How do we know what is true? None of us has the time or the inclination to test everything for ourselves. We rely on trusted experts to tell us. Few doubt that the heart pumps blood to our lungs and other tissues, although few have seen our hearts do that. We know that William Harvey discovered that fact in 1628, and it is now universally accepted as true and foundational to all cardiology. Even fewer know how the nerves cause the heart to beat, how arrhythmias are diagnosed, or how plaques can cause heart attacks. We rely on cardiologists to know all that, and within cardiology are sub-specialties (e.g., heart transplant specialists, sports cardiology, etc.). There are dozens of medical specialties, each with several sub-specialties. There are even specialists in cutting across categories, and assuring that the latest innovations become available to patients; this is called “translational medicine.” In this era of specialization, few know much outside of their specialty, and as patients, we must, at some point, rely on the experts for our knowledge about disease, diagnosis, and treatment.
Medical science became probabilistic in the 20th Century. All medical institutions agreed that statistics are the only way to reject hypotheses, judge superiority or inferiority, infer causality, and to analyze and reduce errors. Statistics are difficult to understand and are non-intuitive, even for many doctors. As sophisticated statistical techniques were adopted by the medical institutions and their publications, lay people, who did not have their arcane knowledge, were increasingly left out of the truth community.
The Dunning-Kruger Effect is a cognitive bias on the part of incompetent people overestimating how much they know. In medicine, a little knowledge is a dangerous thing. When I started writing my novel, Thaw’s Hammer, about a killer virus, I thought I knew enough about the subject to write a credible novel. Four years later, I knew how much I didn’t know. I grew to admire the experts who had to understand the biochemistry of the replicative apparatus, the interactions with host cells, and the immune system. Viruses are the most numerous and diverse forms of life on Earth. Anyone who thinks they understand them is wrong. The experts differ from lay people in knowing they don’t completely understand them. Still, an expert understands a lot more than any lay person who thinks he knows more. I know enough to reject any advice from a Jenny McCarthy or a Joe Rogan in favor of advice from the CDC.
Overconfidence in subjective assessments, when contrary to scientific consensus, is also influenced by alignment with political and religious social groups. The Dunning-Kruger Effect is particularly strong on the issues of vaccination (particularly Covid-19 vaccination), genetically modified foods, and homeopathic medicines (see link below).
Knowledge is progressive and cumulative. Newton said, “If I have seen farther, it is because I have stood on the shoulders of giants.” Opposing this kind of humility, are people who think, based on a few facts or “alternate facts,” that they have arrived at the truth hidden from the rest of us. What they are really doing is inhabiting what Rauch calls an “epistemic (knowledge) bubble.” They are only allowing into their knowledge bubble those data, and persons, that confirm their biases. They take studies out of context and fail to rigorously analyze studies they agree with while finding reasons to disqualify studies that don’t agree with their preconceived notions. They reject the methods of analysis developed by the institutions they reject. They are usually smart and think that they are fully capable of judging the data for themselves. This takes a certain kind of narcissism – as if the whole world is full of “sheeple” and only they know the real truth. They are also lazy – it would be too much work to learn and evaluate the whole body of knowledge.
Fundamentalism has been around in religion at least since the Protestant Reformation. But it emerges in all other areas of human knowledge – politics (as populism), law (as originalism/ anti-stare decisis), and folk/Internet medicine. It is usually short-lived: the fundamentalists of one generation eventually give way to the acceptance of an orthodoxy and hermeneutics for interpretation of texts. Fundamentalism substitutes personal authority for institutional authority. Personal knowledge is acquired rapidly and doesn’t require input from others. Because personal ego is at stake, it excludes all information that doesn’t confirm. Institutional knowledge, on the other hand, builds on a foundation of knowledge of the “truth community,” and includes conflicting data. The conflicting data create new hypotheses and the opportunity for knowledge to expand. If enough conflicting data accumulate, they may cause what Thomas Kuhn called a “paradigm shift.”
