Fake Nephrology Facts

Written by Meguid El Nahas on Wednesday, 20 December 2017. Posted in OLA Blog

Fake Nephrology Facts

At XMas time and the end of every year, one reflects on the year that has passed.

2017, has seen the explosion of fake news...false news....made up news...truth and reality dont seem to matter any more but instead, whoever shouted louder and repeated it often could promote any idea false or true...

This brought to mind a similar phenomenon in Nephrology...

Over the years, fake news, fake data, falsehoods, and semi truths permeated our profession. They became accepted out of ignorance of the facts, disrespect for the truth and propaganda like marketing of ideas based on half-truths and flawed facts...it any! The propaganda of these fake nephrology facts has been promoted intensively and aggressively by those who have vested interest in these semi-truths, falsehhoods and fake news...some went as far as bullying the nephrology community and nephrologists to accept these promoted falsehoods...I once witnessed a correspondance openly threatening a colleague who was rejecting one such falsehoods by one of the promoters of the propaganda...the subject was the classification of CKD...

  Many examples of such fake Nephrology permeate our thinking...

Here are some examples,

"One third of the world population suffers from CKD"...more propaganda than facts!

"Hyperfiltration causes progressive CKD"...more propaganda than facts!

"Albuminuria is not only a marker of progressive CKD, but a maker of CKD progression".... more propaganda than facts!

"ACE inhibitors have unique nephroprotecting properties other antihypertensives dont have"....more propaganda than facts!

"eGFR is a valuable marker of kidney function"....more propaganda than facts!

"The Lower the BP, the slower CKD progression"...more propaganda than facts!

These fake information have been peddled long enough...to become realities many if not most nephrologists beleive in...and have adopted blindly without questionning...or without a minimum of critical thinking!?

The herd instinct dictates that following the herd dictats and propaganda is safer than standing up and questionning the direction the herd is taking...it often feels safe to be a sheep than a shepherd...

Like fake news, repetition and mass media promotion and propaganda, make these fake facts, nephrology realities...even though they are not subject to scrutiny, critical thinking or even credible and substantiated evidence...

So as with fake news and social media promotion of fake news, it is high time Nephrologists and the Nephrology community as a whole takes a critical stand of what it is been fed...and start filtering facts from fiction!

I urge in 2018 Nephrologists worldwide to start asking questions and critically analyse what they are told...sold..what they are encouraged to beleive....and be more discerning regarding the fake facts propaganda that doesnt spare medical information, news or publications...

Also beware of those who try to manipulate us by providing shallow and unsubstantiated information dressed up as facts...dont let them bully you to beleive them...and beware they will repeat them often enough for you to beleive them...without a shred of evidence provided...



Meguid El Nahas

Professor Meguid El Nahas PhD, FRCP

Chief Editor, OLA Director

Professor El Nahas was born in Cairo, Egypt and undertook his undergraduate medical education in...
Posted: 2 months 3 weeks ago by arif.khwaja #21639
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Very perceptive. But it very hard to challenge conventional wisdom. The role of journals and editors is to do what you say.. Critically appraise information
Yet we are drowning in information and in journals and in literally piles of academic junk! Associative data dressed up as research. its hard to see the wood from the trees
Posted: 2 months 3 weeks ago by elnahas #21640
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You also drew my attention today to the notion of the "emotional bias" of many key opinion leaders whose opinions and perception of the nephrology facts is tainted by their emotional attachment to their own work and its conclusions and implications, often regardless of a more hard nosed and objective critical evaluation of the facts... they basically believe uncritically their own data and promote it regardless of its limitations often taking any challenge to their assumptions and assertions as personal attacks on their integrity and on their ego... a mostly non Popperian approach to science and research...
Posted: 2 months 3 weeks ago by anderson #21641
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Good medical research takes around 17 years to be adopted in clinical practice. What about bad researches? Why they enter so fast in the medical practice and take so much to disappear?
Posted: 2 months 3 weeks ago by arif.khwaja #21642
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Excellent point Anderson
the Popperian view of science I guess doesn't really factor in the individual psychology and motivation of the scientists
Posted: 2 months 3 weeks ago by elnahas #21643
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to Anderson: Bad research finds its way to the professional psyche not because of its intrinsic value, as quality is seldom appreciated as most nephrologists dont know how to critically appraise a publication..., but instead because bad research is promoted by repetition and propaganda....to convince its audience that it is good and valuable research...repetition, repetition, repetition of fake news turn them into realities...not just in medicine but in myths and religions!

two such medical nephrology examples of bad research promoted are: ACE inhibitors...and nowadays Rituximab...none really superior to the best available treatment at the time, be it antihypertensives or cyclophosphamide or even azathioprine..., but heavily promoted by efficient marketing and propaganda!

