# Helen Pearson: What Constitutes Real Medical Evidence?

An episode of [Ground Truths](https://invisiblenetwork.ai/podcast/1728526108), 6 Jun 2026, 52 min.

Audio: https://api.substack.com/feed/podcast/195892207/9eb7870e89be72db72db911458a83738.mp3

Helen Pearson, PhD, is an award-winning biomedical journalist at Nature, named European Science Journalist of the Year in 2025. She teaches science writing at University College London. BEYOND BELIEF is her second, just published book. THE LIFE PROJECT was her first. The points we covered include: —The evolution of evidence over 8 decades, moving from rationalism, expert opinion, hunches (eminence-based) to empiricism, evidence-based —The enormous devastating adverse impact of Dr. Spock’s Baby and Child Care book from a single sentence change, leading to an epidemic of sudden infant death syndrome. And how it ultimately got corrected. —The term evidence-based medicine was coined in 1991 at McMaster University —Iain Chalmers, Archie Cochrane and the Cochrane Collaboration “The scandalous failure of science to cumulate evidence scientifically”—Iain Chalmers —Systematic reviews —Natural experiments (such as with Shingles) —Resistance to change “Challenging a doctor’s conventional way of practice is like hitting him in the intellectual testicles”—Drummond Rennie, past JAMA editor —Evidence-based practice (and not) in the Covid pandemic —Recent examples of challenging dogma (kindly stones, thymus involution) —AI and misinformation, false evidence Thank you Harshi Peiris, Ph.D., Ageless Mind Project, Anthony Higgins, E West, MagnaAnimus, and many others for tuning into my live video with Helen Pearson! Join me for my next live video in the app. A big thanks to Ground Truths subscribers from every US state and 212 countries. Your subscription to these free essays and podcasts makes my work in putting them together worthwhile. If you’re not a subscriber, please join! If you found this interesting PLEASE share it! Paid subscriptions are voluntary and all proceeds from them go to support Scripps Research. They do allow for posting comments and questions, which I do my best to respond to. Please don’t hesitate to post comments and give me feedback. Let me know topics that you would like to see covered. Many thanks to those who have contributed—they have greatly helped fund our summer internship programs for the past two years. It enabled us to accept and support a record number of 51 summer interns coming in 2026! These are high school, college and medical students selected from thousands of applicants. We couldn’t do this expanded program without the funds coming in throughGround Truths. Get full access to Ground Truths at erictopol.substack.com/subscribe

## Transcript

[0:01] SPEAKER_02: We have a really great podcast today with Helen Pearson.
[0:06] SPEAKER_02: Helen is a terrific journalist,
[0:09] SPEAKER_02: award-winning,
[0:09] SPEAKER_02: in fact,
[0:10] SPEAKER_02: the Journalist of the Year in Europe last year.
[0:14] SPEAKER_02: This is her second book.
[0:16] SPEAKER_02: She writes features for nature.
[0:18] SPEAKER_02: And this book is quite extraordinary.
[0:23] SPEAKER_02: It's called Beyond Belief.
[0:25] SPEAKER_02: How Evidence Shows What Really Works Okay,
[0:29] SPEAKER_02: so that's what we're going to be talking about today and related matters,
[0:32] SPEAKER_02: you know,
[0:32] SPEAKER_02: not just everything that's in the book.
[0:35] SPEAKER_02: So, Helen, welcome.
[0:36] SPEAKER_02: It's wonderful to have you.
[0:38] SPEAKER_00: Thank you so much for having me.
[0:39] SPEAKER_00: Yeah, it's great to be here.
[0:41] SPEAKER_02: Well, evidence is the topic I couldn't resist, which I'm surely in.
[0:46] SPEAKER_02: And I learned a lot from your book, Things I Didn't Know About.
[0:50] SPEAKER_02: And clearly,
[0:51] SPEAKER_02: As you aptly describe here,
[0:54] we've been going through this evidence revolution where the
[0:57] demand for better
[0:59] SPEAKER_02: evidence has continued to kind of culminate to where we are today.
[1:04] SPEAKER_02: But on the other hand,
[1:04] we have some anti-forces that we'll talk about that are
[1:08] diminishing or detracting
[1:09] SPEAKER_02: from evidence.
[1:10] So what I wanted to start with is the amazing story that you
[1:15] present in the book,
[1:16] SPEAKER_02: which I wasn't familiar with the details about Dr.
[1:19] SPEAKER_02: Spock and how
[1:21] SPEAKER_02: His original book,
[1:23] SPEAKER_02: I think in 1946,
[1:25] SPEAKER_02: and how he revised one sentence,
[1:28] SPEAKER_02: and as a result,
[1:29] some 54,000 babies died of sudden infant death syndrome before
[1:34] the actual evidence.
[1:35] SPEAKER_02: Is that about the right summary?
[1:38] SPEAKER_02: Could you take us through what really happened there?
[1:41] SPEAKER_00: Sure, yeah.
[1:42] SPEAKER_00: I mean,
[1:43] it is a really striking story in that I sort of opened the book
[1:45] with that because I
[1:46] wanted to illustrate what happens when we don't use evidence
[1:48] with this kind of
[1:49] SPEAKER_00: striking example.
[1:50] SPEAKER_00: So yeah, so I've actually got the copy here.
[1:52] SPEAKER_00: My mum sent me her copy of this service.
[1:55] SPEAKER_00: So Dr.
[1:56] SPEAKER_00: Spock's book,
[1:56] SPEAKER_00: Baby in Child Care,
[1:57] SPEAKER_00: was like this best-selling,
[1:58] SPEAKER_00: you know,
[1:59] SPEAKER_00: childcare manual,
[2:00] SPEAKER_00: all parents had it.
[2:02] SPEAKER_00: But what happened was in this 1958 issue,
[2:05] SPEAKER_00: which is the one I've got here,
[2:07] SPEAKER_00: he made a small change to the text,
[2:10] SPEAKER_00: whereas before he'd been advising parents to put their
[2:12] Babies Down to Sleep on Their Backs and he switched it and
[2:16] suggested that they put
[2:17] SPEAKER_00: babies to sleep on their fronts.
[2:18] SPEAKER_00: And the reasons were a bit,
[2:19] SPEAKER_00: I mean,
[2:19] SPEAKER_00: he basically was sort of speculating,
[2:21] SPEAKER_00: saying,
[2:21] SPEAKER_00: you know,
[2:21] SPEAKER_00: if babies on their backs might end up with a flat head or,
[2:24] SPEAKER_00: you know,
[2:24] SPEAKER_00: might choke on their own vomit.
[2:26] So there wasn't really any,
[2:27] you know,
[2:27] substantial evidence to support this change.
[2:29] SPEAKER_00: Now, to be fair, he wasn't the only one.
[2:32] So this was generally sort of put forward by pediatricians
[2:34] around this time.
[2:36] SPEAKER_00: But because,
[2:37] SPEAKER_00: you know,
[2:37] SPEAKER_00: this book had such huge influence,
[2:39] SPEAKER_00: parents did start following this advice and
[2:41] SPEAKER_00: So there was a rise in children sleeping on their fronts.
[2:45] SPEAKER_00: And meanwhile,
[2:46] SPEAKER_00: you know,
[2:47] there was this rather kind of sinister also rise going on in
[2:50] sudden infant death
[2:51] SPEAKER_00: syndrome and nobody really knew,
[2:53] SPEAKER_00: you know,
[2:53] SPEAKER_00: why this was happening.
[2:55] SPEAKER_00: So what was kind of,
[2:56] SPEAKER_00: so people were speculating like what's causing this rise in SIDS and,
[3:00] SPEAKER_00: you know,
[3:01] what was missing from this kind of conversation and debate was
[3:03] some actual evidence
[3:04] SPEAKER_00: from studies.
[3:04] So eventually these kind of first good case control studies
[3:08] start coming out about
[3:10] SPEAKER_00: 1968,
[3:10] SPEAKER_00: I think the first one was,
[3:11] SPEAKER_00: where obviously what was needed to happen was
[3:13] you need to compare a group of children who've unfortunately
[3:16] died from SIDS with a
[3:17] group of control babies who are very similar in other ways and
[3:19] try and tease out
[3:20] these factors that might be responsible and these first studies
[3:25] kind of hinted at a
[3:25] link but it was hard to see but then over time eventually the
[3:29] weight of evidence
[3:30] built up and eventually I mean I think I said in the book or
[3:33] it's been called
[3:34] SPEAKER_00: elsewhere that really Dr.
[3:35] Spock's advice was probably one of the most lethal pieces of
[3:38] unsubstantiated advice
[3:39] SPEAKER_00: in the history of child health because it became clear
[3:43] SPEAKER_00: that front sleeping was associated with increased risk of SIDS.
[3:47] And the other reason I kind of told this story was because it
[3:51] also illustrates like
[3:52] SPEAKER_00: the power of synthesizing evidence together.
[3:55] So that was like this really big theme in the book is the sort
[3:58] of how difficult it
[4:00] SPEAKER_00: can be to just take one study and later on.
[4:03] SPEAKER_00: So at the time, evidence synthesis wasn't really common.
