and debridement of “shaggy” cartilage in patients with osteoarthritis only was of benefit. That is, it didn’t study other reasons for arthroscopic knee surgery such as synovectomy, or surgery on meniscal injuries. So lets be clear that the study did not conclude that all arthroscopic knee surgery is a waste of time, and certainly the orthopaedic surgeons I know are aware that surgery for OA alone is in most cases no longer indicated and don’t do it. So there you go! Even orthopaedic surgeons read the literature from time to time!
I didn't find it too long and was very interested to hear what was said. I would love to hear a discussion between him, Steve Novella and other medical praciticioners.
My own experience with a surgeon and my daughter was interesting. She presented to the hospital with severe pains in the gut. Appendicitis was suspected by the attending doctor. The old school surgeon turns up, examines her and grumpily declares he's not going to operate and ticks off the doctors for wasting his time. At first I was quite angry with his manner and would have ticked the "dissatisfied" box. However the old boy was right. Hours later she was 100% fine. A few weeks later, a bloody good diagnositician and it was resolved she was Coeliac. One in 400 know they have it. One in a 100 have it. So if you get tummy pains, are skinny, can drink anyone under the table and have other strange symptoms (which are caused by lack of vitamins)go get a blood test.
My own experience with a surgeon and my daughter was interesting. She presented to the hospital with severe pains in the gut. Appendicitis was suspected by the attending doctor. The old school surgeon turns up, examines her and grumpily declares he's not going to operate and ticks off the doctors for wasting his time. At first I was quite angry with his manner and would have ticked the "dissatisfied" box. However the old boy was right. Hours later she was 100% fine. A few weeks later, a bloody good diagnositician and it was resolved she was Coeliac. One in 400 know they have it. One in a 100 have it. So if you get tummy pains, are skinny, can drink anyone under the table and have other strange symptoms (which are caused by lack of vitamins)go get a blood test.
Thanks for your comments (Ian Harris here), I will take them all on board. I would like to clarify a few points.
Firstly, there will be no prizes for detecting my bias against medicine (and surgery in particular), but this is probably a result of my daily contact with doctors who perform procedures that do not have good supporting evidence, and seeing an endless stream of iatrogenic complications. I am probably trying to compensate for the bias amongst many doctors whereby they overestimate the benefits and underestimate the harm of what they do. But this phenomenon is not confined to doctors, as man of you are aware.
I don't think I strayed away from my area of expertise. Although I practice as an orthopaedic surgeon, I have a Masters and PhD in evidence based medicine (clinical epidemiology) and I have studied the evidence base for many different areas of medicine.
Also, I am certainly not arguing against clinical research: I use it all the time, and perform research myself. My point is that research findings are biased towards favouring medical intervention, and this has been shown in studies that explore the correlation between effect size and study methodology. These show that studies with better methodology (randomised, blinding etc) report treatments to be less effective, when compared to studies with poorer scientific methods.
Happy to have a discussion about this anytime, as suggested.
Firstly, there will be no prizes for detecting my bias against medicine (and surgery in particular), but this is probably a result of my daily contact with doctors who perform procedures that do not have good supporting evidence, and seeing an endless stream of iatrogenic complications. I am probably trying to compensate for the bias amongst many doctors whereby they overestimate the benefits and underestimate the harm of what they do. But this phenomenon is not confined to doctors, as man of you are aware.
I don't think I strayed away from my area of expertise. Although I practice as an orthopaedic surgeon, I have a Masters and PhD in evidence based medicine (clinical epidemiology) and I have studied the evidence base for many different areas of medicine.
Also, I am certainly not arguing against clinical research: I use it all the time, and perform research myself. My point is that research findings are biased towards favouring medical intervention, and this has been shown in studies that explore the correlation between effect size and study methodology. These show that studies with better methodology (randomised, blinding etc) report treatments to be less effective, when compared to studies with poorer scientific methods.
