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Admitting our own bias in medical research June 27, 2022

I would love to say that I, your fearless guide to all things virtuous, true, and noble, am myself, truly virtuous, true, and noble all the time. But alas, this is not so. Don’t get me wrong, I would love to see some type of objective instrument show me how unbiased I am. After all, I am not taking any money from anyone to push a narrative. I have nothing to gain from giving you free medical information.  I like to call it how I see it. I’m the “real deal” and “no spin”. Unfortunately, I am still a human, not a machine. Ever so subtle biases affect my decision making process every day. But the important thing is not that I have biases–we all do–but that I am able to recognize these biases and try to find solutions to overcome them. 

The story of ivermectin repurposed for COVID-19 should be a recent cautionary tale. While those with a bias against ivermectin will find studies to exclude based on, ironically, a high risk of bias, those with a bias toward ivermectin will take issue with how to score a study on risk of bias, and cry foul when well done studies indeed show some benefit, but have an objectifiable  high risk of bias. Interestingly, in many studies,  ivermectin’s effects remain  just barely outside statistical significance parameters, so the authors state in unequivocal language that ivermectin has no effect and no role in treating COVID-19. Are the authors biased? After all they are technically correct. 

Or look at alcohol for heart disease. For many years, we’ve been instructed to advise a glass of wine daily for optimal heart health and reduce heart attacks and cardiovascular death. Do you remember that? Now, that’s out the window, and any alcohol is now problematic, in any quantity. What changed? Who was biased back then? Who is biased now? 

Aspirin for heart attack prevention? For years we talked about this, now we don’t–unless you already have had a heart attack or stroke. What changed? We can say we had further research, but who talked about any benefit for aspirin before? A lot of smart people did. Biased people. You know–humans. 

This begs the question, are we to trust anything coming out of the medical literature? Who can we trust? Where can we go to find good information that we can trust? And when is it bias or when is it just scientific progress making changes to the general medical knowledge base? A great book I have read recently is The Structure of Scientific Revolutions by Thomas Kuhn.  Fairly well written, and very timely. 

The first and very most important characteristic of anyone who does any kind of research, is to constantly and consistently evaluate and re-evaluate yourself! Ask yourself “where am I wrong?” Humility must come first, every time! I typically ignore people who sound too confident in their proclamations of how right they are and how wrong the other people are who disagree with them. Why is humility so hard to come by? Seriously? 

The more that you can peel away layers of bias, the better you can become with seeing fact through fiction. These include ignoring any research quoted in the news media. Go straight to the source and use google scholar, cochrane database, and pubmed. Try to see all sides to the issue. Was the study a randomized controlled trial? A retrospective observation? How long did the study trial go? How recent is it? What journal was it published in? Does it square with your personal biases? If not, why not? And lastly, the moment you start belittling someone that doesn’t have anything to do with the scientific question at hand, you have ceased to be a scientist, or a researcher by any definition.

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