[4:05] SPEAKER_00: And so it was sort of, well, more
[4:08] At some point there were enough studies to think that there was
[4:11] a link and actually
[4:12] SPEAKER_00: the advice only changed in the 1990s.
[4:14] SPEAKER_00: But later on some researchers went back and said,
[4:17] what happens if we actually synthesize these case control
[4:19] studies together?
[4:21] At what point was there a signal from the evidence that we
[4:24] should have been able to
[4:24] SPEAKER_00: see there was a link between SIDS risk and front sleeping?
[4:27] SPEAKER_00: And actually that would have been clear in 1970 if that had been done.
[4:31] SPEAKER_00: And that's where this figure came from,
[4:33] SPEAKER_00: that if the evidence had been synthesized and acted on at that time,
[4:38] They calculated that about 50,000 children,
[4:41] you know,
[4:42] deaths could have been avoided.
[4:43] SPEAKER_00: And I think that was just in like the US and Australasia.
[4:47] SPEAKER_00: So globally, you know, who knows?
[4:49] SPEAKER_00: So it's just this really kind of powerful,
[4:51] SPEAKER_00: you know,
[4:52] SPEAKER_00: tragic,
[4:52] SPEAKER_00: cautionary tale of how important it is not just to,
[4:55] SPEAKER_00: you know,
[4:56] SPEAKER_00: do careful studies,
[4:57] SPEAKER_00: but also to synthesize those studies together.
[5:00] SPEAKER_02: Yeah,
[5:01] SPEAKER_02: before we move on from this,
[5:02] SPEAKER_02: because it's such a vivid example of what could go wrong,
[5:06] SPEAKER_02: because it was eminence-based medicine,
[5:09] SPEAKER_02: as you say,
[5:10] SPEAKER_02: it wasn't just Dr.
[5:11] SPEAKER_02: Benjamin Spock,
[5:12] SPEAKER_02: it was Paul Woolley and pediatricians had this opinion,
[5:18] SPEAKER_02: wasn't backed up,
[5:19] SPEAKER_02: it was the classic rationalism based on,
[5:23] SPEAKER_02: you know,
[5:23] SPEAKER_02: hunches,
[5:25] SPEAKER_02: not narcissism.
[5:26] SPEAKER_02: I mean, of course, that's really this transition from
[5:29] SPEAKER_02: because eminence-based expert opinion, the actual real evidence.
[5:34] The other thing,
[5:35] of course,
[5:36] is this book,
[5:37] after the Bible,
[5:38] was like the second biggest purchase.
[5:41] SPEAKER_02: I was struck by this, 50 languages.
[5:45] SPEAKER_02: So this book,
[5:47] especially with this one sentence change about going from
[5:53] sleeping on the front
[5:56] SPEAKER_02: rather than the back,
[5:59] SPEAKER_02: wow.
[6:00] SPEAKER_02: Wow.
[6:00] SPEAKER_02: And so,
[6:01] SPEAKER_02: as you say,
[6:01] there was a synthesis of these studies and probably hundreds of
[6:06] thousands of deaths
[6:07] SPEAKER_02: from this,
[6:08] SPEAKER_02: if you go globally.
[6:09] SPEAKER_02: So, just so extraordinary.
[6:12] SPEAKER_02: And so,
[6:13] we went from one of 25 per thousand of sudden infant death
[6:22] syndrome in 1964,
[6:23] SPEAKER_02: years after the change,
[6:26] SPEAKER_02: to now approximately one in 100,000.
[6:31] SPEAKER_00: And in a sense,
[6:32] SPEAKER_00: you know,
[6:32] that was the most convincing evidence of all that when the
[6:35] advice finally started
[6:36] SPEAKER_00: changing again,
[6:37] SPEAKER_00: this is in the 1990s,
[6:38] SPEAKER_00: then if you look at the kind of rates of SIDS,
[6:40] SPEAKER_00: it started to drop like a stone.
[6:42] SPEAKER_00: So that really kind of supported the fact that there was this link,
[6:45] SPEAKER_00: although it's still not fully understood,
[6:47] SPEAKER_00: actually,
[6:47] SPEAKER_00: you know,
[6:48] why that the sort of mechanisms by which front sleeping
[6:51] increases that risk.
[6:52] SPEAKER_00: But it is, as I said, it's sort of just powerful.
[6:54] SPEAKER_00: I mean, really powerful example of
[6:56] SPEAKER_00: What happens sometimes,
[6:58] SPEAKER_00: you know,
[6:58] SPEAKER_00: if we follow unsubstantiated advice and the risks that can go with that.
[7:03] SPEAKER_02: Well,
[7:03] SPEAKER_02: and then one other thing you touched on here,
[7:05] SPEAKER_02: which is so important,
[7:06] SPEAKER_02: is there were these studies that were coming out in 1965,
[7:11] SPEAKER_02: 1970.
[7:12] SPEAKER_02: One I think was from Ireland.
[7:14] They were dismissed because they weren't,
[7:17] P was non-significant or whatever.
[7:19] It was going against the dogma,
[7:22] which we suffer from not challenging dogma enough,
[7:26] SPEAKER_02: And so it really is quite extraordinary.
[7:29] So now let's go fast forward because what you do in the book is
[7:35] you get into the
[7:35] personal stories of these pioneers that have brought us forward
[7:39] with evidence and
[7:41] SPEAKER_02: the importance of it.
[7:42] SPEAKER_02: And one of them
[7:43] uh was Ian Chalmers who you from the UK you certainly got to
[7:49] know him this is a
[7:50] colorful character he has no shortage of strong statements like
[7:55] the scandalous
[7:56] failure of science is to accumulate evidence scientifically
[8:01] yeah uh he he worked on
[8:04] you know measles and antibiotics he talked about license to
[8:07] kill of physicians I
[8:09] SPEAKER_02: mean this yeah so could you tell us about uh
[8:13] SPEAKER_02: Ian Chalmers and his impact in the world of the evidence revolution Yes,
[8:19] I would love to because really meeting in was kind of the
[8:23] inspiration actually of
[8:23] the whole book I mean I think anyone who's met him knows he's
[8:27] quite a sort of I
[8:28] SPEAKER_00: mean he's a wonderful figure,
[8:29] SPEAKER_00: he's inspiring and he's also kind of ferociously modest
[8:33] SPEAKER_00: And downplays everything that he's ever done.
[8:36] But I met him when I interviewed him for my previous book and
[8:39] kind of through him
[8:40] SPEAKER_00: learned about his story.
[8:42] SPEAKER_00: I mean,
[8:42] SPEAKER_00: his story is that he,
[8:43] like many doctors actually who were kind of training in the
[8:46] sort of 50s or 60s,
[8:48] they weren't really being taught much about evidence or
[8:51] clinical trials in medical
[8:53] SPEAKER_00: school.
[8:54] and so he went forth and was actually practicing in obstetrics
[8:59] and gynaecology in
[9:00] Wales in the 70s and he kind of realized something a bit odd
[9:05] was going on in that
[9:06] different doctors were handing out different advice so you know
[9:10] one would say well
[9:11] SPEAKER_00: you know
[9:12] Bed rest is really important during pregnancy and somebody else
[9:15] would say no such
[9:15] thing or you know one would say this is a situation where we
[9:18] need a cesarean
[9:19] section and somebody else wouldn't to the point where he once
[9:22] told me that when he
[9:23] was woken in the night to treat a woman the first thing he
[9:25] would say was what's
[9:26] wrong and the second thing he would say was who's treating her
[9:29] because it was going
[9:30] to change you know so it really illustrated so of course this
[9:33] was very um you know
[9:34] SPEAKER_00: puzzling to him and then he he came across in the 70s um
[9:39] this influential work by Archie Cochran whose name you might
[9:42] know now because it's
[9:43] associated with the Cochran Collaboration so it's sort of
[9:45] become cemented in you
[9:47] SPEAKER_00: know the it's like a giant of evidence um
[9:50] SPEAKER_00: And Cochrane was a real kind of early promoter of this idea,
[9:54] SPEAKER_00: which sounds really obvious when you say it,
[9:56] that the best way to know whether one treatment is more
[9:58] effective than another is
[10:00] SPEAKER_00: to use scientific evidence.
[10:01] And one of the most powerful forms of evidence is to test
[10:04] things in randomized trials.
[10:06] SPEAKER_00: He was a real fan of randomized trials.
[10:09] SPEAKER_00: And Chalmers was kind of, you know, his eyes were opened by this.
[10:13] SPEAKER_00: And
[10:13] SPEAKER_00: You know, he'd never even heard of randomized trials before.
[10:17] SPEAKER_00: And so through this,
[10:19] he undertook this kind of really kind of pioneering effort in
[10:23] synthesizing
[10:24] SPEAKER_00: evidence.
[10:25] He wanted to know what actually works to treat women or to help
[10:28] women in pregnancy
[10:29] SPEAKER_00: and childbirth.
