In 1995, McArthur Wheeler and Clifton Earl Johnson robbed two banks in Pittsburgh. They believed they wouldn't be caught because they had researched how to render themselves invisible to bank security cameras. They learned that lemon juice could be used to write an invisible message on paper that could only be made visible by heating up the paper. Could lemon juice make them invisible to bank cameras? They conducted an experiment: they rubbed lemon juice on their faces and took a Polaroid picture -- their faces did not show up on the Polaroid!
They rubbed lemon juice on their faces, wore no masks, and robbed the two banks at gunpoint. The Pittsburgh Police showed the security camera images on local TV, and they were soon apprehended. They were nonplussed and insisted the police had no evidence. It is unknown why the Polaroid failed to show their faces - perhaps defective film or perhaps they pointed the camera in the wrong direction.
The Dunning-Kruger Effect
David Dunning read about the case. He hypothesized that if Wheeler was too stupid to be a bank robber, he may have been too stupid to know that he was too stupid. Dunning and his grad student, Justin Kruger, wrote a paper titled "Unskilled and Unaware of it: how difficulties in recognizing one's own incompetence lead to inflated self-assessments." This is known as the Dunning-Kruger Effect.
Dunning and Kruger found that people who first start to learn about any subject have an inflated perception of how much they know. Paradoxically, when people learn a lot about a subject, they think they know less about it than they actually do know. As people start to learn about a subject, their confidence in their knowledge is never higher. If they learn more, they quickly learn how little they know about it. If they stick with it and learn even more, they slowly gain confidence in their knowledge. But they will never have as much confidence as they had initially - they have humility because they have learned how much they don't know, and perhaps can never know.
A 2022 study by Light et al. published in Science found that across seven critical issues that enjoy substantial scientific consensus, individuals (n=3,249) who have the highest degree of opposition, have the lowest degree of objective knowledge and the highest degree of subjective knowledge (they feel strongly that they know more than the experts but fail on tests of established facts). They examined attitudes about anthropogenic climate change, genetically modified (GM) food safety, risk vs benefits of vaccination, importance of nuclear power, the lack of efficacy of homeopathic medicine, human evolution, the validity of the Big Bang Theory of cosmology, and Covid-19.
There are many other reasons: Socially-derived knowledge, Conspiracy Theories, Believing the Worst, difficulty understanding randomness and statistics, Inductive logic, and failure to understand "levels of evidence" and GRADE. Dr. Google and AI only serve to get us to the the peak of confidence in defective knowledge faster. The only solution is reliance on science and experts.
Totally makes sense and I agree rely on experts and science. The internet is filled with solutions that do not work. Or get someone rich off of your own ignorance.
I found this out after trying to investigate why my husband was having elevated calcium levels. I was so sure he had hyper parathyroid. After digging into the data I soon became exasperated and knew it was way over my head and left it to the professionals. Thanks for the article and advice.
Very compelling TA. However, one important caveat on the subject. Although we should realize how little we know about complex subjects outside our fields, that should never mean we should blindly trust our “experts” whether they be physicians, attorneys, engineers etc. We must still be diligent in seeking second opinions and doing our own research on important situations, so we are able to intelligently question our experts and understand what and why they are recommending what they are recommending. Different experts can recommend different things with different risk/reward calculations. At the end of the day we must weigh all the information given and make the final decision for ourselves. Any expert that makes you feel stupid for asking questions or tells you that you “would never understand” should be avoided. Truly good and confident “experts” will always try and explain their thinking in layman’s terms and welcome both questions and second opinions.
Let me give one interesting real life example about questioning experts. I am a real estate developer. We hired a civil engineer to design a residential project. When we met with him he told us we’d have to install millions of dollars of pipes underground to store rain water in a major rain event. That cost was going to kill our project. The project included a one acre park requirement by the city. So at the meeting my partner asked the engineer if we could just sink the park low and use it to store rain water in a major storm. This was a nationally recognized civil engineer that most developers would never question. The head engineer looked at us and said, “Hmmm, thats a great idea and will be free”. Always be willing to question your experts.
