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485 thoughts on “Reflexive doubt

  1. pmoran says:

    @Lizkat

    It is not in the least elitist to hold that what you call “the average person” would have extreme difficulty in even finding the time to assimilate and understand the enormous amount of data that is available concerning the nature and treatment of HIV/AIDs, or of many other medical conditions. Even just getting a handle on the basic medical vocabulary can take months. Some can do it, most can’t, and those who can’t are clearly not always aware of that fact.

    If you want proof of this, Lizkat, I simply refer you to what you yourself have described as “the chaos on the Internet.”

    So by all means make up your own mind, and make your own decisions. That is your right when you are acting at your own expense and risk.

    But don’t come here, or anywhere else, pretending that you actually know anything of importance to anyone else.

    For example, you are clearly don’t know enough about virus infections, and especially retrovirus infections, to understand what a triumph it is that the lives of HIV patients are being prolonged at all by treatment, in what is a mostly patient-acceptible trade off between life extension and side effects.

    You don’t understand why doctors might be reasonably proud of that, or do you? (I don’t trust drug companies either, but I do trust my fellow doctors when they are so sure that lives are being extended. That should be your inclination too, if you have any sense.)

  2. micheleinmichigan says:

    “If we are unlucky enough to catch a serious disease, we should meekly obey our doctors and not waste time trying to making sense of the chaos on the internet.”

    If you are unlucky enough to catch a serious disease you should do what you want with the attitude that you wish. No one is going to stop you.

    There is a point that you can NOT get help from a doctor unless you chose to work with him or her. That is all there is to it. If you do not want help from any doctor, don’t seek them out or seek them out and don’t listen to them. It’s your dime.

    Like weing, I do not see your argument here. Nobody is requiring you to take any AIDS treatment. Nobody is requiring AIDS patients to take any treatment. Whether they want it or not is THEIR decision, it really doesn’t matter what you think of it.

    And by the way, it is nobody’s job to prove to you that gravity exists either or the color blue or Mongolia. If you chose to disbelieve. So be it. Good Luck with that.

  3. micheleinmichigan says:

    Alison gets the award for best use of an asterisk in a SBM comment.

  4. EricG says:

    a humorous rearrangement of lizkat’s quotes…as per her(?) quotes

    “I have never been involved in AIDS research. There has not been, as far as I can tell, the kind of substantial high quality research that would normally be required by science-based medicine. I would very much like to read case studies that illustrate this. I could not find any. I have been looking! And no one here provides helpful clues! It bothers me so much that these wonderful drugs are doing such wonders for people. I just don’t trust the drug companies and have seen many examples of their sleaziness.”

    ok, joking aside (and the obvious sarcasm intended in the 2nd to last sentence) I (perhaps we…or some) get it. you are a skeptic, you exist alone on an island of doubt, impenetrable to various biases, coming to your own bold, fresh, evidence based, hard-nosed, tried and true, put through the wash, conclusions. great, all contributors should be the wiser for your “challenge to authority.” however, if you wish to actually learn something, i would advise to go read something (a lot of things…all things). this has been an exercise in masochism; i would venture to say that no one has learned a thing (about AIDS anyway).

  5. Plonit says:

    No one has provided any good evidence or reasons for their approval of the AIDS drugs. No one has even described an example of a patient who was dying from AIDS, went on the drugs and recovered and lived relatively normally for many years.

    ++++++++++

    LIZCAT! YOU ARE WILLFULLY IGNORING MY RESPONSE TO THIS CALL FOR EVIDENCE AND CLINICAL EXPERIENCES. I HAVE POSTED THEM SEVERAL TIMES. HERE IS ONE

    http://www.impactaids.org.uk/lancet363.htm

    (Sorry for shouting folks, I didn’t want lizcat to miss it yet again!)

  6. Plonit says:

    I brought up the subject in response to Dr. Tuteur’s glowing praise for the treatments.

    ++++++++

    Actually, it wasn’t even in her list of top 20 medical advances off the top of her head – which also says something.

    I was the one who raised HIV/ADIS treatments as a ‘modern medical miracle’ (of course, I don’t think it’s literally a miracle) – and one brought about through challenge to authority (not science).

  7. BillyJoe says:

    micheleinmichigan,

    “Alison gets the award for best use of an asterisk in a SBM comment.”

    Damn, you beat me to it!

    =====================

    Alison,

    “I am unlucky enough to have developed a serious disease. I am lucky enough to have access to doctors, people who have been to medical school, treated thousands of patients, understand how tests work and know how to interpret research; as such they are essential collaborators. I am also lucky enough to be literate and to be able to go some way to educating myself on topics that interest me. If I had delayed seeking help for my serious illness until I had given myself the equivalent of a medical school education and residency by googling the internet* I would be dead today. If I had the capacity to be a doctor myself, I would have gone to medical school. I don’t and I didn’t.”

    * This is not possible, by the way. Just so you know.”

    Spot on!
    In that paragraph you have encapsulated, and exposed the myth of, “informed choice”.
    Congratualtions!

  8. BillyJoe says:

    LizKat,

    Moment of truth.

    You have HIV/AIDS.
    At this point in time, you are not going to be able to improve your knowledge of your illness after all the internet “education” you have already given yourself so you may as well give your decision now:
    Do you take HAART?

    Yes or no?

  9. lizkat says:

    My attitude about medical doctors is that they have access to certain diagnostic tests and technology, the ability to write prescriptions and the skill to do certain kinds of procedures. I cannot do those tests myself or write those prescriptions. I can’t do surgery on myself, obviously.

    As for the person who said she doesn’t have the ability to become an MD — that is exactly the kind of meek attitude that certain old-fashioned doctors love to see. It’s ridiculous.

    From what I currently know about HAART, BillyJoe, no I would not advise you to take it if you havee AIDS. My opinion could change depending on whether anyone here ever provides good evidence for it.

    Since no one has yet, I doubt anyone will.

  10. Plonit says:

    My opinion could change depending on whether anyone here ever provides good evidence for it.

    +++++++++++

    Why are you ignoring the evidence? Please look at the links I’ve posted! Won’t you comment on them?

    http://www.impactaids.org.uk/lancet363.htm

  11. (Um, thanks folks.)

    Lizkat and anyone else, you might be interested in http://boards.medscape.com/.29f3af03/ .

    Mark Crislip (who commented above) is an ID (Infectious Diseases) doctor. His blog Rubor Dolor Calor Tumor is carried by Medscape, which anyone can access. (You have to register, but it’s free.) It’s technical (I don’t understand most of it) but it’s the best illustration I’ve seen of how doctors approach problem-solving. He’s well aware of the problems – more problems than his patients would be able to discover by googling – that’s his job. And he has to figure out the best way to help. Often he doesn’t have a really good solution; sometimes he does.

    Note that by definition the cases he discusses have been referred to a specialist – possibly lots of specialists – because other doctors don’t know what to do. So it would be false to conclude that “Dr Crislip can only make an educated guess so doctors are just guessing so my guess is just as good as anyone else’s and doctors don’t do anything.”

    And note that because of his speciality, most of what he can do for someone is choose the right antibiotic or antimycotic or antiretroviral or whatever. Lifestyle counselling isn’t going to fix a fungus ball in someone’s kidney, and if their own immune systems were up to the job his services wouldn’t have been called in. So it’s a narrow view of medicine: doctors generally do many other things, but that’s what Dr Crislip does.

    Disclosure of COI: my father’s life was saved by an ID doc when he came home from Bangladesh with paratyphus that he had been unsuccessfully trying to treat with Cipro.

  12. Zoe237 says:

    “My attitude about medical doctors is that they have access to certain diagnostic tests and technology, the ability to write prescriptions and the skill to do certain kinds of procedures. I cannot do those tests myself or write those prescriptions. I can’t do surgery on myself, obviously.

    As for the person who said she doesn’t have the ability to become an MD — that is exactly the kind of meek attitude that certain old-fashioned doctors love to see. It’s ridiculous. ”

    Oh good grief. I figured the existence of people with “reflexive doubt” surely was exaggerated (as compared to the number who reflexively trust)… but you are proving every point in the original post.

  13. weing says:

    “My attitude about medical doctors is that they have access to certain diagnostic tests and technology, the ability to write prescriptions and the skill to do certain kinds of procedures. I cannot do those tests myself or write those prescriptions.”

    Why didn’t you says so in the first place? Why, even a child can write a prescription and anyone can do the procedures by just observing the mechanics of them. Why bother to learn the basic sciences and clinical sciences and go through years of residencies and fellowships? They are obviously not necessary.

  14. Fifi says:

    lizkat – “As for the person who said she doesn’t have the ability to become an MD — that is exactly the kind of meek attitude that certain old-fashioned doctors love to see. It’s ridiculous.”

    Actually, not everyone has the ability to become an MD for all kinds of reasons (financial, intellectual, emotional, psychological). Not everyone can afford the very lengthy training it takes to be an MD, not everyone can pass the basic entry exams and finish the necessary science to train as an MD and some people faint at the sight of blood and are horrified by the things the human body does when not healthy. So, no, not everyone can become an MD and it has nothing to do with them being “meek”. And some of us just didn’t want to become MDs and wanted to focus our lives on other things that interest us. While I may well have the ability to become an MD (at least intellectually and constitutionally), I chose not to. I have no difficulty accepting that my friends who are neuroscientists and medical researchers know more than me about their specialization, just as I know more than them about mine. We often discuss each other’s areas of expertize but only a fool would assume that simply because one has the potential to an expert in an area of study and experience that one IS an expert without the necessary study and experience. Growing up around medicine, neruoscience and psychology certainly made me more knowledgeable than the average person about biology, medicine, the brain/mind and the politics/ethics around medicine but it doesn’t make me a doctor. Even doctors (well, ones that aren’t egomaniacs) don’t assume to be experts in specializations that they’re not trained or experienced in – even if their training may give them more insight that the average person, it doesn’t make them an expert in that field.