[10:29] SPEAKER_00: And so he went on this kind of 10-year odyssey of
[10:32] to gather together all of the controlled trials that had ever
[10:35] been done on almost
[10:36] anything in pregnancy and childbirth and produced from this 10
[10:39] years later in the
[10:40] SPEAKER_00: 80s,
[10:40] SPEAKER_00: these massive two books that I've got on my shelf,
[10:43] SPEAKER_00: which had hundreds of systematic reviews in them,
[10:45] SPEAKER_00: which themselves,
[10:46] SPEAKER_00: you know,
[10:46] a systematic review being a sort of rigorous synthesis of
[10:50] evidence in one area.
[10:52] SPEAKER_00: And these books kind of,
[10:53] SPEAKER_00: you know,
[10:54] SPEAKER_00: revealed that,
[10:55] SPEAKER_00: you know,
[10:55] really quite sort of invasive practices which countless women
[10:59] had been exposed to
[11:00] SPEAKER_00: shaving women's pubic hair during labour,
[11:03] having episiotomies were being done with basically no evidence
[11:07] to support them.
[11:08] And over time,
[11:09] you know,
[11:09] it helped,
[11:10] his work helped overturn and change some of those practices.
[11:17] SPEAKER_00: But then,
[11:17] SPEAKER_00: and then this inspired him to then do this,
[11:20] SPEAKER_00: even this is Ian Chalmers,
[11:21] SPEAKER_00: inspired him to go on and say,
[11:23] SPEAKER_00: okay,
[11:23] SPEAKER_00: well,
[11:23] SPEAKER_00: if we've done this in pregnancy and childbirth,
[11:26] could we look at every single medical speciality and synthesize
[11:29] the evidence that
[11:30] shows which treatments help but do not harm and this led on to
[11:34] this idea of the
[11:35] Cochrane Collaboration which was founded around 1993 which is
[11:40] now known as for
[11:41] producing kind of gold standard systematic reviews of evidence
[11:44] which you know show
[11:46] hopefully which treatments are most effective so he really I
[11:49] mean I mean through
[11:50] that I mean the Cochrane Collaboration of course now is just
[11:52] one of many sources of
[11:54] SPEAKER_00: systematic reviews but this kind of
[11:56] SPEAKER_00: This bedrock,
[11:56] SPEAKER_00: I sort of think it was this bedrock of evidence of systematic reviews,
[11:59] SPEAKER_00: which is now what medicine's kind of built on,
[12:01] SPEAKER_00: right,
[12:02] SPEAKER_00: because that leads on to clinical guidelines,
[12:04] SPEAKER_00: really sort of grew out of this work that he had done all that time ago,
[12:09] SPEAKER_00: looking at pregnancy and childbirth.
[12:12] SPEAKER_02: Yeah, no, quite a force.
[12:13] And he,
[12:14] of course,
[12:15] did gang up with Archie Cochrane for this Cochrane diagnosis.
[12:21] SPEAKER_02: initiative,
[12:23] SPEAKER_02: Archie Cochrane's quote,
[12:25] we should always assume that a treatment is ineffective unless
[12:28] there's evidence to
[12:29] SPEAKER_02: the contrary.
[12:30] SPEAKER_02: And that couldn't be more true.
[12:32] SPEAKER_02: But there's a problem with the Cochrane in more recent times.
[12:38] gotten controversial,
[12:39] whereby the thought was the systematic reviews were not
[12:48] objective.
[12:48] SPEAKER_02: It was one even just a week or so ago about the Alzheimer's drugs were
[12:53] SPEAKER_02: They were mixing in drugs that were very old with the current drugs.
[12:59] And I'm not trying to say that these anti-amyloid drugs are so
[13:04] effective because they're not.
[13:05] SPEAKER_02: But a lot of people in the field,
[13:07] SPEAKER_02: particularly neurologists that specialize in Alzheimer's,
[13:10] SPEAKER_02: were attacking the Cochrane.
[13:12] SPEAKER_02: And it's gone through some controversy in recent years.
[13:15] SPEAKER_02: Perhaps you could touch on that.
[13:18] SPEAKER_00: Yeah, it has.
[13:20] SPEAKER_00: I mean, I think it's always...
[13:23] SPEAKER_00: been open to criticism I will say Cochran I mean I've reported on it as a
[13:28] journalist I do I do think because they have a reputation for
[13:33] holding up this very
[13:33] high standard of evidence that they probably do attract
[13:36] criticism I mean you know
[13:37] and systematic reviews in general do have this responsibility
[13:40] right I sort of say
[13:41] SPEAKER_00: that in the book that like
[13:43] SPEAKER_00: They're coming forward as giving the word,
[13:45] SPEAKER_00: you know,
[13:45] SPEAKER_00: the sort of,
[13:46] SPEAKER_00: not the final word,
[13:46] SPEAKER_00: but you know,
[13:47] they're giving this overview of evidence and have some
[13:50] responsibility to get right.
[13:52] So I do agree that sometimes Cochrane reviews maybe don't
[13:58] communicate well enough
[14:00] SPEAKER_00: that they're looking at it,
[14:01] SPEAKER_00: that
[14:03] SPEAKER_00: The top line gets interpreted as,
[14:05] SPEAKER_00: without necessarily talking about,
[14:06] SPEAKER_00: well,
[14:06] we've only looked at these very specific types of randomized
[14:09] controlled trials,
[14:10] SPEAKER_00: or,
[14:10] SPEAKER_00: you know,
[14:10] SPEAKER_00: we've looked at,
[14:11] SPEAKER_00: we've brought together these different groups of drugs,
[14:14] SPEAKER_00: as you might say.
[14:15] SPEAKER_00: I suppose I'm a reasonable,
[14:19] SPEAKER_00: I mean,
[14:19] SPEAKER_00: I think it's easy to criticize,
[14:22] SPEAKER_00: but at least their goals are worthy and
[14:27] the other sort of big change that they've been going through
[14:29] over the years of
[14:30] course is at the beginning they were the source of systematic
[14:32] reviews and now
[14:33] hundreds if not thousands of systematic reviews are coming out
[14:37] every year and so
[14:40] there's an element I think where they're finding their place in
[14:43] that ecosystem and
[14:44] also of course now grappling with the fact that historically
[14:49] systematic reviews
[14:49] SPEAKER_00: have been very complicated and
[14:51] SPEAKER_00: Yeah, so this has become a very hot area over the years.
[14:54] SPEAKER_00: And as you say,
[14:55] you can't go a week without some multiple systematic analyses
[14:57] of this or that in
[14:58] SPEAKER_00: medicine.
[14:58] SPEAKER_00: But
[15:17] SPEAKER_02: You know,
[15:18] SPEAKER_02: one of the people I really look up to in the UK on this,
[15:21] SPEAKER_02: Ben Goldhager,
[15:22] SPEAKER_02: who's done a great job of collecting data,
[15:26] SPEAKER_02: he said,
[15:27] SPEAKER_02: as you quote in the book,
[15:28] the notion of a systematic review looking at the totality of
[15:32] evidence is quietly
[15:34] SPEAKER_02: one of the most important innovations in medicine over the past 30 years.
[15:38] SPEAKER_02: So I'd agree with that, but here's the problem.
[15:42] It's great when you have systematic reviews where you actually
[15:45] have the individual data.
[15:48] Whereas the back of the envelope where you just basically are
[15:53] taking the data
[15:54] SPEAKER_02: that's not at the individual level,
[15:56] SPEAKER_02: but what the manuscript has.
[15:58] Can you comment about the difference when you actually have the
[16:01] granular data for
[16:02] SPEAKER_02: each person in these analyses?
[16:05] SPEAKER_00: I think you're probably more qualified to do that than I am, honestly.
[16:08] SPEAKER_00: I mean, I've never myself done a systematic review.
[16:10] SPEAKER_00: I can comment from a journalistic perspective because I do think,
[16:14] SPEAKER_00: I mean,
[16:14] SPEAKER_00: as a journalist,
[16:15] SPEAKER_00: one thing I
[16:16] SPEAKER_00: Eric Topol ericol
[16:40] to look for syntheses to look for systematic reviews and so the
[16:43] way I run up
[16:44] against your problem is that I'm looking for systematic reviews
[16:47] that give me the
[16:48] overview but it's the quality of them now which is the
[16:51] difficulty right because
[16:52] some systematic views are high quality and some aren't and it's
[16:56] almost like only by
[16:57] reporting and going to talk to people in that field can I work
[17:00] out which are the
[17:01] ones I should be looking at so I think we're running up against
[17:04] the same problem
[17:05] SPEAKER_00: but with different expertise yeah
[17:08] SPEAKER_02: No,
[17:08] SPEAKER_02: I mean,
[17:09] SPEAKER_02: I think these systematic reviews can be very helpful,
[17:12] SPEAKER_02: but the quality of the review and the granularity of the data can be very
[17:16] SPEAKER_02: important.
[17:16] SPEAKER_02: Plus, there's also the issue of the bias of the researchers.
[17:20] You see,
[17:20] they might write the bias of the actual studies,
[17:23] but then there's a bias of
[17:25] And so those type of qualitative things that I find as a
[17:30] science journalist,
[17:30] SPEAKER_00: you can only really get by talking to someone in the field.
[17:33] SPEAKER_00: And I do think that's the kind of problem,
[17:34] SPEAKER_00: and that's the sort of thing you're circling with the Copern Review,
[17:37] SPEAKER_00: is if you just take it on face value,
[17:39] SPEAKER_00: you don't know some of those important factors around it.