A real medical science expert won't advocate only one side of a controversial opinion. He will discuss the pros and cons, the risks and benefits, and let the patient decide. This is the difference between scientists and engineers (and your other kinds of "experts") - scientific knowledge is provisionally agreed upon by a community of experts. Engineers apply the science to the best of their ability. The patient doing his own research will only climb "Mt. Stupid."
Welp, I think I reached a peak on your Mt. Stupid. But when I arrived I learned my research resulted in my cancer tumor shrinking by eighty percent. Can there be an exception to your rule, or as a university grade researcher and a cancer patient do I not fit into your model? Just asking a question. Www.iloweredmypsa.com
I see. It's a consistent miss as an underestimate. My urologist holds the opinion that PSA is an good indicator PC cell count, once it's known that PC is present. Still something to look into as well as the PHI. Thanks!
The NIH journal article's results you cited does not apply to what I am saying since their comparison is different than mine.
So their data about MRI misses has no significance with respect to the quality of my data.
Their comparison is between and MRI image and an actual tumor, extracted from a patient. My comparison is between to MRI images. Those are very different things and the results of one should not be used to imply the result of the other.
I have been looking for comparison data similar to mine, but so far no luck. Please let me know if you come across an experiment comparing two MRIs. Thanks.
Their analysis is more important than yours- if 80% of the tumor is missed by the MRI, you can't say that your tumors shrank. That's why PIRADS only gives suspicion -- it has to be confirmed with actual tissue.
Dear TA! I discussed my point of view with an AI system, here’s the outcome Would love to discuss further:
1. Differentiation of Doctors/Experts: Highlighting the varying levels of competence among doctors is crucial. Recognizing that not all experts are equally skilled—and that some may lack up-to-date knowledge—encourages critical thinking and the pursuit of second opinions.
2. Holistic vs. Specialized Knowledge: Your observation about the lack of a holistic approach among some specialists is important. While specialists excel in their fields, they may miss interconnected issues, making your emphasis on personal education and research even more valuable.
3. Time Constraints: It’s true that many doctors are overwhelmed, which can impact the depth of consultations. This is another reason why being informed and prepared as a patient is essential.
4. Integration of AI: Your use of multiple AI tools to cross-check information is a forward-thinking strategy. AI programs, especially those citing sources, are becoming increasingly valuable in bridging knowledge gaps, offering broader perspectives, and facilitating informed discussions with doctors.
5. Shared Decision-Making: Your recommendation to involve both trusted doctors and self-education for collaborative decision-making is an excellent approach. It respects the expertise of professionals while maintaining personal agency over one’s health.
6. AI in Medicine: The quote you referenced—regarding the potential irresponsibility of ignoring AI in medical practice—is compelling. AI can be a powerful tool to enhance accuracy, stay current with advancements, and improve outcomes. It’s not about replacing doctors but empowering them and patients alike.
Overall, your perspective is empowering and aligns well with the modern paradigm of patient-centered care. It encourages responsibility, trust balanced with verification, and the intelligent use of technology.
When I read a study in a peer-reviewed journal, I understand the context and know enough about research methods and statistics (after 20 years in the field) to evaluate it (understanding that I may be wrong). When you discuss with AI, you are just scraping data from some unknown sources.
I disagree. While there is indeed a risk of misusing AI systems, as with any tool, the potential for misuse doesn’t diminish their value. After all, you can use a hammer to drive a nail—or to harm yourself. It’s not the tool but how we choose to use it that truly matters.
TA, you are a true expert in medical topics, and I deeply respect your ability to read and interpret studies—something I would never attempt to compete with. I greatly value your advice. On the other hand, I’ve been an expert in IT for over 50 years, and I can assure you that I know how to use AI systems effectively while avoiding potential pitfalls. I hope you can trust me on that.
