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Who you gonna believe, me or you own eyes?

Mrs. Teasdale: Your Excellency, I thought you’d left!

Chicolini: Oh no, I no leave.

Mrs. Teasdale: But I saw you with my own eyes!

Chicolini: Well, who you gonna believe, me or your own eyes?

Duck Soup. Funniest movie ever.

If I could choose a super power, it would be neither flight nor invisibility, but the ability, like Triad, to separate into multiple people so I could accomplish more. I find that my multiple personality disorder is not all that efficient at getting things done. The Goth cowgirl? Lazy.

So sometimes I have to cut corners. As this post goes live I am at TAM helping with panel discussions and workshops and the only way I can get a post up is to cannibalize my lecture. Dr. Gorski will not let me post the slides and be done with it; those managing editors can be so unreasonable. Full sentences. Proper spelling. Good grammar. Sheesh. Some people.

The topic of my presentation is the cognitive errors that lead people to believe in nonsense and is, or was, a brief tour of the flawed ways in which we think and how the brain allows everyone to be under the false impression that fictions are real.

In the old days I simplistically thought people were just stupid, uninformed, or both. With 45% of Americans believing in faith healing, 37% in astrology, 30% in UFOs and 25% in reincarnation (if true I am sure the fates will bring me back as a rabbit in a syphilis lab), it was just that people are ignorant dumb-asses, right? Give people the facts and they will realize that they are wrong an alter their opinion accordingly. Right? Nope.

I have met the ignorant dumb-ass and he was me.

Pogo. Sort of.

Most folks are neither stupid nor dumb-asses.  Critical thinking is not default mode of the brain and most of the time, for most people, critical thinking is a waste of time. It is for me. For the activities of daily living there is little need to think critically. We rely on our experience and the experience of others to decide what to do. It is often an invaluable short cut. I want to eat out, I check out Yelp. I want new music, I ask my kids (except the hip-hop. Tats, hip-hop and square glasses are some of the styles that confirms I am old. I don’t understand the aesthetic of any of them). I read many of the reviews on Amazon before ordering a product. And I never bought a car because it was highly rated on consumer reports. I get the car that elicits a frisson of want and I have enjoyed every car I have owned.

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.

— Richard Feynman

It is fun to quote Feynman, but for day to day life it rarely applies.

And then you get to health care. Life and death, sickness and health. And for probably the first time the paradigm by which everyone interprets the world, experience and the advice of others, is no longer applicable or reliable for patient or doctor. It is no wonder that people trust the anecdotes and narratives of SCAM users and providers. They are using the methods most of us use to evaluate the world.

I like to say the three most dangerous words in medicine are ‘I lack insurance’. No. That’s not it. It is the words ‘In my experience.’ But experience dominates over critical thinking every day in every way. If I liked to participate in the naturalistic fallacy, I would say critical thinking is un-natural, like plastic, cement and Twinkies (I suspect all are made in the same factory from the same material), a man-made construct never found in the wild.

Feynman was a genius; most of us are not. W was closer to the human condition:

There’s an old saying in Tennessee — I know it’s in Texas, probably in Tennessee — that says, fool me once, shame on — shame on you. Fool me — you can’t get fooled again.

The lists on Wikipedia of cognitive biases, logical fallacies, and memory biases are sobering. There are so many ways to think poorly it is remarkable we get anything done. Everyone has their favorite fallacies. I like:

  • Focusing effect: the tendency to place too much importance on one aspect of an event; causes error in accurately predicting the utility of a future outcome.
  • Confirmation bias: the tendency to search for or interpret information in a way that confirms one’s preconceptions.
  • Illusory correlation: inaccurately perceiving a relationship between two events, either because of prejudice or selective processing of information.
  • Clustering illusion: the tendency to see patterns where actually none exist.

These are arguably the most important fallacies that allow people to see efficacy in nonsense. SCAMs would have difficulty existing without them.

I am terrible at recognizing logical fallacies in realtime. (I always fail when they do Name That Logical Fallacy on SGU. Or is that conformation bias?) When I do note fallacies in others, I discover that people do not take my observation that they are thinking poorly with grace and gratitude.

Go figure. People do not appreciate having their intellectual flaws identified. It is like telling them they have no sense of humor or are a lousy driver. It is one of the reasons rational opinions are ignored. No one likes a know-it-all and we all are aware of what ultimately happened to Mr. Know-It-All.