[17:42] SPEAKER_00: And I think that that is certainly one of the challenges,
[17:45] SPEAKER_00: I think,
[17:45] SPEAKER_00: I mean,
[17:46] SPEAKER_00: certainly for journalists,
[17:47] SPEAKER_00: and when we're trying to communicate those types of overviews,
[17:49] SPEAKER_00: is how to explore that and reveal that and how to filter
[17:54] you know systematic reviews are trying to filter right and
[17:56] synthesize the primary
[17:57] literature and now we're stuck with like too many systematic
[18:01] reviews and they need
[18:01] filtering as well like now they're umbrella reviews have you
[18:04] seen those which like
[18:06] there were so many systematic reviews we're going to do a
[18:08] review of the reviews so
[18:11] SPEAKER_00: It just all reflects this huge volume of research.
[18:16] SPEAKER_02: And you don't even have to then be a researcher.
[18:18] SPEAKER_02: You can just go to one of the AI models and say, you know, do it for me.
[18:24] SPEAKER_02: And, you know, make the tables, make the figures.
[18:26] SPEAKER_01: That's the danger.
[18:28] SPEAKER_02: That's the danger, yes, for sure.
[18:31] SPEAKER_02: I've already seen what that can do.
[18:33] SPEAKER_02: Missing studies, giving the wrong data, making up citations.
[18:37] SPEAKER_02: I mean, it can be a problem.
[18:39] SPEAKER_02: It probably will keep getting better.
[18:41] SPEAKER_02: But right now, it's a way to generate papers and it's concerning.
[18:46] SPEAKER_02: Now,
[18:47] SPEAKER_02: before I leave the systematic review,
[18:49] SPEAKER_02: which is a very important topic,
[18:52] SPEAKER_02: I do want to point out,
[18:53] SPEAKER_02: you know,
[18:53] SPEAKER_02: sometimes they don't
[18:55] SPEAKER_02: Agree or Align with Clinical Practice.
[18:57] SPEAKER_02: And by the way,
[18:59] SPEAKER_02: we've got quite a few people joining and if you have any questions,
[19:06] SPEAKER_02: comments,
[19:06] you can put them in the message and I'll try to bring them up
[19:09] with Helen as we go
[19:10] SPEAKER_02: along.
[19:12] SPEAKER_02: But one of the issues with the systematic reviews
[19:15] SPEAKER_02: when they don't align with clinical practice.
[19:17] SPEAKER_02: So the group in Oxford who have written quite a bit on statins and have
[19:24] SPEAKER_02: individualized data on all the trials,
[19:28] SPEAKER_02: the big trials with statins,
[19:30] they basically have said that there's no real increase in
[19:36] muscle cramps and muscle
[19:39] SPEAKER_02: soreness in people taking statins or it's so minimal.
[19:43] But yet,
[19:43] as a cardiologist in practice,
[19:45] I have a lot of patients who complain.
[19:47] SPEAKER_02: And if I try to tell them, well, in the meta-analysis, that isn't found.
[19:52] SPEAKER_02: They say, that doesn't help me.
[19:54] SPEAKER_02: I can't sleep at night because I have these terrible muscle cramps.
[19:57] SPEAKER_02: And so it's interesting because,
[19:59] SPEAKER_02: you know,
[20:00] SPEAKER_02: the group that had published these multiple analyses of statins,
[20:03] SPEAKER_02: they've done a great service,
[20:04] SPEAKER_02: but they have a one shot where they're getting out of the trial,
[20:09] SPEAKER_02: not a longitudinal assessment of people,
[20:12] SPEAKER_02: you know,
[20:12] SPEAKER_02: might have taken statins.
[20:13] SPEAKER_02: It happened to me even.
[20:15] SPEAKER_02: I took them for years and never had a problem.
[20:16] SPEAKER_02: And then I started developing.
[20:18] SPEAKER_02: Right.
[20:19] SPEAKER_02: So,
[20:19] SPEAKER_02: you know,
[20:20] SPEAKER_02: there's some limits of even the best,
[20:24] SPEAKER_02: even individual participant meta-analysis,
[20:26] SPEAKER_02: just so people are aware.
[20:28] SPEAKER_02: There's no perfect form.
[20:30] SPEAKER_00: I mean,
[20:31] SPEAKER_00: that's like the big lesson,
[20:32] SPEAKER_00: I think,
[20:33] of evidence-based medicine and actually all of these fields
[20:36] I've looked at.
[20:36] SPEAKER_00: I mean, if you go back and look, like, I mean...
[20:39] So the interesting thing about looking at the history of this
[20:43] is that evidence has
[20:44] SPEAKER_00: always provoked opposition.
[20:45] So when Ian Chalmers and these early pioneers put forward this
[20:49] idea that we should
[20:50] SPEAKER_00: use evidence to see what works,
[20:53] SPEAKER_00: Ian Chalmers was called a terrorist,
[20:56] SPEAKER_00: they were called upstarts,
[20:57] SPEAKER_00: troublemakers,
[20:58] SPEAKER_00: because people...
[21:00] SPEAKER_00: I'm getting off-tangent a bit,
[21:01] SPEAKER_00: but people don't really like to be told that what they're doing is wrong.
[21:06] But one other thing that came out of that is this realisation
[21:13] that evidence alone
[21:14] SPEAKER_00: never tells you what to do.
[21:16] SPEAKER_00: One of the founding principles,
[21:18] SPEAKER_00: it seems to me,
[21:18] SPEAKER_00: of evidence-based medicine is that you've got evidence,
[21:22] SPEAKER_00: but then you factor in the clinical expertise of the doctor.
[21:28] SPEAKER_00: And of course you have to take on board the preferences of the patient.
[21:32] The most obvious example being that we know that antibiotics
[21:35] cure a bacterial
[21:36] SPEAKER_00: infection,
[21:38] but if someone is at the end of their life and they've chosen
[21:40] not to be treated,
[21:40] SPEAKER_00: you're not going to give them the antibiotics.
[21:42] So the evidence is the same,
[21:43] but the preferences of the person are absolutely paramount.
[21:47] SPEAKER_00: And so that kind of speaks to what you're getting at,
[21:50] SPEAKER_00: is that the evidence is only ever one part of the picture.
[21:53] SPEAKER_00: And that's true across all of these different
[21:56] SPEAKER_00: I think that's a really important message about evidence.
[22:12] SPEAKER_02: Yeah,
[22:12] SPEAKER_02: no,
[22:13] and also I applaud you in the book because there's fields that
[22:16] I didn't know had
[22:16] incorporated the randomized trials like the randomistas of
[22:22] economists and the
[22:23] SPEAKER_02: policing and the corporate management.
[22:27] SPEAKER_02: So, you know, to get into other areas that I'm familiar with.
[22:31] Now,
[22:33] one of the other colorful people that you got profiled and
[22:39] talked to in the book
[22:40] was an editor for many years of JAMA,
[22:44] Drummond Rennie,
[22:45] who I got to know a bit.
[22:48] SPEAKER_02: His quote of many,
[22:50] challenging a doctor's conventional way of practice is like
[22:53] hitting him in the
[22:54] SPEAKER_02: intellectual testicles.
[22:57] Maybe you could tell us a bit about your interactions with
[23:00] Drummond and your views
[23:02] SPEAKER_02: of what he tried to do at JAMA because he had a pretty big impact.
[23:06] SPEAKER_00: He did have a big impact, yeah.
[23:07] SPEAKER_00: And so,
[23:08] SPEAKER_00: I mean,
[23:09] SPEAKER_00: the backstory to this,
[23:10] SPEAKER_00: and that was a brilliant quote,
[23:11] and I was only fortunate enough to speak to him for a short
[23:13] time and he came out
[23:14] SPEAKER_00: with many colourful quotes of which one made it into the book,
[23:16] SPEAKER_00: I think.
[23:17] SPEAKER_00: But, I mean, the backstory was that, you know,
[23:20] And aside from this sort of interesting history that was taking
[23:23] place in the UK
[23:24] with Ian Chalmers is there was this because evidence-based
[23:27] medicine has almost like
[23:27] SPEAKER_00: these two parallel kind of roots to it.
[23:30] SPEAKER_00: And meanwhile,
[23:30] SPEAKER_00: in the US,
[23:32] David Sackett and a group of kind of really bright sort of
[23:35] rebellious doctors at
[23:36] SPEAKER_00: McMaster University.
[23:38] SPEAKER_00: Did I just say in the US?
[23:39] SPEAKER_00: I mean, in Canada.
[23:40] SPEAKER_00: Yeah.
[23:41] SPEAKER_00: Eric Topol erictopol Ground Truths
[23:53] SPEAKER_00: So they had this sort of idea.
[23:56] SPEAKER_00: They were trying to teach students this way.
[23:58] SPEAKER_00: They'd come up with this approach.
[24:00] SPEAKER_00: Drummond Rennie was really important in kind of seeing,
[24:02] SPEAKER_00: I think he called them young geniuses or something.
