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briandavidearp's profile
Brian D. Earp
Brian D. Earp
Brian D. Earp
@briandavidearp

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Brian D. Earp

@briandavidearp

@Yale; @UniofOxford; @hastingscenter; @TheAtlantic - psychology, philosophy of science, bioethics, tech, politics, gender and sexuality, etc. RT ≠ endorsement.

oxford.academia.edu/BrianEarp
Joined July 2011

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    Brian D. Earp‏ @briandavidearp 29 Dec 2018

    People seem interested in how a small group of researchers with an agenda can 'rig' a "systematic review" in medicine to make it say whatever they want, albeit dressed up in objective-sounding rhetoric. Here is a follow-up for those who want to see the details of how it is done.pic.twitter.com/yIE1BT1ohn

    3:55 pm - 29 Dec 2018
    • 505 Retweets
    • 961 Likes
    • Ryutaro Reborn Grim Humanity Seneca the Shitlord Jonathan LaTourelle Leo camp002 ty 🛰⚡️ Roland Derek
    31 replies . 505 retweets 961 likes
      1. New conversation
      2. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        The case study from my previous thread was this highly-cited review by Morris & Krieger on the potential (adverse) sexual effects of male circumcision, published in the leading journal in this area, @jsexmed (https://bit.ly/2EWwBUy ). M&K reported "no conflict of interest," butpic.twitter.com/Hf8BCJVowV

        3 replies . 6 retweets 49 likes
        Show this thread
      3. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        as I wrote, M is co-founder & chief spokesperson of a pro-circumcision lobbying organization petitioning 4 government insurance to cover medically unnecessary circumcisions, which would directly financially benefit several board members (see https://bit.ly/2QYZmWY ), and Kpic.twitter.com/rrdySItUmx

        1 reply . 11 retweets 79 likes
        Show this thread
      4. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        had submitted a patent application months before the review came out for a new circumcision clamp (https://bit.ly/2An1uO1 ). If removing sensitive tissue from the penis (the foreskin) turned out to have negative sexual implications, this could be bad for business. Conveniently,pic.twitter.com/NInl1afOEY

        3 replies . 8 retweets 52 likes
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      5. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        then, M&K discovered - after rating the available studies using SIGN criteria (https://bit.ly/2rZcBrC ) - that the high-quality studies "uniformly" showed no negative effects of circumcision, whereas all studies that DID report negative effects were of low quality. But aspic.twitter.com/PShksWIGqB

        2 replies . 4 retweets 45 likes
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      6. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        @JennBossio pointed out in a little-noticed letter to the editor (https://bit.ly/2QXhZub ) SIGN guidelines require that quality ratings be done by a multidisciplinary panel carefully assembled to minimize any possible bias among raters, whereas M&K did all their *own* ratings.pic.twitter.com/5GJNwXD9jY

        1 reply . 7 retweets 82 likes
        Show this thread
      7. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        And as Boyle noted in an even more obscure rebuttal (https://bit.ly/2AkuNAy ), several of the ratings M&K assigned for quality seemed to track the results of the study (that is, whether it supported their conclusion or not), rather than the actual quality. So how was this done?pic.twitter.com/prx4WOOAww

        1 reply . 2 retweets 47 likes
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      8. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        In the rest of this thread, I'll walk through a couple examples, so you can see the sleight-of-hand authors may sometimes use to assign ratings to studies that support their desired conclusion. Take a study by Masters & Johnson, which M&K rated 2++ for quality, which refers topic.twitter.com/TUdZeJNAOK

        2 replies . 5 retweets 42 likes
        Show this thread
      9. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        "High-quality systematic reviews of cohort or case and control studies; cohort or case and control studies with very low risk of bias and high probability of establishing a causal relationship." Masters & Johnson reported "No clinically significant difference between the

        1 reply . 2 retweets 31 likes
        Show this thread
      10. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        circumcised and uncircumcised glans" in exteroceptive and light tactile discrimination (https://bit.ly/2LGPif8 ). Okay, so why should we think this study deserves the highest possible quality rating for a case-control study (2++)? The answer is: we shouldn't. The "study" consists

        1 reply . 1 retweet 38 likes
        Show this thread
      11. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        of a single paragraph (reproduced below) in the 1966 popular book by Masters and Johnson, "Human Sexual Response," in which they refer to some "routine neurological" tests they performed on a small sample of men. No description of the tools or methods used, nopic.twitter.com/bl9Ve9LOld

        2 replies . 2 retweets 41 likes
        Show this thread
      12. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        description of statistical analyses performed, no description of participant sample characteristics, no peer review, no nothing. It is literally impossible to evaluate the quality of the study by Masters & Johnson. Yet based on a single paragraph mentioning a "brief clinical

        2 replies . 2 retweets 47 likes
        Show this thread
      13. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        experiment" in passing in an out-of-print 1966 book, M&K rated this evidence as being of the *highest possible quality* (2++) for a case control study! At the same time, they rated a similar experiment by Sorrells et al. published in 2007 in the widely respected, peer-reviewed

        1 reply . 1 retweet 48 likes
        Show this thread
      14. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        British Journal of Urology as the *lowest possible quality* for a study of this kind (https://bit.ly/2JIgpbv ), despite more than twice the sample size, a priori power analysis, and exhaustive description of methods and tools used. How could this be so?pic.twitter.com/ggNKSuGiKl

        1 reply . 2 retweets 50 likes
        Show this thread
      15. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        One possibility is that they didn't like the main findings reported by Sorrells et al. (2007), namely, that "the glans of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis" and that the foreskin - which is removed by circumcision -pic.twitter.com/gHsUmbVLIO