Not only do people not like having their intellectual shortcomings noticed, they probably are unable to recognize the fact that they are not excellent thinkers. So much of life is explained by the Dunning-Kruger effect:

The Dunning–Kruger effect is a cognitive bias in which unskilled people make poor decisions and reach erroneous conclusions, but their incompetence denies them the metacognitive ability to recognize their mistakes.

The unskilled therefore suffer from illusory superiority, rating their ability as above average, much higher than it actually is, while the highly skilled underrate their own abilities, suffering from illusory inferiority.

Actual competence may weaken self-confidence, as competent individuals may falsely assume that others have an equivalent understanding. As Kruger and Dunning conclude, “the miscalibration of the incompetent stems from an error about the self, whereas the miscalibration of the highly competent stems from an error about others.

The effect is about paradoxical defects in cognitive ability, both in oneself and as one compares oneself to others.

Ever see a second year surgical resident treat a bacteremic Staphylococcus aureus infection with clindamycin? Orally? And underdosed at that. I have. Many times. They have a culture and susceptibility, what more is needed to treat an infection? They have no clue that they do not know a burro from a burrow when it comes to treating infections. Kind of scary.

Combine Dunning-Kruger with the Peter Principle and history is explained far better than Das Kapital or The Foundation Trilogy.

And then there is memory. It is remarkable how flawed our memories are. In my ignorant youth I had though the memory of my life was like Super 8 film, or, perhaps for you youngsters, a youtube video: a perfect recording of events. One of my intellectual epiphanies was the book The Seven Sins of Memory by Daniel Schacter. I had no idea just how unreliable my memory is and how much of my past is a constructed narrative.

The Sins

Sin 1: Memory fades

After a month 75% of the memory of an event fades. Except the lyrics of songs from high school. Those ARE forever. Most recollections of past events are reconstructions based on current expectations and knowledge: people remember the past not how it was but how they think it should have been.

Sin 2: Misattribution

We remember events that never happened or attribute events to people and things that were not there, or recall what happened but it occurs at the wrong time and place. One of the many reasons “anecdotal evidence” of therapeutic efficacy is suspect.

Sin 3: Memory is suggestible

More than one-third of subjects recalled being hugged by Bugs Bunny at Disneyland. Impossible because Bugs is not a Disney character – after a researcher planted the false memory.

If you don’t accurately remember whether an SCAM worked, and you think it should, and someone tells you the SCAM worked, you will remember that it was indeed effective.

Sin 4: Memory is biased

I call it the Gigi effect. The whole thank heaven for little girls thing is kind of creepy now, but we have all had, shall we call it a discussion, with our significant after a social event and we both remember the events under disagreement in ways that make us look noble and the other suspect. And if you think a SCAM is the next best thing to champagne, then you will remember the intervention fondly.

Sin 5: Memory has persistence

Especially when associated with stressors. Medical training has left me with TNTC memories associated with a wee bit of PTSD. I still have not-ready-for-the-test dreams. Intense experiences imprint memory and give them disproportionate importance later. I can be far more biased by failures and complications than any good outcome.

Health issues are major stressors, so the flawed memories are going to have a disproportionate impact.

To be complete, 6 and 7 are absentmindedness and blocking, but are not germane to this discussion, but I know if I did not include them there would be HE-doublehockeysticks to pay. Our readers are a fastidious lot.

It all comes together in the archetype, at least for research, in N-Rays. I love the story of N-rays because it is in the hardest of the hard sciences, physics. Blondot was a French physicist who thought he saw changes in the brightness of an electric spark that he thought as due to a new form of radiation, naming it the N-ray. 120 other scientists had over 300 published articles claiming to be able to detect N-rays emanating from most substances.

Most researchers at the time used the perceived light of a dim phosphorescent surface as “detectors”, although work in the period clearly showed the change in brightness to be a physiological phenomenon rather than some actual change in the level of illumination (Wikipedia).

It was suspected at the time that Blondot was seeing things that were not actually there since the observations made no sense given the understanding of the times. A killjoy physicist, Robert Wood, visited the lab, surreptitiously sabotaged the N-ray machine, yet Blondot et. al. still saw the N-rays.

The modern equivalent is people who have adverse effects from cell towers even when the towers are off or who have salubrious effects from magnets even when there is no magnetism. The ability to experience what is not there is astounding.

