Post-Midterm 2 Content Flashcards
How does times of uncertainty or lack of perceived control influence belief in CTs?
Circulation of rumours/misinformation/falsehoods increases
Government and public health info is contradictory or unclear (inevitable)
Why is it easy to believe confident but unreliable claims during times of uncertainty?
CTs provide simple answers for unanswered Qs (tendency towards wrong answers over no answer at all)
Allows people to retain a sense of perceived control
Why is it psychologically comforting for some people to believe in CTs
We don’t like to think that out of the blue something terrible can happen, and would sometimes rather blame highly organized, evil people than accidents`
How do CTs provide an enemy to blame?
Give a scapegoat for disruption to people’s lives and motivate people for collective self-defense
How do CTs provide a sense of being the hero
People believe the scapegoat is truly evil and they are “the people” against the “power bloc”
Otherwise good people can perform violent acts
How and why do CTs provide a chance to be an expert
The holder of the CT possessed hidden, important knowledge not held by the “experts”
The less we know about something the more confident in what we believe about it
Explain the irony of people who believe in CTs
They are unusually fearful of being the victim of a hoax, yet CTs are hoaxes created to manipulate the public
Personality traits associated with conspiracy belief:
- Low agreeability
- Narcissism
- Machiavellianism
- Desire for Uniqueness
- Openness to experience
Distrust
Personality traits associated with conspiracy belief:
- Distrust
- Narcissism
- Machiavellianism
- Desire for Uniqueness
- Openness to experience
Low agreeability (less likely to get along with others)
Personality traits associated with conspiracy belief:
- Distrust
- Low agreeability
- Machiavellianism
- Desire for Uniqueness
- Openness to experience
Narcissism
Personality traits associated with conspiracy belief:
- Distrust
- Low agreeability
- Narcissism
- Desire for Uniqueness
- Openness to experience
Machiavellianism (cold and manipulative)
Personality traits associated with conspiracy belief:
- Distrust
- Low agreeability
- Narcissism
- Machiavellianism
- Openness to experience
Desire for uniqueness
Personality traits associated with conspiracy belief:
- Distrust
- Low agreeability
- Narcissism
- Machiavellianism
- ## Desire for Uniqueness
Openness to experience
Personality traits associated with conspiracy belief (6):
Distrust, low agreeability, narcissism, machiavellianism, openness to experience, desire for uniqueness
The more someone believes in conspiracy theories, the less likely they are to….
trust scientific facts
What happens when scientists try to present evidence to disprove a CT and what is one possible reason
It makes the false beliefs even stronger
Repeating the CT strengthens the belief (mistake familiarity with truth)
Explain what happens to the first to point the finger
They are less likely to be perceived as the source of deceit
- Small group
- Variable effectiveness (whistle blowing is common)
- Local
- Transient duration (leaks occur)
- Motivated by greed/personal gain
- Limited abilities by factors beyond control
Characteristics of REAL conspiracies
- 100s to 1000s of people are in on it
- Unerring
- Global scale
- Perpetual
- Conspirators are inherently evil
- Unlimited ability to maintain control
Characteristics of FAKE conspiracies
What is an example of unwarranted credibility
Donald Trumps endorsement of:
- wind farms cause cancer
- he won the 2020 election
- MMR vaccine causes autism
- Obama is not an American
- global warming is a hoax
What does belief in medical conspiracies demonstrate
The inherent ability to believe mere speculation with no concern for evidence
Tendency to confirm; if we can imagine a claim being true, we ignore contradictory evidence)
What does belief in medical conspiracies demonstrate
The inherent ability to believe mere speculation with no concern for evidence
Tendency to confirm; if we can imagine a claim being true, we ignore contradictory evidence)
What drug was hastily approved by the UK government as an oral treatment for COVID-19 in November 2021?
Molnupiravir
What were the original Molnupiravir claims
Reduces risk of COVID-19 related deaths and hospitalizations by 50%
What is the issue with preprints
Not peer reviewed (not unusual during COVID)
T/F the molnupiravir human RCT used to guide the UK decision made claims of efficacy
F (it looked at the viral burden in the nasopharynx and clearly stated it should not be used to guide clinical decisions)
What study was the basis of the UK decision to stockpile Molnupiravir
MOVe OUT
An interim analysis of an unpublished, in-progress trial
Was MOVe OUT done on in or out-patients (with decisions directed towards hospitalized patients)
Out-patients (not hospitalized)
What was the MAIN issue for the MOVe OUT trial
Conclusions were based on analysis of only half of the originally planned participants (interim analysis)
What is the issue with stopping a trial early based on positive results
High false-positive risk (effect looks much stronger than it really is)
Why did MOVe OUT stop the trial early
Not based on rigorous statistical testing but on rushed assessment of the data
Is it normal for a trial to originally show a very large risk but when it is eventually published the risk is significantly lower?
