Thank you Theodore Dalrymple (aka Dr. Anthony Daniels) for encapsulating for the general audience the problems that have been both historically present (data integrity and study reproducibility issues and drawing conclusions beyond the study data), and also newly suffused into the field of medicine (toxic political correctness via the "Perspective" and editorial sections in which spewed shibboleths are fired out as if as axiomatic as "The Sun Rises In The East".
Having practiced newborn intensive care and general pediatrics for 39 years I have watched with deep concern as the NEJM (New England Journal Of Medicine) has in the approximately past 10 years mutated into the NEJWM (The New England Journal Of Woke Medicine[and political phrenology]). Unfortunately this is not a benign mutation and metastasizes into the general culture (even if benign, given the influence of the NEJM is in a malignant location in terms of causing damage to the culture). On a personal professional level caring for children I found this most disturbing in their Clinical Practice guidelines "Care of Transgender Persons" N Engl J Med 2019; 381:2451-2460 DOI: 10.1056/NEJMcp1903650 in which they quote the American Academy Of Pediatrics (AAP) Guidelines on the same topic. In both of these papers "watchful waiting" and caution in patient selection is summarily declared "obsolete" and "harmful". Just one problem. The references given in support of this statement (#45 in particular in the AAP guidelines) are not new longitudinal follow-up data but rather further policy/opinion/consensus statements. By putting out such a practice guideline. NEJM has created a form of feedback loop in which it seems that "everyone" agrees. Dalrymple notes many such examples (usually buried quietly within articles or reviews) in which the tone and statement create a political undertow intended to drag the reader to the only correct position (the "woke" one) on the issue.
Dalrymple notes a constant flow of statements within "scientific" articles as well as opinion pieces that all lean in the direction of removing agency from any and all sufferers of conditions in which their own behavior would be understood by most non-medical people to have contributed to their condition (obesity, alcohol abuse and drug abuse in particular). He notes that "abuse" is never used to describe the behavior, there is only "use". One must never judge anyone the NEJM clearly communicates However, he quite appropriately attacks the physicians who wantonly prescribed opiates for all types of pain when such use was not indicated. To be fair to some of these physicians, at least in the United States, they were caught between a rock and a hard place which Dalrymple does not discuss. In my state we (physicians) were required to obtain 12 credit hours of training in pain control and end-of-life care and other such topics or risk losing our license to practice medicine and could be subject to medical board sanction and lawsuits for not adequately controlling pain. Similar laws and vulnerability to lawsuits were also created in many other states.
Complex inferential statistics come under scrutiny with the caveat (true) that most physicians will not be able to deeply understand these tools and must therefore rely on authors and journal editors to act in good faith in terms of verifying that the methods are valid and support the conclusions. Unfortunately, concludes Dalrymple, such quality control is often lacking and articles are therefore misleading on some level (usually by overestimating the benefit of a new drug or treatment). Often the abstracts of such articles focus on relative risks and ignore absolute risks when the subject is exposure to some agent, toxin, or dietary choice. If something doubles one's risk of a certain cancer (relative risk), yet the absolute risk is only one-in-a-million does it really matter from a practical standpoint if now the risk is two-in-a-million?
Some of the material covered in this book is also covered in other works by Dalrymple. In particular "Life At the Bottom" and "Our Culture, What's Left Of It" (particularly the movement away from personal agency and responsibility. An excellent and complementary book would be "The Parasitic Mind: How Infectious Ideas Are Killing Common Sense"
by Gad Saad
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Thor
Interesting info but writing tone is a put-off
Reviewed in Canada on July 28, 2019