The More Data You Have, The Further You Are From The Truth
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- Опубликовано: 1 июн 2024
- Dr Pavlos Msaouel: faculty.mdanderson.org/profil...
Produced by @chubbyemu
Audio only version: spotifyanchor-web.app.link/e/...
0:00 Pretext and context MD Anderson Cancer Center
1:42 The Early Experiences That Shaped Dr Msaouel
3:39 The System of Cancer Research In the United States
5:25 FDA Drug Approvals and Special Designations For Oncology
11:09 A trade-off in our current system
12:35 Whoops 😞 I misspoke
14:35 Randomized trials are not supposed to be representative of a population
18:10 Inference for the treatment of Katie Coleman (metastatic oncocytoma)
25:12 It is much more valuable to refute hypotheses than to confirm them
28:05 All Models Are Wrong, But Some Are Useful
30:05 Recasting the Bias-Variance Trade-off as the Patient Relevance-Robustness Trade-off
33:38 High Relevance, Low Robustness: Subjective Bayes
34:46 High Robustness, Low Relevance: Pure Randomization
41:47 Signal To Noise Ratio
45:49 The Big Data Paradox
53:41 How the Big Data Paradox fits in with Katie Coleman's case
54:33 How the Big Data Paradox fits in with other branches of medicine
57:54 How do we rectify subjectivity in The Truth?
01:00:43 How do we address the problems introduced by the Big Data Paradox?
01:04:21 Duality in nature and a Twitter argument re: the Evidence-Based Deep Medicine Iceberg
01:07:03 Why the ideas coming from MD Anderson are coming from MD Anderson
01:09:39 Where you can find Dr Msaouel
Dr Msaouel: / pavlosmsaouel
Heme Review: / hemereview
Production Assistant: Nick Brown
Secret channel: @BigEmus
Cancer Patient Speaks With Her Oncologist ► • Kidney Cancer Patient ...
A Woman Had A Headache Lasting 3 Days (Katie's case) ► ruclips.net/video/i9fLEvgZzRE/видео.html
References:
Stephen Senn. Statistical Issues in Drug Development.
Why representativeness should be avoided. academic.oup.com/ije/article/...
Commentary: Representativeness is usually not necessary and often should be avoided. academic.oup.com/ije/article/...
Impervious to Randomness: Confounding and Selection Biases in Randomized Clinical Trials. www.tandfonline.com/doi/full/...
A Causal Framework for Making Individualized Treatment Decisions in Oncology. www.mdpi.com/2072-6694/14/16/...
Causal Diagram Techniques for Urologic Oncology Research. www.sciencedirect.com/science...
Causal inference and the data-fusion problem.
www.pnas.org/doi/10.1073/pnas...
Causal Inference: What If. Miguel A Hernán and James M. Robins. www.hsph.harvard.edu/miguel-h...
There is Individualized Treatment. Why Not Individualized Inference? arxiv.org/abs/1510.08539
Unrepresentative big surveys significantly overestimated US vaccine uptake. www.nature.com/articles/s4158...
Unrepresentative Big Surveys Significantly Overestimate US Uptake arxiv.org/pdf/2106.05818.pdf
Statistical Modeling: The Three Cultures. hdsr.mitpress.mit.edu/pub/uo4...
How “centaur AI” will radically reshape the future of healthcare. bigthink.com/health/how-centa... 
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“All models are wrong, but some are useful.” That is a powerful statement that makes me rethink a lot of things 😮
I would recommend every student wishing to get a MD/PhD degree in any aspects of biology to watch this video. Super informative. At least for me, it lets me reflect on the way I design experiments and analyze data.
I agree
Edit, this is actually the first time in my life that I go download the paper while still in the middle of the video! On top of that, I’ve been watching academic content regularly as a hobby for years so this is huge for me because this video is longer than what I normally watch and I mostly archive things for later use, not digging into it right away like this 😃
Man, this discussion was so erudite and wide ranging that I was having trouble keeping up with it. And that's a good thing.
