We're told a lot of things by "officials" not because it's correct, but because it holds the least legal liability for official parties involved, especially anything involving healthcare. These officials also sometimes include doctors, who work to protect themselves and the system first, and then patients.
Sometimes doing what you're told is the right thing. Sometimes, not doing what you're told is the right thing. Sometimes, you're told to do the intuitive thing, and it's wrong. Sometimes, you're told to do the unintuitive thing, and it's wrong. It's hard to tell the difference between those situations, even when you're not stressed.
Do you really think that in a high stress situation you’re going to make the best decisions?
Do you really think health workers are all concerned about legalities first?
Not moving a patient unless you explicitly know how is probably right the vast majority of the time. Sometimes that’s wrong, but how are you going to get the entire public to understand what the right situation is?
It’s so easy looking at a single case in hindsight. May we all have the ability to make the right choices all the time.
I mean that statement could be used to excuse any mistake in any project/system ever made, and is mostly a cop out. Yes, the system is definitely designed to minimize legal risk for the health-workers/hospitals. A system is only as good as what it's' design objectives are, and if "save a life at all cost" was the objective the system might as well look entirely different.
100%. Legal issues are a huge deal in healthcare. This is a snippet from a study [1] on the topic, just to get an idea of the scale (which I think most do not realize at all):
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Each year during the study period, 7.4% of all physicians had a malpractice claim, with 1.6% having a claim leading to a payment (i.e., 78% of all claims did not result in payments to claimants). The proportion of physicians facing a claim each year ranged from 19.1% in neurosurgery, 18.9% in thoracic–cardiovascular surgery, and 15.3% in general surgery to 5.2% in family medicine, 3.1% in pediatrics, and 2.6% in psychiatry. The mean indemnity payment was $274,887, and the median was $111,749. Mean payments ranged from $117,832 for dermatology to $520,923 for pediatrics. It was estimated that by the age of 65 years, 75% of physicians in low-risk specialties had faced a malpractice claim, as compared with 99% of physicians in high-risk specialties.
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I can give a very specific example of how legal issues play directly into behavior, and how it leads to antibiotic over-prescription. Antibiotics are obviously useless against viral infections but many, if not most, doctors will habitually describe them for viral infections anyhow. Why? Because a viral infection tends to leave your body more susceptible to bacterial infections. For instance a flu (viral) can very rarely lead to pneumonia (bacterial). And that person who then gets very sick from pneumonia can sue for malpractice. It's not malpractice because in the average case antibiotic prescription is not, at all, justified by the cost:benefit, but doctors do it anyhow to try to protect themselves from lawsuits.
There have been studies demonstratively showing this as well, in that doctors who live in areas with less rampant malpractice lawsuits are less likely to prescribe antibiotics unless deemed necessary. Or if you have a friend/family in medicine you can simply ask them about this - it's not some fringe thing.
[1] - https://web.archive.org/web/20250628065433/https://www.nejm....
How does alleged research fraud affect someone’s ability to be a caregiver?
> We're told a lot of things by "officials" not because it's correct
What needs to be understood is that no rule can be so well written that there are no exceptions. Rules are guides. Understanding this we can understand why certain guidelines are created, because they are likely the right response 9/10 times. This is especially important when dealing with high stress and low information settings.
BUT being statistically correct does not mean correct. For example, if the operator had information about the ETA of the ambulance (we don't know this!) then the correct answer would have been to tell them to not wait. But if the operator had no information, then the correct decision is to say to wait.
The world is full of edge cases. This is a major contributor to Moravec's paradox and why bureaucracies often feel like they are doing idiotic things. Because you are likely working in a much more information rich environment than the robot was designed for or the bureaucratic rules were. The lesson here is to learn that our great advantage as humans is to be flexible. To trust in people. To train them properly but also empower them to make judgement calls. It won't work out all the time, but doing this tends to beat the statistical rate. The reason simply comes down to "boots on the ground" knowledge. You can't predict every situation and there's too many edge cases. So trust in the people you're already putting trust into and recognize that in the real world there's more information to formulate decisions. You can't rule from a spreadsheet no more than you can hike up a mountain with only a map. The map is important, but it isn't enough.