[24:06] SPEAKER_00: And he gave them a kind of platform,
[24:08] SPEAKER_00: basically,
[24:09] SPEAKER_00: because what they needed was to kind of,
[24:11] SPEAKER_00: you know,
[24:11] they were developing this exciting way of teaching and people
[24:13] seemed to like it.
[24:14] But what happened was that Drummond Rennie helped them publish
[24:18] these series of articles that
[24:19] in this super high-profile,
[24:21] prestigious journal drama that really takes this around the
[24:24] world.
[24:25] SPEAKER_00: And also sort of published it paper by paper,
[24:28] which sort of became this manual for evidence-based medicine
[24:31] that allowed other
[24:32] SPEAKER_00: people to adopt it.
[24:33] SPEAKER_00: And I think,
[24:35] SPEAKER_00: I mean,
[24:35] SPEAKER_00: it's interesting,
[24:35] SPEAKER_00: again,
[24:37] SPEAKER_00: looking at other fields,
[24:38] SPEAKER_00: because if you look at other fields like whatever policy or conservation,
[24:42] SPEAKER_00: these other things I've looked at,
[24:43] SPEAKER_00: they all sort of look at evidence-based medicine as being like,
[24:46] SPEAKER_00: you know,
[24:46] SPEAKER_00: how has that field managed to embed evidence so
[24:49] Well and its practice and you know how have they got it so good
[24:51] and we're really
[24:52] struggling here and I think one you know drama was part of it
[24:57] but it was also in my
[24:58] view partly because it was born in medical schools so and so it
[25:03] meant that you know
[25:03] SPEAKER_00: these young doctors were learning this approach and they still do.
[25:07] SPEAKER_00: and they take it with them into practice.
[25:09] SPEAKER_00: Whereas,
[25:09] SPEAKER_00: let's say you look at education,
[25:10] SPEAKER_00: for example,
[25:11] there's loads and loads of evidence about what works to help
[25:13] children learn in
[25:14] SPEAKER_00: education,
[25:15] but teachers aren't necessarily taught about that when they
[25:18] train to be teachers,
[25:19] SPEAKER_00: and that's the case in policing and these other fields.
[25:23] So maybe that's a kind of broader lesson,
[25:25] I guess,
[25:25] coming out of evidence-based medicine.
[25:27] SPEAKER_02: Yeah,
[25:28] SPEAKER_02: no,
[25:28] SPEAKER_02: I mean,
[25:28] SPEAKER_02: so many things came from that movement,
[25:30] SPEAKER_02: like numbers needed to treat and numbers needed to harm,
[25:34] SPEAKER_02: all sorts of things that sack it and
[25:36] SPEAKER_02: helped popularize through German Rennie and JAMA.
[25:42] Now,
[25:43] one of the areas or the great test case for evidence or lack
[25:48] thereof was COVID-19.
[25:53] SPEAKER_02: And here we were without knowledge of this virus, brand new,
[26:01] SPEAKER_02: and very scary effects around the world.
[26:06] SPEAKER_02: And we had all sorts of eminence-based medicine.
[26:11] SPEAKER_02: We had the WHO and the CDC,
[26:15] SPEAKER_02: among other public trusted,
[26:17] SPEAKER_02: at least trusted then,
[26:20] SPEAKER_02: public health agencies saying that this wasn't airborne,
[26:26] SPEAKER_02: and the Six-Foot Rule and all this stuff.
[26:30] SPEAKER_02: And on the other hand,
[26:31] SPEAKER_02: we had very massive randomized trials of vaccines in record time,
[26:37] SPEAKER_02: 10 months,
[26:38] SPEAKER_02: which usually take eight years,
[26:40] SPEAKER_02: that were developed and placebo-controlled,
[26:43] SPEAKER_02: showing very potent benefits.
[26:47] SPEAKER_02: Yes, risks, but overriding potent benefits.
[26:50] SPEAKER_02: So how do you frame, here you wrote a book about evidence.
[26:55] and COVID-19 was perhaps the greatest test after all these
[27:00] eight decades of progress.
[27:03] SPEAKER_02: How do you see the COVID-19 story in the evidence world?
[27:08] SPEAKER_00: Yeah, I mean, I agree.
[27:10] SPEAKER_00: It was just this huge test and I think there were these massive wins.
[27:13] SPEAKER_00: You've kind of alluded to some of them,
[27:15] SPEAKER_00: but there were also just,
[27:16] SPEAKER_00: I mean,
[27:16] I wrote a piece for Nature called How COVID Broke the Evidence
[27:19] Pipeline because I
[27:20] SPEAKER_00: think it created such a,
[27:22] I've interviewed quite a lot of people about this so the wins
[27:29] were there were these
[27:31] incredible trials like recovery in the UK that within months
[27:36] remarkably managed to
[27:37] SPEAKER_00: show that dexamethasone was an effective treatment and
[27:42] SPEAKER_00: And of course,
[27:42] SPEAKER_00: we had the vaccines,
[27:44] SPEAKER_00: which went through randomized trials in clinical,
[27:47] SPEAKER_00: in record time.
[27:48] SPEAKER_00: So these huge wins, right, for the kind of evidence-based approach.
[27:51] SPEAKER_00: And yet, there were also just these massive challenges at the beginning.
[27:55] SPEAKER_00: Doctors,
[27:56] SPEAKER_00: I mean,
[27:56] SPEAKER_00: people said to me,
[27:57] SPEAKER_00: sort of throwing out,
[27:58] SPEAKER_00: that was forgetting the concepts of evidence-based medicine,
[28:00] SPEAKER_00: just grabbing what they could off the shelf,
[28:03] SPEAKER_00: you know,
[28:03] SPEAKER_00: trying anything.
[28:04] SPEAKER_00: I mean, to be fair, as you said, a lot wasn't known about the virus.
[28:07] SPEAKER_00: People were just desperately trying to help people.
[28:10] SPEAKER_00: But also then complicated by,
[28:12] SPEAKER_00: you know,
[28:12] what didn't happen 30 years ago when there was a crisis with
[28:15] this huge infodemic of
[28:17] SPEAKER_00: information which people were receiving,
[28:18] SPEAKER_00: which I think,
[28:19] SPEAKER_00: again,
[28:19] SPEAKER_00: is just a huge problem today.
[28:21] SPEAKER_00: Just complicating people's understanding and beliefs.
[28:26] So,
[28:28] you know,
[28:28] I think you could have the sort of pessimistic view and the
[28:30] optimistic view.
[28:31] SPEAKER_00: I mean,
[28:31] SPEAKER_00: I decided to take a bit of an optimistic view,
[28:33] SPEAKER_00: I think,
[28:34] SPEAKER_00: in the book in the end because...
[28:36] you know they again if you look at the history it sort of helps
[28:39] you get some
[28:40] perspective I suppose on what's happening today in terms of
[28:43] evidence and also what
[28:44] happened in the pandemic and that like you know evident that
[28:47] only the term
[28:47] evidence-based medicine was only coined in 1991 it's this
[28:51] unless you are a doctor
[28:52] you don't realize how recent this is you know that we started
[28:56] using evidence in
[28:57] this way and so you know you could say okay well it's like you
[29:01] know we're already
[29:01] sort of 30 well okay not 35 years but let's say a few decades
[29:05] into this gradual
[29:06] SPEAKER_00: You know,
[29:07] SPEAKER_00: I share your overall optimistic view,
[29:09] SPEAKER_00: Helen,
[29:09] SPEAKER_00: I think it's great,
[29:10] SPEAKER_00: but the issue I think that's occurred is because of the missteps of,
[29:13] SPEAKER_00: you know,
[29:13] SPEAKER_00: WHO and CDC,
[29:14] SPEAKER_00: it gave
[29:32] SPEAKER_02: The anti-science,
[29:34] anti-vax community that already was developed and became even
[29:39] more strident and
[29:40] SPEAKER_02: organized and financed,
[29:43] SPEAKER_02: it gave them an opening to grow and to challenge because here the trusted
[29:49] SPEAKER_02: authorities were way off the mark.
[29:52] SPEAKER_02: The whole thing about masks was starting, do you need a mask?
[29:56] SPEAKER_02: Just because in the U.S. there were shortages of
[30:00] SPEAKER_02: He said, oh, you don't need a mask.
[30:04] SPEAKER_02: I mean, he's like, what?
[30:06] SPEAKER_02: Do you need randomized trials for a respiratory virus?
[30:08] SPEAKER_02: I mean, you know, help me.
[30:10] SPEAKER_02: At any rate,
[30:11] SPEAKER_02: so this led to all sorts of misinformation and disinformation,
[30:17] which really undermined where there was gathering evidence and
[30:22] the benefits.
[30:23] SPEAKER_02: It's sad, but unfortunately, some of that eminence-based
[30:29] And then that eminence base extended to these treatments that
[30:32] had no data,
[30:33] SPEAKER_02: hydroxychloroquine,
[30:35] SPEAKER_02: ectin,
[30:39] the blood convalescent plasma that just were absent at least in
[30:43] the initial
[30:44] SPEAKER_02: And because people that stood up for them,
[30:47] SPEAKER_02: you know,
[30:48] SPEAKER_02: some of them had a track record that was embraced.