  15. lizkat has inadvertently supplied an outstanding example of reflexive doubt in action.

    She has emphasized two themes that pervade the philosophy of reflexive doubt: the assumption that only the weak and stupid trust authority and the presumption that lay people can acquire the knowledge necessary for evaluation of complex medical phenomena by self-education.

    Indeed, it is possible to rewrite parts of my post to capture why lizkat’s is impervious to scientific evidence and why she insists on her own “expertise.”

    So AIDS denialism (about the disease or about efficacy of various treatments), like most forms of “alternative” health is about the believers and how they would like to see themselves, not about HIV and not about effective treatments. In the socially constructed world of AIDS denialists risks of treatment “outweigh” any possible benefits. Individuals are divided into those (inferior) people who are passive and blindly trust authority figures and (superior) denialists who are “educated” and “empowered” by taking “personal responsibility”.

    Similarly, the purported “risks” of ARV’s and HAART express cultural anxieties over expert systems and the concommitent devaluation of self “education.”

  16. lizkat says:

    It is discouraging to see a scientific skeptics’ web site promoting blind faith in authority, and the enthusiastic acceptance of treatments without RCTs.

  17. micheleinmichigan says:

    My attitude about medical doctors is that they have access to certain diagnostic tests and technology, the ability to write prescriptions and the skill to do certain kinds of procedures. I cannot do those tests myself or write those prescriptions. I can’t do surgery on myself, obviously.

    Firstly, can you say “frustrated drug seeking?”

    and since we are paraphrasing lizcat.

    ‘My problem with doctors is that they refuse to act as mindless tools catering to my wishes (informed or otherwise). They should meekly give me the prescriptions, tests and surgeries I tell them to, regardless of what education, common sense or ethics dictates.

    If insurance companies deny payment for these treatments they are facists. If I suffer negative effects from the treatments, I can always blame the doctor.’

  18. lizkat says:

    Ok weing, I’m sorry. MDs also have specialized knowledge. But I still do not have blind faith in their advice.

  19. lizkat says:

    [Similarly, the purported “risks” of ARV’s and HAART express cultural anxieties over expert systems and the concommitent devaluation of self “education.”]

    Wow. You really don’t think these drugs have risks. Incredible.

  20. “promoting blind faith in authority”

    Rejecting your outlandish and unsupported claims is not “blind faith in authority.” It is merely rejecting your outlandish and unsupported claims.

    YOU are the only person who has invoked “authority” and it is typical of the grandiosity of CAM believers and conspiracy theorists to imagine that their “ideas” represent a bold and brilliant challenge of authority. They merely represent nonsense and defiant behavior.

  21. Lizkat, it’s not that the drugs don’t have risks. It’s that you will never believe that it’s possible for the benefits to be worth them, whereas people who have access to both science and patients believe the benefits are often more significant than the risks. Patients who take the medications obviously find that the risk/benefit ratio works for them.

    If it’s not possible for a risk to be outweighed by a benefit, then we must assume that the “risk” is not something quantifiable, like diarrhea, mood swings or neutropenia; it must be something more abstract. For instance, “cultural anxieties over expert systems.”

    *** *** ***
    In related news, a friend learned yesterday that his doctor doesn’t recommend continued chemotherapy; he thinks my friend should be concentrating on quality of life issues now. (That is, end-of-life issues.) My friend is 35 and was diagnosed at 33. So his surgery and chemo probably ended up buying him two additional years. The kind of chemo and surgery he got are not for the faint-hearted, but they were worth it to him.

  22. Fifi says:

    I though I’d share something positive and exciting regarding patient advocacy and involvement with science – and the power of non-profit medical research. Not all medical research has a profit motive or is conducted by Big Pharma, in fact much of it doesn’t and isn’t.

    This is a remarkable non-profit research project that focuses on ALS

    http://www.als.net/

    And a site developed by the same people that provides patient support and allows people to compare their experiences of treatment, disease progression and so on. I think it’s a brilliant initiative on many levels, I’d be curious how some of the SBM bloggers view it…

    http://www.patientslikeme.com/

    And a TED talk by the man behind it…

    http://www.ted.com/talks/jamie_heywood_the_big_idea_my_brother_inspired.html

    Like it or not, information technology has already changed the practice of medicine in a million and one ways. The question is whether the response is reactionary and fearful of change or proactive so that the changes are constructive and serve all involved – patient and doctor – in the best way possible.

  23. “[O]nly a fool would assume that simply because one has the potential to an expert in an area of study and experience that one IS an expert without the necessary study and experience.”

    Aye-aye, Fifi!

  24. Fifi says:

    It’s perhaps relevant to point out the difference between faith and trust. Faith is unearned, we believe in someone or something even though we have no evidence. Trust is earned, we believe in someone or something because there is evidence that they walk their talk, and can do or are what they claim.

    I don’t have faith in medicine, science or doctors. I do trust that science – when practiced ethically and not corrupted by corporate interests – is the best way to study and understand physical reality and the objective world (and can give us huge insights into our subjective experiences). This is because I’ve seen science do this repeatedly and even overcome ideological biases that are prevalent in society. I don’t have faith in science, I do trust the scientific method to be the best means for studying the objective world. I don’t have faith in medicine, however I do trust unbiased researchers to do their best to understand what they’re researching and I do trust specific doctors based upon my experience with them. However, Big Pharma has earned my mistrust (and I do question any doctor who is uncritical and/or unaware of how commercial interests can bias science and medicine and who dismisses some of the unethical behaviors of Big Pharma and only focuses on Big sCAM). This doesn’t mean I think drugs are evil, I just think that the commercial developers can’t be trusted to not fudge the science or exploit and try to manipulate people they see as “consumers” (and I’d mistrust a doctor who viewed me as a consumer rather than a patient too).

  25. weing says:

    As long as you are also critical and aware of how government interests can bias science and medicine and not dismiss the unethical behavior of big government too, I have no problem with your ideology.

  26. lizkat says:

    [Rejecting your outlandish and unsupported claims is not “blind faith in authority.” It is merely rejecting your outlandish and unsupported claims.]

    I have not been making any claims. I have expressed skepticism regarding some of your claims. And your whole post was about how patients should have faith in MDs, rather than try to figure things out for themselves.

    [YOU are the only person who has invoked “authority” and it is typical of the grandiosity of CAM believers and conspiracy theorists to imagine that their “ideas” represent a bold and brilliant challenge of authority. They merely represent nonsense and defiant behavior.]

    You often write, angrily, without ever reading what a commenter said. I NEVER said I was a CAM believer. I said the opposite. And I am NOT any kind of conspiracy theorist!

    My objections to the AIDS treatments is not nonsense. I have some good reasons. I am not an MD but I might understand how to analyze research better than some MDs, who may be clinicians but not researchers.

    This blog is about basing medicine on treatments that have been studied carefully with high quality research. My objections are related to the fact that some, or most, of the AIDS treatment research does not appear to be high quality.

    Because of patient advocacy groups, and because of financial incentives, these drugs may have been rushed through the approval process.

    Once AZT was approved, after some hasty and questionable trials, placebo-controlled studies were not generally possible, because of ethical concerns.

    My point here has been pretty simple, and it has been answered with anger and insults, rather than skeptical logic and science.

    I do not believe Amy Tuteur is a skeptic. She seems to think with her emotions and to be a true believer in a certain ideological approach to medicine. I think she is basically pro-drug.

  27. lizkat says:

    “My friend is 35 and was diagnosed at 33. So his surgery and chemo probably ended up buying him two additional years.”

    That is the kind of uncritical thinking we should be discouraging at a skeptics’ blog. You are assuming that he would have died immediately after being diagnosed, How can you possibly know that?

    “Lizkat, it’s not that the drugs don’t have risks. It’s that you will never believe that it’s possible for the benefits to be worth them, whereas people who have access to both science and patients believe the benefits are often more significant than the risks.”

    My point has been, again, that it is very hard to know. If a patient is diagnosed with HIV, when their CD4 count falls below a certain critical level they are given HAART. The assumption is that without HAART they would have soon progressed to AIDS.

    My question is, simply, how can we know? There might be important genetic differences between patients that would cause some to get AIDS and others to remain healthy.

    The scientist who discovered HIV says that a healthy immune system can usually fight off HIV. So maybe there is something about patients who progress to AIDS that goes beyond HIV infection. Some other factor that contributes to HIV to cause AIDS.

    If something like that is true, then we cannot know how often HAART actually does prevent HIV infection from progressing to AIDS.

    This is the sort of problem we should be thinking about, rather than reflexively going with the status quo.

    I feel like I have to sign each and every post with the reminder that I am a scientific skeptic, not a CAM believer. And I have never heard a conspiracy theory that I believed.

    I am a skeptic and I have good reasons to wonder about the AIDS drugs.

    And while there is a lack of clear pro-HAART evidence, there is no shortage of evidence for the damaging effects of these drugs. Yes, that would be ok if they could eradicate HIV within a limited time period. But they can’t.

    We know that the effects can be severely damaging to all the body’s systems. But we don’t know how extensive and serious the damage might be after decades of use.

    We also don’t know how the drugs may effect a patient who is HIV positive but who lacks the other factors (if there are any) required for progression to AIDS.