The last thing that I have learned is that for many people the facts just do not matter. People will hang on to their beliefs no matter what the evidence: derp.

English has no word for “the constant, repetitive reiteration of strong priors”. Yet it is a well-known phenomenon in the world of punditry, debate, and public affairs. On Twitter, we call it “derp”.

Which is to say, a policy commentator is “derpy” when his or her (usually his) prior assumptions about the world are so unwarrantedly strong that he is unswayable by evidence. Derpers have a faith-based approach to policy.

When I asked my youngest son about derp, he groaned and said something to the effect that my mentioning the word was the definition of cringe-worthy and to never do it again. Just a warning for those of you with teenagers at home.

My favorite one star review of my Quackcast in iTunes was:

Harm to the brian (sic).

Didn’t need to listen.

No facts for him. Derp.

And Brian? So Sorry.

So when someone mentions errant information in support of a particular SCAM, your response with some reality based fact will likely go nowhere. I suspect the key word is ‘actually’. Start a sentence with ‘actually’ and you might as well stop there. They do not want to hear what you have to say and will not consider it valid even if they hear it. If ‘actually’ was removed from the skeptical lexicon, we would never get a sentence started in a discussion with a woo believer.

Human nature predisposes us to believe SCAM. You can’t change human nature but you can be aware of its flaws and compensate.

It is, actually, what makes a skeptic and a critical thinker

BTW: Some of this post was cut and pasted from old Keynote presentations without references. I do not think I am plagiarizing other authors, but I am not certain if all the words are indeed mine, but Google searching suggests they are.

Posted in: Critical Thinking, Science and Medicine

Leave a Comment (34) ↓

34 thoughts on “Who you gonna believe, me or you own eyes?

  1. Stephen H says:

    Having written a whole screed after reading this article, I realised that it is largely irrelevant in this particular post’s context. Regardless, I am not prepared to just express my frustration on the keyboard – so here goes.

    I saw a post on another website recently, with a comment along the line of “skeptics are killjoys”, followed by lots of “yeah, who do they think they are” and “they think they’re so good just because they don’t believe…”, along with “skeptics must all be so depressed, not being able to just trust things…”. Wait, what? I’m not a skeptic to feel better than you. You could all be skeptical, and still have a damn fine time of your life. Being skeptical is just a way of thinking that perhaps adds some value. It means not automatically assuming that the Nigerian prince wants to give you millions of dollars. It means asking just some basic questions when you’re expected to “believe” something. If anything, being skeptical improves quality of life, because you are less likely (although still liable – we are all human) to be bullshitted. I don’t see how that makes me depressing, or why people who want proof must therefore be assholes.

    I would love a (properly trained) scientist to have a go in the political journalism game. I am often frustrated at untested claims, special pleas, bullshit statistics and other garbage that seems to spew forth from the average politician’s mouth. The average political journalist seems unable or unwilling to challenge the person who has responded to a question with an irrelevant answer.

    Maybe decently trained (skeptical?) journalists would quote politicians’ words back: “You said at the start of this social experiment that x would happen. Y has happened – can you please explain how?” Maybe they would have to make specific, justifiable claims rather than bland “I’m saying in general that blah, but of course I’m not racist/homophobic/idiotic”.

    /rant off

    1. windriven says:

      A couple of thoughts Stephen –

      “I would love a (properly trained) scientist to have a go in the political journalism game.”

      Don’t wait. Arm yourself with facts and engage. Scientists do not have a lock on critical thinking skills.

      As Dr. Crislip pointed out, many of these people are refractory in their credulousness. Pointing out their errors is more likely to irritate them than to educate them.. So be it. It isn’t their minds you are fighting for, it is the minds of the readers who are trying to stretch and grow and learn something.

  2. JesusR says:

    I think examples are better than theory. Common examples of widely-shared but wrong beliefs are the best to convince people that these things happen. Though I don’t seem able to find a handful of good ones…

  3. Janet Camp says:

    Maybe one day when the trailer and Jeep are paid for, I will have enough money to go to TAM. In the meantime, I will happily settle for QuackCast and SBM.

    This discussion is illuminating, and most entertaining, but leaves me with the inevitable question of why some get on to critical thinking, but so many do not?