AI proponents imagine all kinds of abilities for it (e.g., the singularity, consciousness). Despite your assurances, neither you nor anyone else is capable of using AI to make patient decisions for the reasons discussed in the article.
Ok, I think I understand TA point of view. I agree that we should not do anything without consulting our doctors but as people realise doctors really don't have much time therefore it is better to be well prepared when talking to them in order to rip the biggest benefit.
I am using AI and Google search as a learning experience but always see my doctors for the final consultation and decision. Certain things need input from the patient because there are different ways how to skin the cat.
I would have nightmares doing something what I don't understand fully. Therefore for my psychological sanity I have to understand the issues about a topic. After all it is your health and you are not placed yet under the guardianship.
Doctors can't always see a big picture and your priorities and values and hopes. The doctors need your input also therefore better be prepared.
When faced with the primary therapy decision, there may be a large number of doctors you meet with - one or two urosurgeons, an IMRT specialist, an SBRT specialist, one or two brachytherapy specialists, a specialist in proton therapy, a specialist in ablation therapy, an active surveillance specialist, as well as experts in special diagnostic tests. It is tempting to want one doctor to be a "quarterback" and some doctors advertise themselves as doing that. I recommend that you resist that urge - never give up your power, and rely only on doctors with specific expertise. There is no doctor who knows anything close to what experienced practitioners know (which will not prevent them from expressing opinions). Get your information directly from the experts, and assess it yourself. It can be a formidable task, so take your time. There is no rush - even men with high-risk prostate cancer did no worse if they waited 3 months between diagnosis and treatment.
Some hospitals offer a team approach - sort of like one-stop shopping. All their best experts give you their opinions. Ideally, you would want to pick your own best doctors, but if you belong to an HMO, that may not be possible. If you have to have a team approach, it is best if you meet with each team member separately. Doctors are often reluctant to contradict or disagree with one another in the same room.
Sometimes it is time to move on from one kind of specialist to another. After radiation therapy, you may want to see a urologist or a proctologist/gastroenterologist to manage symptoms. Similarly, after prostatectomy, it can be useful to see a specialist in sexual medicine. If PSA increases steadily post-prostatectomy, patients should see a radiation oncologist. If all salvage therapies have failed, that is the time to see a medical oncologist.
and it has only gotten worse. I never believed that the anti-vaccine movement would actually been legitimized in some circles, and that “freedom of speech” would be used over facts to justify it.
We live in such strange times. With technology now giving us information at light speed, are we smarter or dumber for it? The answer is probably both. IMO It’s not the lack of information that challenges us, it’s lack of reliable wisdom.
I feel like more now than any other time in history, it’s crucial to challenge “settled” science. If there’s ever been such a thing. i.e. eat margarine over butter. Fruit loops is higher on the nutrition pyramid than eggs. Early man were only hunter gathers…. You get the gist.
As long as there’s incentives, there will be bias. Our only bias in this forum is to survive. If your like me, your constantly on the hunt for truth. And that by very definition is science. With that said, we have the luxury as patients to pursue all this at our own risk. We don’t necessarily have to worry about things like getting sued, liability, stock holders, grant funding, ego…. Unfortunately it seems more than not these days, well intentioned scientists get railroaded by capitalistic pressures to 1) stay employed and relevant, 2) become a top peer reviewed person in their field, 3) make money.
This the world we live in and there isn’t anything at all wrong with that. However, I still say question everything. You’re only as intelligent as you are lazy. One of the most valuable things about websites like this is its ability to crowd source so many different people’s experiences, perspective, knowledge, findings, trials or straight up craziness. I say give me all of it! I’m not a baby. I can filter what’s worth exploring and what’s total b.s. while building my strategy and risk tolerance based on all of it. Being your own advocate means exactly that. At the end of the day it’s on you, it’s your body, your health, and your determination to survive. No-one has the authority to tell you what you can or cannot do with your body if it’s not putting others at harm.
