Episode 11.11 When Evidence Misleads

We sit down with Joshua Oommen to get nerdy about clinical reasoning, FDA standards, and why “good evidence” is harder to define than most of us admit. We challenge the reflex to trust p-values and meta-analyses, then test our instincts against real OBGYN examples where the literature has whiplashed practice. 
• why the podcast is called Thinking About OBGYN and how clinical reasoning shapes our work 
• the NEJM proposal to make one pivotal trial the FDA default and what “confirmatory evidence” might mean 
• medical reversal, surrogate endpoints, and how trust erodes when practice changes late 
• why Bayesian thinking fits how clinicians interpret tests, trials, and prior beliefs 
• how meta-analyses fail through small study effects, publication bias, p-hacking, and heterogeneity 
• the amnioinfusion comeback as a case study in applicability and overconfident conclusions 
Be sure to check out thinking about obgyn.com for more information and be sure to follow us on Instagram. 

0:00 Welcome And Today’s Big Question

3:48 Why “Thinking About OBGYN” Exists

11:54 The NEJM Push For One Trial

16:38 Medical Reversal And Trust Problems

24:43 AI Proteins And CRISPR Pressure Tests

32:33 Bayes Thinking Beyond P Values

36:43 Why Meta-Analyses Often Mislead

41:08 Bias And Heterogeneity Red Flags

46:24 Amnioinfusion And A Meta-Analysis Comeback

1:02:29 Final Warnings And How To Learn

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