  28. lizkat says:

    [ This doesn’t mean I think drugs are evil, I just think that the commercial developers can’t be trusted to not fudge the science or exploit and try to manipulate people they see as “consumers” ]

    Right, that’s how I feel about it. That is why I am skeptical about the AIDS drugs. The research is messy and contradictory, and some of it might also be faked or distorted because of financial interests.

  29. lizkat says:

    Right, that’s how I feel about it. That is why I am skeptical about the AIDS drugs. The research is messy and contradictory, and some of it might also be faked or distorted because of financial interests.

  30. “I NEVER said I was a CAM believer. I said the opposite. And I am NOT any kind of conspiracy theorist!”

    You have made it clear that you are a conspiracy theorist by insisting that HIV therapies and antidepressants are scams.

    You are also very confused about the meaning of the word “skeptic” as it is used in connection with science. In this setting it has NOTHING to do with being skeptical of authority and it is NOT indiscriminate skepticism. It is NOT an idiosyncratic and selective reading of the scientific literature and it is certainly not bizarre assertions that the risks of treatment for HIV or depression are never justified by the benefits.

    Your thinking and claims are hardly original. They are merely recycled drivel from CAM advocates and conspiracy theorists garnished with the usual self congratulation.

  31. “My friend is 35 and was diagnosed at 33. So his surgery and chemo probably ended up buying him two additional years.”

    That is the kind of uncritical thinking we should be discouraging at a skeptics’ blog. You are assuming that he would have died immediately after being diagnosed, How can you possibly know that?

    I don’t know. That’s why I said “probably.” And no, I’m not assuming he would have dropped dead the minute he declined treatment: he was still walking around. And for that matter, he’s walking around today, though now he uses a cane.

    What we do know is that the typical life expectancy post-diagnosis for his type of cancer is about six months, even with treatment. Because he is young and considered more able to tolerate aggressive interventions than an older cancer patient, he was treated very aggressively, both surgically and with chemo.

    Nobody knows for sure what will happen, ever. All we can do is play the odds based on the best of our knowledge.

    If you think that none of the many thousands of medical researchers and ID doctors around the world have noticed any of the questions about study design being asked on the denialist sites, you are just wrong. It’s unfathomable. How could it be that only the folks who maintain that website have noticed that there is no evidence whatever that anti-retrovirals prolong lives? What kind of special powers do you have that make you able to notice problems that nobody else can see, even people who have spent years being trained to notice problems with research?

    You keep bringing up the lack of RCT trials. There are many. You want to say that the only valid RCT trials are against placebo. This is only true if the standard of care is nothing.

    Let’s go back to the parachute analogy. You notice all these people jumping out of planes and smashing into the ground and dying. You think that maybe there could be a way to slow their fall. So you put together some rudimentary parachutes, give them to some randomly-selected plane-jumpers and see what happens. The death rate drops from almost 100% (interestingly, not everybody dies when they leave a plane without a parachute*) to, say 80%. You think you’re on to something, because your parachutes seem to be saving about 1 person in 5. So you keep fiddling with your design, and you keep trying it out. You randomly assign opening and non-opening parachutes to plane-jumpers. For those people with opening parachuntes, the death rate from jumping out of planes drops to 50%, 10% and then 1%. The death rate for people with non-opening parachutes stays stuck at right around 100%.

    When you have a parachute design that is 99% effective in saving lives, what are you going to compare your new, improved model to? A non-opening parachute? Or the current, 99% effective parachute?

    Are you really going to tell us that it’s not possible to learn anything by comparing the new, improved parachute to the best available model? That the only valid base of comparison is a non-opening parachute?

    Let’s say that you relax a little bit and decide that you will use the best current model of parachute to test your new, improved model against. You think it will be more ethical. So now all plane-jumpers get funcitioning parachutes; it’s just a question of which model.

    By using this methodology you eventually come up with a parachute that saves lives 99.999% of the time. How are you going to test the latest and greatest model? Unless your new and improved model is seriously defective, you would need hundreds of thousands of plane jumpers to compare death rates. If you substitute rates of broken legs or rates of getting tangled in trees to compare one model of parachute to another, that’s a sign of victory for your rigorous parachute testing model.

    If someone starts a website explaining that Lizcat doesn’t look at death rates when she tests her parachutes, and that her test design is invalid because it doesn’t include a control arm with non-functional parachutes, therefore there is no reason to think that her parachutes are effective at all, and in fact they are cumbersome and expensive, and we know that some people do survive jumping out of a plane without a parachute,* and that therefore anyone who uses a parachute when they jump out of a plane is a meek, unskeptical victim of Big Parachute, how seriously should they be taken?

    http://www.popularmechanics.com/science/air_space/4344036.html?page=1

  32. Fifi says:

    weing – Of course I’m critical of political corruption too, why else would I discuss it here when it seems relevant to SBM? (Though you and windriven seem to get upset when I do since it’s often corporate corruption of government by Big Pharma and Big sCAM that I bring up, something you don’t seem to find problematic.) I guess in some ways wanting science and medical research to be as free from corruption and bias as possible is ideological or at least idealistic. However, it seems quite in line with the scientific method that is very specifically designed to try to eliminate or at least minimize bias. I highly doubt we’ll ever see eye to eye since I’m, by nature and nurture, prosocial or collectivist (I grew up with “first do no harm” and the idea that doctors have a social/ethical responsibility) and you seem to be individualist of the Randian variety. (Speaking in game theory terms here, which have little to do with being conformist or original in the way “individualist” means in general usage – it has to do with how one socializes and navigates relationships with others and society.)

  33. Fifi says:

    lizkat – “I feel like I have to sign each and every post with the reminder that I am a scientific skeptic, not a CAM believer. And I have never heard a conspiracy theory that I believed.”

    The reason why I’m skeptical regarding your claims to be a “scientific skeptic” is that you’re not in the least bit swayed by the evidence and you trot out all kinds of disproven ideas promoted by Big sCAM while constantly proposing that Big Pharma is engaged in a conspiracy. If you walk like a duck and quack like a duck – and DNA tests keep coming up as duck DNA – it’s pretty likely you’re a duck. A duck claiming to be a moose is still a duck! So, until you actually start acting like a skeptic instead of just acting like a denier who keeps repeating crap pushed by Big sCAM, people are going to be skeptical of your claims to be a “scientific skeptic”. (It’s also worth mentioning that a skeptic doesn’t need to be a “scientific skeptic”…adding “scientific” doesn’t make anyone more of a skeptic. Unless, of course, you simply mean you’re skeptical regarding science all together as a means to understand the physical and objective world.)

  34. Diane Henry says:

    Lizkat = pec? The same “how can we possibly know if these people were actually helped by teh drugz?” that pec always dragged around.

  35. weing says:

    Fair enough. I grew up in a socialist state and acquired an aversion to it. Anyway, it’s not medicine. I prefer to stay out of ideology.

  36. lizkat says:

    “You have made it clear that you are a conspiracy theorist by insisting that HIV therapies and antidepressants are scams.”

    I NEVER insisted that! As I said, you do not read what commenters write. I think most people would agree that antidepressants are overused because of marketing. And I said that they are not a wonderful cure for mental illness. That is not the same as saying they are a scam!

    And I said I am skeptical about HIV drugs, which is very different from making a blanket statement that they are scams! You are very found of blanket either-or statements. There is no ambiguity in your mental world.

    “You are also very confused about the meaning of the word “skeptic” as it is used in connection with science. In this setting it has NOTHING to do with being skeptical of authority “”

    Wow. You know what — Dr. Tuteur is the kind of close-minded true believer I swore I would never try to reason with again.

    NOTHING to do with being skeptical of authority! Well then what in the world is skepticism supposed to mean?

    If we are skeptics then we question all sorts of claims, made by all sorts of organizations and industries. We question claims from the government, from pharmaceutical companies, from CAM practitioners, and also — yes that’s right — from mainstream medicine.

  37. lizkat says:

    “You have made it clear that you are a conspiracy theorist by insisting that HIV therapies and antidepressants are scams.”

    I NEVER insisted that! As I said, you do not read what commenters write. I think most people would agree that antidepressants are overused because of marketing. And I said that they are not a wonderful cure for mental illness. That is not the same as saying they are a scam!

    And I said I am skeptical about HIV drugs, which is very different from making a blanket statement that they are scams! You are very found of blanket either-or statements. There is no ambiguity in your mental world.

    “You are also very confused about the meaning of the word “skeptic” as it is used in connection with science. In this setting it has NOTHING to do with being skeptical of authority “”

    Wow. You know what — Dr. Tuteur is the kind of close-minded true believer I swore I would never try to reason with again.

    NOTHING to do with being skeptical of authority! Well then what in the world is skepticism supposed to mean?

    If we are skeptics then we question all sorts of claims, made by all sorts of organizations and industries. We question claims from the government, from pharmaceutical companies, from CAM practitioners, and also — yes that’s right — from mainstream medicine.

  38. Fifi says:

    And to be clear, I’m no fan of Big Pharma and drug companies have been caught conspiring many times. There’s good evidence that they’re untrustworthy and need to be highly regulated. That doesn’t mean that all drugs are worthless, it just means that relying solely upon studies conducted by Big Pharma isn’t a good idea. It’s a bit like assuming all CAM treatment modalities are entirely worthless in a reactionary way without investigating whether there may be some plausibility. In many cases…well most really…there isn’t but there are exceptions like certain forms of meditation (which simply harnesses neuroplasticity, it’s not magic and it’s through studying it using science that we’ve come to understand how it works).