For some reason, chronic contrarians always to point at a few details that were gotten wrong during the fog of war, and shout from the rooftops that if only they were in charge, we'd all be living in castles made of candy and shitting rainbows.
Joke's on us, though, those contrarians have since made a moron who doesn't believe in germs... The Secretary of Health.
For really complex cases there is the Mayo Clinic model (also used in a few other health systems). A patient can come for a day and be seen by an integrated team of specialists to get a diagnosis and treatment plan. But this isn't really scalable.
https://www.mayoclinic.org/patient-centered-care/what-makes-...
But let’s not pretend that many of the precautions and policies weren’t performative. Mask mandates were always dumb. Most people didn’t wear effective masks and many didn’t cover their noses. You had to wear a mask on airlines long after the vaccines were available and everyone took them off at the same time to eat or drink.
The US government down played that immunity wore off within six months and that the vaccine was much less effective than they publicized at first even when there were credible studies and evidence from other countries health departments and domestically.
Again, I have every recommended vaccine imaginable. I get a flu shot every year and Covid shots at the recommended times
That being said, anytime I’m looking on the web doing research, the first thing you find are lawyers looking to sue doctors. I absolutely hate that’s the first thing parents think about to blame doctors. Some times things just happen.
The doctor gets paid irrespective of their diagnosis—and I am yet to hear of a conspiracy where the doctor makes more money when their patients die.
We've gone from accused of research fraud to psychopath.
My original point is that I don't see how the effort to produce new knowledge has any bearing on the appropriate management of diabetes/thyroid hormone.
What's interesting to me is that in societies not prone to blame, or lawsuits, it can be much easier to have human interactions without being inhibited by legal fear.
Accepting that people make mistakes makes progress simpler. I recently had a medical issue which would have turned out simpler had he run a specific test earlier. I'm not the litigious sort (and I'm not in a society that is litigious) so I can now go back to him and we can discuss the mistake so he doesn't make it in the future.
I accept he's not perfect. I seek his development not his censure.
This is outside the US. No doubt inside the US fear of lawsuits would make this feedback untenable.
> According to the regulator for Ontario doctors, Jamal initially tried to place all the blame on her innocent research associate, almost ruining her career. She then tried to discredit her colleagues, claiming they had ulterior motives for questioning her results.
> When that didn’t work, they found Jamal tried to cover up her fraud: She illegally accessed patient records to destroy and change files, disposed of an old computer so investigators couldn’t examine it and even went into the Canadian Blood Services facility and changed freezer temperatures to damage blood and urine samples to mask her deception.
> And in March 2018, after admitting her misconduct before a disciplinary committee of the College of Physicians and Surgeons, Jamal was stripped of her medical license.
https://torontosun.com/news/local-news/mandel-despite-commit...
It has to do with the integrity and willingness of someone to tell the truth; if she's willing to destroy evidence to avoid criticism, what other types of mistakes is she willing to cover up when dealing with a patient?
This seems pretty obvious, how are you not understanding this? It isn't her effort to produce new knowledge, its her willingness to lie in the face of failure.
If a patient of hers dies or starts to decline, she could falsify cause. The list goes on. She is so far on the slippery slope that it is dangerous for her to care for anyone.
And yet I haven't heard how this affects this person's ability to be an endocrinologist. Most of any job is routine busywork—and if ethical purity is the requirement to hold a job that impacts the lives of the public, we may never have a politician (or hospital chief) for the rest of humanity.
I am not saying that OP should love their endocrinologist. I am saying that all of this is a non sequitur.
Where did you derive any of this from what the OP said? He said there was an allegation of research conduct, and this is the statement to which I responded.
Almost all research uses artificial cell lines and animals—where did you get the idea that we were talking about 'a therapy would help someone'?
The story presented here is that OP disliked their mother's physician. There was no discussion of malpractice. Then, OP seems to have searched for information about the physician.
'Research misconduct' and murdering your fellow man are... not the same thing.
Correct. And, a panel of this person's peers found that, in fact, the alleged research fraud should not disqualify the person from treating patients.
