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27 October 2009
Fantastic visualisation of human understood as a machine. By Henning Lederer.
Der Mensch als Industriepalast [Man as Industrial Palace] from Henning Lederer on Vimeo.
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27 October 2009
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12 October 2009
This Wednesday, October 14th: Movie Night about STALKER
what: filmdiscussion night about Stalkerwhere: Ina Bouider-Bakkerlaan 41-4when: Wednesday, October 14thwhat to bring: some foods (chips/brownies etc.) drinks to share, your agenda for planning some winter movie nights, ideas about what movies you want to watch next time, and prejudices about Russian Cold War movies to bring to the test!
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01 October 2009
Jacoline Bouvy won the Night of Descartes Essay Contest on Evidence Based Medicine, featured in the latest UBlad:
RANKING EVIDENCE IS NOT ENOUGH
Doctors have always treated patients according to what they believed were effective treatments. Until the late 19th century, however, bloodletting was thought to be a cure for a variety of diseases. Today, we prefer treatments that are ‘scientifically proven’ to be effective and expect our doctors to practice evidence-based medicine. But evidence-based medicine is not a medical doctrine: it is a set of tools that allows doctors to practice medicine by preferably using treatments that have been shown to be efficacious and effective. It helps doctors to be able to provide the ‘best’ therapies to their patients. However, evidence-based medicine is far from perfect and holds several weaknesses.The foundation of evidence-based medicine is the ‘hierarchy of evidence’ model, which ranks different types of scientific research study designs according to the authority these types of research hold. The hierarchy of evidence model wrongly regards the randomized controlled trial (RCT) (and systematic reviews of RCTs) as the ‘best’ type of medical research. Furthermore, it discriminates against lower ranked study designs that in the past have contributed to a great extent to current knowledge of diseases.In the development of medical evidence-based guidelines, the hierarchy of evidence model is used to rank the authority of different types of research. The randomized controlled trial and systematic reviews of RCTs are ranked above observational studies, case reports and expert opinion. A systematic review of at least two independent randomized double-blinded controlled trials of sufficient quality and size is considered the highest form of evidence in medicine followed by a single randomized double-blinded controlled trial. Ranked below RCTs are comparative studies (e.g. case-control studies and open trials), and at the bottom we find non-comparative observational studies and expert opinion.The randomized controlled trial is the closest medicine has come to a formal experiment which is why it is ranked highest. Yet, it is exactly the nature of RCT design that is problematic for its application in medicine: the highly controlled circumstances and selected patient population result in problems with external validity. The homogenous patient sample of an RCT is not very representative for the real-life, daily practice of health care, where the patient population is naturally very heterogeneous. Possibly even more important, pharmaceutical companies that have an obvious interest in publishing promising results of their products often fund RCTs. This does not mean we cannot trust the outcomes of their studies; it does mean we have to be aware of the issue of objectivity in their studies. Ideally, their results should be repeated by independent studies.
Objectivity
Unfortunately, neither does independent research guarantee objectivity of study outcomes. The well-known ‘Scientists behaving badly’ publication (2005) has shown that 33 percent of researchers have engaged in at least one form of serious misbehavior in research (Martinson et al. 2005*). Thus, objectivity in medical research and publications in scientific journals does not exist. The hierarchy of evidence model does suggest that when study design conditions (e.g. sufficient quality and size) are met, RCTs will always produce reliable results. This is a wrong assumption.Randomized controlled trials have another major fallacy: they are short-term oriented. Observational studies (that are ranked below RCTs) are essential in investigating long-term effects of treatments and determinants of disease. The Framingham Heart study that started in 1948 is an example of a well-known observational study that has contributed greatly to our knowledge of cardiovascular diseases. Also, the relationship between smoking and lung cancer was shown not by randomized controlled trials but by epidemiological study designs. These examples clearly show that study design does not necessarily indicate the importance of the study’s results to the field of medicine.Evidence-based medicine and its hierarchy of evidence model clearly put randomized controlled trials above observational studies and, therefore, forces rigid judgment on their value and utility in medicine. But history has shown us that we need to look beyond study design to determine the true quality of scientific research and the extent to which published studies contribute to our knowledge of diseases and treatments. The hierarchy of evidence model is useful but has several limitations that create a need to look beyond evidence-based medicine. True evidence-based medicine should value research according to its importance and contribution to our increasing understanding of medicine. The evidence-based medicine model that simply ranks scientific studies based on their study design is not sufficient.
