[zemvpferreira]

As a former scientist it's embarrassing how easily the dismal state of science today could have been predicted decades before by applying Goodhart's Law, or any simple train of thought on incentives and moral hazard. Instead we chose to assume scientists collectively behave on a higher plane. No wonder the general public distrusts "the intelectual elite", we deserved it.

[tstactplsignore]

This article is about MD doctors, not scientists (although there may be some MD-PhDs in it, and yes MDs can get research positions).

MD doctors poll at extraordinarily high levels of trust, over almost any other professional group in the United States. So it really isn't correct to directly link this article's topic to "distrust". The effect you're talking about may exist in science, but this article is essentially a counter example to the effect you propose: clinicians publishing bullshit, but retain a high level of public trust.

Especially because the article is basically entirely quoting practicing scientists who identified this problem in the first place! More real scientific training or collaborating for clinicians who want to (or have to) do research could potentially improve the situation.

[thegrim33]

>> MD doctors poll at extraordinarily high levels of trust

"1966–2012: Historical Harris Polls show a steady long-term erosion, with "great confidence" in the leaders of medicine dropping from 73% to 34% over these decades."

"2021–2024: According to Gallup data, the perceived "honesty and ethics" of doctors fell 14 points, dropping to 53%—the lowest seen since the mid-1990s."

"2024–Present: Major Johns Hopkins University / JAMA Network Open research highlights an overall institutional drop from 71.5% in April 2020 down to 40.1% across socioeconomic groups"

[fluidcruft]

MD doctors (and even to a large extent DO doctors nowadays) are philosophically grounded on science. An MD fundamentally practices science. That used to be one of the key differences between MD and DO physicians, but science has been so successful at advancing the standard of care that DOs cannot ignore it anymore. That's just to say that MDs are expected to be fluent in science and it's not some arbitrary expectation of bureaucracy run amok.

[jmalicki]

An MD does not practice science.

Science is a process of discovering new knowledge through experiments.

An MD is much more akin to an engineer that applies scientific knowledge (and yes, some proportion of both MDs and engineers do create new knowledge through experiments and thus do science, but it's not the baseline expectation).

[dghlsakjg]

Doctors run small experiments constantly. “Let’s see if this ailment responds to this treatment”.

They test theses constantly “These symptoms may be cancer, let’s test that theory with a biopsy”

Science can be local to a single patient.

[jmalicki]

It's not a scientific experiment if you don't have some form of control, just an observational study.

The lack of training physicians get in the scientific method is probably one of the biggest things holding humans back today.

[fluidcruft]

"Practicing" something means applying it. It's similar to how practicing law and creating law are related but not the same thing.

[jmalicki]

I practice medicine everytime I take a Tylenol then.

Am I guilty of a felony for not having a license?

Practicing law and the practice of applying legal regulations are quite different, just as practicing science and the practice of applying scientific knowledge are quite different.

Not that MDs are less than scientists. I stand firm that Flat Earthers who do experiments to prove the earth is flat are absolutely practicing scientists! They are complete idiots who don't know anything, but they set out to create experiments to prove or disprove their ideas.

Whereas an excellent physician who is extremely learned and takes medical studies at face value, and knows more knowledge derived from science than most scientists who created it, is only using knowledge derived from science, not practicing science.

It's like during COVID people had those signs "I believe in science!". I probably agree with everything they believe, but science is a process of testings theories and creating knowledge, it's not a body of facts you agree with.

[georgeburdell]

Due to the high trust they get from the public, I have run into many MDs who are used to making unfounded assertions with little pushback.

[SoftTalker]

Why is this? MDs are among the people I trust the least, along with lawyers, financial advisors, and real-estate agents.

[estearum]

Information asymmetry

[mistrial9]

"fasting is a disaster for the body" says radio MD with complete confidence.. one of my personal favorites

[jjulius]

>Instead we chose to assume scientists collectively behave on a higher plane.

People are people.

[mmooss]

If the solutions are so simple, what are they? Yes, incentives are distorted, but what system - that does not rely on everyone being on a higher plane - would have better incentives?

By your definition, every human endeavor is dismal and always has been - all are corrupted and flawed to some degree. Is there evidence that current science is more dismal than others or than before? You can look at any day in history and see people saying the same things about how it's so dismal and not like the good old days.

> No wonder the general public distrusts "the intelectual elite", we deserved it.

The general public has no idea about scientific publishing, publish or perish, or the distorted incentives it creates. Science has delivered at an incredible level for centuries, arguably more than any other human enterprise. Covid-19 vaccines were available in record time - it wasn't the science that caused it to go somewhat off the rails.

[zemvpferreira]

I didn't claim there's a simple solution, rather that the simplified system of publish-or-perish doesn't work. Personally I believe you can't replace a management layer that's aligned with the institution with a career progression based on metrics. Embrace complexity, let managers decide who should be promoted, sack or pay those managers based on their performance. Propagate onwards through the ownership chain.

The fact that Covid vaccines worked so well is precisely an endorsement of a hands-on, results-driven approach.

[mmooss]

> Embrace complexity, let managers decide who should be promoted

You know better than I do about academia, but speaking generally about management that sounds like an issue not of complexity but of bias and corruption, which are prevelant enough in academia as I understand it: Faculty advisors have so much power they can crush careers, leading to abuse (including sexual harassment and abuse) and corruption.

For a manager to do it effectively, they need objective, quantified metrics as a major input. 'I can't manage what I can't measure.' And to manage managers based on performance, we need to measure their performance. Which would seem to bring us back to publishing, impact factor, etc.

> management layer that's aligned with the institution

Why do we care about alignment with the institution (you mean the university?)? Very broadly, institutional interests are often quite corrupt and cruel to people and society. It would seem to pervert research, encourage corruption, and harm scientists personally.

> The fact that Covid vaccines worked so well is precisely an endorsement of a hands-on, results-driven approach

What do you mean here? I don't know how the Covid vaccine research was managed, other than non-tenure-track faculty earned a Nobel!

> the simplified system of publish-or-perish doesn't work

The point is, maybe there's no better solution. That's often the case in practice. The way I think of it is that theory prioritizes truth over having a solution - no 'truth', no theory; that's science. Practice prioritizes having a solution - no 'truth', do the best you can; that's engineering, management, clinical healthcare, etc.