We have specific evidence that not masking and not distancing caused superspreader events. Before there were too many cases, contact tracing backwards showed that specific parties, weddings, etc. were responsible for accelerating the early spread above baseline.
Thus, the burden of proof is on the "anti-mask, anti-distancing" people to prove that they aren't worse than the alternative--doubly so given the post hoc analyses available due to Norway and Sweden.
It’s fine to have your opinion but don’t dismiss others’ experiences and values.
The extreme lockdowns caused irreparable, long-term harm to many people. You’re glossing over this as if it’s a minor error that anybody could’ve made, which is not correct.
It is essentially a trolley problem. You value “extreme intervention that is statistically better overall but unnecessarily devastating to some”, whereas many other people are happy to let nature run its course to some extent than have their government turn against them “for the needs of the many”.
That is a moral discussion, not a scientific one, and people are rightfully angry when it’s misrepresented as purely a scientific one.
This makes no sense with how endocrinology works. And OP did not give any evidence of malpractice, so we have no reason to believe that less effort or patient risk regarding the practice of medicine was involved.
Fuck that bad doctor, it’s not like they’re some Holy Paladin. He had no remorse either and didn’t really pay much attention to me.
I hope AI puts as many doctors out of work as possible so that only the best, like my CC doctor, remain.
> Wuh wuh.
Yes, I have not heard of the endocrinologists who perpetrated the opioid crisis in Canada.
This was not presented in the original post. My question was, why is alleged research misconduct a disqualification?
Also a panel of this person's peers decided she merited reinstatement.
> If a patient of hers dies or starts to decline, she could falsify cause.
Not something that is happening in outpatient endocrinology.
I am very specifically responding to the post I saw when I made my post.
Here is an example for the HN crowd.
"I really dislike my pointy-haired-boss project manager. He is unreasonable and terrible at management.
I learned that he was investigated at a previous job in computer science algorithmic research at a University—before he ever worked in industry—and ultimately found not liable for this. I am convinced that this is why I dislike my PHB"
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> I also replied above, so at risk of overextending myself in this thread: you are either too lacking in discernment to effectively have this conversation, or you are willfully arguing in bad faith. You are describing completely different scenarios.
I can't respond to this comment—but if I am "arguing in bad faith" yet responding rationally, we truly cannot have a discussion.
Asking a lay person to know what a BLS (non-EMT fire & police), EMT (Ambulance), Parmedic, or MSO can take care of, or even what the differences are, is, I don't think, super useful. The red vehicle shows up and takes you to care.
In the case of MCI, EMTs can a) give aspirin or nitro (rx), b) have an AED and lots of CPR training but have to stop the vehicle to give effective compressions, c) a radio and the ability to meet up with Paramedics.
Paramedics have more complex treatments (drugs) and EKGs, but it's still 2 folks in a truck, not a hospital. They can do amazing things.
But as the joke goes, sometimes the best treatment is High Volume Diesel Therapy (burn rubber).
Someone who takes the hippocratic oath and then behaves in this manner is not fit to be a caregiver. Medical care is about more than technical competence.
I’d hate to see the state of the flattened world you seem to be arguing for. Please go read about the origins of professional standards.
> Someone who takes the hippocratic oath and then behaves in this manner is not fit to be a caregiver. Medical care is about more than technical competence.
> I’d hate to see the state of the flattened world you seem to be arguing for. Please go read about the origins of professional standards.
So much pathos—I was responding to an illogical set of statements.
People holding your current naive viewpoint is why we have professional societies with the power to remove licenses/disbar. - or maybe the evidence was insufficient?
> hippocratic oath
https://en.wikipedia.org/wiki/Hippocratic_Oath
I don't see a comment about research standards. Let's stick to rationality here, please.
> I’d hate to see the state of the flattened world you seem to be arguing for.
Exactly the opposite of what I am asking.
> about the origins of professional standards.
The suggestions of your comment have been falling flat, so I'm not going to take this ill-defined assignment. If there are logical statements you wish to provide, please do.
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Again, the OP did not say anything about malpractice. Had the OP done so, I would have made no comment.
