Hacker News Reader

Comment by ssivark | Hacker News Reader

While I appreciate the trend towards open-access and wider dissemination, I don't think that the slowness of dissemination is one of the bigger problems in medicine.

Given that the subject deals with trying to "fix" complex, organic systems, it's worth taking time to get things right before designing interventions. It is important to realize that a flood of rapid communication often makes it harder to settle on the underlying truth (as clearly evidenced by the recent atmosphere) by rendering the search process unstable.

As some other articles (on the HN front page) have recently argued, the rush to faster publication is one of the biggest causes of research debt. And I think that is a much more important problem to solve. So, by all means let's have open-access and also more distilled dissemination. But optimizing for speed (eg: race to publish) often gets in the way of correctness.

View on HN

I don't think anyone is advocating for health decisions to be based off shoddy-half baked research--some might say that is the current situation. Rather, if it takes a year from experiment completion to publication and the data is embargoed for all that time--that replication, criticism, and independent confirmation of the work is delayed for at least a year. Since this is usually on the critical path to implementing a discovery in a therapy--this publication delay does real harm to the advancement of healthcare and doesn't seem to provide a commensurate benefit in paper quality.

Right now we have research that is slow to publish, but publishing is careful, and once published we treat is as a kind of truth. You can call it a "Brittanica" approach.

Alternative is not just a faster publishing, but more feedback, and better discussion around the subject. You could call it a "Wikipedia" approach.

In the "Wikipedia" approach, you don't rely on the publisher's prestige, nor citations, as a meter of trustworthiness. Before accepting the results you review it's discussions and critique.

A similar switch happened with traditional news publishing. Years ago you had to rely on the fact that an article was published in Economist, and vetted by their good editors. Nowadays, there is a lot of independent content, and there are communities (like HN, or Reddit's AskScience), and non-profits (fact checkers, or Snopes) that point out the potential issues.

I don't think using the decentralization of news as a comparison is a good one. I agree that there are great things about new media outlets, but on the balance we are arguably worse off -- news is more polarized and political than ever. There's more great analysis and commentary online, but there's also more analysis and commentary in general.

You're right about distillation and research debt. Additionally, though, the lag from research to clinical practice is a major issue in medicine, so speed has to be a factor in any solutions. This is complex, since it's not just a question of improving throughput of publication, we need to examine issues of practitioner attitudes and capacity to change practices.

For refs, Google Paul Glasziou's research in this area.

Isn't it even worse than that, with the problem being doctors who don't bother to keep up with new practice or even resist it out of (more or less) habit?

There is a very large problem with doctors favoring what they were trained to do, and what their local colleagues do, over what's actually standard practice.

It's extremely hard to move the needle on that particular issue.

Someone said that medicine moves one doctor's grave at a time.

Reply on news.ycombinator.com