  39. Fifi says:

    weing – Fair enough, I grew up in social democracies and am pretty happy with them as a social system. Living next to the US during the rise of Randian ideology has made me pretty averse to unfettered capitalism. Certainly ideology isn’t medicine but, in the real world, it does influence the practice of medicine, and medical and scientific research, so it’s bound to get touched on when discussing SBM and protecting it from all kinds of ideological attacks (be they academic, governmental or commercial).

  40. EricG says:

    @ lizkat

    ““You are also very confused about the meaning of the word “skeptic” as it is used in connection with science. In this setting it has NOTHING to do with being skeptical of authority “”

    Wow. You know what — Dr. Tuteur is the kind of close-minded true believer I swore I would never try to reason with again.

    NOTHING to do with being skeptical of authority! Well then what in the world is skepticism supposed to mean?”

    yea, you do confuse it. once again:

    being skeptical of *authority* as the default position (or evoking authority as an argument) is an “appeal to authority.” if you leap to the institutions, organizations and experts as a first recourse, you are committing a generalized ad hominem fallacy.

    evaluate claim -> evaluate evidence for claim -> reevaulate claim. from there you can decide to trust (to evoke fifi) that source, or not. from what I can see, you distrust Dr. T as an “authority” based on lack of agreement and unapologetic bluntness that fails to considers your ego.

    if you cannot possibly fathom “what in the world skepticism is supposed to mean” if *not* oriented towards authority itself, you are COMPLETELY and repeatedly failing at logic in its most basic form.

  41. Fifi says:

    lizkat – I actually find you and Dr Tuteur to be two sides of the same coin when it comes to ideology masquerading as scientific skepticism.

    And, yes, it’s ridiculous for Dr Tuteur to claim that skepticism doesn’t include questioning authority when it’s warranted. Just as ridiculous as when you claim you’re simply being skeptical when you’re being equally as reactionary. I suspect you’re both entirely convinced that you’re skeptics and advocates of SBM and you both seem to be unwilling to consider for even a second that you may be being blinded by your biases.

  42. EricG says:

    fifi

    from someone who has studied rand, this rise you speak of is not based on any sort of objectivism rand might condone. it has been warped into a money oriented religion and a tool for power. selective interpretation at its very worst. sorry, a mere quibble.

  43. weing says:

    I always thought the appeal to authority dealt with a situation where because someone is an authority in one field, their claims in other fields carry the same weight. Sort of like Linus Pauling’s claims regarding Vitamin C.

  44. EricG says:

    crap! was that an appeal to authority? well, you may certainly question my assertions! im no expert, just hate to see it trashed cause of the abuse it has inspired

  45. EricG says:

    weing,

    hmm, good point. possibly both? here’s my favorite from a chiro friend:

    “see, [insert professional athlete here] uses chiropractic, shouldn’t you?!”

  46. EricG says:

    fifi

    “ridiculous for Dr Tuteur to claim that skepticism doesn’t include questioning authority when it’s warranted. ”

    example? if you perhaps suggest a debunked “authority” then that is not an appeal to such. the doubt of claims have preceded doubt of the authority itself.

  47. Fifi says:

    You don’t consider Greenspan and Friedman Randians? I’m no expert on the subject but they certainly associated with her and seem to have adopted her philosophy. However, I’m no expert on Rand so it may well be that they twisted her philosophy to their own ends. (But wouldn’t that be Randian within itself?) She always just seemed like a narcissist justifying her narcissism to me – though an interesting character from a distance. And, of course, we’re veering out of SBM here.

  48. EricG says:

    fifi

    “However, I’m no expert on Rand so it may well be that they twisted her philosophy to their own ends. (But wouldn’t that be Randian within itself?)”

    that underscores the complete mischaracterization of the philosophy. first and foremost, she advocates agreement that was free from force or fraud, an agreement between rational consenting individuals in the choice of matters. likewise, its an interesting *philosophy* and its not actually grounded by psychological research of any kind (or really any data at all).

    in a nutshell…

    her books were merely a vehicle for her philosophy. in theory, her philosophy centered around cardinal virtues and values, reason, purpose and self esteem. she also called for the abolition of religion and subserviency of any kind along with advocating the empowerment of the self (often misconstrued as “selfish” as we have defined it in our societal norm structure – which she does no favors by calling it the same). she elevated science and reason while bashing religion, entitlement and ignorance.

    she merely referenced capitalism as the economic system “that best respects the individual’s right to pursue personal property” (which ultimately is a truism, regardless if that is whats best overall) and was more an advocate of ideas such as intellectual property and right to pursue ones own interest, while never inflicting ones will on another. this automatically includes environmentalism (john galt would have signled handedly eliminated carbon emissions with his brilliant invention) and spoke out against the corporation for it weakened the decision making power of the individual (think trader joes, in and out etc. for great orgs that abide by this and basically our financial melt down to those who do not). if she rejected AGW, for instance, should would be in conflict with her own philosophy considering the science, reason and evidence leading to such claims.

    there are obvious conflicts as to her opposition to regulation and taxation, but, ultimately she never advocated wealth and power for its own sake (and her literary antagonists always did just that) but as a tool to shape your own destiny (i.e. create, invent, start a business etc.). likewise there is the “is-ought” problem…but again, its not exactly science.

    the fauex rand-capitalists have surely chosen their whims over their self-interest and chosen money hoarding for its own sake as opposed to a tool for creation and elevation of man as a god (i.e. man qua MAN). in the sense that we are self-determiners and should act as if there is nothing but our own sheer will and intellect to guide us.

    that being said, its not science, its not supported by an ounce of data and is basically a nice story for self-empowerment. anyone who “lives their life by it” is really no different than a jihadest adhering to the teachings of allah. rand wouldn’t advocate that in the slightest. i suppose this all makes me a “rand apologist” :)

  49. Fifi says:

    Just to be clear about the term “authority”. There’s a difference between someone being “an authority” and questioning or accepting their expertise as an individual and “questioning authority” – the latter tends to mean questioning bodies that claim to be authoritative (be they professional organizations, government or any other body that has power). Dr Tutuer does the latter herself when she questions a medical association’s position, for instance. Clearly being skeptical does including questioning authority, even if it does also recognize the specialized knowledge that an authority on a particular subject has (not that individuals shouldn’t be questioned when they’re making unfounded claims either).

  50. rosemary says:

    I admire Amy’s patience and dedication. However, for myself I think it is an utter waste of time to try talking to people who equate the risks of C-sections and circumcision with the risks of having health care practitioners practicing medicine in hospitals who reject science, believe in magic and maintain that when good, solid scientific studies refute their beliefs that the studies are wrong and their beliefs are right. It is rather like comparing the total destruction of a large city with the burning of a small house that results in a few injured people.

    While pseudo-intellectuals may think it is very clever to question “experts” or doctors simply because they are experts or doctors, real intellectuals look at the evidence and draw their own conclusions. When they don’t have the necessary resources to do that, they find and trust those who do.

  51. Fifi says:

    Thanks EricG, I appreciate the explanation and hearing your perspective.

  52. Harriet Hall says:

    lizkat said, “your whole post was about how patients should have faith in MDs, rather than try to figure things out for themselves.”

    For crying out loud! That is NOT what the whole post or any part of the post was about!

    Once again you respond to what you wanted to think Dr. Tuteur wrote rather than to what she actually wrote. I don’t know whether to pity your lack of comprehension or be angry at your willful distortions.

  53. EricG says:

    fif – understood. i would posit that her “questioning authority” would be presupposed by claims (based on x y z evidence) that she disagreed with…tomahto…tomayto…

    final note on rand, which I think is important.

    she had a penchant for engineers, chemists, musicians, architects, doctors etc. and her heroes were, as a consequence, primarily of such professions. She despised critics (as in, professional critics), politicians, economists (armchair thinkers in general), salesmen and board executives. If you could fabricate something of your own hands (or mind) and offer it as a tangible service to another, you’re good (further including mechanics, teachers, drivers and trades of all types). If your bread is necessarily buttered elsewhere, you’re bad. Interestingly enough, those that often employ objectivism to justify free market capitalism are strangely often of the latter, hence my umbrage with the mischaracterization. Anyway, thanks for listening :)

  54. rosemary says:

    Alison, “If I had delayed seeking help for my serious illness until I had given myself the equivalent of a medical school education and residency by googling the internet* I would be dead today. If I had the capacity to be a doctor myself, I would have gone to medical school. I don’t and I didn’t.”

    Billy Joe, “In that paragraph you have encapsulated, and exposed the myth of, ‘informed choice’.”

    I don’t think so. On two levels. First, as I understand it, informed choice involves being informed about and understanding the known risks and benefits involved when making specific choices so that you can decide for yourself if you want to take the risk that comes with those choices. IMO, a very large portion of the population is able to evaluate such things when the information is presented to them either by others or by doing their own research although I know from your previous comments that you disagree with that.

    Second, there are many cases in which people who have graduated from medical school either haven’t learned all they should have, have forgotten a lot, haven’t kept current or are biased for some reason whereas many patients can research the topic and discover what is known, unknown and suspected for themselves. Also, doctors are required to study and know a great deal about many things whereas patients usually present with a specific problem or two. The fact that they only have to learn about their specific problems gives them a big advantage over the doctor especially when their problems are rare.

    I am speaking from personal experience. I was permanently disfigured by an MD when I was very young. I am not elderly. The powerful lesson I learned was to look at the evidence. I strongly suspect that at least half the people reading this are more intelligent and most certainly more articulate, although perhaps not more motivated, as I am. Yet at least one prominent dermatologist considers me “the world’s leading expert” on argyria. My webpage on the topic has been cited in medical and scientific journals. I’ve written an article for a journal. It is human interest not scientific but I did it at the request of the editors while I have refused the request to write a scientific paper on the topic because I don’t think that another one is necessary.