[30:52] SPEAKER_02: So we had really big tests for the evidence story.
[30:55] SPEAKER_02: And obviously there's some mixed results,
[30:58] SPEAKER_02: but,
[30:58] SPEAKER_02: you know,
[30:59] SPEAKER_02: many,
[30:59] SPEAKER_02: many lives were saved because of the quality evidence,
[31:03] SPEAKER_02: millions perhaps.
[31:04] SPEAKER_02: Now, I think not only perhaps, millions just in the U.S. Now,
[31:11] SPEAKER_02: We also have another form of evidence that's become big in recent years,
[31:16] SPEAKER_02: natural experiments,
[31:19] SPEAKER_02: whereby like for shingles,
[31:21] SPEAKER_02: we have four of them,
[31:23] SPEAKER_02: where just because of a birth date
[31:25] and you have hundreds of thousands of people that were one day
[31:29] off and they're in
[31:30] one group that didn't get the shingles vaccine or got the more
[31:35] recent Shingrix
[31:36] SPEAKER_02: rather than the Zostavac vaccine.
[31:38] And we see in four different countries with these big natural
[31:41] experiments that the
[31:43] shingles vaccine leads to 20-25% reduced dementia and
[31:48] Alzheimer's disease,
[31:52] and what's interesting about these studies unlike randomized
[31:55] trials that have been
[31:56] SPEAKER_02: held up as the gold standard these studies don't have any entry criteria
[32:04] So it's not cherry-picking people that have to fulfill entry
[32:07] and exclusion criteria.
[32:09] SPEAKER_02: What do you think about this type of evidence,
[32:11] SPEAKER_02: which we don't have that much of because there's special circumstances,
[32:16] but it seems to be a way to help prove things when we're
[32:20] looking for really hard
[32:21] SPEAKER_02: evidence?
[32:23] SPEAKER_00: Yeah, I mean, I think it's fantastic, right?
[32:26] SPEAKER_00: I mean,
[32:26] SPEAKER_00: there's a sort of ongoing debate,
[32:29] SPEAKER_00: I think,
[32:29] SPEAKER_00: across these fields or concern,
[32:31] SPEAKER_00: perhaps,
[32:32] SPEAKER_00: that,
[32:32] SPEAKER_00: you know,
[32:32] SPEAKER_00: too much primacy is given to randomized controlled trials and that,
[32:36] SPEAKER_00: you know,
[32:36] SPEAKER_00: we can't know anything until it's been tested in a randomized trial.
[32:39] But I feel like people,
[32:41] most people who are in the kind of evidence world have a
[32:43] more...
[32:45] Sort of inclusive attitude to evidence and natural experiments
[32:48] have been really
[32:49] SPEAKER_00: important,
[32:49] SPEAKER_00: for example,
[32:50] SPEAKER_00: in development economics,
[32:51] SPEAKER_00: which you talked about the randomistas.
[32:53] I mean,
[32:53] that's the idea of testing whether policies help people living
[32:57] in poverty,
[32:58] effectively.
[32:59] SPEAKER_00: And,
[32:59] SPEAKER_00: you know,
[33:00] a natural experiment is just when kind of the world does your
[33:04] randomization for you
[33:05] SPEAKER_00: or allocates people into groups.
[33:07] SPEAKER_00: So rather than scientists doing it,
[33:08] SPEAKER_00: you know,
[33:08] SPEAKER_00: something's changed,
[33:09] SPEAKER_00: like you said,
[33:10] like a policy shingles vaccine policy changes and we naturally
[33:12] have two groups and
[33:13] SPEAKER_00: follow the outcomes.
[33:16] SPEAKER_00: So I'm personally all for it.
[33:19] SPEAKER_00: We have to sort of draw on the best evidence that we have.
[33:22] And that was one of,
[33:22] again,
[33:22] the principles of evidence-based medicine at the beginning.
[33:25] SPEAKER_00: It's drawing on the best available evidence.
[33:28] SPEAKER_00: Sometimes randomized trials aren't possible.
[33:30] SPEAKER_00: They're too expensive.
[33:32] SPEAKER_00: It's just not necessary.
[33:33] SPEAKER_00: And I think some of the frustration maybe you get, as I said, from
[33:38] towards evidence-based medicine is because people have drawn
[33:42] these hierarchies
[33:43] SPEAKER_00: where you've got randomized controlled trials at the top and it gives the
[33:46] SPEAKER_00: impression that that's the only evidence that counts,
[33:48] SPEAKER_00: but that's not the case.
[33:49] SPEAKER_02: Absolutely.
[33:50] So I did want to make sure that we emphasize that point is that
[33:55] randomized trials
[33:56] SPEAKER_02: are good when they're done well and
[33:59] maybe even better when they're systematically coalesced but
[34:04] there's other really
[34:05] solid forms of evidence and this whole idea of gold standard
[34:09] science or platinum
[34:10] SPEAKER_02: standard science yeah
[34:13] SPEAKER_00: I talked in the book about aluminium standard evidence synthesis because,
[34:18] SPEAKER_00: again,
[34:18] SPEAKER_00: it depends what situation you know.
[34:20] SPEAKER_00: I mean,
[34:20] SPEAKER_00: if you are in medicine,
[34:21] SPEAKER_00: then yeah,
[34:22] ideally you've got gold standard randomised trials synthesised
[34:25] into a gold standard
[34:26] SPEAKER_00: systematic review.
[34:27] But if you're working in policy and a policymaker needs to know
[34:30] tomorrow the
[34:33] SPEAKER_00: evidence behind some decision they have to make,
[34:35] SPEAKER_00: you have to go with what you can get together in the time.
[34:38] SPEAKER_00: So it depends on the situation.
[34:41] SPEAKER_00: and the needs of the person who needs that evidence.
[34:45] SPEAKER_02: Yes, no, that's great.
[34:47] SPEAKER_02: Now,
[34:48] SPEAKER_02: another area I wanted to touch on because this basic,
[34:56] SPEAKER_02: I think,
[34:56] SPEAKER_02: progression from rationalism to empiricism,
[35:01] SPEAKER_02: which is really the fundamental change here that we no longer accept
[35:07] SPEAKER_02: This intuition and opinions deduction, but we have to have proof.
[35:13] SPEAKER_02: It has to be established.
[35:14] SPEAKER_02: Do things really work?
[35:16] SPEAKER_02: Now,
[35:16] SPEAKER_02: recently,
[35:18] SPEAKER_02: there was a,
[35:18] SPEAKER_02: you know,
[35:19] SPEAKER_02: last month or so,
[35:21] SPEAKER_02: there was a randomized trial,
[35:22] SPEAKER_02: large randomized trial,
[35:24] SPEAKER_02: of hydration for kidney stones,
[35:27] SPEAKER_02: okay?
[35:27] SPEAKER_02: Okay.
[35:28] And this trial was unique because there had never been a large
[35:31] trial and everything
[35:32] SPEAKER_02: was kidney stones.
[35:34] SPEAKER_02: The number one thing you have to do in having suffered kidney stones,
[35:38] SPEAKER_02: I read this everywhere,
[35:39] SPEAKER_02: is you've got to hydrate.
[35:40] So they really went after this and they even paid the
[35:45] intervention group to drink fluids.
[35:48] SPEAKER_02: Paid them, right?
[35:50] SPEAKER_02: And at the end of the day,
[35:52] SPEAKER_02: The randomized intervention group for the high hydration versus,
[35:55] SPEAKER_02: you know,
[35:56] SPEAKER_02: not to,
[35:56] SPEAKER_02: these are people who already had stones.
[35:58] SPEAKER_02: Yeah.
[35:59] SPEAKER_02: Wasn't any significant difference in recurrent stones.
[36:02] SPEAKER_02: Now, this is challenging the dogma.
[36:06] SPEAKER_02: Now,
[36:07] SPEAKER_02: the critique of the trial is,
[36:08] SPEAKER_02: well,
[36:09] SPEAKER_02: even though they paid them,
[36:10] SPEAKER_02: they didn't drink that much more,
[36:12] SPEAKER_02: you know,
[36:13] SPEAKER_02: so you data.
[36:14] SPEAKER_02: And so here you have a randomized trial.
[36:17] and it's the only one that really exists and they did as good a
[36:22] job as they could.
[36:23] It just shows you how getting people to take aggressive
[36:26] hydration to prevent
[36:27] SPEAKER_02: stones,
[36:28] SPEAKER_02: not so easy,
[36:29] SPEAKER_02: even though stones are such a painful thing.
[36:32] So that was really interesting and that challenged dogma and
[36:36] the trial further
[36:37] SPEAKER_02: didn't fix the problem.
[36:41] And then just recently,
[36:42] another thing that's just biologically interesting
[36:46] the thymus gland and all of us accepted that by age 19 or 20
[36:53] our thymus gland had
[36:54] just involuted and became fatty tissue and then this group led
[36:59] by Hugo Ertz
[37:00] published in Nature two papers they did AI of the chest CT and
[37:07] they found that the
[37:07] SPEAKER_02: thymus was alive and well even in people in their 80s
[37:12] SPEAKER_02: You know, some people had a perfect thyme score or function, you know.