    I would add that I do not read many Amazon (or any other) “citizen” reviews. I tried, but most of them only expressed an impression (“this vacuum cleaner sucks!”, “I LOVE this movie!”) without giving any reason, details, or demonstrating any real knowledge of the subject. The experience has given me new respect for the formerly hated professional reviewers. I don’t care for Consumer Reports either, because they don’t include enough of a product line to be fair–they will exclude high end for instance, and then say that such-and-such is the “best” choice. They did this with sewing machines and I quit reading them then and there as I was in the market for a high end sewing machine! How’s that for logic?

    Thanks for offering some needed insight into why I fail so miserably with the dedicated alties–I guess I knew this when my last attempt (fatally begun with, “Actually…”) ended with the response, “I’m just not a science person”.

    1. windriven says:

      I don’t know what it is about Las Vegas but I’d rather do almost anything than spend a few days there. Maybe it is the garish simulacrum of ‘class’. Maybe it is that the town’s raison d’etre is to separate fools from their money. In any event the place makes my skin crawl.

      So I’m waiting for TAM to move to Ottumwa* or Flatbush**. And yes, I realize that I’m in for a wait. Call me Estragon.

      *Birthplace of Radar O’Reilly
      **Birthplace of Philip J. Fry

      1. Stephen H says:

        Yes, Vegas is designed to separate fools and their money. Which means that if you’re not a fool you can get lots of the cheap/free entertainment, designed to attract said fools.

        Unfortunately it’s not quite as cheap as it was 15 years ago when my wife and I first went, but I expect the cross-subsidies from gamblers to non-gamblers continue. And we just love tacky, so Vegas is perfect.

        1. windriven says:

          “And we just love tacky, so Vegas is perfect.”

          One of my dearest friends shares your love of the tacky. He collects, among other bits of flotsam, snow globes.

          You make a good point about the gamblers subsidizing the sane. I attend a professional conference that rotates venues and about every four or five years lands in Vegas. One year I was approached with one of those ‘free week in Las Vegas’ deals where you get X nights of accommodations, some meals and a chit for chips in exchange for sitting through a pitch for a time share. So I did. I was more earnest in my sales resistance than they were in their salesmanship so I got a free stay and a couple of decent meals in exchange for 2 hours of my time. Also the lasting enmity of a couple of salespeople.

          Say ‘hi’ to Drs. Crislip and Gorski and Novella and Hall while you’re there. And give Rebecca Watson a nice slap on the ass for me. She just loves that sort of thing you know ;-)

  4. windriven says:

    “Duck Soup. Funniest movie ever.”
    Blazing Saddles. Second funniest movie ever.

    “Most folks are neither stupid nor dumb-asses. ”
    I have to disagree on technical grounds. By definition half the people are dumber than the average guy. The average guy is pretty dumb. Ipso facto. Who you gonna believe, Wechsler or your lying eyes?

    “Our readers are a fastidious lot.”
    Crap. I was so looking forward to noting your age and that while counting to seven you got distracted and only made it to five.

    - – -

    On a serious note:

    “Most folks are neither stupid nor dumb-asses.”

    Arguable. Sort through the frightening dross that populates the legislatures of these United States, freely elected by the body politic.

    While we may quibble on whether most folks are stupid, a prima facie case can be made that many folks are ignorant and, really, willfully ignorant. The tools for self examination and improvement are ubiquitous. One need only pick them up and use them.

    Dr. Crislip seems to make the case that our brains’ flaws make critical thinking difficult and that we should understand sCAM in this context. But this absolves the ‘neither stupid nor dumb-asses’ from arming themselves with readily available tools that can be used to understand our inherent flaws and at least partially compensate for them.

    Stupidity cloaked in a robe of intellectual sloth is still stupidity. Genius wearing the same cloak is no better.

    1. Stephen H says:

      I think you’re being a bit rough here – aren’t most people above average?

      /s

      In other words, I agree – there is a world of stupid out there just waiting to be tapped as a source of boundless energy.

    2. Rork says:

      “Our readers are a fastidious lot.” Pedantic even.
      They will even note that it’s the median that half the people are dumber than.
      And that median person is astonishingly dumb, so I disagree with Crislip.
      Most people are also lazy, not wanting to think very hard about anything. They get upset when concentration is required.

  5. calliarcale says:

    Clustering illusion: the tendency to see patterns where actually none exist.