I had a very strong feeling that you were talking about MD Anderson in Houston, TX! My daughter was also treated there for DIPG and they were amazing! Unfortunately she passed away there 11 yrs ago when she was 6 yrs old and this type of brain-stem cancer is still considered rare. Back in 2011, there were under 200,000 cases worldwide with the life expectancy of no more than 6 to 18 months from diagnosis. Nowadays there have been strides where expectancy has been 3 - 5 yrs from diagnosis.
I recommend this hospital to everyone I meet!!!
I'm so glad there's been that much change in expectancy! I'm sorry for your loss my friend.
Been a while since you made this comment but I hope you're doing well.
I remember the days I was involved in marketing research, one of the foremost the boss would stress is to pick a good focus group. He always says if you pick focus group correctly, you do not need a large data size, hence the importance of questionnaire design, and that is deeply involved with domain knowledge.
I guess this coincides with his argument that Bayesian and random sampling are two sides of the same coin. If you dont know what you are doing, it always be garbage in, garbage out.
Thank you for such a cathartic video. The philosophical and medical rigor in this conversation needs to be celebrated.
As someone who is currently going through (seemingly endless) investigations to determine the cause of my illness, this podcast is extremely relevant and raises important points.
It seems to me that many conditions are often missed or misdiagnosed due to being compared to an average that does not actually exist in reality. Such things should be taken in the context of the individual patient, as stated in this interview. Each patient is individual.
Furthermore, as raised here and relating to the recent video on the Chubbyemu video, it seems that some medical professionals are reluctant or unable to extrapolate on their knowledge and follow their intuition - particularly if there has been very little literature on the subject, as with the patient in the Chubbyemu video. I would imagine this leads to a lot of unnecessary hardship and treatment for patients, had they been caught earlier.
Sorry for the long comment, thank you for the great videos!
That's because 99 times out of 100 their intuition is wrong and following it will end badly.
Did you find an answer to your illness yet
@@HenriFaust I have a rare genetic disease, and I was rather the main "diagnoser" for my own case. Medical practitioners do indeed compartmentalize their knowledge and follow it through a guideline to keep on the right track for this bad 99 out of their 100. Unfortunately, for the 1/100 , we won't get the help we need, or the 1 in a million like my case.
@@modrribaz1691 does this boil down to how hard it is to work with unknowns? We can know that we do not know every 'disease' resulting from each specific genetic mutation or even worse all the potential combinations that will still allow life to be viable. Yet creating a method that would deal with how to efficiently deal with this unknown aspect could be regarded as an unknown unknown as in we cannot know what is needed for this method yet as we do not have the required information about the characteristics of the unknows we want to look at? (Ok, this isn't making much sense here. I probably am using the wrong concept to describe what is going on as I haven't properly understood the concept of unknown unknowns.)
@@rogerrabbit3200 Doctors tend to look at what they think is wrong and focus on that. They think inside of the box not outside of the box. Patients advocating for themselves are more likely to think outside of the box.
I love how excited you are talking to him. It makes me really happy to see the just bright smile on your face.
Very philosophical, but interdisciplinary science is the only way to go.
This is the way
Listened on my podcatcher, came here to like the video, add it to my general "favorites to share" list, and commend this absolutely stellar interview. I'm a huge medicine nerd, patient education nerd, and fledgling data science nerd, and this is just some of the best material on these logic/research topics I've ever heard. I'm sending the link to several of my professors and public health friends. Thank you SO MUCH for the awesome work you do!
This is a treasure to humankind. Thanks for all the scientists and physicians trying to give people the best and most efficient treatment for cancer, which is such a heartbreaking disease to our species.
This podcast makes me really think how important personalized medicine along with pharmacogenetics is especially when the tests to put these drugs on the market are not the most representative
nice long-form discussion, thanks heme review!
Wow this entire video was very well made, thank you Dr. Bernard.
Please keep doing these amazing interviews/discussions. And thank you!