[37:16] SPEAKER_02: So we should never accept these things.
[37:20] SPEAKER_02: I mean, challenging dogma is really important.
[37:24] And I think that's why your book is so important is we've got
[37:28] to get the evidence
[37:29] SPEAKER_02: and never accept things that are widely accepted.
[37:32] SPEAKER_02: And even when you do a trial, that may not answer the question.
[37:36] SPEAKER_00: You have to be a bit careful because at some point,
[37:38] SPEAKER_00: I mean,
[37:38] SPEAKER_00: the evidence is,
[37:39] SPEAKER_00: the consensus,
[37:40] SPEAKER_00: the evidence is enough,
[37:41] SPEAKER_00: right?
[37:41] SPEAKER_00: I mean,
[37:42] SPEAKER_00: we don't need to challenge the dogma that vaccines,
[37:44] that the benefits of vaccines outweigh the risks because
[37:47] there's such a huge,
[37:48] SPEAKER_00: huge consensus and weight of evidence there.
[37:50] SPEAKER_00: I mean,
[37:51] SPEAKER_00: I think the lesson from evidence is one of humility,
[37:55] SPEAKER_00: that evidence often doesn't give clear answers and it's always changing.
[38:02] SPEAKER_00: And again, it's one factor in making a decision.
[38:06] SPEAKER_00: But
[38:10] SPEAKER_00: It should be there in the conversation.
[38:14] SPEAKER_00: And yeah,
[38:15] SPEAKER_00: I mean,
[38:15] SPEAKER_00: one of the fun things about the book,
[38:17] SPEAKER_00: to go back to your point about dogma,
[38:18] was that I discovered across all of these fields that a lot of
[38:23] the people who are
[38:23] SPEAKER_00: kind of pioneers of evidence are these sort of rebellious characters,
[38:26] SPEAKER_00: because they were willing to...
[38:30] SPEAKER_00: You know, they were willing to speak truth to power, basically.
[38:33] And say,
[38:33] actually,
[38:33] we've always done it this way,
[38:35] but why are we doing that?
[38:38] SPEAKER_00: And so that's why it was kind of full of these,
[38:40] SPEAKER_00: you know,
[38:41] fun people who were willing to challenge senior doctors or
[38:45] challenge the most
[38:46] SPEAKER_00: senior person in the room.
[38:47] SPEAKER_00: And then,
[38:47] SPEAKER_00: by the way,
[38:48] I have to drop in that there were just some wonderful acronyms
[38:50] for those people.
[38:52] SPEAKER_00: So maybe you know the one in medicine,
[38:54] SPEAKER_00: this is a way of doing eminence-based medicine,
[38:56] SPEAKER_00: which is GOBSAT,
[38:57] SPEAKER_00: which is good old boys sat around the table.
[39:00] SPEAKER_00: Eric Topol erictopol
[39:17] SPEAKER_02: Yeah, no, these acronyms are great.
[39:22] SPEAKER_02: I think this is why it's such a unique book,
[39:25] SPEAKER_02: is that you bring in a perspective that is a vital one,
[39:30] and you get into these personal stories and the
[39:34] characterization of the folks that
[39:36] SPEAKER_02: really changed the whole progress,
[39:39] SPEAKER_02: the whole evolution of evidence-based medicine.
[39:43] SPEAKER_02: Now, in wrapping up,
[39:46] SPEAKER_02: I want to get into AI and misinformation.
[39:50] SPEAKER_02: And you also touched on in the book the fact that,
[39:53] SPEAKER_02: you know,
[39:53] SPEAKER_02: there's funds that are being put into this 2025.
[39:57] SPEAKER_02: Maybe you can comment on that.
[40:00] SPEAKER_02: But recently,
[40:01] SPEAKER_02: just over a week ago,
[40:03] I got an email from a person who I didn't know saying that he
[40:09] was recently
[40:09] congratulated on a paper that was published in a journal he'd
[40:14] never heard of.
[40:16] SPEAKER_02: And I was a co-author, in fact, the first author.
[40:19] SPEAKER_02: And it was a shock that he said,
[40:22] SPEAKER_02: he was congratulated and he looked and he said,
[40:24] SPEAKER_02: I never heard of this article.
[40:26] And he wrote to me and the other authors,
[40:28] did you ever know anything about this article?
[40:30] SPEAKER_02: And it turned out it was a fraudulent article in a fraudulent journal.
[40:34] And all the authors were made up by these people who the URL
[40:39] was eventually taken
[40:40] SPEAKER_02: down,
[40:40] SPEAKER_02: but traced to someplace in Russia.
[40:44] SPEAKER_02: This inaugural issue of a journal.
[40:45] So we've already seen this precedent that we could get a
[40:50] totally fraudulent article
[40:53] SPEAKER_02: and you wouldn't.
[40:53] SPEAKER_02: And by the way, it was published in nature font.
[40:58] SPEAKER_02: It looked like a nature paper, right?
[41:00] SPEAKER_02: So this is scary that the difference between truth and fiction is
[41:06] SPEAKER_02: And misinformation and real evidence or information is not just blurred,
[41:11] but deep fakes in the scientific literature to an extent that I
[41:18] didn't even imagine
[41:19] SPEAKER_02: was going to happen.
[41:20] I mean,
[41:20] I knew there were AI-generated papers,
[41:23] but this is like a whole different spin on that.
[41:25] So what are your thoughts about this new challenge,
[41:29] what really is evidence and what isn't?
[41:32] SPEAKER_00: Yeah, I mean, I think that's the kind of next frontier, isn't it?
[41:35] The next huge challenge which the evidence communities or
[41:39] people who are evidence
[41:40] SPEAKER_00: champions have got to face.
[41:42] I mean,
[41:42] the problem of having fake papers produced by paper mills
[41:46] predates AI.
[41:47] SPEAKER_00: That was happening.
[41:48] But AI puts it into overdrive because all of a sudden it's just
[41:51] incredibly easy to
[41:52] SPEAKER_00: churn out papers.
[41:53] SPEAKER_00: And I mean,
[41:54] SPEAKER_00: we've reported at Nature on how,
[41:55] SPEAKER_00: you know,
[41:56] SPEAKER_00: journals are being,
[41:56] just the volume of submissions coming into journals is now
[41:59] going through the roof,
[42:01] SPEAKER_00: you know,
[42:02] some of these are fake papers some of these just used AI to
[42:05] generate them so it
[42:06] makes it much harder even if you're within science to work out
[42:10] what is you know
[42:11] genuine and then of course outside science you know we've just
[42:15] got all of these
[42:16] sort of it puts sort of misinformation into overdrive just on
[42:19] social media and just
[42:20] generally in the kind of digital world which makes it harder
[42:23] for the rest of us to
[42:24] SPEAKER_00: filter what's
[42:26] SPEAKER_00: You know, what to believe, basically.
[42:28] SPEAKER_00: I mean,
[42:29] SPEAKER_00: the one thing,
[42:29] SPEAKER_00: and of course I don't have answers to this because I feel like,
[42:32] SPEAKER_00: I mean,
[42:33] SPEAKER_00: this is the conversation of the moment.
[42:34] So certainly everything I get asked to speak about ends up in
[42:37] this question,
[42:38] SPEAKER_00: right,
[42:38] SPEAKER_00: of like,
[42:38] SPEAKER_00: how are we going to deal with this problem?
[42:41] SPEAKER_00: I mean,
[42:41] I will say this sort of glimmer of hope around like what AI
[42:44] could do for us,
[42:45] SPEAKER_00: which I do write in the book.
[42:46] SPEAKER_00: So what, you know, one of the challenges is...
[42:49] SPEAKER_00: We've got research gushing into the world, right?
[42:51] SPEAKER_00: And it's hard even if you're a specialist to make sense of that.
[42:55] SPEAKER_00: And,
[42:55] SPEAKER_00: you know,
[42:56] SPEAKER_00: there are some really,
[42:57] SPEAKER_00: you know,
[42:57] SPEAKER_00: genuine,
[42:58] SPEAKER_00: I think,
[42:58] important efforts to build AI tools which could sort of filter
[43:04] and do quality
[43:05] SPEAKER_00: evidence syntheses which could answer a question in real time.
[43:09] SPEAKER_00: So the dream of my evidence community,
[43:12] my evidence synthesis community that I've written about is that
[43:14] almost anyone,
[43:15] SPEAKER_00: you know,
[43:15] SPEAKER_00: you're a policymaker or a citizen,
[43:17] SPEAKER_00: Eric Topol erictopol
[43:35] SPEAKER_00: Eric Topol
[43:54] SPEAKER_02: Yeah,
[43:54] SPEAKER_02: I've been struck that in recent times,
[43:57] SPEAKER_02: these deep research tools are just getting so good and they're getting,
[44:02] SPEAKER_02: hey,
[44:02] SPEAKER_02: you know,
[44:02] I could do a deep research and they would include an article
[44:06] published the day
[44:07] SPEAKER_02: prior and accurately summarize it.
[44:09] SPEAKER_02: So hopefully this is going to, as you say, help us to sort through
[44:15] What is becoming,
[44:16] you know,
[44:16] harder to deal with,
[44:18] with all the fake stuff,
[44:20] essentially.