    Obligatory Who Quote:
    “I love humans. Always seeing patterns in things that aren’t there.” — 8th Doctor

  6. calliarcale says:

    Oh, and regarding the word “derp” — I don’t see that narrow definition taking hold. It’s already a rejoinder for any stupid remark, or an indicator that the speaker is either stupid or foolish, or to indicate that you yourself have just done/said something ridiculous and realize it. And at Memebase, it’s come to function like “foo” and “bar” (the classic dummy variables used in programming examples) as a placeholder/anonymizer for anything in a story where the actual identity isn’t important. It’s often associated with wall-eyed characters (so I guess Marty Feldman was the first derp?), like the My Little Pony background character Derpy Hooves (though the alternate name Ditzy Doo also exists, with conflicting indications of which is correct).

  7. pmoran2013 says:

    Critical thinking time again? –

    It’s actually the better educated and presumably less “stupid” who use CAM most.

    There may be many reasons for that including lower income, but it could also mean that the below average are to some degree aware of their limitations and more likely to invest their trust in their doctors rather than other voices. Why, then, would have the better educated have less trust in us?

    It is still, in part, a reflection on us if we have been unable to create a safe medical environment for people of any level of intellect and knowledge. Public health is our responsibility, even if we share it with the individual and are up against competing interests such as personal freedoms.

    Let’s review our understanding of CAM, the ends we seek, and how to go about it. Telling people they are stupid is not going to earn anyone’s trust. It is an excuse for sitting on our hands, while now and then engaging in self-congratulatory sniping at the mental deficiencies of others, and awaiting a public enlightenment that is never going to happen to the required degree.

    1. windriven says:

      “It’s actually the better educated and presumably less “stupid” who use CAM most.”

      Peter, I’m going to presume this to be a personal anecdote as you haven’t provided a link to the data. I’d just like to make a couple of observations. First, there is a difference between graduating school and being educated. Second, educated people are not necessarily educated broadly. I would consider myself to be a relatively well educated person. But my ignorance* regarding, say, modern dance is breathtaking. Third, the better educated are not alone in embracing sCAM. Summoning anecdotes of my own, a woman with whom I occasionally walk my dog is a high school graduate of quite modest intelligence. She regularly sees a chiropractor and uses and believes in acupuncture and a stupifying array of supplements. I’m happy to say she’s never tried reiki but never say never.

      As to your last two paragraphs, I could not agree more.

      *I prefer ignorance to stupidity. First, it is more accurate and second it is not freighted with pejorative overtones. Ignorance is curable, stupid runs right to the bone.

      1. pmoran2013 says:

        Windriven: “It’s actually the better educated and presumably less “stupid” who use CAM most.”

        Peter, I’m going to presume this to be a personal anecdote as you haven’t provided a link to the data
        —————————–
        I am surprised you are not familiar with the many studies showing this. It is now beyond dispute. You will find such correlations described in earlier articles on SBM.

        As I myself have said, there are confounders which are likely to explain some of the correlation of CAM use with higher educational status, but it still creates a problem for the view that you have to be stupid to use CAM. It’s just not so. That is not even usually a scientific decision in any normal sense.

        1. windriven says:

          Peter, I did a Pubmed search on ‘education CAM correlation. I got 30 hits and scanned the abstracts. Not a single one actually reported a link between educational attainment and acceptance of CAM. But I did find one disturbing report.

          The use of complementary and alternative medicine (CAM) is increasing in Europe as well as in the USA, but CAM courses are infrequently integrated into medical curricula. In Europe, but also especially in the USA and in Canada, the attitudes of medical students and health science professionals in various disciplines towards CAM have been the subject of investigation. Most studies report positive attitudes.” (emphases mine) Psychol Health Med. 2011 Mar;16(2):225-37.

          I then did a follow up search using ‘intelligence CAM correlation’ and got 11 hits but only one addressed the issue in question and in that study the intelligence was ‘social intelligence’. No attempt at correlating IQ and CAM usage was reported.
          Explore (NY). 2008 Nov-Dec;4(6):359-67

          I do not claim this to have been an exhaustive survey of the literature. But I report this modest effort to make the point that it is easier to claim a correlation than to demonstrate it.

  8. WilliamLawrenceUtridge says:

    Why, then, would have the better educated have less trust in us?

    Dunning-Kruger would be my explanation. They think that medicine is simple, and, oddly, that they can trust people who tell them it isn’t. It’s relatively easy to address every claim made by a Portland housewife with a degree in English literature and an internet connection, if they take the time to listen. While the average person lacking post-secondary education will retain an almost religious-like faith in medicine with doctors as the priests, a bit of education convinces people that medicine is simple. Unfortunately, it seems to be a basic issue in human cognition, and one that is not easily remedied by education.