The incidental prior incidence of alleged research fraud has no a priori bearing on why OP did not like this person.
> Jamal now takes full responsibility and “regrets having exposed patients to the risk of harm by enrolling them in studies which had no value.”
There is no pathos in my comment. Your statement is literally naive.
If a therapy that doesn't help is adopted then those that suffer from lack of care as a result are harmed.
Then there were aspects that we had pretty quickly figured out made no sense (no hiking by yourself, no leaving to do solitary things). Worse, they were broadly ignored by most people-- I was worried I'd get busted in a parking lot with my telescope when I knew people who were having dinner parties.
Then the very strict orders continued well after the containment was ineffective and the rest of the country had, to some extent, eased up. A couple of weeks to flatten the curve became "wait until there's a vaccine" which is not what we'd all signed up for, and unnecessarily restrictive even for these purposes.
It would have been better to pick a "set point" for policy that could have been actually upheld, rather than setting a very strict policy that was often ignored and then enforced arbitrarily.
But unfortunately:
> if the operator had information about the ETA of the ambulance (we don't know this!) then the correct answer would have been to tell them to not wait. But if the operator had no information, then the correct decision is to say to wait.
I expect the operator just is not allowed to give advice like that, even if they did have information on ambulance ETA. There could be liability if someone is advised to drive to the hospital, and something bad happens. Even if that bad thing would have happened regardless. I think that's a bad reason to do the situation-dependent incorrect thing, but that's unfortunately how the world works sometimes.
Yes!
I answered your question clearly: research misconduct and her reasoning for it indicates a willingness to lie that should not be allowed in a high trust field such as medicine. She has been banned from receiving Canadian federal funding for life. Her medical license was reinstated but it was a split vote (3-2) and widely criticized, but she is banned from conducting research and has to be monitored by a therapist.
I get that you like to argue, but you should probably learn to admit when you're wrong.
I live about 6 minutes from the closest ER. If an ambulance can get to me in, say, 3 minutes, it's still not clear if it's better for me to get myself to the ER on my own. Maybe I get an ambulance with EMTs who aren't trained/authorized to do what needs to be done for me. Maybe I really need to be at the hospital within 8 minutes or I'm going to die, and waiting for an ambulance just isn't going to cut it.
But I think, statistically, people should usually prefer to wait for the ambulance. It's just that specific circumstances can make that the wrong move, but most people won't know when that's the case.
> I expect the operator just is not allowed to give advice like that
I also want to say that I'm giving this advice as someone who loves math, data, and statistics. Someone who's taken and studied much more math than the average STEM major. It baffles me how people claim to be data oriented yet do not recognize how critical noise is. Noise is a literal measurement of uncertainty. We should strive to reduce noise, but its abolishment is quite literally impossible. It must be accounted for rather than ignored.
So that's why I'm giving this advice. It's because it's how you strategize based on the data. All data needs to be interpreted, scrutinized, and questioned. And constantly, because we're not in a static world. So the only way to deal with that unavoidable noise is to have adaptable mechanisms that can deal with the details and nuances that get fuzzy when you do large aggregations. In the real world the tail of distributions are long and heavy.
A rigid structure is brittle and weak. The strongest structures are flexible, even if they appear stiff for the most part. It doesn't matter if you're building a skyscraper, a bridge, a business, or an empire. This is a universal truth because we'll never be omniscient. As long as we're not omniscient there will is noise, and you have to deal with it
> I said it was stupid to have a mask mandate when most people wore ineffective cloth masks and even then didn’t cover their nose.
This was mostly true because "wearing a mask" became a partisan political issue so half the country wouldn't even try to be responsible.
Even if you didn't want to wear a mask, not getting together in gigantic gatherings like churches and weddings as well as quarantining yourself after such gatherings or travel was also effective. The fact that I quarantined after air travel prevented my in-laws from catching the Covid that someone gave to me.
Alas, this also became a partisan issue.
And, as I pointed out, the burden of proof is on the anti-mask, anti-quarantine crowd. We actually have analyzed the tracking and spread after the fact and have the appropriate evidence.
But that doesn't matter to people like you. It was never about evidence and facts anyway.