NO (the authors that looked at the study called it unprecedented and hinted at scientific fraud)
What is the issue with Merck funding the study
High COI (they are the manufacturers of the drug)
Discuss the method of analysing MOVe OUT data
Inappropriate (using the correct test showed no effect)
How did MOVe OUT treat lost to follow up patients
As deaths (inappropriate)
If data were analysed correctly, would have seen no effect
Describe the PANORAMIC Molnupiravir study and its findings
20x the sample size of MOVe OUT
Preliminary analysis showed no effect of Molnupiravir, but that it does reduce symptom duration by 4 dats
What other drug besides Molnupiravir was the topic of a similar scandal
Oseltamivir (influenza scare)
what is another word for a difference-in-differences analysis
An observational study (cannot infer causation)
When is an RCT not needed? (3)
- drugs that do not heal (ex. anaesthetic; fluorescein dye)
- when effects are immediate (ex. lancing an abscess)
- when the body is incapable (ex. insulin; thyroxine)
What is the duration for effects to be considered immediate?
seconds to minutes
What direction is random error
No direction (can make interventions appear more or less effective with equal frequency)
What direction is systematic error or bias
Unidirectional
How can random error be minimized
Can’t be minimized in a single trial, but performing systematic reviews (large number of studies) evens out the random error
How can systematic error be minimized
Following CONSORT (performing a well-designed trial)
Why are many research findings not reproducible
Researchers exaggerate their findings
Where is exaggeration most often encountered in research papers
In the abstract conclusions (58%)
When press releases do not exaggerate…
A minority of news stories do
When press releases exaggerate…
A large majority of news stories do
What proportion of the time do universities exaggerate findings (in health advice, causation claims, and inferences from animals to humans)
1/3 of the time
Who is responsible for exaggeration in health science news
the research institutions (we should be able to fix most of the problem)
What is the purpose of CONSORT?
To ensure that whatever was done in the study was DESCRIBED thoroughly (whether it was done well or not)
What is the purpose of GRADE
To assess the QUALITY of the science of one or more RCTs
What is the BODY of EVIDENCE
The group of RCTs that meets the minimum standards to be assessed
- INCONSISTENCY
- INDIRECTNESS
- IMPRECISION
- PUBLICATION BIAS
RISK of BIAS
The GRADE process includes an examination of:
- RISK of BIAS
-
- INDIRECTNESS
- IMPRECISION
- PUBLICATION BIAS
INCONSISTENCY
The GRADE process includes an examination of:
- RISK of BIAS
- INCONSISTENCY
-
- IMPRECISION
- PUBLICATION BIAS
INDIRECTNESS
The GRADE process includes an examination of:
- RISK of BIAS
- INCONSISTENCY
- INDIRECTNESS
-
- PUBLICATION BIAS
IMPRECISION
The GRADE process includes an examination of:
- RISK of BIAS
- INCONSISTENCY
- INDIRECTNESS
- IMPRECISION
-
PUBLICATION BIAS
The GRADE process includes an examination of: (5)
- risk of bias
- inconsistency
- indirectness
- imprecision
- publication bias
The quality of the evidence can be graded as: (4)
- high
- moderate
- low
- very low
What is a quality of evidence grade of HIGH
very confident that the true effect is similar to the estimate of the effect
What is a quality of evidence grade of MODERATE
the true effect is probably similar to the estimate of the effect, but there is a chance it is different
What is a quality of evidence grade of LOW
The true effect might/could be substantially different from the estimate of the effect
We don’t know the effect of the treatment
What is a quality of evidence grade of VERY LOW
The true effect is probably substantially different from the estimate of the effect (probably much smaller)
There were multiple routes for entry of bias in most studies
How does GRADE evaluate risk of bias
Looks at ~6 CONSORT items (randomization, allocation concealment, blinding, selective reporting, etc)
Each paper is scored for each CONSORT item as:
- low risk (+)
- unclear risk (?)
- high risk (-)
What is inconsistency in a SR
Unexplained heterogeneity of results across studies
What are signs of inconsistency
- CI’s have minimal or no overlap (suggests variation is more than random chance)
- large differences between means/point estimates
- statistical tests of heterogeneity (I2)
Explain I2 test
ranges from 0-100%
0 = very consistent (random chance)
100 = very inconsistent (complete heterogeneity)
How does GRADE assess indirectness
PICO
Populations
Interventions
Controls
Outcomes
Research is conducted in the POPULATION we want to provide answers for
RCTs include the INTERVENTIONS we are interested in and compare these to the appropriate CONTROLS
OUTCOMES of interest have actually been measured and not a poor surrogate
How is imprecision evaluated using GRADE
- large CI
- is there an OIS?
- is there sufficient number of events?
