Medical-evidence giant Cochrane battles funding cuts and closures

https://www.cochrane.org/news/statement-physical-interventio...

The original Plain Language Summary for this review stated that 'We are uncertain whether wearing masks or N95/P2 respirators helps to slow the spread of respiratory viruses based on the studies we assessed.' This wording was open to misinterpretation, for which we apologize. While scientific evidence is never immune to misinterpretation, we take responsibility for not making the wording clearer from the outset. We are engaging with the review authors with the aim of updating the Plain Language Summary and abstract to make clear that the review looked at whether interventions to promote mask wearing help to slow the spread of respiratory viruses.

The problem was how they communicated. The data is the data.

$230k, which when indexed by median household income, is comparable to the UK at 100k (I assume you used dollars? If not that’s $126k).

Edit: I’m not making any tax statements because taxes are unavoidable and applied to everyone in the nation, so are part of the indexing. That said US taxes sound comparable or more in some areas (taxes in NYC for instance can exceed 50%)

According to https://www.moneysavingexpert.com/tax-calculator/ , someone in the UK who earns £100k takes home £67,049:

>Earn £100,000 in 2023/24 and you'll take home £67,049. This means £5,587 in your pocket a month. Over the year you'll pay £27,432 income tax and £5,519 in national insurance.

While it depends on the specialty, in Australia it is not uncommon for consultants to be on AUD 300-400K (= 150-200K GBP, 200-250K USD). I don't understand why salaries in the UK are so low, even for highly educated professionals.

My grandfather was a GP. He hated the NHS so much, he left the UK and never went back. Pay was likely a factor, but he also viewed the NHS as a denial of his professional freedom. While Australia eventually adopted something akin to the NHS (Medicare), I don't think he objected so much to that, since it involved less government control over the how of his job.

Where did your 60% come from?

[1] https://www.gov.uk/income-tax-rates

I'm not sure I'm exactly understanding what you're getting at. If you expand on those statements to find direct evidence of MACE (of which there is plenty) then it is an evidence based medicine decision not a science based one.

Please disregard the specific intervention being discussed, it's just an example of the different thought processes and decision making between SBM and EBM. In real life there is plenty of science and evidence behind statins but I'm not intending on addressing reality or why this specific intervention is in use today.

Note the "medicine" part in these refers to the clinical practice of medicine. Maybe this is clearer:

The science based medicine approach (as traditionally defined) only considers the mechanisms and "indirect evidence" when making the clinical recommendation (i.e. statins are proven to lower cholesterol which are strongly correlated with MACE. Cholesterol reduction has also been proven to reduce plaque formation and artery stenosis, therefore we expect MACE will be reduced through statin use and are deciding to administer the intervention).

In this thought process we have not directly measured the outcome of interest (MACE) but we are giving an intervention because it makes sense/through chain of thought, or in other words we are intervening to optimize a variable (serum cholesterol levels) because we have reason to believe this variable reduces MACE based on the mechanism (which may have components proven by evidence like reduction in plaque formation but the primary outcome measure we are discussing, MACE, has not been measured).

In the evidence based medicine approach we are deciding to provide an intervention based on direct measurements of the outcome of interest in a specific population (i.e. less MACE was directly proven) and the decision making process is entirely independent of the mechanism or nature of the intervention (i.e. we are not considering plaque formation and cholesterol levels, simply that statins reduce MACE).

This is effectively the science based method, since it can be tracked to a, perhaps, 'plausible' mechanism (although often now lean towards more 'intriguing' than parsimonious, especially if published somewhere like Nature)

Evidence based medicine has other faults. One subfield is meta-analysis, which looks for very solid observations that are reproducible, but often lacks the complicated modeling that may be necessary to see any highly conditional effects. So the findings tend to be real, but boring and often "well-known". It is however, a good way to check if the "well-known" observations in the literature are reproducible.