[44:21] SPEAKER_02: I mean,
[44:22] SPEAKER_02: just extraordinary challenge that adds to the challenge of,
[44:27] SPEAKER_02: you know,
[44:27] SPEAKER_02: anti-science in general.
[44:30] SPEAKER_02: Now, before we wrap up, two things.
[44:33] SPEAKER_02: Here we have a question of anyone in the group who's joined us.
[44:40] SPEAKER_02: We've got over 450 folks.
[44:42] SPEAKER_02: If you have a question for
[44:44] SPEAKER_02: Eric Topol erictopol
[45:01] SPEAKER_00: Wow, we've covered a lot.
[45:03] SPEAKER_00: I mean,
[45:03] SPEAKER_00: I could have the same length of time talking about evidence-based policy,
[45:09] SPEAKER_00: conservation,
[45:10] SPEAKER_00: you know,
[45:11] SPEAKER_00: management.
[45:12] SPEAKER_00: I mean, it's just, I suppose if anything, it's just to kind of
[45:17] I think sometimes people working in one field aren't aware that
[45:19] there's an evidence
[45:20] SPEAKER_00: revolution going in and all these others as well.
[45:23] And I think it's worth kind of remembering that evidence-based
[45:28] medicine is part of
[45:28] this much bigger kind of story by which evidence is becoming
[45:31] kind of ingrained in
[45:32] SPEAKER_00: our lives.
[45:33] SPEAKER_00: So yeah, there are these huge challenges, but there is kind of slow
[45:38] Progress being made and that really was the point of the book
[45:40] to remind us of that
[45:41] and sort of hopefully to kind of empower people that even
[45:44] though evidence is
[45:45] complicated and changing you know it can also be a factor in
[45:49] our decisions and it
[45:51] SPEAKER_00: ought to be.
[45:52] SPEAKER_02: Yeah,
[45:53] while we're on this policy evidence story and how it intersects
[45:57] with medicine,
[46:00] SPEAKER_02: the environmental burdens of certain ultra-processed foods,
[46:04] SPEAKER_02: micro and nanoplastics,
[46:07] SPEAKER_02: forever chemicals,
[46:09] SPEAKER_02: air pollution,
[46:10] SPEAKER_02: I mean,
[46:10] SPEAKER_02: these seem to be incontrovertible,
[46:12] SPEAKER_02: but we haven't seen policy changes.
[46:17] that need to be done because it's very hard for any individual
[46:20] to make substantial differences.
[46:24] SPEAKER_02: So when you have evidence,
[46:26] SPEAKER_02: then there'll always be some naysayer,
[46:28] SPEAKER_02: oh,
[46:28] SPEAKER_02: well,
[46:28] SPEAKER_02: really,
[46:28] SPEAKER_02: there is no climate crisis and climate change.
[46:31] SPEAKER_02: There's no problem with air pollution.
[46:33] SPEAKER_02: Oh, and the ultra-processed foods, they're fine.
[46:36] SPEAKER_02: And you have the huge body of data and evidence that incriminates these
[46:41] SPEAKER_02: environmental burdens or nutrition issues.
[46:45] SPEAKER_02: And then you have no policy changes.
[46:48] SPEAKER_02: How do you grapple with that?
[46:54] SPEAKER_00: I wish I had the answer to that question.
[46:58] It's difficult if people have deliberately chosen to reject the
[47:05] body of evidence
[47:05] SPEAKER_00: which is there,
[47:06] SPEAKER_00: which is obviously what's happening in many cases in the US.
[47:10] I think that the US is a particular case study where that's
[47:14] happening to an extreme.
[47:16] I see much more optimistic signs of the way that evidence is
[47:18] actually becoming
[47:19] incorporated into policy as more of a routine conversation if
[47:22] you look at many
[47:23] SPEAKER_00: other countries around the world.
[47:25] SPEAKER_02: That was exactly what I was hoping for you to say.
[47:30] SPEAKER_00: Okay.
[47:31] SPEAKER_00: I mean, that was, again, sort of part of the point of the book.
[47:33] SPEAKER_00: I mean, what's happening in the US is really important.
[47:36] I think that there's opposition to evidence and absolutely has
[47:41] to be taken seriously.
[47:42] SPEAKER_00: But again,
[47:42] SPEAKER_00: it's sort of like putting it in context,
[47:44] SPEAKER_00: like we're on this kind of multi-decade journey,
[47:47] SPEAKER_00: if I can use that overused word,
[47:48] SPEAKER_00: you know,
[47:49] SPEAKER_00: to
[47:49] SPEAKER_00: in which,
[47:50] SPEAKER_00: again,
[47:50] SPEAKER_00: evidence has become sort of incorporated into our lives and into policy,
[47:53] and it is increasingly part of policy conversations and
[47:57] conversations across lots
[47:58] SPEAKER_00: of different fields.
[47:59] And so maybe it's just having that context and a little glimmer
[48:03] of optimism.
[48:04] But I don't want to suggest I have the answers to what's going
[48:07] on in the U.S.
[48:09] That was helpful.
[48:11] That was what I was hoping you were going to bring up because
[48:13] we are an outlier in that.
[48:15] SPEAKER_02: Paula has asked about your views on the changing
[48:20] um hormone replacement therapy evidence over time so i i have
[48:26] not dug into that in
[48:27] great detail i do mention at the beginning that it was a bit of
[48:29] a case study in um
[48:31] in the early days because because hormone replacement therapy
[48:34] was was hugely
[48:35] prescribed on the assumption that you probably know more about
[48:38] this than i do eric
[48:39] SPEAKER_00: so stop me if i'm wrong but um
[48:41] you know on this sort of assumption which was a little bit
[48:43] untested that it was it
[48:45] reduced heart disease amongst women right and then there were
[48:48] these sort of seminal
[48:49] randomized trials that came through that suggested actually
[48:52] there was an increased
[48:53] risk amongst women who took HRT but but the body of evidence as
[48:56] I understand it has
[48:57] just evolved enormously since then and so now this is one of
[49:00] these cases where the
[49:02] evidence would be part of the conversation that you would have
[49:04] with your own
[49:05] Doctor that would work out what's right for you and it would
[49:08] depend on your age and
[49:09] SPEAKER_00: your risk groups and all these other things.
[49:11] SPEAKER_00: But do tell me if I'm wrong.
[49:12] SPEAKER_00: Well, no, no.
[49:13] SPEAKER_02: I think that's a very fair summary.
[49:15] I wrote a subject about it and obviously I interviewed Jen
[49:20] Gunter and many others.
[49:22] SPEAKER_02: This is a big problem because the Women's Health Initiative,
[49:25] SPEAKER_02: which was billions of dollars expended to work this out,
[49:28] led to some misleading conclusions because of who they enrolled
[49:33] in the randomized
[49:33] SPEAKER_02: trial.
[49:35] SPEAKER_02: And I think we have a much better handle on that now,
[49:38] but it took decades and a lot of women unfortunately missed the
[49:42] benefit that could
[49:43] SPEAKER_02: have been provided.
[49:44] SPEAKER_02: All right, so we're going to close it out here.
[49:47] SPEAKER_02: This is the book.
[49:49] SPEAKER_02: It's Beyond Belief.
[49:51] it's really a great book I thought I knew a lot about evidence
[49:54] but I actually
[49:55] learned a lot I really thank you Helen for all the work and all
[49:59] the research you
[50:01] know it was 10 years since your last book so I know you put a
[50:04] lot of time to this
[50:06] SPEAKER_02: one
[50:08] SPEAKER_02: And I think, you know, we're really indebted to you for this.
[50:11] SPEAKER_02: And also, this has been a fun conversation.
[50:14] We can never get enough hard evidence for the things that we're
[50:17] doing in medicine.
[50:19] And as a clinician,
[50:21] we really rely on patient decisions on the latest evidence.
[50:25] SPEAKER_02: And hopefully, we're just going to get better and better with that.
[50:28] SPEAKER_02: That is, as you mentioned, where AI could be helpful rather than harmful.
[50:32] SPEAKER_02: So we'll see how this plays out.
[50:34] SPEAKER_02: And there's so many dynamic
[50:37] Frontier to see,
[50:39] you know,
[50:39] how it will settle when we revisit this in the years ahead.
[50:42] SPEAKER_02: So thanks for what you're doing.
[50:44] I think the people that take your courses at UCL in science
[50:49] writing are very lucky.
[50:50] SPEAKER_00: Thank you very much.
[50:51] SPEAKER_00: It was really great talking to you.
[50:53] SPEAKER_00: I felt we could talk for hours, but another time.
[50:57] Thanks for what you're doing for science and biomedical
[51:00] journalism and for teaching
[51:02] SPEAKER_02: about science journalism.
[51:03] SPEAKER_02: Thank you.
[51:04] SPEAKER_02: Thanks, Helen.
[51:04] SPEAKER_02: Thanks for being with us.
[51:05] SPEAKER_02: And thanks, everybody, for joining today.
[51:07] SPEAKER_01: Alright, take care.
[51:09] SPEAKER_01: Bye-bye.

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