    I’ve also met my share of “bad” doctors. An example. One walked into the examining room, stood in the doorway looking at me as if he were afraid to enter, then asked, “Why are you that color?”

    I said, “I have argyria.”

    From his expression I knew he didn’t know what that was. So I explained there was silver in my body that got there because an MD had given me a silver drug when I was a child. The arrogant idiot responded, “I knew that. I just wanted to see if you did.”

    What the fool apparently didn’t know or knew and didn’t think that I did, was that there are other things that cause a similar discoloration most of which are fatal. He could not possible simply look at me and know for sure that I had argyria.

    That is one example of many which leads me to believe that just because one has earned an MD does not mean that one has actually reviewed the relevant evidence and based one’s treatment decisions upon it although I suspect that the more common an illness is the more likely it is that the physician is following an accepted standard that is evidence based.

  55. rosemary says:

    Alison to Amy, “I care about your style because you do not communicate well.”

    Alison, when I find someone doesn’t communicate well, I don’t care about their style. I just don’t read what they write.

    In my post above, “I am not elderly,” should read, “I am now elderly.”

  56. lillym says:

    ” I think most people would agree that antidepressants are overused because of marketing. And I said that they are not a wonderful cure for mental illness.”

    No one said that antidepressants are a cure for mental illness. Not anyone in the comments in this blog. And as a consumer of mental health services for nearly 30 years I can say that not once from any mental health professional, medical professional, pharmaceutical literature, consumer advocacy group, or anyone else for that matter has EVER said that antidepressants or other psychiatric medication is a CURE for mental illness.

    They’ve said that medication (and most times that medication and therapy) are effective treatments. But effective treatment is not the same as cure.

    In fact the very first doctor who ever ever realized I had a mental illness told me — “there is no cure, no magic pill that will make everything better. There are medicines that can help but it takes medicine and a lot of work in therapy for this to be effective”

    And I’ve seen some crappy therapists and psychiatrists in my day too so I don’t automatically trust everyone who is a doctor.

    Lizkat, since you like making outrageous claims like the one I quoted I’m going to go out on a limb and say one of your big problems is reading comprehension.

    Otherwise how could mistake “effective treatment” for “cure” and also miss the 4 or 5 posts with links to information when you claimed no one gave you a clue where to find information.

  57. Rosemary, “IMO, a very large portion of the population is able to evaluate such things when the information is presented to them either by others or by doing their own research although I know from your previous comments that you disagree with that.”

    I most certainly do not disagree with that. There are concepts that are difficult for human beings to grasp (one example is probability theory) but all that means is that doctors need to use all their creativity when presenting information so that it can be received in a way that people can use. About half the doctors I have consulted have been able to present me with the information I need in a way I can use it at a level that is appropriate to me. (The other half I have had the luxury of being able to ditch after the first meeting.)

    What I disagree with is assuming that a doctor cannot filter the huge amount of information about the human body and about patients to present the appropriate information for the context, and that someone without either a medical background or particular expertise can.

    Knowledge and specialization matter.

    The problem I ran into was not being able to access a specialist who was on top of the literature. The first time I was prescribed medication the doctor literally said “I don’t know much about this, but I have some free samples of [drug] so you might as well try it.” The guy acted like a jerk, but I have to give him credit for being honest with me that he didn’t know. It was not a success.

    When I finally did access a specialist, I was treated with compassion and respect, I was offered a treatment plan I could use and that worked for me, and I was involved in decision-making at every step.

    You are absolutely right that not all MDs have sufficient knowledge and specialization about everything. But they do have more than the guy who pushes pills at the health-food store. It’s the lack of knowledge, or the will to refer to independent sources, that’s the problem in either case.

    Your point about rare conditions is very well taken. MDs often say they are thrilled when their patients with rare conditions can educate them. (Whether this is always true or just something they say to look magnanimous probably varies with the individual.)

  58. Little anecdote sort of à propos of informed patients:

    Many years ago I went to see a doctor at a local clinic. He was young, warm and friendly, and asked me what brought me there. “I have a urinary infection.” Well, he said, he would decide that. Why did I think I had a urinary infection? “I have a fever, I‘m peeing every twenty minutes, and it burns when I pee.” Well, that certainly sounds like a urinary infection. If you can give me a urine sample I’ll take a look. How often do you have urinary infections? “Never. This is the first time.” Oh, well if this is your first time, how do you know you have a urinary infection? “[boggled] I have a fever. I’m peeing every 20 minutes. It burns when I pee. What else would you like it to be?” He conceded my point.

    I took two lessons away from that encounter. One — the easy one — is that even nice, friendly doctors can be jealous of their expertise and don’t like to be told things. One must be very tactful when communicating with doctors so that they can come to their own conclusions. When asked, “What brings you to the ER today?” the correct answer is not “I cut off my hand with a tablesaw.” It is, “I think there might be something wrong with my hand. Could you take a look? Here, it’s in this bag.” Respecting this aspect of doctor communication etiquette can lead to great frustration when the doctor misses crucial points. (Hence the “etiquette, schmetiquette” lessons I learned in later years.)

    Anyway. The second lesson was that I had to wonder about the general patient population. If something I assumed was self-evident (fever + frequent burning urination = urinary infection) was something that he assumed was exclusive, specialized medical knowledge, what does that say about the education of most people he worked with? Maybe they were all well-informed and he just wasn’t paying attention. This is certainly possible. Or maybe many of his patients don’t know the most basic things about the way bodies work, and he had learned the hard way to assume absolutely nothing. This is possible too. I’m guessing it’s some mix of the two, and I have a lot of respect for professionals who are able to engage creatively, respectfully and effectively with their patients about something as critical and complex as their health.

    It’s clearly not easy, because so many doctors can’t manage it. To those who do — kudos.

  59. upnorth says:

    I recently had a baby, and encountered TONS of questionable information about natural childbirth.

    It seems to be based on three ideas: The reflexive or default questioning of authority that is discussed here; nostalgia for a distant “better” past; and the belief that a certain experience will create a transcendent or redeeming spiritual/emotional experience.

    The second idea is expressed in statements like “it’s been done this way for thousands of years” and “it’s the way our ancestors did it.” As an archaeologist, I have to say that we have very little objective knowledge of how our ancestors or anyone else’s handled pregnancy and childbirth (except we know that they frequently died). Underlying the idea is the assumption that the “natural way” has been perfected somehow. I take the position that we are large-brained, bipedal hominids, a situation that creates an inherently risky and dangerous childbirth situation. It’s “natural” in my mind to use our big brains to reduce those risks in any way we can.

    The third idea is a religious belief, or akin to one.

    I got an IV and an epidural, and had an emergency c-section. I am very grateful for all three!

  60. micheleinmichigan says:

    I just wanted to commend FiFi on her post up-thread where you talked about the difference between faith and trust and taking a balanced approach to evaluating claims by drug companies as well as the competence, credibility of individual doctors or scientific claims.

    Just to take it a step farther, realistically that might only be the start of the patient decision making process. From there you go to trying to balance information from overlapping specialities, with different philosophies. Maybe one has earned a higher level of trust and advocated for you, and the other seemed disinterested in the problem but has more expertise in the applicable field. Then you have the question of emerging technology or rare conditions that require a certain level of interpolation from current scientific research.

    Today, I had an specialist tell me about a “evidence based” recommendation” to wait on a certain technology. It’s became clear that the evidence does not indicate that technology is unsuccessful. There is not enough evidence to give a high level of certainty when it will be successful or not. Level of risk is there (low) level of monetary cost (high). Also, because my son has a relatively rare situation, the evidence will probably never be an exact match. While I was happy for the information, I ended up wondering where that left our decision.

    Regarding Government Influence/Corruption

    Just a reflection on how the government does not have to behave corruptly to influence science. For instance I was talking today with our doctor about how Medicaid coverage (for children) varies per state. So state with the best Medicaid coverage have the ability to research emerging (FDA approved) technologies more. With children and a technology that will be used primarily in schools maybe the the quality of the schools will influence the result of the medical research, but school quality can be very different per state. It would be best to correct for quality of education somehow, but how are the results being skewed by this funding disparity? (Disclaimer: I am not a scientist, I have a BFA, feel free to correct my poor assumptions researchwise.)

    Last observation based on the whole skeptical/reflexive doubt discusssion. Just as faith is to trust as paranoia is to skepticism.

  61. micheleinmichigan says:

    Alison and etiquette smetiqette OR how not to step on the toes of your doctor.

    It seems like I struggle with this each time I go to my doctor. The best time was when I went in to my (at that time, pretty new) doctor with a list of internet printed thyroid symptoms and told her “I have a lump in my throat when I swallow, I have these symptoms. I think I have a thyroid problem” and she replied “We’ll see about that!” This is not my typical style, I really am not overbearing with doctors, but I had just about had it with my various symptoms and my sister, who had thyroid issues, kept saying “I felt exactly like that when my thyroid was going.” I couldn’t take it any more. :)

    The doctor did note a inflamed thyroid very quickly, so luckily we did not have much contention for long.

    I learned a valuable lesson that day. Blame it all on your sister. Now I say “I’m feeling this way, my sister thought it might be this. I wouldn’t suggest it, but she’ll hassle me if I don’t bring it up.” I’m sure it works with husbands, wife, mother’s, etc.

  62. Zoe237 says:

    @Michelle:

    “”I just wanted to commend FiFi on her post up-thread where you talked about the difference between faith and trust and taking a balanced approach to evaluating claims by drug companies as well as the competence, credibility of individual doctors or scientific claims.”.