Happy to have a discussion about this anytime, as suggested.
As someone with an hour commute I find most interviews are too short and raise more questions than they answer. I found this to be the same. I don't think the length of interview matters as much as the thoroughness of the discussion, and I wished for a more thorough examination of some of Dr. Harris' statements. Eran did seem to control the amount of challenge he voiced to some of the statements.
And with all respect to Dr. Harris, I found some of his statement too generic and encompassing areas outside the studies he mentioned in support. One would almost walk away from that interview thinking it would be safer to never visit a doctor, and that it would be positively dangerous to set foot in an hospital.
What I took away from the interview is there is a strong placebo effect to surgery, and that most people get better on their own. The first seems to me flawed because to my understanding of placebo, it does not actually cure anything; at best it alters the patient's perception.
I generally agree with the second for most conditions, but it seems as one gets into the more destructive and dangerous condition one would increasingly be in need of medical assistance. If not outright, Dr. Harris at least peripherally implied something along the lines of the fatalistic "when it's your time, you go, and nothing can change that".
Subjectively speaking, I think our knowledge of human physiology has raised our understanding of factors associated with longevity, and in that I think modern medicine has excelled. Whether that translates into effective procedures may be a matter of debate, but looking at life expectancy alone is a little misleading. One also needs to look at quality of life associated with mobility, and the ability to enjoy those additional years of life.
That said, the discussion did prompt me to initiate my own research of what studies are available. As someone with a healthy aversion to both medicines and medical procedures unless there are clear benefits and the benefits outweigh the risks, the interview raised my determination to research, research, research.
Overall, very interesting and informative.
And with all respect to Dr. Harris, I found some of his statement too generic and encompassing areas outside the studies he mentioned in support. One would almost walk away from that interview thinking it would be safer to never visit a doctor, and that it would be positively dangerous to set foot in an hospital.
What I took away from the interview is there is a strong placebo effect to surgery, and that most people get better on their own. The first seems to me flawed because to my understanding of placebo, it does not actually cure anything; at best it alters the patient's perception.
I generally agree with the second for most conditions, but it seems as one gets into the more destructive and dangerous condition one would increasingly be in need of medical assistance. If not outright, Dr. Harris at least peripherally implied something along the lines of the fatalistic "when it's your time, you go, and nothing can change that".
Subjectively speaking, I think our knowledge of human physiology has raised our understanding of factors associated with longevity, and in that I think modern medicine has excelled. Whether that translates into effective procedures may be a matter of debate, but looking at life expectancy alone is a little misleading. One also needs to look at quality of life associated with mobility, and the ability to enjoy those additional years of life.
That said, the discussion did prompt me to initiate my own research of what studies are available. As someone with a healthy aversion to both medicines and medical procedures unless there are clear benefits and the benefits outweigh the risks, the interview raised my determination to research, research, research.
Overall, very interesting and informative.
i found the conversation bold and interesting as it was a departure from the standard skeptic fare. as right as it may be, a lot of the skeptic conversation on podcasts can turn into a bit of a choir, so it was good to hear the Dr's opinions, and it did cause me to question some things i had taken for granted.
that said, i was very frustrated (increasingly) that there was no one to question his claims, especially the broader ones. i hope there is a follow-up where someone examines what he said, because a lot of things struck me as very persuasive and i don't necessarily have the time or resources to investigate them all.
that said, i was very frustrated (increasingly) that there was no one to question his claims, especially the broader ones. i hope there is a follow-up where someone examines what he said, because a lot of things struck me as very persuasive and i don't necessarily have the time or resources to investigate them all.
I very much enjoyed this interview (certainly not too long). It was refreshing to hear a really challenging set of data put forth. I am not completely convinced of all the Professor's arguments, but have heard a lot of similar information from other sources from within the medical "industry" (for want of a better term). I, too, would love to hear Steven Novella have a discussion/debate with Ian Harris on a lot of these topics.