As to good research, its proponents believe that it can breakthrough on its merit and therefore may have less inclination to push it aggressively through propaganda and fake statements?!

to Arif: The Popperian notion is that good researchers should know that the facts they uncover will be challenged and proved lacking in order to advance science and therefore do not need to hang to them as if their life depended on it; but if your reputation is built on a falsehood...you will do all you can to make others believe it is a righthood...
Posted: 2 months 3 weeks ago by tukaram #21647
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Nice discussion. I feel onus also is on the readership in addition to the editors and researchers. Our students need to be much more skeptical than what they typically are today. So ultimately responsibility comes to teachers, not all of them are critical like Prof Meguid
Posted: 2 months 3 weeks ago by elnahas #21648
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As long as Nephrologists dont have the basis of critical appraisal and dont know the difference between good data-publication and poor and flawed data...how can they base their medical practice on facts and not fiction...?!
In the absence of critical thinking, they remain hostage to propaganda and fake nephrology news!
Posted: 2 months 3 weeks ago by JoseMario #21649
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So called "Cognitive Dissonance" i,e, the trend of human beings to stay in a psychological "Comfort Zone" with established wrong myths as those cited here by Meguid, instead of applying Popperian science principles.

And in my humble opinion also the nowadays strong transformation of Medical Practice and Medical Teaching to Commodity values reinforce the non-critical medical thinking in almost if not all fields of Medical Practice and Medical Thinking.

Sorry to say that.
Posted: 2 months 2 weeks ago by elnahas #21650
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You are absolutely right.

Management and business took over the practice of medicine and dictated its limits and objectives; often away from humanism but more towards Businessism...and capitalism! This has led to the guidelines and management hospital governance dictats, to maximise management control and minimise doctors' influence, perceived as dangerous..., and also minimise doctors' initiatives and critical thinking...critical thinking is a challenge to authority...is a challenge to totalitarism....

Medical totalitarism is promoted by hospital management, medical societies, as well as professional qwangos and vested interest groups as well as Big Pharma...all with the goal of promoted capitalism, and a form of fascism!

Fascism as defined as:
a philosophy, movement, or regime that exalts a system above the individual and that stands for a centralized autocratic government headed by a dictatorial leader, severe economic and social regimentation, and forcible suppression of opposition...

much of this applies to many medical myths that are forcefully promoted at the expense of suppression of free thinking and opposite viewpoints....
Posted: 2 months 2 weeks ago by elnahas #21651
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Excellent analysis on medical misinformation:

Eur J Clin Invest. 2017 Nov;47(11):795-802. doi: 10.1111/eci.12834. Epub 2017 Sep 28.

How to survive the medical misinformation mess.

Ioannidis JPA, Stuart ME, Brownlee S, Strite SA.

Most physicians and other healthcare professionals are unaware of the pervasiveness of poor quality clinical evidence that contributes considerably to overuse, underuse, avoidable adverse events, missed opportunities for right care and wasted healthcare resources. The Medical Misinformation Mess comprises four key problems. First, much published medical research is not reliable or is of uncertain reliability, offers no benefit to patients, or is not useful to decision makers. Second, most healthcare professionals are not aware of this problem. Third, they also lack the skills necessary to evaluate the reliability and usefulness of medical evidence. Finally, patients and families frequently lack relevant, accurate medical evidence and skilled guidance at the time of medical decision-making. Increasing the reliability of available, published evidence may not be an imminently reachable goal. Therefore, efforts should focus on making healthcare professionals, more sensitive to the limitations of the evidence, training them to do critical appraisal, and enhancing their communication skills so that they can effectively summarize and discuss medical evidence with patients to improve decision-making. Similar efforts may need to target also patients, journalists, policy makers, the lay public and other healthcare stakeholders.

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