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johnlawrenceaspden comments on The Thyroid Madness: Two Apparently Contradictory Studies. Proof? - Less Wrong Discussion
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Okay, but you said it was evidence in favor of your own hypothesis. That’s what my question was about.
Suppose they’re measuring on a 10-point scale, and we get ordered pairs of scores for time A and time B. One person might have 7 and 6, another has (4,3), another has (5,6), then (9,7), (7,7), (4,5), (3,2)...Even if they’re aware of their measurements (which they might not be), all sorts of things affect their scores and it’s unlikely that any one person would be able to make a conclusion. You’re basically asking an untrained patient to draw a conclusion from an n of 1.
There are several assumptions here that I think are probably incorrect, the biggest being the causal link between introducing the test and people suffering. But what I described before is just the application of reductionism to better distinguish between disease states based on their causal mechanism.
Sometimes, but replacing an objective measurement with a subjective one isn’t usually a step forward.
Problems with this include: you can’t justify the parameters of the dose increase, you still have to agree on how to measure the response, and you also have a multiple testing issue. It isn’t inaccessible, but it’s a complication (potentially a major one), and that’s just in the abstract. Practically, in any one situation there might be another half dozen issues that wouldn’t be apparent to anyone who isn’t an expert.
Not knowing anything about the subject, I would expect to observe a low basal metabolic rate in CFS regardless of its ultimate cause or causes.
No, it just means we put very little weight on individual studies. We don’t pay much attention to results that haven’t been replicated a few times, and rely heavily on summaries like meta-analyses.
You’re talking about the overall process and how science moves in the direction of truth, which I agree with. I’m talking on the level of individual papers and how our current best knowledge may still be overturned in the future. But you can leave out “just like..wisdom” from the paragraph without losing the main points.
The alt med people have a lot of funding. It’s a multi-billion-dollar industry.
A few things, not just one, but it’s the best we have at the moment.
I must be confused here. Sorry, I'm not deliberately evading your (good!) question.
If none of the patients had had any sort of thyroid problem, I'd have expected it to be equally bad for everyone. That would be strong evidence against 'it's widespread and treatable with thyroxine', and very weak evidence against 'CFS is thyroidy'.
A test is allowed to produce weak evidence one way and strong evidence the other. Imagine rolling a dice. If it comes out 5, you've not learned much. If it comes out 7, that's a big surprise, and enough to smash the 'six-sided' theory into the very long grass.
If a fair number of the normal-TSH patient group had nevertheless had a thyroid problem amenable to thyroxine 100mg/day, then I'd have expected that to make a difference between healthy controls and patients. Which appears to be what happened. I think that's actually fairly strong evidence in favour of 'common and treatable with thyroxine'. Nowhere near proof, but it strengthens Skinner's paper, which is already strong evidence, rather than weakening it.
I'm actually really surprised by that. That thyroxine made any difference at all.
I believed it was thyroidy just on the argument in 'A medical mystery'. (Looks like hypothyroidism, existed in Victorian times, didn't exist 1900-1970 when hypothyroidism was diagnosed by symptoms and treated with desiccated thyroid, which has too much T3 in it, validity of TSH test never checked)
I've been saying for a while that it must be to do with T4/T3 balance, because I couldn''t believe that if it was amenable to thyroxine that wouldn't already be known. Because I literally couldn't believe that medical science could have been that careless and stupid.
But now I'm looking at the only two papers I've ever been able to find on the subject, and thinking, 'they both imply that thyroxine works'. It might not be optimal, but it seems to do something!
And sure, it's nowhere near proof, and I wouldn't want public health policy changed on this kind of evidence. But it's worth a good look. And the level of carelessness implied is just staggering.
<rant> <sorry>
If they'd just made a terrible mistake and then ignored millions screaming for help for forty years, that would be criminal, but John Lowe and lots of medical doctors had/have been asking, perfectly clearly and sanely, for endocrinology to check its beliefs, for decades.
And they've been marginalised, ridiculed, and persecuted for it. "TSH tests normal, therefore it can't be a thyroid issue." Over and over and over again. No evidence whatsoever.
Even if CFS turns out to be caused by magic space pixies who deliberately confuse all the experiments, medical science has my utter contempt.
Six months ago I would have said: "There's no point to alternative medicine, if they had anything that worked it would just be real medicine.". In fact my friends (and the chiropractor I used to go and see even though I believed her treatments didn't really help and I was allowing myself to buy a placebo) tell me I used to say that quite a lot.
Because I trusted something extravagantly publicly funded, that called itself a science, to use the scientific method.
After taking a (fairly brief) look at this one problem, I'm now thinking "How many lives have these morons fucked up through their arrogance and carelessness?".
"How much of the random crap in Holland and Barrett actually works, and how much public money is being shoved down the drain buying chemical poisons for the ill on dodgy evidence produced by drugs companies when they could be fixed with cheap treatments that have been known for years?"
</rant>