Google is a wonderful thing. Knowledge is potentially at our fingertips, but information out of context can mislead. Instead of knowledge, we can be left with information that only confirms what we think we know. Social media ideally expose us to all sides of any issue. But if we are not open to all sides, social media can only reinforce the knowledge bubble we have built around our pre-determined beliefs. Without challenges to what we think we know, there is no progress.
Part 3: Distrust of Institutions and What We Can Do to preserve the Constitution of Medical Knowledge
Written by
Tall_Allen
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Perhaps man's deepest drive is belonging to a group, something that has been crucial to our survival throughout almost our entire history. Defending the group's views has been a prerequisite for being a part of it. Consequently, defending the group's views means survival. The brain is therefore hard-coded to ignore information that challenges the group we belong to. It constantly looks beyond the facts it is faced with and asks itself: “what are the social consequences of accepting these facts? Am I risking exclusion? ” Thats why people with different opinions do not listen to each other. It is powerful "thought trap". Fundamentalism is part of our biology!
I would not equate interest in all kinds of medical knowledge as "religious fundamentalism." I am not against science or the scientific method. I simple state that money has tainted the science. There are plenty of instances of "medical science" in this country gone wrong in the name of profits. Results of studies by the FDA or skewed to the benefit of big pharma.
I said nothing of the kind- I suggest you re-read. I said that substituting personal authority for institutional authority is dangerous.
You keep saying that there are "plenty of instances where "medical science in this country has gone wrong in the name of profits," but you have yet to provide even one, or where FDA "skewed to the benefit of big pharma." It just seems to be more conspiracy theory.
There is a revolving door between those in the pharmaceutical industry and the federal agencies that are charged with regulating them. After leaving government service some are hired by the same companies they were supposed to be regulating and for outrageous salaries. I do call that collusion and not a good basis for science
I once worked for a governmental organization. After that, I was employed by a private company that wanted to use my knowledge of how the governmental organization works to get business with it. Do you see an ethical problem with that? What exactly is the problem with that?
To make my point, it is what those government employees did while in government service to earn outrageous salaries afterword in private companies. As one of the articles I posted above states, a staffer was hired by the company after "successfully" managing their drug review. I don't think that is not just a happy coincidence.
We live in a society that needs to discuss, debate, decide upon and ultimately implement policies that are based in science. However, pure science only informs, it does not advocate. Its use in social policy can often become awkward and hotly debated, especially as regards risk. As an engineer that was involved with human safety, environmental, and health regulation, I have a detailed understanding of how (American) society decides on acceptable risk. Keeping science - and even its lazy, shortcutting sibling, engineering - as the main factor in the decision process is difficult.
A major reason for this is that, no matter what branch, science has an unavoidable problem with communication to and education of laypersons. A true scientist cannot express the "importance" of a fact (e.g., "risk") in any other language than statistics - and the human being's innately twisted perception of personal risk does not easily think in this language.
In my opinion, this is partly why "engineering" was (unintentionally) developed in the first place: To provide an intermediate communication space between science and layperson with the ultimate goal of developing socially-accepted algorithms/routines (i.e., codes and regulations) for the repeated social application of science. This process works because engineering implicitly and explicitly takes shortcuts by eliminating "unnecessary" scientific information from the design/decision process so that something actually gets done - statistics is built in or ignored outright. Now, whether dismissing that "unnecessary" information and that the "something" is the ultimately the best "something" for society is another question. But at least there is a repeatable (hopefully editable) process in an algorithmic form.
Now let's focus on medicine. My experience is as a medic in the U.S. emergency medical services (EMS) system for 20 years. It is supported by a society that wants to respond to "emergencies" and tacitly understands that in an "emergency", not everyone will be saved.
Consequently, our EMS system is truly engineered: From trauma to allergic reaction to cardiac, there are a series of accepted algorithms that are applied from initial patient contact in the field to the start of stabilizing/comprehensive care in a hospital. This is the EMS standard of care (SOC), and an even a sloppy EMS team can communicate their part of the treatment path clearly to each patient/patient family.