But, to be honest, I'm mainly commenting here to share with you the oh-so-relevant recaptcha at the bottom of the page:
"0.0 harmed" :) :) :)
Cheers,
Chris
But, to be honest, I'm mainly commenting here to share with you the oh-so-relevant recaptcha at the bottom of the page:
"0.0 harmed" :) :) :)
Cheers,
Chris
I found the interview interesting and thought provoking, the length of the piece in the end was overcome by by the genuine interest it generated.
posted by: Sean the Blogonaut on Sun, 10/25 08:03 AM EDT
Like a few others before me, I found the Prof strayed into areas we skeptics call Woo. That said it was good to hear an interview that was not run-of-the-mill skepticism, but had me sitting up and saying "Woah". I'd like another opinion.
It would certainly be great to hear Prof Harris and Dr Novella discuss matters.
Dr Novella will be here next year and a discussion between the two would be a drawcard.
Will Prof Haris be available?
It would certainly be great to hear Prof Harris and Dr Novella discuss matters.
Dr Novella will be here next year and a discussion between the two would be a drawcard.
Will Prof Haris be available?
Somewhat belatedly reading comments on the show.
I thought it was the best episode I had heard for a while. Some of Ian's comments I found challenged assumptions I had - which is always worthwhile.
The point I got; (which makes a lot of sense), is that doctors are human and fall victim to myths or simply keep doing what they have done for years without evidence or in the face of evidence to the contrary.
It doesn't make people peddling woo right; it just means that standard medical treatment is sometimes wrong (obviously). At least with standard medical treatment, (like with science as a whole) there are mechanism's for tending towards correctness - including people like Ian working away to back up treatment regimes with evidence.
I thought it was the best episode I had heard for a while. Some of Ian's comments I found challenged assumptions I had - which is always worthwhile.
The point I got; (which makes a lot of sense), is that doctors are human and fall victim to myths or simply keep doing what they have done for years without evidence or in the face of evidence to the contrary.
It doesn't make people peddling woo right; it just means that standard medical treatment is sometimes wrong (obviously). At least with standard medical treatment, (like with science as a whole) there are mechanism's for tending towards correctness - including people like Ian working away to back up treatment regimes with evidence.
posted by: Grant on Sun, 11/1 04:45 PM EST
Very late to comment. This episode confirms what I'd already thought about that neurosurgeon on one of those hospital shows. You know, the bloke who loves to operate at any given oportunity... w@nker.
On a serious note. Probably the most challenging (as in thought provoking) interviews I've ever heard.
Back to being less serious (my preferred MO). I've a bit of dodgy knee. Can anyone recommend a good orthopaedic surgeon in Brisbane?
On a serious note. Probably the most challenging (as in thought provoking) interviews I've ever heard.
Back to being less serious (my preferred MO). I've a bit of dodgy knee. Can anyone recommend a good orthopaedic surgeon in Brisbane?
posted by: Theo on Thu, 11/5 10:29 AM EST
Ep 52 blew my mind.
As many suggested, I would certainly enjoy listening to another discussion involving Prof. Ian Harris, and this time with Dr. Steven Novella and probably Dr. Rachael Dunlop, and maybe a few other skeptics Dr., on a panel when the rogues from The Skeptics guide to the Universe visit you in a year or so. That would be very stimulating.
As I am from Canada, if this were to happen, I would enjoy it as video format as I certainly can't be there. You guys can make it happen.
Keep up the good work.
As many suggested, I would certainly enjoy listening to another discussion involving Prof. Ian Harris, and this time with Dr. Steven Novella and probably Dr. Rachael Dunlop, and maybe a few other skeptics Dr., on a panel when the rogues from The Skeptics guide to the Universe visit you in a year or so. That would be very stimulating.
As I am from Canada, if this were to happen, I would enjoy it as video format as I certainly can't be there. You guys can make it happen.
Keep up the good work.
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