    I agree. I guess I haven’t quite figured out the relationship, the balance between skepticism, doubt, denialism, questioning authority, and faith vs trust vs. doubt. I too have been taught in 20 years of education that “questioning authority” is generally a good thing, the flip side of the logical fallacy “appeal to unqualified authority.” With the understanding that questioning does NOT mean rejecting, necessarily.

    Feynman, THE ROLE OF DOUBT IN SCIENCE:

    “”This is not a new idea; this is the idea of the age of reason. This is the philosophy that guided the men who made the democracy that we live under. The idea that no one really knew how to run a government led to the idea that we really should arrange a system by which new ideas could be developed, tried out, tossed out, more new ideas brought in: a trial and error system. This method was a result of the fact that science was already showing itself to be a successful venture at the end of the 18th century. Even then it was clear to socially minded people that the openness of the possibilities was an opportunity, and that doubt and discussion were essential to progress into the unknown. If we want to solve a problem that we have never solved before, we must leave the door to the unknown ajar. …”.

    http://laserstars.org/bio/Feynman.html

    ——————————————————————————–
    from “What Do You Care What Other People Think?: Further Adventures of a Curious Character” by Richard P. Feynman.

    There is also a video of Feynman on youtube called “disrepect for authority.” (how’d that happen… didn’t he die over 20 years ago?).

    I also really like this:
    http://www.sciencebasedmedicine.org/?p=1

    “Too often the nature of science itself is misunderstood or misrepresented to the public. Science is not an arcane and privileged discipline. By its very nature it is meant to be transparent and public. .

  63. BillyJoe says:

    Alison,

    “I most certainly do not disagree with that.”

    Actually, rosemary was adressing me with that statement :D
    I said your paragraph encapsulated the myth of “informed consent” and rosemary disagreed (see below)

    ====================

    rosemary,

    “I don’t think so. On two levels. First, as I understand it, informed choice involves being informed about and understanding the known risks and benefits involved when making specific choices so that you can decide for yourself if you want to take the risk that comes with those choices. ”

    I agree with that definition.
    But what I am saying is that this is not actually “informed consent” but “the illusion of informed consent”.
    You don’t know the risks and benefits, the doctor tells you what they are. Unless you have been shown the details of how these risks and benefits were arrived at, and unless you understand what you have been been shown by having sufficient background knowledge, how do you know they are accurate? And, if the doctor has provided you with accurate information, how do you know he has not slanted the information in such a way as to almost force your choice, or to amke your choice for you (remember Dr. Amy and her 600 dead babies one of which could be yours – and most of the time the effect is not as obvious as that example)

    “IMO, a very large portion of the population is able to evaluate such things when the information is presented to them either by others or by doing their own research although I know from your previous comments that you disagree with that.”

    I do disagree with that. You , me, and others commenting in this blog are a rather unusual breed of people in that we happen to be interested in researching these things for ourselves. Some of us even have the aptitude to do a good job on occasion. Your occasion was “argyria” and for a good reason. My occasion was prostate cancer, also for a good reason. But even we cannot do this for all diseases. Even GPs cannot do this and must rely on specialists.
    As for the general population, to be honest, they generally do not have a clue. Nor are most of them interested in knowing about disease other than the sexy stuff they are misinformed about by the media.

    “Second, there are many cases in which people who have graduated from medical school either haven’t learned all they should have, have forgotten a lot, haven’t kept current or are biased for some reason”

    I agree, bit I think that is part of my argument. ;)
    How can you give informed consent if you have not been given the correct information?

    “whereas many patients can research the topic and discover what is known, unknown and suspected for themselves.”

    I would say *few* patients would be able to do that adequately enough to make an informed decision. For a start, they would need to know how to evaluate a clinical trial. What percent of the population have the interest, time, and aptitude to do that?

    “Also, doctors are required to study and know a great deal about many things whereas patients usually present with a specific problem or two. The fact that they only have to learn about their specific problems gives them a big advantage over the doctor especially when their problems are rare.”

    I agree with you.
    Let me just suggest that you with your argyria, and me with my (well, my father’s) prostate cancer, are not the norm.

    “That is one example of many which leads me to believe that just because one has earned an MD does not mean that one has actually reviewed the relevant evidence and based one’s treatment decisions upon it…”

    Which just means that choosing on the basis of that doctor’s information is not “informed choice”.

    In my opinion, the vast majority of patients in the vast majority of circumstances really only have the illusion of making an informed choice. It is also my opinion that a good doctor – one who knows from his extensive knowledge and research what the best treatment should be, for this patient with this problem – would ensure, by the way he presents this information, that the patient made the “correct choice”.

    regards,
    BillyJoe

  64. Plonit says:

    @ BillyJoe

    Imperfect informed consent (which is the only kind we’re ever going to exercise – none of us have complete knowledge) is surely better than the absence of informed consent. The kind of paternalism that you suggest should operate is actually very bad for science-based medicine, since it encourages clinicians to ignore uncertainty, and discourages them from truly considering the endpoints that matter most to patients.

    For example, in your scenario a doctor might assume that patients of a particular type (younger, with children) care mostly about prolonging life, while patients of another type (older) care more about quality of remaining life and reduced pain – and that assumption may inform notions of the ‘correct choice’ of treatment. But actually, you can’t know whether the individual patient in front of you conforms to your assumptions about types of patients, unless you have an honest discussion about the options and trade-offs. Not to mention the many situations in which the doctor, with his or her extensive knowledge and research, ought to be uncertain about the best treatment. Again, honest dialogue with patients on this issue would educate them about the need for more widespread clinical trials and encourage their participation in reducing that uncertainty.

    Can I recommend chapter four of Testing Treatments, which has some very good points to make about the unequal ethical standards for clinical trials versus ordinary medical practice.

    http://www.jameslindlibrary.org/pdf/testing-treatments.pdf

  65. The distinction between trust and faith is an incisive observation. However, I would caution that there is a very important distinction to be made. There is a big difference between trust in medical science and trust in an individual doctor.

    Trust in medical science tells us nothing about whether a particular doctor ought to be trusted. A doctor is a person subject to the same strengths and weaknesses of any individual. He or she might have good diagnostic skills or not. He or she might be up to date with the medical literature or not.

    That’s why second opinions are critically important and sometimes even third opinions. You want to know what “medical science” says about your condition and possible treatments. An individual doctor may or may not accurately transmit that information. Talking to other doctors gives you a much better sense of your options than talking to only one doctor.

    Unfortunately, patients tend to decide whom to trust based on how nice the doctor is. A doctor with good bedside manner inspires trust, even when it isn’t warranted. And a doctor who is a total jerk may be the most knowledgeable and skilled person in the field.

    Doctors themselves recognize the benefit of second opinions in both formal and informal settings. M&Ms (morbidity and mortality conferences) are a fixture in surgery and surgical subspecialties. It is a formal way for doctors to share opinions about particular patients. Oncologists have enshrined the benefits of additional opinions in Tumor Boards, requiring every cancer case to be presented to a group of specialists from multiple fields in order to craft the best treatment recommendations for patients.

    Informally, doctors constantly “run things by” other doctors, a shorthand form of second opinion.

    You can trust “medical science” but in order to know what “medical science” shows, it is often best to consult more than one doctor.

  66. micheleinmichigan,

    Yeah, it’s hard to know how to walk the line. I certainly understand the doctor needing to make their own diagnosis. I could have thought I had a urinary infection for all kinds of reasons. Maybe my grandmother appeared demented when she was in the nursing home, but it turned out it was just a urinary infection and she got all better when it was treated. And my beloved is complaining that my memory is really bad these days, so I’ve decided I have a urinary infection and a course of antibiotics will fix everything. I think that’s a question of bedside manner: there must be more tactful ways to explore what someone thinks is wrong with them. But even when the doctor is tactless I can rationalize it to myself that this is the humiliating but necessary part of the encounter, and just grit my teeth and endure my role as idiot.

    It’s really annoying though when you have classic symptoms of something very ordinary, the doctor confirms your self-diagnosis, and instead of congratulating you on your acumen they accuse you of lying about coming to the classic and ordinary conclusion on your own. That one is totally poor bedside manner.

    If you’re in a situation where the doctor is very clear that they are the one who is driving, and you’re afraid they’re going to get all weird on you for volunteering your concerns – or even information – how do you coax them into asking the questions that are important to you? Ideally the doctor would take responsibility for being the one who is driving and at some point say something like, “Are there other questions I should be asking?” but that must be very hard to do when they need to keep their appointments short and focussed.

  67. Fifi says:

    Dr Tuteur – “The distinction between trust and faith is an incisive observation. However, I would caution that there is a very important distinction to be made. There is a big difference between trust in medical science and trust in an individual doctor.”

    Thank you for acknowledging this. While I do believe that the scientific method is the best means to discern the objective world, I’d argue that “medical science” has not always been trustworthy and it can also be important at times (please note the qualifier “at times”) to question “medical science” to discern whether it really is well done, unbiased science or someone merely dressing up their opinion, product or ideology in “medical science” to claim authority or absolute certainty. After all, the other bloggers here at SBM do question “medical science” at times to discern whether it’s good science that is being practiced and it’s a common practice within medical research to question.