    I always hope that a socratic dialogue would work – leading people to the conclusion that the claims of SCAMsters are false or hypocritical while demonstrating their assertions contain assumptions which are false. Unfortunately in my case, perhaps because of my approach, perhaps because of my personality, perhaps because it is simply difficult, it usually ends up being about winning an argument rather than identifying core philosophical and factual truths.

    1. pmoran2013 says:

      Windriven: Try your pubmed search on “CAM use and educational status”. That produces several showing the association of CAM use with higher educational status. I assure you it is a generally accepted finding, although we cannot be sure quite what it means for our purposes. .

  9. pmoran2013 says:

    WLU” — it usually ends up being about winning an argument rather than identifying core philosophical and factual truths.”

    Perceptive. Here’s some food for that thought.

    If you listen in on CAM discussion groups you will hear quite a few “it didn’t work for me” testimonials. While they will not usually say so, CAM users already understand that the methods they choose to use may not work for them — they are merely something to try out for that persistent medical problem.

    So what will critical thinking skills do for them? They should provide additional reasons why certain claims may not be true, and thus discourage some kinds of CAM use, but they cannot on their own show that any claim is definitely NOT true. When CAM supporters ask us to “prove it’s not so” they are not naively asking us to “prove the negative”, they are making a reasonably valid response to what we are carrying on about as if we had absolute knowledge.

    Actually we CAN mount a very compelling case against most CAM claims, but not with that kind of logic. All we need is a few years of a person’s undivided attention so as to impart a very sophisticated understanding of several areas of science, and of medicine and of scientific methods and what they can tell us. For we are not merely seeking theoretical assent to our viewpoint, we want to instil a level of conviction that will cause people to endure illness rather than yield to the easy temptations and kindly camaraderie of CAM.

    It can’t be done. Fortunately there is a helpful short-cut, such that most people still behave sensibly in relation to CAM without ever having to undergo this impossibly inefficient and otherwise useless investment of their time. . Remember how CAM use sank to a historical low during the early part of last century? It did so because science looked as though it might soon have all the answers. Doctors were looked up to. Public trust in the medical profession was probably at an historical high.

    I think our task is to regain that trust, to the degree that that is possible through matters that are outside our control, such as the slow pace of medical advancement in some areas.

    I have said enough for now, but this thought has implications for all aspects of medical sceptical activity.

  10. WilliamLawrenceUtridge says:

    I think our task is to regain that trust, to the degree that that is possible through matters that are outside our control, such as the slow pace of medical advancement in some areas.

    I honestly don’t pay enough attention to your comments to know if it is true or not, but my impression seems to be that you think we (or, I should say doctors) should regain that trust by caving in to demands for CAM. I personally think fixing the system would be a better solution. The US is making strides in that regard by attempting to implement a more universal health care system, but one that seems woefully imperfect to me. Not paying for CAM while paying for effective therapies would seem a much better option in my mind. I’m thankful I don’t have to address this given I live in a country where I have universal health care.

    I could be wrong about my assumptions about your arguments, though I agree with many of the premises you present above even if I disagree on your solutions.

  11. pmoran2013 says:

    I am fairly sure of my premises, but I am not yet sure where they will lead, WLU. I need the help of other minds. Any “solution” will be a matter of degree and emphasis.

    I am fairly sure that the medical profession should stop fighting battles it cannot win on ground that is not worth the taking. That is what happens when we get caught up in the noble pipe dreams of “general scientific scepticism” and think that it is our job, too, to get everyone “thinking properly”. The average sceptic does not necessarily understand the complexities of human needs and of medical interactions. We should.

    As a corollary, I think we will be led to focus upon safety issues.

    I think it could lead to more telling argument and influence in the political sphere once we understand that all this has little to do with science, and that the scientific approach alone is not achieving the ends we want — or, perhaps, that it has led us to think we want. .

    For example, I have also said many times that we should in principle not pay for CAM — but not because of any certainty that it is not sometimes helpful for the individual (which we are unable to prove and which also goes against what many voters will be saying), but because it is for most an optional add-on to conventional medical care. Throw in uncertain cost-effectiveness, if in general use, and that argument is surely all but won.

