A great deal of these studies are in vitro.
For someone who has engaged in in vitro, animal in vivo and clinical studies it is very clear that one may observe a set of in vitro properties of an agent which supports a potential positive benefit. This hypothesis when tested in a double blind placebo controlled trial ( the gold standard of scientific evidence in clinical medicine) may show very divergent results.
I myself have observed the same dichotomy in my own research over the past few decades.
A very humbling reminder by Mother Nature indeed.
Numerous examples of this have emerged over the past few decades. The HERS study is just one example of this ! For years it was postulated that one reason why women tend have a lower risk of heart disease than men was due to the “cardiovascular protective “ effect of estrogen in pre-menopausal women and once menopause occurs, this protective effect is lost. Many physicians and gynecologists for years promoted hormone replacement therapy in women as being cardio-prospective.
When the HERS study was published to test this hypothesis, the results were to the contrary.
In my opinion it is futile to throw countless in vitro or poorly designed clinical trials in the face of CardioMD when he is simply stating the rigor of scientific evidence that we as clinicians use to practice evidence based medicine.
Yes, I have reviewed articles published by recognized “experts” holding MD. PhD degrees from “respected” institutions ( including MIT ) who posit subgroup analyses and poorly designed clinical trials as hypothesis testing rather than hypothesis generating.
Over the years it has become less surprising to me how few MD PhDs are familiar with the application of statistics in clinical medicine.
AVII, on this board, in my opinion stands out uniquely in his in-depth knowledge on statistics.
In fact, it was AVII, ( thank you AVII) who introduced me to the work of the outstanding biostatistician, Fleming, who certainly is a great educator for those who would like to study this subject matter in greater detail rather than flinging countless non conclusive studies onto this board, hoping that 1000s of inconclusive results would leap into a category of conclusive evidence.