What is the OIS
Optimal information size (if you combine participants from all studies, is the number larger than the sample size needed for a single adequate study)
How is publication bias evaluated using GRADE
funnel plots (want symmetry)
What is a meta-analysis
Take all the data from all RCTs and assess it as if it is data from one massive trial
What is the value of a SR
Its estimates of certainty (the actual grading of the evidence) because it tells you if the results are believable or not
T/F SR will use observational studies if there are no RCTs available
T
What was the conclusions of the Wakefield (1998) study
There was no link between the MMR vaccine and the condition described (ASD)
Where did Wakefield make claims of the MMR-autism link
a) Study
b) Press release
b
What were the COI in the Wakefield study
- he received $430,000 to find a link
- he filed a patent for a single vaccine
What did Brian Deer find about the medical records used in the Wakefield study
Wakefield manipulated data on patient histories, descriptions and diagnoses to make it look like he had discovered a novel syndrome
- medical community cast as a villain
- vaccine fear is resistant to evidence
- physicians threatened with murder
- more infections and deaths
fear of vaccines
GLOBAL CONSEQUENCES of WAKEFIELD (1998):
- fear of vaccines
-
- vaccine fear is resistant to evidence
- physicians threatened with murder
- more infections and deaths
medical community cast as a villian
GLOBAL CONSEQUENCES of WAKEFIELD (1998):
- fear of vaccines
- medical community cast as a villain
-
- physicians threatened with murder
- more infections and deaths
vaccine fear is resistant to evidence
GLOBAL CONSEQUENCES of WAKEFIELD (1998):
- fear of vaccines
- medical community cast as a villain
- vaccine fear is resistant to evidence
-
- more infections and deaths
physicians threatened with murder
GLOBAL CONSEQUENCES of WAKEFIELD (1998):
- fear of vaccines
- medical community cast as a villain
- vaccine fear is resistant to evidence
- physicians threatened with murder
-
more infections and deaths
GLOBAL CONSEQUENCES of WAKEFIELD (1998): (5)
- fear of vaccines
- medical community cast as a villain
- vaccine fear is resistant to evidence
- physicians threatened with murder
- more infections and deaths
What is the issue with Medical Hypotheses
It welcomes “probably untrue ideas”
What are the issues with the study about mercury-based preservatives and autism risk
- the MMR vaccine never contained mercury
- the authors of the opinion piece included a marketing consultant
- the opinion piece was not peer-reviewed
T/F when mercury-based preservatives were removed from vaccines in 2001 it changed the rate of autism
F
What were the results of the CDC study finding no MMR-autism link?
Death threats by the anti-vaccine community
What is happening with herd immunity and the vaccine controversy
Herd immunity is essential for children that cannot develop or hold an effective vaccine titre
Parents who refuse to vaccinate benefit from herd immunity while helping to impair and dismantle that protection
What is the known reason for the increase in autism rates
Changing definitions (ex. including Aspergers may have doubled the number of children under the definition of ASD)
What is the risk for the most serious side effect from the MMR vaccine (allergic reaction)
1/1,000,000
Explain pseudoscience used in the MMR-autism debate
- using papers that were withdrawn due to data manipulation
- using reviews that purposely excluded data showing no link or included studies that actually saw no link but then claim they did have a link
- using studies with clear COI
- ignoring contradictory papers
when does selection bias most often occur
controversial topics or when COI are present
what is the issue with the VAERS database
it is an online vaccine adverse effect reporting system and should not be used to draw links of causation, yet it is used as scientific evidence against vaccines
what is citation diversion
citing a paper but claiming it has a different meaning
what is a dead end citation
citing a paper that does not contain comments addressing the claim you are using it to support
what is citation transmutation
converting a hypothesis to fact through the act of citation alone
what are the two inherent tendencies that drive anti-vax beliefs
- tendency to accept a false answer over no answer
- tendency to believe (emotionally charged) stories over data
what can the medical community do to combat vaccine resistance
- use stories and get them circulating online
- develop skills to help you identify reliable medical info
- license to practice medical science
What is the def’n of evidence based medicine (EBM)
- the integration of the best available evidence with clinical expertise and patient values in pursuit of the best possible outcomes
what is the best research evidence
Clinically relevant and patient centered
- accuracy and precision of diagnostic tests
- power of prognostic markers
- efficacy and safety of therapeutic and preventative treatments
what is clinical expertise
The ability to rapidly identify:
- health state/diagnosis
- benefits/risks of interventions
- personal values and expectations
what are patient values
unique preferences, concerns and expectations
- track down the best available evidence to answer these questions
- critically appraise the evidence for its validity and usefulness
- implement the results into clinical practice
- evaluate performance
convert information needs to answerable questions (formulate the problem)
The essential steps in the science of EBM:
- convert information needs into answerable questions
-
- critically appraise the evidence for its validity and usefulness
- implement the results into clinical practice
- evaluate performance
track down the best available evidence to answer these questions
The essential steps in the science of EBM:
- convert information needs into answerable questions
- track down the best available evidence to answer these questions
-
- implement the results into clinical practice
- evaluate performance
critically appraise the evidence for its validity and usefullness
The essential steps in the science of EBM:
- convert information needs into answerable questions
- track down the best available evidence to answer these questions
- critically appraise the evidence for its validity and usefulness
-
- evaluate performance
implement results into clinical practice
The essential steps in the science of EBM:
- convert information needs into answerable questions
- track down the best available evidence to answer these questions
- critically appraise the evidence for its validity and usefulness
- implement the results into clinical practice
-
evaluate performance
The essential steps in the science of EBM: (5)
- formulate the problem
- track down the best available evidence
- assess evidence for validity and usefulness
- implement
- evaluate
