Articles

Barriers To Adoption of Science-Based Medicine

I have a confession to make – it’s not easy keeping up with the other “Joneses” on this blog. My colleagues do a terrific job with thoroughly referenced analyses of key issues in medicine – and I sometimes struggle to think of topics that they haven’t already covered in more depth than I can. So today I asked my friends on Twitter if they had any suggestions for this week’s post.

One Twitter respondent asked me for my “perspective on the biggest barriers to better funding and adoption of science- based medicine.” As I contemplated that question, an experience leapt immediately to mind…

I attended a recent press conference held at a major Washington, DC think tank. An all-star cast was assembled, including Senator Baucus and Peter Orszag, to discuss the subject of comparative effectiveness research (CER). The most memorable part of the conference, however, was when one of the CER policy “experts” took the podium and actually said this (I’m going to paraphrase slightly):

The problem with science is that it’s too narrow. We’d have a lot more information to go on if we got rid of the narrow inclusion criteria in clinical trials. The exclusivity is not an irreversible flaw in the method – we just need to open up trials to larger groups of people of all kinds of different backgrounds so we can get better information.

Wow. Where to begin with that one? Amazingly, the man was not challenged about his point of view and is probably happily developing and shaping healthcare reform policy right now. Which brings me to my first “barrier” to better funding and adoption of science based medicine – a fundamental lack of understanding of the scientific method on the part of certain people who hold purse strings. If you think that this is a an anomalous point of view in Washington, please consider Senator Harkin’s recent arguments about the role of NCCAM as a “validating” agency for alternative medicine.

Now, in all fairness, there are certainly reasonable people in Washington who understand the importance of science and the basic tenets of the scientific method. But these people may be outnumbered and outgunned by those without science backgrounds when it comes to creating policy. So, from what I can see, the first barrier to adoption of science based medicine is a fundamental lapse in science education. How can one appropriately fund and adopt something they don’t understand? It’d be like asking a bunch of doctors to reform the legal system – something we recognize immediately as foolhardy. Still, no one bats an eyelash when people without any background in science or medicine work to reform healthcare.  I don’t get it.

The second barrier that comes to mind is our human tendency to value personal experience over objective evidence. This is really, really hard to overcome. No one is immune from personal biases and scientists themselves have a hard time parting with beliefs that are misguided. For example, it seems intuitive that mechanically propping open an artery would be superior to just leaving it all clogged up – and yet, careful analysis suggests that stents (cardiac or renal) are not superior to medical management in many cases. When will physician practice behaviors change to reflect this evidence? Probably a decade.

Of course, experientialism is often left unchecked in consumer news, TV programming, and publications – where pseudoscience and an argument that “sounds good” becomes sufficient evidence to accept all types of information as fact. Some believe Oprah because she’s winsome – some listen to Jenny McCarthy because she’s attractive and passionate about motherhood. The experience that entertainers create has mass appeal, even while it’s often pure fluff or even outright harmful.

A third barrier to science-based medicine is economics. Good research is expensive, and definitive research is exorbitant. But beyond the incredible expense of carefully teasing out cause and effect in complex organisms like humans, there is the problem of financial incentives to put good research into practice. One person’s waste is another person’s income – and so there will always be industry and provider resistance to clear winners and losers in healthcare.

In summary, adopting evidence based practices in healthcare is difficult for many reasons. First, healthcare decision-makers often have insufficient science education to make informed decisions about health policy. Second, humans all have the tendency to lean on personal experience over objective evidence when it comes to making decisions – and consumer heart strings are often intentionally pulled for sales and marketing purposes. Third, economic factors introduce another layer of friction in science-based medicine implementation. There are no doubt many other barriers that I did not discuss in this post, so please feel free to add your thoughts below.

Posted in: Politics and Regulation

Leave a Comment (36) ↓

36 thoughts on “Barriers To Adoption of Science-Based Medicine

  1. Scott says:

    “One person’s waste is another person’s income – and so there will always be industry and provider resistance to clear winners and losers in healthcare.”

    I think this deserves greater prominence. There are substantial numbers of well-funded people – homeopaths, reiki practicioners, acupuncturists, chiropractors – whose livelihoods are 100% based on explicitly divorcing medicine from science.

    That sort of active ideological resistance is quite a different kettle of fish than a manufacturer of MRI machines who stands to lose out if MRIs are judged to be overused.