You have just given a young student the sign she needed to determine what she wants to do with her life! I will work on achieving an M.D. ❤
The elephant is very like a wall.
The elephant is very like a fan.
The elephant is very like a rope.
The element is very like a spear.
The elephant is very like a tree.
The elephant is very like a snake.
While each man was in the right, they all were in the wrong.
Thank you for sharing this video! I will re-view it as many as I can. A lot of things are to be absorbed out of this interview.
Lots of love, cheers, & mabuhay, from my end--the Philippines!
This is amazing content; seriously grateful to see such high value and informative interviews available. You are a hero for taking this time to produce intelect inspiring videos; thanks!
This guy is just very fun to listen to. He has a nice cadence to his voice somehow.
patient relevance and robustness tradeoff, lol I love this. I stumbled upon chubbyemu almost a decade ago and I never would have thought that an interesting quirky academia video would take me down a rabbit hole like no other. If anything I binge even more now with collogues between cases and profs. between classes. Loving the Heme Review content as well, there hasn't been much content on youtube that has had me eagerly go to the damn paper link a quarter of the way through the video .
Loved this! Do more interviews like this!
Making Greece proud
What if the rarest cancers seem rare because they're actually the most common cancers...and the body is just really good at catching and eliminating them as a result
Then it wouldn't surface as a problem. You wouldn't be at the doctor with a complaint.
Your body is constantly battling intrusions and diseases. It becomes a problem when the body did not supress/eliminate the issue.
@@Liriq obviously! But the impications would be a big deal, don't you think? If a cancer actually occured a lot but was easily destroyed?
E.g. maybe there is something about them that makes it easier for the body to identify and destroy them usually, and if there is that would be worth knowing surely
They often worry about cancer tests being too sensitive, but that could be so helpful for reseach
@@therabbithat nice flip of perspective! 😊
Deserves more likes, great talk, very informative.
Great conversation 👌
As someone who has worked in large data computational epidemiology, the correct usage of data is not easy. In the internet age, any person can access a ton of data on pretty much anything, but generally without the knowledge on how to use it. Even professionals can misinterpret whether something leads to something else "correlation doesn't lead to causation and all that". At the personal level, I'd blame it for much of the anti-vax stuff around COVID-19. It's easy to go look at VAERS data which is open to anyone, without any training on how to interpret that data. Just because there's a record of someone having a heart attack after vaccination doesn't mean the vaccine caused it, but if you don't know how to compare cohorts, you might just assume it does.
This is amazing!
Amazing video!!
My mom has a mass and she has lost a lot of weight without trying, certain foods she used to love taste terrible, and she is often in pain. Yet when they did an invasive biopsy (after a normal one showed no cancerous samples) they did not find any cancer in the samples they obtained. They don't know what else to do but just watch her and see her every 3 months. I am worried about her. At first they thought she had a prolapse but found the mass through an MRI above her uterus. However the mass is small and I worry that if they cannot find anything what could it be and could it be the only one in her body. Any advice? I am in Canada.
Not medical advice, but I suggest looking into the cancer research of Thomas Seyfried.
He shows evidence the root cause of cancer is metabolic not somatic mutations, and uses this to manage, treat, and cure cancer.
He has many papers using animal models with great success rates.
They don't yet have human trials due to US regulations and requiring standard of care, but has human case studies.
Other groups have done trials combining a portion of his method, with standard of care and showing improved outcomes vs standard of care in humans.
In short his treatment of cancer is elegant and simple, targeting the root cause and nature of all cancers, building on work done by Nobel Laureate Otto Warburg. *Cancer produces energy via fermentation metabolism alone,* and cannot use respiration anymore due to damaged mitochondria.
Eliminate the fermentable fuels, glucose and glutamine, and the cancer cells die.
His process is called Press Pulse. It uses strict ketogenic diets, along with some drugs and other therapies to increase effectiveness. They monitor glucose and ketone levels closely, and when the glucose ketone index(GKI) reaches a specific range, they begin pulses of glutamine-blocking drugs till the cancer is gone.
