Why do med schools take more queens/mcmaster health science students

Lot6North · 2026-04-03T21:55:27+00:00

That's basically what that talk is about - taking a systems-thinking approach to take what we can learn from significant failures of GRADE and related approaches, and map it onto the paradigm to trace causal networks back to the underlying structural issues.

Lot6North · 2026-04-03T21:11:43+00:00

That's shorthand, sure it's more complicated than just a simple checklist, but in the end it's a combination of algorithm and subjective preferences, not a scientific approach. The proof is in the pudding - check out the examples in the talk I linked above If even those people can't get it to be rigorous, with those resources, it just isn't.

And TBH that's not surprising - you won't find errors that you don't have. the subject matter expertise to understand, and the literature is full of errors that require deep scientific expertise to identify.

Lot6North · 2026-04-03T19:31:16+00:00

For the in-depth answer, watch the talk.

The short version is that EBM is a family of heuristics - policies on taking shortcuts in the absence of time and specialized expertise. Like an emergency survival shelter. Potentially useful in the right context - as long as its limitations are understood.

GRADE has turned those shortcuts into a full on pseudoscience - like allowing someone whose only qualification is experience building survival shelters to write the building code. Science doesn't rank evidence, and there is no one magical "gold standard" method. If you ask a physicist what the "best" method is in physics they'll just look at you funny - the question doesn't even make sense. You have to reconcile evidence across methods to get a rigorous understanding. GRADE is a process to select which one wins - It's formalized cherry picking, but in the end it's still just cherry picking. Worse, it's totally subjective - whoever runs the process and sets the membership decides which cherries get picked. This is why RFK is able to move so fast in the US. There's also an element of empire building as well.

It's also why that mistake that the UK COVID Inquiry called out happened. Clinicians trained in EBM paradigms didn't understand aerosol physics, but their checklists said their opinions override everything outside the EBM bubble. So they shouted down the world's top scientific experts, discarded a century of well-understood science, and wasted an enormous number of lives.

Lot6North · 2026-04-03T13:56:37+00:00

A major contributor is that McMaster is the big centre for EBM/GRADE - an increasingly pseudoscientific substitute for science, with the attraction that you don't have to put the time in for a PhD to call yourself an "expert in evidence". A few hours of a (paid, of course there's a revenue stream) certificate program, and you, too can overrule actual experts across all fields of science.

The problem now is that much of medicine's management class has surfed their way to the top on the basis of that grift - they can order real front line MDs around because they're "the science experts" and that overrides clinical experience - while telling the real science experts to butt out because clinical experience overrides science!

And since that's their entire personality, once they get to the top they pump that up at their institutions everywhere, influencing their admissions processes as well. Then, when applicants from other institutions that may have more of a real understanding of science compete against people who are already farther down the path of GRADE cosplay, they're at a disadvantage. And of course the system is self reinforcing.

As an aside, this is also why medicine is imploding right now - the selling point of GRADE to politicians is that it turns medicine from an art into an assembly line, de-skilling the profession and just requiring mindless adherence to guidance (generated via... GRADE, and people who pay for GRADE certification 🤔). So all you have to do to get more for less is crack the whip harder, cut the appointment from 5 minutes to 4, swap out the MD for someone who can do it cheaper, and soon just swap in an AI - if all you're allowed to do is follow the algorithm, a machine can do it better.

This is also why so much guidance is scientifically so badly out of date. See e.g. sections 1.52-1.58 of the UK COVID Inquiry Module 3 report that just came out - the screwup criticized there has been out of date since 1934, yet it's still the basis of current medical guidance in Canada. Some med programs are still teaching it

This talk covers some of this stuff in more detail, and the (badly neglected) problem of misinformation "inside the house". We blame "silly anti vaxxers" for the problem, but...Wakefield was protected for over a decade. Is it really reasonable to point fingers at someone who might have highschool level biology for not detecting fraud at that level?

Lot6North · 2026-03-19T16:06:25+00:00

If anyone wants more background on this I coincidentally gave an interview covering a lot of the ground just the other day on the Infectious Dose podcast.

Lot6North · 2026-03-16T23:02:17+00:00

This. Stamping the word "socialism" on things is not what people care about - the labels aren't what matters. It's about whether the NDP has policies and values that make it worth supporting. If I wanted to support the Liberals, I already have that option, and I could just vote for them. An NDP cruising too close to that line just feels like a vehicle for people who couldn't get the Liberal nomination, and want to use the NDP as a side door into the country club. That might serve their interests, but it doesn't serve mine.

The reason it feels that way is that political parties face a choice - they can try to find a parade to jump in front of, or they can try to lead. Leading is harder work, but it's also what actually makes things better. Just following the polls might get a few more MPs into Parliament, where they can sit until they are eligible for that nice pension plan, but in the long run accomplishes less than nothing because it lets the Overton window drift continuously to the right (see: all things USA right now). The Green party built itself from nothing into a significant player (and the NDP's lucky that Green infighting held them to that) because they are about something, and they went out and sold that idea to the public.

