Donald Trump the Megathread part II - Mod Warning updated in OP 12/2/26

Of course they don’t know boards.ie exists. It’s a fairly niche message board in the grand scheme of things

Thanks for your polite and thoughtful answer. I obviously didn't do a great job of explaining my thinking. I agree that loss of trust in institutions is terrible for society. On the other hand blind trust hasn't served us too well in the past.

Let me clarify / expand on a few of the things you took issue with.

Experts: I didn't say not to trust experts. I think you should be careful which experts you trust. For example, I find Joanna Moncrief trustworthy. She is a psychiatrist who carried out a landmark study debunking the serotonin theory of depression. She published her results in the Journal of Molecular Psychiatry and wrote a book on it - I haven't read the book yet. In the aftermath of the publication of her study, other psychiatrists (so presumably experts) were wheeled out to try to undermine her. When asked why they thought she was wrong, the said stuff along the lines of "we know the drugs work" or "the research shows" without any explanation. Einstein said if you can't explain it in language a five year old would understand, then you don't know what you are talking about. They failed that test. No, we can't all do out own research, but when we rely on others to do it for us, they should be people that are willing to answer the question why in a manner that doesn't rely on "trust me I'm an expert". Something else that would improve matters would be providing doctors with information on drugs that doesn't come from the companies selling the drugs. That's difficult though when they're the only current source. Proper investigation of adverse event reports would help inform better drug labelling and patient information leaflets - as things stand doctors are remarkably blasé when patients report one or other side effect.

Kim Witczak is a drug safety advocate. In 2016, she was appointed Consumer Representative on the FDA Psychopharmacologic Drug Advisory Committee. I think she wasn't reappointed to that post last year. She has written extensively about the inner workings of how drugs get approved by the FDA. I referred to the FDA as most people know what it is -most regulatory authorities have similar shortcomings. There's lots online about the FDA.

On RCT's - if it was just the messy human stuff, there are ways round that. But wash-out periods, substituting one surrogate outcome for another of deciding to use a different rating scale after the trial has commenced, designing trials long enough to demonstrate a benefit compared to a placebo but too short to discover long term effects, making all sorts of assumptions about drop outs and adding those assumed numbers in to calculate the outcome - I have huge problems with that. See the study 329 debacle for more information.

On corruption - it's worth looking at Dopesick or reading Empire of Pain. They outline all sorts of sharp practices. However, it's not necessary to bring doctors to the Caribbean for conferences in order to influence - I did read about a study that indicated doctors who had a branded pen were more likely to prescribe the product it advertised. But corruption is not just a problem in the bribery sense. Large organisations, even if set up with the best of intentions, tend to become corrupt over time in the sense that they prioritise the survival of the organisation over the mission it was set up to achieve. Things can go badly wrong even if most people are not actively doing anything wrong. Whistleblowers still get treated badly enough for most people to be unwilling to risk it.

I agree fully with your last paragraph - I spent my time in the medical device world in the full knowledge that even if I did my job well the outcome wasn't 100% guaranteed, and I have no doubt some people have been injured by products I had a hand in making. I am an optimist however, and I think the very fact of perfection being an impossibility is the reason for healthy scepticism along with doing everything we reasonably can to minimise harms. Asking sensible questions is a good start.

Edit: Despite being famous for an article called Why Most Published Research Findings are False, John Ioannidis (worth googling) is optimistic that things can be improved. In order to improve we have to admit there is a problem in the first place.

So to answer your question, it's nothing more than money.

Agreed - having lived in the US for 13 months in '02/'03, and visited a few times since, I've never ceased to be amazed at how money flows through everything, and how people tend to make decisions based only on how the outcome would directly affect their finances. I was amused by people who wouldn't vote for a 0.5% increase in local taxation to fund schools on the basis that "I finished school years ago and I haven't got kids". The idea that better funded schools might be good for the community at large and hence indirectly good for the voter, albeit on a longer timescale, wasn't factored in at all. No, we're not immune to that thinking here, but we have a much better sense of the common good. Of course, we're not at risk of bankruptcy due to illness.