He has some great talks and lectures on various locations on RUclips, to get into the details.
I don't really know anything substantial about how Canadian healthcare works, but how much agency do you have over seeking a second opinion? Depending on what's known about the mass, maybe talking with doctors of a couple of different specialties could help, or at least it'd be good to talk to more doctors in the same relevant specialty. It sounds like, at the very least, you and your mom could stand to be given more complete and informative communication about what's going on and what the data says about similar cases. Best of luck, I hope you're able to get useful answers!
You said his title and I said to myself “that’s the first of many things you won’t understand”
And I was right
I had a whole genome analysis done last year and uploaded results in multiple sites. Found out i have very high predisposition to breast cancer. But also found out i have almost every possible gene (2 alleles not just 1) for bad BPA detoxication. Obvious risk factor at play. Studying now very thoroughly what are the practical steps to avoid all bisphenols A, S, F or whatever. As is not practical to throw away anything from plastic, i am mostly focused on finding out where the risk ACTUALLY is and how to avoid it. For example no need to remove existing dental fillings but i might want to have a talk with the dentist what does she know about fillings she is using and if she could be placing fillings carefully as the risk is mainly at placing the fillings. And contact with thermal receipts is very high risk etc ....
I found this talk incredibly interesting even though it's not my line of work or anything. Although in the engineering profession 'Six Sigma' has become popular to the point of being rampant. It's like 'when all you have is a hammer everything looks like a nail'.
I'm sure I speak for many when I say that it would be very interesting to hear your opinions on the covid vaccines and especially the FDA (and global) approval procedures. Especially because Mr. Msaouel is in an excellent position because he has experience both in the European and US systems.
Dr. Bernard, we are looking forward to more content like this. Thanks a lot and greetings from Holland.
This video is so underrated 😔
Great
Interesting indeed
Dr Pavlos Msaouel is my hero
I understand very well the controversy behind the 2010 trial that the New York times reported on. In my opinion, the European standards for clinical trials are outdated at best and cruel at worst. Personally, I believe that control groups should always be given the most up-to-date standard of care for whatever disease they're seeking treatment. Yes, different people respond to current treatments differently and that could introduce some variables into studies that are difficult to account for, however, The need to supply patients, even experimental patients with the best and most up-to-date treatment possible is I believe a moral imperative that outweighs the need for a perfectly even control group; and more practically, the hope for all experimental drugs and treatments is that they outperform the best in current treatments for any particular disease, and letting your control group be treated with the best most current standard of care provides a perfect benchmark in that respect.
I’ve seen him before on RUclips. Maybe it was on this channel 🤘Ah…it was the renal medullary carcinoma video
The "twitter" spat with y-know-who makes me a bit sad. Though he did have videos against the "mechanistic" bias, which I also agree with and understand his viewpoints, especially since the context is Covid,
but still, the two concepts aren't mutually exclusive. While the Mechanistic Bias is true, this "Bayesian" doctrine and "Personalized Care" did and does save lives, because the assumptions and analysis were true. Actually, this methodology is literally the forefront of certain (albeit niche) research areas. After all, how does one design a trial with 1-in-a-million freak-accident patients?
What a great guy
As some very intelligent lawer says: "it depends"
The data as in what people write is exactly what that is. The truth is what you see for yourself. Difference between what's real and what someone told you.
I am too dumb to follow this but I will try.
Everyone who ever understands something was once someone who didn't understand that thing. The only truly "dumb" trait is being unwilling to expose yourself to new info. If you're having trouble understanding some of what you hear, that's a good sign (especially if you understand just enough about it to seek clarification and come to an understanding later). Never stop stretching your brain. :)
This was an interesting conversation. Too bad more medical practitioners don't share his willingness to examine and explore. They need to find a way to incorporate those traits into the programming of future AI doctors! Then we would all receive the best advice and treatment.
Interesting
Because it's incredibly costly and time consuming
A heavy metal doctor. That's a new one!