*Martinson BC, Anderson MS, de Vries R. Scientists behaving badly. Nature 2005;435(June):737-738.
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23 August 2009
Museum's are hot these days. At least, debates on Dutch museums keep on going. Sometimes it's about negative news, such as the renovation of the Rijksmuseum of Art and History which continues to take longer and gets more and more expensive, or the National Museum of History in Arnhem of which the content remains a mystery... sometimes it's about good news, such as the Hermitage Amsterdam, a great new museum (built within budget and period), and the Giroloterij Museum Price 2009.
This price of €100,000 will be given to one of the by jury selected museums best able to tell Dutch history to its visitors. The nominees are:
- Beeld & Geluid experience / Sound and Vision Experience
- Het Dolhuys
- Nederlands Openluchtmuseum / Dutch Open Air Museum
- Het Spoorwegmuseum / Dutch Railway Museum
- Tropenmuseum
You can vote for the best museum: Museum Prijs 2009.
On the history of the sciences, The Dolhuys is of course the one. On the history of technologies, you can consider Sound & Vision and the Railway Museum. Cultural history is shown in Open Air Museum and Tropenmuseum. Likely winners are Dolhuys, Open Air and Railway Museum. We'll see on 24 September...
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21 August 2009
Taken from Ublad.uu.nl:
Zo’n twintig jaar geleden werd de term ‘evidence-based medicine’ (EBM) geïntroduceerd. Bij het maken van een keus voor de behandeling van een patiënt diende de arts gebruik te maken van wetenschappelijk bewezen inzichten. Schrijf een essay over dit thema en ontvang voor 250 euro aan boekenbonnen. Het winnende essay wordt bovendien gepubliceerd in het Ublad.
De tweede ‘Nacht van Descartes’ – die plaatsvindt op 24 september in de Geertekerk in Utrecht - is gewijd aan 'evidence-bases medicine' (EBM). Voor die gelegenheid hebben het Descartes Centre, Studium Generale en het Ublad een prijsvraag over dit fenomeen uitgeschreven.
Vragen die geopperd worden zijn: Had de geneeskunde zich voorheen dan niet op de wetenschap gebaseerd? Hoefde de effectiviteit van medische ingrepen voorheen niet te zijn bewezen? Is de geneeskunde sindsdien beter en effectiever geworden? Kan de introductie van EBM misschien ook worden verklaard door factoren van niet-medische aard? Wat heeft EBM bijvoorbeeld te maken met het streven naar kostenbeheersing in de zorg en met de juridisering van het medisch handelen? En heeft EBM bijgedragen aan een versterking van de medische professie of vormt het juist een bedreiging voor haar autonomie? Kortom: hoe moeten we Evidence-based medicine als fenomeen begrijpen en evalueren?
Studenten en medewerkers van de UU en het UMC worden nadrukkelijk uitgenodigd om een bijdrage over dit thema per e-mail te sturen naar a.heijnen@ublad.uu.nl. De bijdrage mag niet langer zijn dan 800 woorden en moet uiterlijk op dinsdag 1 september binnen zijn – voorzien van naam, adres en telefoonnummer van de auteur. Een jury bestaande uit Yvonne van Rooy (College van Bestuur), Herman Philipse (Universiteitshoogleraar), Frank Huisman (Descartes Centre / UMC), Melanie Peters (Studium Generale) en Armand Heijnen (Ublad) beoordeelt de bijdragen. Het bekroonde essay wordt gepubliceerd in het Ublad voorafgaand aan de Nacht van Descartes. De auteur krijgt bovendien een prijs bestaande uit boekenbonnen ter waarde van 250 Euro.
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03 April 2009
Azadeh Achbari presented her first results part of her research into the "Global Science from a Dutch Perspective: Dutch Participation in 19th Century Humboldtian Networks." Azadeh presented the case study of English scientist Whewell and the Dutch professor Gerrit Moll and their work on the tidal waves and water currents in seas and oceans.
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