We have a huge crisis in science/ medicine with reproducibility, expressing uncertainty & limitations, and how we prescribe unproven Rx

I support serious reforms, but not hanging random or visible offenders

here is how we ought to tackle this issue [thread]

First, we have to get a better sense of the extent of the problem.

If we are concerned with the rampant hype of unproven drugs, or drugs contradicted by RCTs (and I am), we should estimate how many people are offenders

My work on reversal/ cancer suggests it may be very high

Second, we need carrots and sticks, but most importantly, our remedies should be those that work, and those those that merely make us feel virtuous but do not solve the problem.

We also need to restructure the current incentives

In other words, academic ranks/ promotion can't continue to be preferentially given to those who 'innovate' Rx with scant evidence, or publish a boatload of papers (they really didn't contribute much too

Carrots should be rewarding folks who run RCTs, and not folks who take, say 3000 pts in a NYC hospital, and given them all full dose anti-coagulation

The current system rewards in precisely opposite way

Sticks can be used, including retraction, professional reputational damage, or punishment, but the rules should be transparent and clear

What is bad behavior should be defined upon apriori

We should enforce it equally for folks who tout unproven remedies we like, and don't

The crime cannot be tied to the outcome, i.e. it can't be wrong to prescribe drug x off label if the RCT later turns out negative, but not if it turns out +, the action must be judged based on information available at the time

The crime cannot be forgiven if someone is part of the right social circles

For e.g. we can't give harvard folks a pass, or folks who are editors of the journal (it should be consistently enforced)

the crime cannot be punished harshly if the number of people who commit the crime is the majority of folks in the field

the crime should be clearly distinguishable from what is not the crime

What defines the crime cannot be shades of gray

The goal is to change the system that led to the crime and not just to destroy a few people

Don't take eyes off the prize

And we should awknowledge that there is something in the zeitgeist. Folks in medicine and especially on Twitter like hanging people. A new person each week.