As someone who is actually an expert in a subfield of medicine, not only do doctors not understand it at all, but the experts making guidelines often recommend the exact opposite of what is the best treatment for the patient, usually for liability reasons, but occasionally for true lack of understanding. The quality of research is so poor that often times there are more flawed studies showing X than proper studies which would show ~X. Other times there is no research on the matter at all, and the conventional wisdom (even among experts!) is incorrect. For fields where practice and theory diverge, like an experimental surgery with sparse research, the surgeons know that the guidelines are useless.
What you yourself _have_ to realize is that the expert researchers who are in a position to create and inform guidelines are themselves not some kind of 'super-experts' who know everything better than normal experts. They're just researchers in a political position in a bureaucracy.
I don't exaggerate when I say that an average HN reader could write better guidelines for patient outcomes in my subfield, with no prior training, simply by reading a few studies and observing a practice.
Now, does any of this apply to internal medicine, specifically covid? Probably not. But when the data is anything other than crystal clear, you should not assume the expert guidelines are anything more than some guesses by guys in a room. The consequence of knowing this is that all guidelines and consensus is suspect until you see the data yourself, like TFA outlines. In this case it seems true that Ivermectin doesn't cure covid. But with my experience, the exact opposite result could have been shown and I would not be surprised whatsoever; experts saying it doesn't work does not constitute in my eyes anything other than noise until the data is clear.
I'm not saying that experts are doing a stellar job or that they're special in any way, far from it. I have slaved enough under 'true experts' to know the extent of the catastrophe. We even had a truly spectacular example of failure at the start of the pandemic with the 'intubate early and withhold steroids' expert opinion. This particular one, I won't ever forget.
What I'm saying is only that:
- on average, experts do spectacularly better than Joe Schmoe. Including science degree holders thinking they understand medical studies while missing the whole political and social context of the field.
- it's not the job of field practitioners to prescribe experimental therapies, and those people cannot do better than follow expert opinion and guidelines.
But I actually agree with you on all points, especially regarding flawed research and understanding. Which makes people basing opinions solely on papers without any practical knowledge of the field wrong all the more often. Does it make it a good idea for people to go and try on their own the thing they read about in the last issue of 'covid today'? I don't think so.
>on average, experts do spectacularly better than Joe Schmoe. Including science degree holders thinking they understand medical studies while missing the whole political and social context of the field.
I'm saying that, when the data is unclear and Joe is thorough, I don't even think that's true. Or at least it's not spectacularly better. My point is that for something like Ivermectin where the data was initially null and even now isn't super clear, the word of experts was basically meaningless. Trust them if you don't care enough to look into it, but if you're Joe I'd say just go ahead and believe whatever you understand to be correct until there's a better consensus.
The medical profession gets it wrong with some regularity, but this Ivermectin thing fell out of the sky without any support, and was touted as the miracle cure that big pharma was withholding in order to protect their profits.
So even if the data is unclear we can safely conclude that it isn't a miracle cure and never was. And Joe Schmoe here isn't talking about some condition that he's been walking around with for a while and has studied extensively, Joe Schmoe here is a guy who believes doing your own research is watching youtube videos by people who have done their own research reading a bunch of papers without understanding any of it.
The problem is that that gets in the way of achieving the goal: beating this pandemic, and that isn't going to happen with ivermectin. (Or HCQ for that matter).
Your Joe is the average HN reader. My Joe is my average patient. I completely agree that the word of experts is meaningless on matters where dust had no time to settle. I however maintain that practitioners have to follow guidelines and experts regardless because I believe in the principle (if not the current application) of evidence-based medicine, and that Joe should not be allowed free access to any drug he wants to prevent frequent self harm.
I don't know about that. I'd rather see all of this stuff disappear from youtube and to deny the conspiracy sphere its oxygen than to let this run its course. The damage is very real. Experts tend to communicate via scientific papers and symposia, not via youtube, that's aimed squarely at the masses only a very small fraction of which has the capacity to interpret what they are hearing, but almost all of them have the capacity to filter that to select the bits that they like or that they feel support their pet desired outcomes.
The damage caused by mis- and dis-information is real, but suppressing dissenting voices (even comically mistaken ones and bad actors) destroys institutional credibility, which is far worse in the long run.
What you yourself _have_ to realize is that the expert researchers who are in a position to create and inform guidelines are themselves not some kind of 'super-experts' who know everything better than normal experts. They're just researchers in a political position in a bureaucracy.
I don't exaggerate when I say that an average HN reader could write better guidelines for patient outcomes in my subfield, with no prior training, simply by reading a few studies and observing a practice.
Now, does any of this apply to internal medicine, specifically covid? Probably not. But when the data is anything other than crystal clear, you should not assume the expert guidelines are anything more than some guesses by guys in a room. The consequence of knowing this is that all guidelines and consensus is suspect until you see the data yourself, like TFA outlines. In this case it seems true that Ivermectin doesn't cure covid. But with my experience, the exact opposite result could have been shown and I would not be surprised whatsoever; experts saying it doesn't work does not constitute in my eyes anything other than noise until the data is clear.