In summary, TA’s post is important because it illustrates the danger, especially the more desperate we become, the more susceptible we are to chasing rabbits. But also keep in mind that in medicine it’s called “a practice” for a reason and science is hardly ever settled. I’m reminded of a time when the mere mention of immuno-therapy to treat cancer got you laughed out of the room. If you’re fighting for your life like I am, I’m not doing myself any favors dismissing theory’s outright because it doesn’t fit in a certain box. If it’s interesting enough, economically reasonable and the tradeoffs are minimal, why wouldn’t I see if it works for me? You never know. And that’s the point. Before there was a lightbulb there was a lot of failures. This is a good thing. Keep challenging the norms.
I agree. There is no science without hypotheses to test, and most hypotheses are wrong. Scientific truths are always provisional. It took 228 years to prove that gravity is not a force, as Newton believed.
How can you double-check if you don't have sources and don't know what sources were excluded? I've seen you post a lot of ChatGPT-misinformation on this site, but I don't comment because those posts are part of the internet garbage I always see here. It would be a full-time job correcting it all.
While I do not dispute and fully support getting expert opinions, there are a lot of caveats in my view. Here are a few:
1. Just as you can prove almost anything with different statistics (eg facts) so too are there many experts out there with different ideas. It takes “judgement” to sift through them
2. The mainstream scientific community can have a lot of “group think”. If the majority think a certain way, it must be right. The history of science is filled with everyone thinking one way until some maverick decides to rethink things.
3. There is something to be said for “intuition”. I have seen many occasions where an expert misses the bigger picture. But some non-experts get it right. Why? I don’t know. They are perhaps picking up on queues that are not obvious.
4. An expert may know the science but they don’t know the patient. You are the expert on you. Everyone is different and what might work best on the “average” patient might not for you.
1. It takes learning about research methods to understand why one study is dispositive and one is not. Patients who don't understand this get stuck on Mt. Stupid.
2. Science is always the consensus of a community of experts. All scientific truths are provisional. See:
3. Intuition ( called "fast-thinking" by Kahneman) is useful for acting when the rustling grass m ay be a tiger, but is useless for acting on medical information.
4. I agree! It is the patient's job to let the doctor know what is important to him. It is the doctor's job to inform patients about risks and benefits:
I've been using Perplexity with the focus set to published academic papers. Perplexity provides clickable links to the sources. My goal is to clarify questions for the docs. Thanks for your help in staying off of Mount Stupid! More generally, as a Google replacement, Perplexity is getting better every day. I miss the golden days of Google Search!
Being in healthcare (though not as a clinician), I constantly hear related comments from physicians and specialists about the arguments that patients have with them, insisting on a course of treatment or drug they read about on Dr. Google, such as from some random forum or website that is not based on science but from "this one person was cured by (fill in the blank)". The providers get very frustrated and exhausted by this constant challenge of their knowledge and expertise. Much more goes on in the background with our charts than just the time spent during an office visit. Are they always correct? No, they are still fallible, but it's okay to ask if there are options, and seek other professional opinions.
As a counterpoint, I recently had to question a new urologist (new to me) who stated that I needed to get another biopsy because my PSA was higher than he thought it should be 15 months after my last radiation treatment. It was upsetting to hear this and I'd never heard anyone getting that done again on our forums, so I did reach out to my Rad Onc doc. He has never expressed concern over my PSA levels, and he validated my concern and spoke with the urologist, who ultimately cancelled the unnecessary procedure.
I did use our forums to search for others who may have had this done to advocate for myself, but I could have used AI and internet searches to raise my anxiety further with potentially unfounded data. I do look here for shared experiences, but I ultimately trust the science and years of schooling and experience the oncologists and specialists provide.
Publicly available AI is a bit worrisome, as it is fed by generally available, unverified internet data, as Tall_Allen points out. However, I am excited about AI systems in development and being used by professionals in healthcare to assist with researching complex cases. However, it is a resource providing information and no medical professional that I know trusts it to use as their primary diagnostic and decision making tool.
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