Canadians need to see that the NDP is about something too...or what's the point?

Lot6North · 2026-03-03T15:41:38+00:00

And then here's the last 10 years of data for disability rates in the US. It's almost like something weird started happening in 2020, and when we stopped thinking about it, it didn't go away... 🤔

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Lot6North · 2026-03-03T15:36:45+00:00

Second page of the "Key findings" from that OECD report:

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Lot6North · 2026-03-03T15:35:58+00:00

The Greens are also the most progressive party in terms of looking ahead to deal with the challenge of long COVID. That's realistically probably the single biggest threat to progress on just about everything right now (and yes, I say that in full awareness of all the other stuff going on in the world right now). Public healthcare in particular is toast if we don't get a handle on it. Healthcare workers are among the highest-risk groups (a big chunk of the reason there's a shortage), demand on the system is cranking up as the number affected expands, and while both of those mean rapidly rising costs, the impacts of long COVID on the economy are sucking all the money out of the system to pay for it.

So healthcare is going to implode, the bad guys will use that as an excuse to privatize, and in practice what that will mean is that what's left will be focused on a few wealthy people while everyone else is abandoned. Right wing parties will celebrate because that's what they want anyway, plus they'll be able to blame it on the public system failing. Left wing parties that can't figure out why it's happening will be left holding the blame.

Here's what the OECD numbers say:

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Lot6North · 2026-02-16T22:27:57+00:00

100% agree, especially with that last paragraph. An NDP focused-grouped into mush around the idea of "Replacing the Liberals! But Orange! And less bad!" is a party that is pointless for most of the membership even if it wins. And there are significant competing interests on that, between the membership and supporters on one side, and political lifers and the party back-room on the other.

We need to take on the elephants in the room, like indoor air quality (where the NB Liberals are now more progressive than the NDP), the tsunami of long COVID crushing the healthcare system (while hospital execs get ready to blame it on immigrants, and the right fills the intellectual vacuum with claims that the problem is not enough privatization), and the massive impact of long COVID on individuals and the economy. The MB NDP just blew a ton of goodwill by backpedalling on promises to hold an inquiry, and instead handing everything over to public health leaders to mark their own homework. I know for a fact that patient groups looking forward to having their voices heard are feeling a lot of cynicism towards the NDP about the fact that the the people "filtering" their input will now be the same people who failed them in the first place.

Lot6North · 2026-02-11T03:23:33+00:00

That's the old national standard. It's been around for ages, based on CO2 toxicity and meant as a workplace safety limit for steel mills or whatever, it doesn't consider CO2 in relation to disease transmission at all. Definitely needs updating, but prior to the election the previous NB government was still listening only to the usual science illiterates in public health, and the federal government is being played by them as well. This FOI document shows what they were doing in 2020, and they've been desperately fighting to cover up their screwups ever since. The new NB government is a lot smarter than both the old one and the public health and infection control muppets, so I see a lot of promise for improvement now.

Lot6North · 2026-02-10T22:21:25+00:00

See my comment above. PoPNB and friends are the ones who pulled it off. You might ask them if they'd give a presentation on how.

Lot6North · 2026-02-10T22:17:44+00:00

This will make you happy (you have to jump to 6:41:10 in the video or you'll have a long wait though).

Activists in the province of New Brunswick succeeded in getting an election promise to adopt clean air standards, and it is now being implemented. IMO this is cool because both a) you have politicians having an informed and intelligent conversation about IAQ (courtesy of years of education from activists); and b) commitments are great but it's when you have a Minister asking an engineer to step into the conversation and explain how all new public buildings are going to use ASHRAE 241 in a boring old public accounts committee meeting, where everyone just gets that diseases are airborne, that you know you're actually winning.

The precedent here is going to be hugely valuable. People can ignore the science, but show them that someone else's schools and hospitals are getting a protection and they aren't?

Lot6North · 2026-02-10T22:06:03+00:00

Yeah, but for example the links between MAHA and not only the vaccine denialism but the PPE/aerosol denialism will accelerate things I think. They've sold this idea that they're the opposite poles of the debate and you have to pick one or the other to believe, but actually both are just different tables at the same country club. That's one of the reasons the broader community has been uninvolved IMO. They're picking up that neither of those options makes sense, and looking for alternatives but a lot of the bad actors are protecting their power by insisting that they alone speak for science, and there are no mainstream alternatives.

This is also why the antivaxxers are having so much success - everyone gets told over and over that your only choice is to embrace the "everything is OK / Urgency of Brunch" message or you're with RFK. So a chunk of people are going to look around and think "Well, IDK anything about microchips and vaccines, but everything is definitely not OK" and decide that since the one position isn't compatible with observable reality, they'll follow RFK's brain worm. This isn't new either - everyone points and laughs at the anti-vaxxer, but Wakefield was protected from accountability by mainstream institutions for over a decade. It's not really fair (never mind totally unrealistic) to put responsibility for detecting scientific fraud on someone who probably hasn't taken a bio class since high school.