Moreover, these algorithms are continually reviewed and updated - over two decades, I saw quite a few treatment paths and medications change. In being educated and trained on those changes, it was immediately obvious that, in certain instances, the previous treatments did more harm than good. But that is the engineering learning curve as informed by science; one that is accepted by society.
My medical experience with PCa is much different. It doesn't have the same absolutist SOC as emergency medicine. Understandably, PCa's medical algorithms are less definitive if only due to its chronic - rather than acute - nature. PCa is also much more complicated than, say, most cardiac events.
But it is human nature to view cancer as an emergency, demand something be done NOW, and have those actions be effective! Many doctors/care teams still seem baffled by this expected human response and are ill-prepared to truly communicate to educate.
Yes, the Dunning-Kruger Effect is real. But in the PCa space, I have been less than impressed by my physicians' communication of their perceived/planned treatment algorithm. There is something to say about actually stimulating a "Dunning-Kruger Response" in a patient population.
In the absence of concrete SOC algorithms for PCa, it is not a surprise that laypeople start to fill in the data gaps for themselves. Given that this data "effort" is supported by someone's sloppy extraction of information from the sloppy database that is the internet, confusion can develop into conflict in a short time.
EMS communication relies heavily the following generic statement: "We don't know yet, but this is what we are going to do in the meantime and why we are doing it." In my opinion, many knowledgeable, educated individuals immediately mess up any meaningful future conversation by being unable/unwilling to adequately admit to that first part of "We don't know yet".
Instead, they power through that awkward reality, and I cannot say I know exactly why. But I can say that less technically-oriented people absolutely view that as arrogance and/or stupidity and are then are that more willing to march down the path of "doing it themselves."
💯 Humility is so important. All medical knowledge is provisional, but in the end, we get better at it. Sometimes, "i don't know" is the best answer. But to many patients, it is an emergency, and who can blame them for wanting a definite and immediate response?
Fundamentalism substitutes personal authority for institutional authority.
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In a religious context, that's not generally true. "Fundamentalism" often substitutes institutional authority (or textual authority, not quite the same thing) for personal authority. As Groucho put it (excuse the mis-quote):
. . . "What are you going to believe, me, or your own eyes?"
There was a flowering of Protestant sects in the Protestant Reformation, but within each of those sects, "acceptable belief" was carefully controlled by the leadership.
That's a nit -- I think your main points are well taken.
As I wrote: "It is usually short-lived: the fundamentalists of one generation eventually give way to the acceptance of an orthodoxy and hermeneutics for interpretation of texts. " Martin Luther believed that enlightenment is personally available to anyone studying the text of the Bible. He wrote his personal beliefs in his "95 Theses," which he widely published and distributed. This was his fundamentalist phase. Later, he collaborated with Philip Melanchthon to codify the "Augsburg Confession." These became the foundational doctrines of the Lutheran Church - by the time they were created as Church dogma, anything departing from it was heretical. Thus, originators of churches always start as fundamentalists- their personal authority supersedes the authority of the institution they are seeking to replace.
>>>Thus, originators of churches always start as fundamentalists- their personal authority supersedes the authority of the institution they are seeking to replace.
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_That_ is a line I'll remember -- thanks!
PS -- My local support group is having a registered dietician speak on "Prostate Cancer: Is Nutrition Important?" tomorrow. I'll ask "Is there any evidence for that, in humans?" for each claim of effectiveness. The last time I did that, all answers were "No."
I expect the same will be true of the SCOTUS originalists. The reason is the same - they want the interpretation to go the way they feel it should be. They then use their textual analysis to justify their feelings - stare decisis be damned. I love the way Jonathan Haidt describes our moral (legal/religious/political) decision making. He describes it as a little man atop an elephant who thinks he is steering the elephant.
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