Some people just have fate on their side. Good 4 him
By that definition i know everything
I think a Bayesian would say that insofar as frequentist approaches systematically win bets, they do so because they're implicitly doing Bayesian math under the hood.
11:45 I agree with the EU SOC, in that it is unethical to not provide care. This is similar to the Tuskegee Syphilis trial.
Is there an audio only format for this?
yes, I have added the link to the description. similarly, if you have the RUclips Music app, it is can be played as an audio podcast if you have Premium
I too played meta gear solid 2
great video. I think though you are standing a tad close to the camera, as you are slightly out of focus. It normally wouldn't be a problem but your facial features are very large on the screen so my eyes naturally keep trying to focus..
He fr used worlds of warcraft to explain how u give a treatment to a patient 💀
I'm surprised they allow plants in a lab.
54:37 the "got it" where all the mf's seeing this video.
Gang
intense IB TOK flashback😅
People who live in areas with 5G masts and a lot of electrosmog in general have a high tendency to develop cancer.
Beautifully new and ever faster technological world that is becoming more and more inhumane.
Geoengineering and the silent consequences...
Very interesting video, and it reminded me about another video I saw about 6 years ago (ruclips.net/video/42QuXLucH3Q/видео.html). A larger sample size is a good thing in some cases, though I guess it should not be an end all conclusion for medical or scientific questions.
Dr Thomas Seyfried
Bookmark 20:00
Not as rare as they are unknown and unreported. Genetic predisposition.
Give us bloopers
Is he sheldon
is it just me or is his winking just a quirk or does he want to convey something
edit: no he definitely has some kind of tic, but he is extremely well spoken, better than me for sure
certified nerd
This guy sounds just like Avi Loeb.
Politician vibes
U look handsome here .. 😊 I was trying to focus on the content though lol ..
Shout out to everyone who just knee-jerks likes someone who's in to metal better 😂
and then is man enough to just wear a bow-tie 🤘
What started as a boring irrelevant discussion turned into a very enlightening discussion on a new way to explain and/or look at the "Scientific Method" completely relevant to the Usual process of the Scientific Method complete with examples.
The pretext of his early life and prior experiences was to establish why he looks outside of medicine to apply those ideas to medicine-- it's something he had been doing since youth. It appears unrelated at first, and maybe we should have tied it together more efficiently
@@HemeReview - i just finished watching the video on the patient, Katie Coleman. Together these two video cover a very fascinating story. Thank you for doing these two videos. I have shared both of them and hope they do well for you and assist other Medical Doctors in diagnosing and treating their patients.
There's no paradox here. You can have too much of a good thing. Outbreeding, which is the opposite of inbreeding, & which is TOO MUCH diversity, can ALSO lead to a decrease in the fitness of an organism. Similarly, too much information can lead to a decrease in understanding. Entropy is the underlying phenomenon in both cases, in which the signal gets lost in a sea of noise (yes, even data can be considered "noise". It's all relative). Make no mistake: that's EXACTLY what's going on here...
please learn basic science, you sound racist. "outbreeding" doesnt exist.
Well put.
it seems to me that what this guy says, that if you know which buttons to push, fda will approve anything to sell. Idk, he maybe speak like this because he is not native, but he is hard to trust.
God cures cancer
God also makes pigs fly.
@@HenriFaust Put a pig on a plane and it can fly. SO your comment is right. Pigs can fly if on a plane
sometimes yes, sometimes no, some people aint ready to go even if god calls them home, we have free will after all.
God creates pigs > God gives pigs immune systems > God gives pigs some cancerous cells > pig immune systems kill cancer cells > cancer cured > God creates humans > humans create planes > planes carry pigs > God gives pigs cancer their immune systems can't handle > humans make pigs into bacon > pigs die > pig cells die > pig cancer cells die > pigs no longer have cancer > checkmate
@@CalvinJKproductions It's neither the pilot, the maintenance team, or the manufacturer that makes a plane fly. Planes are powered by God.