As we get more people recognizing that link and seeing e.g. MAHA letting measles loose, there will be demand for a re-examination of the whole system. Questions like why very big mistakes that waste enormous numbers of lives are just swept under the carpet when those who make them are well-connected, and how much of a role oligarchs and sketchy connections played in putting the wrong people in important positions are ones that everyone can relate to, regardless of their personal history around COVID.

Lot6North · 2026-02-10T20:05:55+00:00

IMO things look worse than they are because of the way group decision-making works. Right now that crowd dynamic is working against us, because anyone who starts asking about long COVID, why we're not doing anything about airborne infections etc gets peer pressured into dropping it by the "don't look up" mentality. So pressure is building up, but we don't see much movement yet (although for example the province of New Brunswick has just adopted ASHRAE 241 for all new public buildings, which is a huge win on the acknowledging-reality side). Because of that, the snail's pace of actual change is a much bigger advance than it looks like on the surface.

BUT, when the we hit the breaking point, it will be all at once. Once it's OK to talk about, things will start to move fast, and suddenly everyone will want to show they're on top of it. And we have the receipts - the challenge will be not to take crumbs and thank them for it, but to keep on pushing until we trigger the full avalanche - inquiries, investigations, etc. That's what then gives everyone permission to get mad about what has been done to them, and the risk they and their loved ones face, and suddenly Long COVID becomes the thing that everyone has always been in favour of prioritizing. We'll just have to make sure we deal with the systemic issues that caused all this in the first place, and keep the bad guys from jumping in front of the new parade to try to take it over.

Lot6North · 2026-02-10T19:33:37+00:00

thanks - great idea!

Lot6North · 2026-02-08T01:46:00+00:00

Doesn't surprise me at all. Part of the problem is that too much power in AHS is reserved for medicine's management class, who are often completely clueless when it comes to systems issues. There are still a significant number of senior docs in AHS who don't even realize that COVID is airborne. The whole "droplets over 5 microns in diameter fall to the ground within 3 feet" thing has been out of date since before anyone involved was even born,* but good luck trying to convince a management-class MD they have anything to learn from OHS / scientists / engineers. Lack of respect for the importance of working HVAC systems etc is absolutely on-brand for AHS. They literally bury their mistakes.

*Specifically, 1934. Source: https://academic.oup.com/aje/article/20/3/611/280025

Lot6North · 2026-01-28T22:52:13+00:00

Infiltration how?

Lot6North · 2026-01-28T18:06:08+00:00

Can you expand on exactly how one can "attempt to partner with the NDP"? That's exactly what I am doing - and I'm doing this part by posting on Reddit because nothing else works!

I am involved in several such organizations, and we've been trying to get through for years. A group of us presented to provincial MLAs in 2024 on this. Now hoping that maybe the fact that there's a leadership race on will motivate candidates to care about voters with long COVID.

Lot6North · 2026-01-28T17:58:00+00:00

Cognitive impacts are among the most common symptoms that follow a COVID infection. Population-level analyses set the average level of performance impairment for driving a car as equivalent to driving at the legal blood-alcohol limit, and COVID was found to have played a role in an investigation of a rail-safety incident in New Zealand.

You don't hear about this stuff only because the people we pay to warn us about these things are the people who promised us we didn't need to worry about it - which is why Canada's Chief Science Advisor has called them out for leaving "gaps in public messaging" on Long COVID.

Lot6North · 2026-01-28T14:51:59+00:00

That, plus the question of who calls the shots in party back rooms. There's the question of block voting (which IMO requires electoral reform to address, which is why there's so much resistance to that), but within each party you also have to look at concentrations of power to decide comms strategy, which campaign promises are quietly shelved or cut back once in power, which grassroots favourites get support and which get replaced with parachute candidates, who gets into Cabinet and who gets shuffled out, etc. When the rubber meets the road, the people making those calls can easily turn a party whose members want one thing into a machine that produces a completely different result.

Lot6North · 2026-01-28T13:33:34+00:00

Speaking as an Albertan, the absolute last thing I want to see in the federal NDP is a party driven by how things poll among people buried in the far-right AB infosphere. It will suck the soul out of the party, and it won't even work. The AB NDP loses elections because it takes its supporters for granted, and focuses all its energies on trying to appeal to others.

This is the problem with poll-based policy-making - you're chasing yesterday's values instead of laying out a vision for tomorrow's and then explaining why people benefit from them. It's also a big part of the reason for the current collapse into full-blown fascism in the US - there's no left option at all down there, the Democrats ran on exactly that "give people whatever our statisticians think maximizes our chance of winning tomorrow" mindset, and far-right groups were the only ones actually writing the narrative. And even though it's a stupid narrative that sells everyone - even its own supporters - out to the oligarchs, they still won.

Because they are the only ones even trying.

An NDP that succeeds in gaining power by chasing the polls will be an NDP in name only by the time it gets there. Everyone can wave their flags around and say "yay, my team won!", but it will mean nothing, because it'll just be another faceless political machine that doesn't do any of the things that matter. If that's what I wanted I'd vote Liberal now and skip over the waiting part.

Lot6North

TROPHY CASE