        1 reply . 4 retweets 42 likes
        Show this thread
      16. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        contains the "most sensitive parts" of the penis to light touch - a finding later confirmed by Bossio et al. (https://bit.ly/2LDQGzi ) (yet bizarrely reported in the media such as @voxdotcom as supporting the exact opposite conclusion, as I discuss here: https://bit.ly/2LEn44H ).pic.twitter.com/S07MFoP9aq

        2 replies . 4 retweets 45 likes
        Show this thread
      17. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        When explaining their lowered rating, M&K cite a letter to the editor, referring to "those who criticized" the Sorrells et al. study [53] <-- if you look at the reference, this is a letter by Morris himself, along with a co-author. Other researchers have noticed that this ispic.twitter.com/WLVgJjf6l1

        1 reply . 4 retweets 43 likes
        Show this thread
      18. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        consistent with a more general strategy employed by Morris (see screenshot below, from https://bit.ly/2QddGpw ), in which he writes a letter criticizing *any* study that appears to show a negative effect of circumcision, on whatever grounds he can think of, then later cites thispic.twitter.com/2F6sB3ETnS

        1 reply . 3 retweets 43 likes
        Show this thread
      19. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        in the third-person as *definitive* reason to reject the study & its conclusions, while failing to cite (much less engage) with the author responses 2 the original critique. Van Howe has recently documented this pattern in detail (see screenshot, from https://bit.ly/2LEZDsb ).pic.twitter.com/Dwa5r4gOZH

        1 reply . 3 retweets 40 likes
        Show this thread
      20. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        Nevertheless, if M&K wish to downgrade a study's quality based on a letter-to-the-editor critique, they should do so consistently. For example, consider the Randomized Control Trials they rated as quality 1++ (the highest possible level of quality for any study design). Thepic.twitter.com/nkkwSExheR

        1 reply . 1 retweet 33 likes
        Show this thread
      21. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        first thing to notice is that one of these trials was conducted *by Krieger* et al., so he is rating *his own study* as of highest possible quality. The potential for bias here is obviously substantial. Now, you might think that because it is an RCTpic.twitter.com/SLHZxFAitG

        1 reply . 1 retweet 44 likes
        Show this thread
      22. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        it should automatically be rated as high-quality: RCTs are generally considered to be the 'gold standard' for establishing causation ... but *only* if they are well-designed and conducted. 'RCT' refers to a type of study design; it doesn't tell you anything about the quality of

        1 reply . 3 retweets 43 likes
        Show this thread
      23. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        materials actually USED in the RCT, including whether they were fit for purpose, capable of detecting a difference should it exist, etc. This screenshot shows *just* the limitations mentioned in the study by Krieger et al., which M&K apparently judged not to matter for quality.pic.twitter.com/sUtqBSNvXS

        1 reply . 1 retweet 35 likes
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      24. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        But critiques by others had been raised before the M&K review, which they certainly were aware of because they came in an author reply letter responding to one of Morris's 'rebuttals' (see screenshot below, from https://bit.ly/2QddGpw ). In short: the questionnaires used inpic.twitter.com/hSnd0DvrUw

        1 reply . 1 retweet 31 likes
        Show this thread
      25. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        RCTs were badly designed & likely couldn't have shown a difference in sexual outcomes anyway (so absence of evidence is not evidence of absence). Other studies have shown *major* differences (see below, from https://bit.ly/2LJPyKE ). But these were rated as "low quality" by M&K.pic.twitter.com/ci9n30OuCc

        1 reply . 1 retweet 38 likes
        Show this thread
      26. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        This is just a couple of the studies they rated, and you can already see how there is enormous room for subjective judgments about whether a study of a given design should be 'upgraded' or 'downgraded' in terms of quality, based on whether one favors the study results or not. So

        1 reply . 2 retweets 45 likes
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      27. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        the more general lesson is: when you see a "systematic review" (or a meta-analysis, or an RCT, or any other scientific artifact claimed to represent the highest quality of evidence), you should not take this at face-value. Meta-analyses are often GIGO ("garbage in, garbage out"),

        1 reply . 11 retweets 91 likes
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      28. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        RTCs are often poorly designed, carried out, and/or analyzed, and then "prettied up" with an attempt by the authors to "spin" their findings in the most dramatic and conclusive direction they can manage; and systematic reviews are often partisan opinion in disguise. Yetpic.twitter.com/svolg2C7VC

        1 reply . 5 retweets 52 likes
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      29. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        doctors, policymakers, and ordinary citizens, rely on such studies, analyses, and reviews to decide what to believe about any given topic of importance to health and society. Even respected, professional organizations like the @AmerAcadPeds can reach unsupported conclusions based

        1 reply . 4 retweets 47 likes
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      30. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        on biased reports and biased interpretations of those reports by whoever happens to be selected to serve on a task force or committee (as I detail at length here https://bit.ly/2AgagNF ). In fact, like M&K, the AAP 2012 circumcision task force members failed to declarepic.twitter.com/2PzBpHeL2Y

        1 reply . 7 retweets 40 likes
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      31. Brian D. Earp‏ @briandavidearp 29 Dec 2018

        their financial and other conflicts of interest in their 2012 policy statement, only later adding a mention in a reply to a critique by international experts (see screenshot below). AAP task force member Dr. Andrew Freedman also forgot to declare his personal conflict of interestpic.twitter.com/95GrI8RJL4

        3 replies . 7 retweets 40 likes
        Show this thread
      32. 5 more replies

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