  2. weing says:

    “First, healthcare decision-makers often have insufficient science education to make informed decisions about health policy.”

    How true. Especially when they think they do.

    I think it would be a good idea to have physicians make legal reforms. Let’s give them a taste of what they have been doing to us. How about $10,000 for a murder trial, including all appeals? Let’s cut out all this unbundling.

  3. Scott says:

    Not seeing the entire speech, are you certain the CER speaker was not referring to effectiveness (i.e., real-world, phase 4) trials vs. efficacy (Phase 3) trials?

    Clinicians and other decision-makers (e.g, formulary committees) can have difficulty interpreting clinical trials and their impact in the “real world” because the inclusion and exclusion criteria are often so narrow that the majority of patients that will ultimately receive a drug/therapy/technology have actually not been studied. And patient behaviour in a clinical trial is also not 100% reflective of real world use, where issues like compliance/adherence, other medications, etc are factors.

  4. Tim Kreider says:

    “One person’s waste is another person’s income – and so there will always be industry and provider resistance to clear winners and losers in healthcare.”

    Although we usually focus on the kind of providers Scott mentions, this point is also important to consider in the context of physician adherence to evidence-based guidelines. If policy makers try to save money by reducing unnecessary stents, to build off Dr. Val’s example, then the surgeons placing the stents are “losers” under a system that creates financial incentives for performing procedures.

    I’d love to read opinions from folks here about Atul Gawande’s recent New Yorker piece on this topic. He describes how medical culture and systemic incentives can affect over-utilization of expensive diagnostic and surgical procedures, but I imagine similar arguments could be made about how culture and incentives influence the use of SBM versus out-dated practices or CAM. http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

  5. ghrasko says:

    I just had a TV debate with two CAM proponents (doctors) here in Hungary. 99% of their reasoning was listing personal experiences. And the examples were very moving, full with emotions. The audience loved it of course.

    I immediately started to think about that we must find a solution for that tactic (or reasoning). Of course we do have arguments, but those do not have the same emotional power. We must have not just the arguments, but the appropriate packaging as well.

    I do not know the solution yet, but maybe we could figure out a good communication model for it.

    Gabor Hrasko
    Budapest, Hungary

  6. Versus says:

    (Tried to post this comment earlier but it never showed up and no message popped up that it was being mediated, so I guess the ether ate it. Here it is again, from memory, and with apologies if it shows up twice.)

    Before you euthanize all the lawyers, please hear me out.

    I am an attorney and am appalled that my state (Florida), as well as the 49 others, allow chiropractors and the like to become “licensed health care providers.” To my legal (and decidedly not-science-trained) mind, this is legalized fraud. So I decided to try to do something about it. I recently formed a not-for-profit, the Campaign for Science-Based Healthcare, which just launched a website, http://www.sciencebasedhealthcare.org. (Please don’t sue me for copyright infringement, SBM — couldn’t think of another adjective.)

    The website gives consumers information about “alternative” healthcare practices licensed in Florida. It also proposes the enactment, by the legislature, of a science-based standard for all healthcare practices in the state. Proposed legislation is on the website.

    It has been slow going getting this off the ground. Many people don’t understand why healthcare should be science-based. (Sigh!) However, those with some background in (you guessed it) science “get it.”

    If any of you have any ideas, I’d love to hear them. You can reach me through the website.

    I have to come to SBM at least every few days to keep my spirits up. Thanks, guys.

  7. James Fox says:

    Val Jones writes: “It’d be like asking a bunch of doctors to reform the legal system – something we recognize immediately as foolhardy. Still, no one bats an eyelash when people without any background in science or medicine work to reform healthcare. I don’t get it.”

    I would think Health Care Reform, is typically seen as an economic and policy concern with little to do with what medical practices are most effective. I don’t know that doctors deserve any more prominent place at the table discussing how my money is spent than any other consumer and/or tax payer. The discussion of science and medicine is one thing and national policy with regard to the provision and allotment of health care resources is more often than not something else entirely. The exception would be the decision to fund CAAM/woo on the national dime. Those doctors who believe in science based medicine need to shout long and hard about that issue. As to whether we need a single payer, socialized or free market health care system seems quite a separate question than what practice is most effective and based on scientifically derived evidence.

  8. ImperfectlyInformed says:

    I’m not sure what to make of Val’s criticism of that comment. Let’s look at again:

    The problem with science is that it’s too narrow. We’d have a lot more information to go on if we got rid of the narrow inclusion criteria in clinical trials. The exclusivity is not an irreversible flaw in the method – we just need to open up trials to larger groups of people of all kinds of different backgrounds so we can get better information.

    The narrow inclusion criteria for clinical trials, in order to make the data more convenient and reduce the side-effects presented (to make approval easier), is an ongoing problem in medical research. It has been highlighted as such by numerous people and papers for a long time now. In 2007, for example, JAMA published an analysis of exclusion criteria. The paper (http://www.ncbi.nlm.nih.gov/pubmed/17374817) concluded:

    The RCTs published in major medical journals do not always clearly report exclusion criteria. Women, children, the elderly, and those with common medical conditions are frequently excluded from RCTs. Trials with multiple centers and those involving drug interventions are most likely to have extensive exclusions. Such exclusions may impair the generalizability of RCT results. These findings highlight a need for careful consideration and transparent reporting and justification of exclusion criteria in clinical trials.

    The argument that this healthcare policy bureaucrat was arguing for CAM seems like a non sequitur. Am I missing something?

  9. Danio says:

    I agree that there is a bit of ambiguity in the original quote, and that it can read as advocating for more studies with more heterogeneity as a means to improve generalized conclusions. Admittedly, if this is what the CER policy guy was in fact trying to say, he worded it very badly indeed.

    I don’t imagine that the data from any clinical trial would be improved by just letting anyone in and ceasing all screening for potentially confounding or risky medical conditions, etc. It seems, though, that differential effects or sensitivities to based on ethnicity or gender are often only noted after a drug has hit the market, and a more representative cross section of the population is actually using it. In principle, it sounds sensible to try and control for this in trials, i.e. add arms to include at least one other ethnic group, or have men & women who were otherwise comparable in relative fitness participate in the study in tandem. Clearly it would cost a lot more to conduct such a study, so maybe that is the limiting factor. Is there an obvious downside from a medical or statistical perspective, though? Is the exclusion criteria being criticized in the JAMA quote a straw man?

    Val, would it be possible to provide some context for why you interpreted the quote as a failure in the application of the scientific method?

  10. Fred Dagg says:

    We treat the U.S. public as a bunch of ignorant morons.
    We have a job to educate, not regulate. The word “Doctor” initially meant “teacher”, not physician.
    Educate the public first, make it sound and rational.
    If CAMs are succeeding, it is because we are hiding behind the word “science” to force people to do things, and you do not hold the same standard to ourselves.
    The biggest barrier to the adoption of science based medicine comes from within the profession. We should look at the self-imposed barriers. As I have said before, “science” can be used to prove whatever one wants, and to hide behind a porous shield called it “science” is unfair on the general public.

  11. daedalus2u says:

    The quote demonstrates a failure to understand the scientific method. The scientific method does have limitations. However the scientific method has the greatest likelihood of getting an answer that is reliable and correct. The method of “guessing” has no limitations at all. It can answer any and every question with no limitations what so ever. However the method of “guessing” is unlikely to reach a reliable and correct answer. There is a trade-off between the ease of guessing and the difficulty of answering questions scientifically.

    Fred, you don’t understand science well enough to apply it. If you think that the scientific method can be used to “prove” anything, then you have not a clue how to do science. The “fault” for you not having a clue about how science is done and what it actually means and can accomplish lies with you. You would rather wallow in your pseudoscience than learn real science.

    People cannot be “taught” things they don’t want to know or understand. It has been compared to trying to teach a pig to sing.

  12. Fred Dagg says:

    Perhaps you are teaching them incorrectly.
    People learn according to their own ability and the information put in front of them. How arrogant you are to presume that the public are too ignorant to understand or do not want to learn, when in fact the “teacher ” is not doing the job properly.

    I am not sure where the concept of “guessing” comes in, I do not support that, and it is presumptuous of you to think that.

    I do understand the scientific method. I have also seen the way “science” is abused to acheive a goal that may at times be unethical.
    I have also seen the way “science” contradicts itself, depending on the eyes of the viewer.

    You seem to retreat behind this self-imposed barrier of “science”, call yourselves “scientists” when someone disagrees with you. Calling soeone a “pseudo-scientist” as an insult, because they disagree with you shows an absolute arrogance. Rigid thinking rather than looking beyond the issue.

    The barrier comes from within, because you believe that you are right and no one else has the same knowledge base as you. That is not “science”, that is dogma.

  13. daedalus2u says:

    Fred, if what you are doing can be used to prove “X” and “not X”, then what ever it is you are doing is not science.

    If you don’t understand that, then there is essentially no common ground on which we can communicate about science.

    If you are not doing science, it is not an insult to say so; it is simply a statement of fact. Which I have on good authority is never the slightest bit insulting or even insolent.

  14. Fred Dagg says:

    Perhaps we should have a think and answer a simple question.

    Name a “pure and absolute science”, about which we know everything?

    It is impossible, because “science” is always changing according to the knowledge and perception we use to interpret it.

    Anyway, please give me an example of a pure and absolute science, about which we know everything?

  15. daedalus2u says:

    If “something” can be used to “prove” both “X” and “not X”, I know that the “something” is inconsistent and so cannot be used as science.

    I don’t need to know everything to know that something is not science. Knowing that something is inconsistent is sufficient for me to know it is not science.

  16. trrll says:

    In the absence of other context, I also read this as a concern regarding generalizing results obtained on a particular, rather homogeneous, group of subjects with similar backgrounds to the entire population, without any science to justify it.

    He seems to be arguing for more diverse, larger clinical studies.

  17. Diane says:

    Fred: > “Anyway, please give me an example of a pure and absolute science, about which we know everything?”

    For something “pure” or “absolute” you’d have to look to religion or some other sort of “ideology”.

    Michael Shermer said that science is more of a verb than a noun. There is no absolute or pure anything. Not in real life, anyway. Science works harder and comes closer than anything else, any other human activity, to bring measurable events into sight line with each other, into correlation, and subtract away irrelevancy, perceptual fantasy, premature cognitive conceptualization.

    Correlation will never equal causation. Science is not only aware of that, it works with it by never making categorical or absolute statements about anything. By never making categorical or absolute statements about anything it comes closer than anything else can, to an abstraction known as “truth”, which can be “trusted” by having had as much nonsense as possible vetted out by scientific processing.

    The scientific method doesn’t change, but the output of the scientific community changes all the time, builds on itself, enables the building of better, more useful concepts to enhance human primate troop life for all, even for those human primates who fail to understand or appreciate science as a verb and not a noun, and take “progress” in health care/food/clothing/shelter/transportation for granted.

  18. Fred Dagg says:

    Well put, Dianne. Some logic for once, and that is what I arguing. “Science” changes, it is a state of flux.

    All one can really say it, “With the scientific method I have at my disposal, and with my knowledge of the subject, these are the conclusions I have come to.”

    But, it can change and the “science” may be obsolete in a very short time. So one cannot hide behind the shield of “science”, when that shield is porous and is continually changing.

    I do not agree with the following statement.

    “For something “pure” or “absolute” you’d have to look to religion or some other sort of “ideology”.”

    I would consider religions to be less than pure as they rely upon interpetation.

  19. pmoran says:

    No, Fred, nothing entitles you to judge that ALL “scientific” judgments are subject to change.

  20. Fred Dagg says:

    Hi pmoran

    please give me an example of scientific judgements that have not changed?

  21. LionDancer says:

    Fred Things fall when I drop them.
    I don’t think that “scientific judgement” has changed.

  22. Fred Dagg says:

    You are right, however the explanation of gravity changed from the time the apple fell on Newtons head. The fact that the apple falls, is correct, however the science changed to explain it.

  23. pmoran says:

    Fred: please give me an example of scientific judgements that have not changed?

    How many do you want? Even assuming we are not talking about the essentially factual descriptions of observable reality that science takes for granted and builds upon, such as that the normal human has a certain anatomy and is made up of certain chemicals, there are innumerable medical judgments that have not only not changed since being proposed centuries ago, but which have vanishingly little likelihood of ever changing.

    The disease scurvy is preventable by certain fruits? Bloodletting will do more harm than good in the acutely and seriously ill?

    I am sure you can think of quite a few too.

    But I was mainly suggesting that just because some major scientific principles may have changed (and usually only at the edges) you cannot predict that of any other.

  24. Scott says:

    “You are right, however the explanation of gravity changed from the time the apple fell on Newtons head. The fact that the apple falls, is correct, however the science changed to explain it.”

    Not really true (or even close). The scientific explanation for it became more precise and general – nothing more. Newtonian gravity is still completely legitimate and universally accepted today. It’s simply now understood as an approximation of general relativity, accurate in the non-relativistic limit. It is similarly generally accepted that general relativity is an approximation to some other, more complete and accurate (but as yet unknown) theory. (It has to be, since it is not a complete description of the universe.)

    Science grows by adding additional layers of knowledge on top of what is already established. Theories that are well-supported by evidence are rarely discarded, precisely because the evidence demonstrating them to have validity doesn’t disappear.

  25. mckenzievmd says:

    I think the key problem is simply our brains and how they work. While our reason can develop and recognize the value of complex statistics and scientific evidence, we have evolved a set of quick and efficient heuristics, along with a strong emotional sense of “rightness” and certainty about their conclusions, that make it hard for even well-educated, rational people to dispense with their own intuitions in place of more rational conclusions. The practical successes of science-based medicine and the wider availability of science education have helped a great deal, but I routinely run into clincians who are comfortable and certain about their clinical impressions and the anecdotal evidence behind them despite “knowing” better at some level.

    Brennen McKenzie, MA, VMD
    http://www.skeptvet.com
    http://skeptvet.com/Blog

  26. Diane says:

    I just learned today about the Dunning-Kruger effect.
    http://en.wikipedia.org/wiki/Dunning-Kruger_effect

    If you look down the page, you’ll see an entry, “crank”.
    http://en.wikipedia.org/wiki/Crank_(person)#The_psychology_of_cranks

    Could this be a large barrier to adoption of science-based medicine?

    From the entry:
    Kruger and Dunning hypothesized that with regard to a typical skill which humans may possess in greater or lesser degree:[5]

    1. incompetent individuals tend to overestimate their own level of skill,
    2. incompetent individuals fail to recognize genuine skill in others,
    3. incompetent individuals fail to recognize the extremity of their inadequacy,
    4. if they can be trained to improve their own skill level, these individuals can recognize and acknowledge their own previous lack of skill.

    They confirmed these hypotheses in a series of tests.”

    I can think of at least one entire so-called profession that was built upon the principles of crankdom.

  27. Geekoid says:

    Frd – I love how you comment on someone using logic for once, yet still haven’t put forth a logical argument for any of your ‘points’.

    You also seem to be missing the fact that science uses facts, where as non-science uses emotional appeal.

    You dont’ even address the problem of HOW to educate people on the sceintific facts. IN a world where a crank pusher like Oprah ahs millions of viewers, how can someone even hope that any group of people won’t take what she says as then ‘truth’?
    IN fact, it Occurs to me Oprah is educating people, but with lies.

  28. trrll says:

    You are right, however the explanation of gravity changed from the time the apple fell on Newtons head. The fact that the apple falls, is correct, however the science changed to explain it.

    There are multiple levels of scientific theory. So it is a theory that masses tend to fall toward the center of the earth. It is theory, rather than fact, because nobody can check all possible masses, past, present, and future, so we are theorizing that we may generalize from a limited (albeit large) sample to all masses. This theory, obviously, has not changed. On the other hand, there are more detailed theories that describe the trajectories, the rates of fall, the dependence upon altitude and the presence of other masses, etc., etc. These theories have changed somewhat over the years. Over time, the magnitude of the changes (in the predictions of the theory for commonly encountered conditions) have gotten smaller and smaller. This reflects the fact that science is a process of successive approximation–i.e. over time it gets closer and closer to the truth, but one knows when or if it has arrived.

  29. Val Jones says:

    Thanks for all the comments. In retrospect, perhaps I didn’t offer enough context for that quote about inclusion criteria. Basically (unless I completely misunderstood 30 minutes of conversation) the guy was arguing that scientists were being narrow for no good reason – that their studies were not helpful because they were too limited in scope – and that this could easily be solved by overriding their apparent prejudices. He didn’t get why variables needed to be controlled, or why confounders could be introduced by broadening inclusion criteria. He wasn’t saying that we needed much larger studies, or even more studies in different populations… he was saying that if we fling wide the doors to anecdote we’ll advance science faster. It’s the same sort of thing as the “wisdom of crowds” philosophy… Let’s ask patients to vote on which medications they like best so we can know which ones work best for each disease/condition.