    Now, this isn’t at all the same as a reactionary “science can’t be trusted” approach from a lay person and that’s not what I’m promoting. I’m promoting that even those of us who are supporters of SBM – be it professional or lay supporters – need to be aware of our own personal biases and ideologies, and how they may be informing what we present when we discuss SBM. We need to be self critical rather than assuming that because we support SBM that we are automatically free from bias, we need to be careful of not putting on SBM as an identity, an armor against the uncertainty of the world and life. If we forget that science can be wrong at times and that we’re really just working with the best information/evidence available to us at this time, and become incapable of self reflection or saying “I/we don’t know”, then we are indulging in faith. While the scientific method is the best means to discern objective reality it is not infallible – since it is us fallible humans who practice science. This doesn’t mean that science isn’t a good or even the best tool we have for understanding our bodies and the physical world, it means that if we look to it for absolute certainty we may well be inadvertently indulging in faith. If we are to defend SBM, it means also being vigilant for the corruption and misuse of science by industry, governments, ideologues and, yes, even ourselves.

    Medical science has come a long way in the last 40 years as religious and sociocultural biases have been seen for what they are, something that has allowed us to truly discern the world and ourselves as we are (and has opened up all kinds of new questions as we discover things such as neuroplasticity and how mind and body interact). Why? Because people both within and without science and medicine started to question orthodoxies and challenge assumptions and ideological beliefs that claimed to be science (and we got better tools, one shouldn’t discount technology’s influence). To get upset or offended because some people don’t unquestioningly trust medical science is to forget the history of medical science in favor of a fantasy of science as infallible and it’s a particularly pernicious thing to do if we assume that we too are infallible or immune to bias.

  68. Plonit says:

    If we are to defend SBM, it means also being vigilant for the corruption and misuse of science by industry, governments, ideologues and, yes, even ourselves.

    ++++++++

    I particularly like the reminder that we need to be vigilant with ourselves. To quote Feynman (second time today!) “The first principle is that you must not fool yourself—and you are the easiest person to fool. So you have to be very careful about that. After you’ve not fooled yourself, it’s easy not to fool other scientists. You just have to be honest in a conventional way after that.”

  69. Fifi says:

    Plonit – Thanks for the very on point Feynman quotes. I also appreciate how you point out that questioning something isn’t the same as rejecting it.

  70. micheleinmichigan says:

    “The distinction between trust and faith is an incisive observation. However, I would caution that there is a very important distinction to be made. There is a big difference between trust in medical science and trust in an individual doctor. – to end of post”

    Very well put. I can not actually say whether patients DO trust likable doctors or not-trust abrasive doctors, but I can certainly say for myself, I have to guard against this tendency regularly. And can you really guard adequately, or do you just spiral into a whirlpool of uncertainty?

    For one thing you can say, well the reason I don’t like said practitioner is that they keep skewing up, so I can’t trust them anyway. On the other hand I find myself in the confirmation bias zone. I don’t like said practitioner, so every skew up is magnified. I like another practitioner so I tend to laugh off their mistakes as peculiarities.

    Or alluding to Plonit’s post. Maybe you just don’t like the first practitioner because they do not listen and seem to solely approach the medicine with the goals they think you should have rather than having a discussion about your goals and your concerns and making recommendations based on that.

    And of course as weing mentioned, it’s easier to trust the practitioner that you WANT to believe. So you have to compensate for that somehow.

    I guess these concerns become amplified when you have medical areas with sparse evidence and the recommendations you get may have more to do with personal technology profiles (early adopters, early majority, late majority, etc) than the evidence available.

    I course it’s comforting to think, no matter what decision you make there are significant people in you life (family, friends, school personnel) who will think it is a crackpot, irresponsible decision. :)

    So maybe you just make your decision based on what you are going to regret deciding more 3,5,10,18 years down the road? Heck I don’t know.

    It may be clear that I am trying to work through an actual medical decision by blabbing about it incessantly online.

    I thank SBM for their bandwidth and tolerance.

  71. micheleinmichigan says:

    screwing up that is.

    skewing up? I don’t usually misspell my swear words. It’s either a Freudian slip or a lack of coffee.

  72. weing says:

    “I also appreciate how you point out that questioning something isn’t the same as rejecting it.”

    This also applies to the physician questioning the patient’s self-diagnosis of UTI, etc.

  73. Fifi says:

    weing – Of course it does, the doctor/patient relationship is a two way street (or is when it’s at its best). In the anecdote you’re referring to, the issue being brought up wasn’t that the physician questioned the patient’s self diagnosis, it was how it was done. In the end both the patient and doctor seemed to come to an understanding. Some doctors – certainly not all by any means – can get rather bent out of shape when someone comes into their office with a self diagnosis, even when it’s correct. Just as some patients can get bent out of shape if a doctor doesn’t confirm their self diagnosis, even when it’s erroneous. This is why the clinical practice of medicine is as much an art as it is a science, it doesn’t just involve facts but also the art of effective communication. It’s why GPs so often end up being translators for their patients when they do to see specialists if the specialist is a bad communicator. It’s also why it is important for a doctor to be aware of their own personal biases so they’re not imposing them upon their patients (or to be honest about their personal biases so that the patient can take that into consideration). Since the doctor is the professional and in the position of power – not only because of their training but also because we’re all prone to feeling vulnerable when there’s something going wrong with our body or mind – the onus is on the professional to use their power responsibly and not to further a personal agenda that may interfere with a patient’s ability to make as informed a choice as possible. Nobody’s perfect, of course, which is why a little bit of humility and compassion all round usually results in a better outcome for all involved.

  74. lizkat says:

    “how could mistake “effective treatment” for “cure” and also miss the 4 or 5 posts with links to information when you claimed no one gave you a clue where to find information.”

    When medical researcher feel satisfied that they have developed an “effective treatment,” even if it is not considered to be a “cure,” they might continue down the same path, instead of considering a change of direction. And I did not miss those links. They were not the kind of information I asked for. No one could provide clear and good quality evidence for how much AIDS drugs prolong life and improve health.

    Even if someone had a friend who was sick with AIDS, then started taking HAART and went on to live a relatively normal lifespan and was able to function relatively normally — that would be interesting evidence.

    But no one could provide even that.

    I have read a lot on the subject. Of course there are tons more to read and I have limited time. But I do see certain kinds of confusing statements repeated.

    For example, an article recommends starting HAART earlier than was previously recommended, before the CD4 count drops below 200 (or whatever). The evidence shows that 5 years survival is much better for AIDS patients who start HAART early.

    The problem with that kind of statement is that starting HAART earlier automatically determines that 5 year survival will rates will improve. Even if the drugs did nothing.

    I saw a claim that because of HAART, AIDS patients can now expect to life a normal life span. It turned out they based the claim on the fact that an HIV patient who starts HAART earlier (before they even have AIDS, by they way) is no more likely to die within the next 5 years than a healthy person.

    But we have been told that the HIV latency period can be 10 years or more. So why would we expect an HIV patient to not survive 5 years?

    There is serious confusion in the AIDS literature. Sometimes HIV and CD4 levels are considered synonymous with improved health, even though some studies showed that HIV and CD4 improvements may not correlate with improved health.

    And by the way I do not doubt that HIV causes AIDS, or that HAART may be helpful in some ways. If HIV had nothing to do with AIDS and if HAART had no benefits whatsoever, there would be no controversy.

    On the other hand, it is possible that decreasing HIV and raising CD4 levels are not as meaningful as the researchers believe. It is possible that HAART does not prolong life or improve health to the degree that we are led to think. It is possible that the adverse affects of HAART are much worse than is currently believed, especially long term.

    Without even knowing the long-term effects of HAART, some are claiming it allows patients to live a normal lifespan. They can’t possibly know that. And, as I said, it could be at least partly an illusion based on the fact that it has always been typical for HIV patients to survive more than 5 years after diagnosis.

    Scientific research is difficult to do and difficult to interpret, even for experts. Not every MD has training or experience in research or statistics. That is why I think I sometimes notice problems that not everyone notices.

  75. weing, of course it does. Did I not make that clear?

  76. Plonit says:

    I wonder if it is useful (or possible) for SBM to address itself to the science of health care delivery.

    For example, it is often asserted that Dr Knowledgeable Jerk is ‘better’ [by what measures?] than Dr Clueless-but-Kind. However, I’m not sure that we know much about the effectiveness of these two types of clinicians – certainly not in a scientific sense. (Not to mention comparison with the effectiveness of the clinicians never raised in these discussions, “Dr Knowledgeable-and-Kind” and “Dr Clueless Jerk”).

    Dr Kind may be a more effective practitioner than Dr Jerk, all other things being equal, especially if being kind helps your patients feel understood, make good decisions, adhere to treatment etc….

  77. Plonit says:

    But no one could provide even that.

    +++++++++++++

    I asked you specifically whether you thought that the stories of individuals from the work of Partners in Health in Haiti and Rwanda were faked. These are the stories of people who were on the brink of death from AIDS and have recovered to the extent of living a full asymptomatic life as a result of HAART.

  78. micheleinmichigan says:

    Plonit,

    YES! and in a nutshell. Thanks.

    Dr Kind may be more effective due to communication, But sometimes you can even grow kinda fond of Dr. Jerk.

    Dr. Jerk can be much better at cutting through administrative difficulties or red tape…as long as he or she is on your side.

    A few years ago there was a study gauging if communication ratings given to doctors by patients correlated to number of malpractice suits. The report I heard on NPR indicate they did (lower communcation ratings more malpractice suits). Sorry, no source and no idea how well run the study was.

    But ultimately there really should be some sort of test like the MeyerBriggs. I’d be nice to know if my doctors are KJ, CK, KK or CJ going in.

    Regarding Lizcat
    I think a politician (not my favorite) once said. “There he goes again”.

  79. lizkat says:

    “I asked you specifically whether you thought that the stories of individuals from the work of Partners in Health in Haiti and Rwanda were faked.”

