An older article, but interesting in light of the replicability crisis that has come out since. FTA:
"It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine."
Physician here (intensive care, about 10 years of practice).
> It is simply no longer possible to believe much of the clinical research that is published
Absolutely agree. I've tried arguing this with colleagues—that we should be more careful about the clinical conclusions we draw from single studies—but I'm just met with resistance. We just added a new drug to the standard treatment of heart failure, based on a shady Novartis-funded study that decided, in a post-hoc analysis, to exclude something like 50% of the patients after-the-fact (and oh look! now we can show a mortality benefit!). It spits in the face of everything I've learned about the scientific method and clinical research. This is the PARADIGM-HF study and the drug is ENTRESTO in case anyone wants to look into it more. Caveat: it might be a beneficial drug for many patients.
> It is simply no longer possible...to rely on the judgment of trusted physicians or authoritative medical guidelines
I'm going to disagree with the author on this one. It is possible to trust and rely on your physician, and in many cases you have no choice. Guidelines are just that: guidelines. Not a replacement for careful thought. And I actually like the direction that many guidelines are adopting: one that brings more continual minor updates rather than infrequent major changes. This is a complicated discussion, and depends on what illness you have that leads to your interaction with our health care system, but my advice is to seek out doctors that seem to communicate well with you.
From briefly reading the paper and the post-hoc analysis, it seems that they were very clear about their post-hoc analysis and its limitations. In this situation, whoever are reading into it more than they should (could be novartis and their marketing, could also be the physician colleagues of yours) are the ones that should be criticized, not the authors themselves.
Edit: here are some quotes from the author of the post-hoc analysis
"Referring to the fact that these observations came from a post hoc analysis, Pfeffer said: 'I normally draw a line here, and I wouldn't cross this line if we had things to do for these patients.'
But he added: 'This is a growing part of the heart-failure syndrome. And if we have something that can help these 40% to 50% of people with symptomatic heart failure and an impaired prognosis—if we can improve their prognosis and take care of the safety measures—then I will go below this line by stating that our observations in the Americas—that spironolactone was associated with reduced CV deaths and hospitalizations for CHF—should be taken into account.'"
Your doctor Googling for 30 seconds (not quite on the correct topic) is no substitute for careful research, either. I trust my doctor, more or less, on many matters; but never more on prescriptions, or surgery (a whole other scandal.)
I'm an anesthesiologist. I'm always interested to hear the story of colleagues on hackernews. Would like to ask you a few questions about your projects. Reach me on albin.stigo@gmail.com
Not just hanging on, it appears to be stabilizing. At the end of March, they had actually sold a handful of more sponsorships in year 3 than they had by the same time in year 2. The goal now is to use the additional funds to purchase a building in SF to be a permanent home for the store once the current lease runs out.
I love this. It's both the epitome of anti capitalism, while being so completely fundamental free trade, that it almost makes my head explode (as a university trained economist). I especially love that many who espouse capitalistic ideals will have a hard time wrapping their minds around this too. It's so easy to forget that any time money changes hands without extortion involved that's capitalism at it's finest. And the fact that the store is looking to the future, and using the patronage (in it's most classical sense) to increase it's capital to help stabilize itself in the long term just really makes me smile from all the dichotomous ideas at play.
It's an interesting example of the value of customer goodwill.
In addition to being a bookshop, Borderlands is a cultural hub for SF/F readers in the Bay Area. As such, it's not simply selling SKUs at the cheapest viable price, it's providing an intangible curatorial service. Amazon may crowdsource reader reviews but they're unlikely to be as insightful as suggestions by enthusiastic staff who know what they're selling, and the usual recommendations engines are less effective than one of those staff engaging in Q&A with a customer to find something new that they might like.
(And this is before we get into things like the cafe side of the business, or the author readings/signings. Disclaimer: I am an author and I occasionally do events there.)
This is a perfectly rational response in a capitalistic society. Sponsors obtain value from sponsorship through perks, social signaling, continued existence of Borderlands, personal gratification, and so on. On the other side of the transaction, Borderlands monetizes it's social and goodwill capital.
This exchange of value for money is done in a way that may be somewhat unique for a retail establishment, but isn't anywhere close to anti-capitalistic.
Capitalism works under a lot of assumptions, one of them is no friction with information. This particular story is just taking advantage of a small, imperceptible (to the rentors) risk capital gap, but some savvy and attached fans saw it and wanted to take advantage of it.
It's just like a lot of microfinance in say a poor struggling neighborhood in Bangladesh. There's money to be made there, but most traditional bankers or participants would ignore it or be blind to it. When socialism steps in is not when it's able to cover that gap, but when it has the foresight or wisdom to know why that gap should be covered. That wisdom is something that doesn't always happen in less than ideal capitalist systems.
> It's so easy to forget that any time money changes hands without extortion involved that's capitalism at it's finest.
I thought that the existence of an individual or group of individuals who hold material wealth and can invest it (those who hold capital, or capitalists) instead of selling labor was capitalism at its core, and maybe therefore at its finest - is that not your take on it?
Just another reminder that the money (and the people behind it) just do whatever they want Honeybadger style, and we scramble along behind them trying to stick labels on what just happened.
"It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine."