Surveys are evidently a popular way to get a paper published. Put “complementary alternative medicine survey” into Pubmed and get 2,353 hits. I would have trouble coming up with a hundred groups about whom I would be interested in their use of SCAMs, but I tend to be a lumper rather than a splitter. But if you want to know about SCAM use in chronic pain patients in one Singapore hospital, the information is available.
I am a survey magnet and a remarkable number of people send me dead tree and electronic surveys which I generally ignore. So people like me, those who ignore surveys (but support public television), are underrepresented in surveys. But evidently there is no group whose attitudes about SCAM are not amenable to analysis including my medical brethren, Infectious Disease doctors.
So I was understandably curious when I was sent a link to “Infectious Diseases Physicians’ Attitudes and Practices Related to Complementary and Integrative Medicine: Results of a National Survey“. The abstract makes it sound like my colleagues are a bunch of ignorant rubes who just fell off the turnip truck: (more…)
Carl Sagan supposedly once said that randomness is clumpy. Those three words have become one of my favorite go-to quotes, particularly when teaching residents and medical students who are often overly impressed with improbable runs of similar diagnoses or exam findings. I love this quote because it is so simple and yet reveals so much about our experience with observing the natural world. Sagan’s ability to offer up insightful nuggets of rational thought, even if he didn’t actually produce this gem, was unmatched and his efforts to bring science and reason to the public have been sorely missed. If you haven’t read any of Sagan’s works, I highly recommend The Demon-Haunted World: Science as a Candle in the Dark.
If you have a coin, and a few hours to kill, record the results of a long run of flips and you’ll see what Sagan meant about the nature of randomness. You will inevitably observe clusters of heads or tails that might seem improbable, but eventually the outcomes will average out to about half of the flips being heads and half resulting in tails. The more trials that you perform, the closer the outcomes will approach 50% for each possible result, assuming you aren’t gaming the system by using a trick coin.
I don’t think that very many people would argue with the fact that on average a coin flip is random chance, although there are still people out there who think that the Earth is flat and that Justin Bieber is a reptilian humanoid. But because of a deeply rooted cognitive bias, the gambler’s fallacy, we frequently fail at recognizing that randomness is clumpy. We accept the established overall odds, but our acceptance wavers in the face of short runs that go against our expectations. This error in logic can lead to the belief, for instance, that after five heads in a row there is a higher than 50% chance that the next flip with land on tails as if to magically even things out.
In my line of work as a pediatric hospitalist, I frequently experience other healthcare professionals making this mistake in a variety of circumstances. There is a known likelihood of bacteremia when an infant less than 28 days of life is evaluated for fever, for example. Despite this, it is common for physicians and nurses to lament, upon seeing fever as the triage chief complaint, that they are due for this life threatening infection after a number of recent febrile neonates have had negative blood cultures. (more…)
The internet is a fabulous resource of information. It is one of those technological innovations for which you soon can no longer imagine how you lived without it. I certainly cannot imagine a project like science-based medicine prior to the web.
The web, however, is also a tremendous source of misinformation, opinion, and ideology. Also the volume of information, good and bad, can be overwhelming. We therefore are frequently asked the meta-question of how we conduct our research into specific topics, or how can the average layperson do their own research online.
Efficiently and effectively researching a complex topic is complex. It is a skill that needs to be developed, and it is especially difficult without having detailed knowledge of the specific topic ahead of time. Therefore there is no simple answer to this question, but I can offer some tips.
There are two main resources I use when searching a topic, Google and PubMed. They each have their strengths and weaknesses. For the average user, Google (or whichever general search engine you prefer) is likely going to be your first stop.
Mrs. Teasdale: Your Excellency, I thought you’d left!
Chicolini: Oh no, I no leave.
Mrs. Teasdale: But I saw you with my own eyes!
Chicolini: Well, who you gonna believe, me or your own eyes?
Duck Soup. Funniest movie ever.
If I could choose a super power, it would be neither flight nor invisibility, but the ability, like Triad, to separate into multiple people so I could accomplish more. I find that my multiple personality disorder is not all that efficient at getting things done. The Goth cowgirl? Lazy.
So sometimes I have to cut corners. As this post goes live I am at TAM helping with panel discussions and workshops and the only way I can get a post up is to cannibalize my lecture. Dr. Gorski will not let me post the slides and be done with it; those managing editors can be so unreasonable. Full sentences. Proper spelling. Good grammar. Sheesh. Some people.
The topic of my presentation is the cognitive errors that lead people to believe in nonsense and is, or was, a brief tour of the flawed ways in which we think and how the brain allows everyone to be under the false impression that fictions are real. (more…)