  30. Fred Dagg says:

    Of course, when talking about examples of “unscientific medicine”, how about someone telling me how “scientific and ethical” appearance medicine is. We have the Michael Jackson’s and the Joan Rivers with their plastic surgery. We have California, the land of the silicon breast implant. How ethical and scientific is this? Any comments from all you “scientists”

  31. gretemike says:

    Fred,

    Plastic surgery is very science-based I think, even if it happens to be used foolishly at times.

    Ethics is another issue. You seem to be suggesting that because mainstream medicine is once in a while used unethically, therefore all mainstream medicine is unethical. That fallacy requires no further comment.

  32. Fred Dagg says:

    Hi Mike,

    not quite right, I am suggesting that no one can hold their profession up to be blame free and absolutely pure. I find that so many of the contributors on this site sit in their ivory towers and infer that there is purity in what they do, and no one else has any validity at all.
    I would suggest to you that plastic surgery is very “technologically” based. Famous plastic surgeons like Mr. Archie McIndoe who operated on the poor burnt fliers during World War Two were absolute icons of their field. He took an infant profession and with experience and observation created some methods in plastic surgery that are still used today.
    You have misinterpreted my comments on ethics. The medical practitioners I deal with would be some of the most ethical people I know. They are also very open minded and science based.

  33. Diane says:

    Fred: > 1. “please give me an example of a pure and absolute science, about which we know everything?

    Fred: > 2. “I am suggesting that no one can hold their profession up to be blame free and absolutely pure.”

    Fred:> 3. “I find that so many of the contributors on this site sit in their ivory towers and infer that there is purity in what they do, and no one else has any validity at all.”

    My bolds.
    I submit that “purity” seems to be something Fred is hung up on a bit.
    I submit that a notion of “purity” or comparing how “pure” one field of human endeavor is against another, has nothing to do with the issue here.
    I submit that a concept of “purity” usually connotes religious thinking, and maybe OCD thinking, and that looking at the world and at arguments defending science through a lens of “why is that any more pure than any other way of doing things” is an odd and inaccurate lens through which to be looking at or judging science-based thinking.
    I submit that notions based on “purity” or lack thereof might, in and of themselves, constitute a barrier to adoption of science-based medicine.

  34. daedalus2u says:

    An infatuation with “purity” reminds me of the movie Dr Strangelove, where “purity of essence” was an important plot element.

  35. David Gorski says:

    Actually, “purity” is a big deal in “alternative” medicine. Indeed, think about how many diseases are viewed by CAMsters as being due to “contamination” with unnamed “toxins” and how much of alt-med involves various “detoxification” modalities, such as colon cleanses, chelation therapy, liver flushes, etc.

  36. Diane says:

    daedalus2u: -> “An infatuation with “purity” reminds me of the movie Dr Strangelove, where “purity of essence” was an important plot element.”

    Yeah. This gets back to what I said earlier, a notion of “purity” is a end-game, a closer, because there is no such thing as “purity” except in the mind, as an absolute, i.e., a religious sort of “idea” (only God is pure) or a political “idea”(my party has purer motives than your party) or a eugenic “idea” (ethnic cleansing). It’s “ideo-logical” therefore, by definition, which means it isn’t a scientific way of thinking or conceptualizing. These two ways of thinking are mutually exclusive, IMO.

    David Gorski: -> “Actually, “purity” is a big deal in “alternative” medicine. Indeed, think about how many diseases are viewed by CAMsters as being due to “contamination” with unnamed “toxins” and how much of alt-med involves various “detoxification” modalities, such as colon cleanses, chelation therapy, liver flushes, etc.”

    Exactly. That’s where I was heading with that.
    There are two main ways humans conceptualize.
    One is idealistic (religious, comparing everything to some impossible and imagined “ideal”); the other is scientific (measuring bits of reality and comparing them to each other, trying to determine if relationships exist).

    CAM reinforces the first. It sees itself as defending ideals, actively tries to be a barrier to adoption of science-based medicine, criticizes SBM for falling short of ideals and/or for failing to support idealism as a method of conceptualization, argues for its own right to continue to exist because idealism is such an institutionalized and entrenched mental behavioural memeplex in human primates in the first place.

Comments are closed.