    Can you re-post the link? I took the link and looked at the page and all I noticed was one before and after photo and brief story. I didn’t see any details that would convince anyone that it was a real lasting recovery. If there were lots of other stories, with details about length of treatment, etc., then I did not see them.

    One point to consider is that an AIDS patient who is near death from opportunistic infections could experience a dramatic, but temporary, recovery if the AR drugs eradicate those infections. So you could get remarkable before and after photos, without a meaningful recovery.

    And yes it is possible that keeping AIDS-related opportunistic infections and cancers in check with AR drugs does allow patients to live relatively normally for a while. This is something I do not claim to know.

    But it is interesting to consider that the drugs might be working in a way very different from what is assumed. And again, I do not claim to know, and am just wondering and being skeptical.

  80. Plonit says:

    Isn’t Myer-Briggs pseudoscience?

    lizkat, it’s there if you want to follow it up. If you want it to be fed to you, and each time spit it out – that’s your business.

  81. lizkat says:

    Very helpful of you Plonit. There’s only 350 or so comments to search.

    http://www.impactaids.org.uk/lancet363.htm

    No, I don’t see a lot of case studies on that site. Just one person who was emaciated before HAART and not emaciated after one year of HAART. There was no information about other patients, and no specifics about this one.

    So if that is and example of good clinical evidence showing that HAART works, it probably doesn’t work very well.

  82. Plonit says:

    lizkat, you are pathetic. You have google, presumably. Try: “Partners in Health”. Try WHO, try Cochrane reviews, try UNAIDS, try looking at some of the many reports and studies linked to upthread. You wouldn’t have to trawl through the 350 or so comments on here if you had looked at them the first time they were mentioned, would you?

  83. Plonit says:

    You refuse to be convinced by clinical trials (having some very high threshold for evidence, do you actually use ANY medicine?) and ask instead for examples of individual cases where HAART works. They are offered to you (in various forms – and for goodness sake, you have google – can you google “Partners in Health” can’t you, if you want more information about the extent and successes of their work) and you reject them.

    You wouldn’t have to trawl through 350 comments if you had bothered to read the many links provided upthread when they were first offered, would you?

  84. Plonit says:

    lizkat, I’m sorry – the first dressing down would have sufficed, I’m afraid my comment appeared ‘lost in the net’ and I got impatient.

  85. micheleinmichigan says:

    Plonit – Isn’t Myer-Briggs pseudoscience? –

    MicheleinMichigan -”But ultimately there really should be some sort of test like the MeyerBriggs. I’d be nice to know if my doctors are KJ, CK, KK or CJ going in.”

    Sorry, the last paragraph, I was joking. I think it didn’t come through in the tone. Sometimes I get sick of the smiley faces, they look so perky.

    As to MeyerBriggs, I have no idea. I think of it as kinda a parlor game. I think there is some science to a break down of personalities on a scale of introvert to extrovert, but I don’t know if there is any correlation between the personality testing results and how people perform in real life. Just my uneducated opinion.

  86. “One point to consider is that an AIDS patient who is near death from opportunistic infections could experience a dramatic, but temporary, recovery if the AR drugs eradicate those infections.”

    Lizcat, Anti retroviral drugs work against the retrovirus — HIV.

    Antiretroviral drugs do NOT work against bacteria. If someone has PCP, antiretroviral drugs will NOT eradicate that infection.

    The only way antiretroviral drugs would help is by suppressing HIV and countering its effects, to let the body recover to the point where it could fight off infection. That is, the only way they could help is by doing what research tells us they do. Fight a retrovirus. And even that would only work if HIV does what research tells us it does. Suppress the immune system.

  87. lizkat says:

    “You refuse to be convinced by clinical trials (having some very high threshold for evidence, do you actually use ANY medicine?) and ask instead for examples of individual cases where HAART works.”

    That is NOT true! I said I could not find RCTs or convincing studies of any kind. So I was willing to accept case studies, which here at SBM are not usually considered scientific evidence.

    And if found your link and re-posted it, and looked at the page again. What you said was there wasn’t there.

  88. lizkat says:

    You refuse to be convinced by clinical trials (having some very high threshold for evidence, do you actually use ANY medicine?) and ask instead for examples of individual cases where HAART works.

    That is NOT true! I said I could not find RCTs or convincing studies of any kind. So I was willing to accept case studies, which here at SBM are not usually considered scientific evidence.

    And if found your link and re-posted it, and looked at the page again. What you said was there wasn’t there.

  89. lizkat says:

    You refuse to be convinced by clinical trials (having some very high threshold for evidence, do you actually use ANY medicine?) and ask instead for examples of individual cases where HAART works.

    That is NOT true! I said I could not find RCTs or convincing studies of any kind. So I was willing to accept case studies, which here at SBM are not usually considered scientific evidence.

    And if found your link and re-posted it, and looked at the page again. What you said was there wasn’t there.

  90. Lizcat,

    Follow this link:
    http://search.medscape.com/medscape-search?queryText=aids

    You’ll have to register, but it’s free, and you get access to the kind of stuff that doctors read on weekends when other people are watching tv.

    Searching on AIDS brings up 6,961 documents. Even if only 1% are the kind of article you’re looking for, that still gives you 70 articles to chew on.

    Enjoy!

  91. Also at the same sourc is the antiretroviral therapy resource centre:

    http://www.medscape.com/resource/antiretroviral-therapy

  92. micheleinmichigan says:

    Just and observation on patient decision making and Lizcats argument.

    For every treatment plan there is a decision. To treat or not to treat (that is the question). You are balancing risk of treatment with benefit of treatment and or risk of not treating.

    When you chose a treatment is should be (I would say it usually is) because you BELIEVE the benefit out weighs the risk.

    When you argue about the treatments that other people choose or BELIEVE that they are misguided. You do not take on their risk. Although, karmically, who knows.

    To put it simply, that fact that Lizcat has nothing to lose is an integral part of her belief system.

    In fact at this point, if she reads all the data she is risking the very obvious fact that she might have to conclude she is wrong and be embarrassed. So the benefit in not reading the studies or opening her mind is obviously much greater than her risk in not believing HAART works.

    So Lizcat has successfully balanced her risk, benefit and come up with a plan that works very well (for her.) Thumb Up!

    Sorry, this was very obvious to everyone following the discussion. I just wanted to get it out in the open.

  93. lizkat says:

    Thank you Alison, but that is exactly the kind of articles I have been reading. It does not help me at all, because I cannot find anything definitive that doesn’t suffer from the problems I mentioned.

  94. lizkat says:

    “if she reads all the data she is risking the very obvious fact that she might have to conclude she is wrong and be embarrassed. ”

    How could I be embarrassed? You don’t know who I am! And in any case I am motivated by curiosity. Even if you did know me, I would rather get this resolved just so I could stop wondering about it. Yes, I would prefer to think the drugs are no good, because I do hope the researchers will try to find something that doesn’t have such horrible effects on the body. I hate to think of those patients suffering, even if their life may be prolonged (and I still don’t know that).

    Do I want AIDS patients to die? Of course not! I want them to have some better options. If nutrition and sanitation are better options in Africa, as the scientist who discovered HIV suggests, then i would much rather see them get that, instead of toxic drugs.

    Maybe treating the secondary infections is also a better option.

    If it turns out that there is good evidence that the drugs substantially prolong life, then I would think that maybe people should take them, so they can hang on to life in case a better treatment comes along.

  95. Plonit says:

    This may help you, lizkat – or maybe not

    http://photos.pih.org/inforesources/Articles/Lancet_2001_community-based%20HIV%20care_Farmer-et-al.pdf

    I must say that you have very very high standards lizkat. Do you hold all medicine to the same high standards?

    Evidence-based medicine means using the best available evidence. It doesn’t mean ignoring the best available evidence in favour of no evidence at all, just because the best available is not the best that it’s possible to imagine.

    Yes, I’m sure trials could have been better. Just about ANY trial could have been better. But I don’t think they were so flawed as to be useless either.

  96. EricG says:

    RE: Meyers Briggs

    interesting, a step into my field for a devilish moment ;)

    I won’t begin to pretend I’m any sort of expert, but I do know a thing or two about personality inventories and they are…useful*.

    For instance, I am currently researching one for a particular position where neuroticism has been demonstrated to predict burnout, agression, violence etc. its not the MB, but they are all somewhat looking at the same thing, different iterations of the “Big 5″ personality features.

    MMPI, WAIS, NEO PI-R, Wonderlich etc. are all widely utilized and validated measures of personality/intelligence factors. The Meyers-Briggs definately teeters the scale towards pseudo science, the wikipedia on validity and reliability actually aptly describes its position in the literature.

    http://en.wikipedia.org/wiki/Myers-Briggs_Type_Indicator#Validity

    its often used as a “team building” and/or “self-discovery tool” within organizations. I have never heard of it being utilized in any sort of meaningful selection or assessment capacity.

    *if you think sbm is messy and complex…look at the psych literature!

  97. Plonit says:

    I hate to think of those patients suffering,

    ++++++++++++

    Well, HAART is very significantly better than early ARVs wrt side-effects.

  98. Plonit says:

    MB is based on Jung, isn’t it? That’s pseudosciency enough for me.

    I’d love to know how these tests are validated as measures of personality/intelligence. For my sins, I have had to work a bit on teaching strategies – and have come up against more than my fair share of quadrants and axes and types that theorists seem to have sucked out of their thumb. None of which had validity as far as I could tell from the educational literature. Perhaps I have an irrational aversion to such neat typologies as a result.

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