    Note how there are better arguments than the instinctive and not easily rammed home one of “It doesn’t work”.

    Note how a simple rational

    Medicine is a special case for medical scepticism. The intensity and immediacy of medical needs and the ability to immediately test out matters in dispute (at least to one’s own satisfaction) makes this quite different to many other areas of pseudoscience.

    1. WilliamLawrenceUtridge says:

      I am fairly sure that the medical profession should stop fighting battles it cannot win on ground that is not worth the taking.

      …and this is where you lose me – the idea that patients should be lied to, basically so CAM practitioners can win a propaganda war, rake in lucrative treatment fees and drive up the cost of care. The idea that medicine can’t win seems ludicrous to me. Ben Goldacre is delightful to watch, Oz was fine until he drank the cool-aid, and those Mystery Diagnosis shows are great too (but the doctors shouldn’t play themselves, they’re awful). I think this is a war that can be won, and pop culture is probably one of the most effective places to fight it.

      Anyway, I’ve lost interest again.

  12. pmoran2013 says:

    Sorry about the editing mishaps — the incomplete sentence — and the last paragraph should commence “Medicine is a special case for scientific scepticism.”

    1. pmoran2013 says:

      —the idea that patients should be lied to –

      WLU, that is an unfair representation of what I have said.

      I entered this thread when angered at the fact that no one else chose to challenge the view being put forward in the comments that CAM use equates to stupidity. That viewpoint is not merely overly simplistic; it is not supported by the evidence, while also being potentially highly polarising and alienating towards the people who most need to be taking some notice of advice.

      Surely a deep understanding of why people use CAM should our starting point if we are to develop rational and realistic strategies and objectives in relation to it That is what I am trying to develop, at least to my own satisfaction, in the first instance.

  13. WilliamLawrenceUtridge says:

    WLU, that is an unfair representation of what I have said.

    Yeah, it probably is. And ironically, as my discussion with Andrey Pavolov on the “business of being born” post from earlier this week has illustrated to me – we’re probably a lot closer in practical terms than our arguments might indicate. For that matter, have a look at my comment here (search for “were I a doctor”), I come across as rather Pete Moranian (Moranish?) when confronted with a hypothetical paitent.

    CAM use is stupid, in the sense that all humans are unscientific (which isn’t quite “stupid” but shades in that direction). It’s not a good use of money and to date is associated with few, if any objective health improvement. It relies on false dilemmas, ad hominen attacks and other logical fallacies both to define itself and to defend its practices. We know why people use CAM – a form of emotion-focussed coping, a security blanket, ideological identification, anticonsumerism. In a lot of ways, particularly in the American context, it’s an expression of frustration with the medical system. In all cases, it illustrates that the proponents don’t understand science, skepticism, critical reasoning, the precepts of what they are promoting, medicine, biology and more. It illustrates that people are uneducated and uninterested in the hard work of the world. I don’t really blame them, why would I insist anyone else have the same niche hobby I do? But that’s why we delegate to specialists, and that’s why the credulous acceptance of CAM into medical schools is so disheartening – a betrayal of all that has made medicine great. In nearly every other field we are forced to defer to specialists, but unfortunately because everybody has an asshole they feel entitled to have an opition about colon cancer.

    I still think the best solution, in addition to better gatekeeping in medical schools, would be for the US to have a real health care system that is supported by a tax base and effective research. While Obamacare is slightly better than what existed before, I don’t think it approaches what could be accomplished with a more conventional system.

    But I could be wrong. And I ramble. But I will concede you get a lot of crap here, only some of which you deserve. No smiley-face, I’m somewhat serious.

  14. pmoran2013 says:

    “I still think the best solution, in addition to better gatekeeping in medical schools, would be for the US to have a real health care system that is supported by a tax base and effective research.”

    This may affect some use of CAM. You do find some US folk enquiring about CAM because they are worried about medical costs.

    OTOH, having such a system as you suggest has not prevented substantial use of CAM in Australia, including by up to 40% of its doctors. We have even had a small subsidy of acupuncture within our Medicare system for some years. I have yet to hear of any major problems with that, probably because it is it only applies to that administered by doctors.

    There is no simple solution to a very complicated problem.

    1. Harriet Hall says:

      No simple solution, indeed! I think the experience in the UK is instructive. They still have homeopathic hospitals, for Pete’s sake!

    2. WilliamLawrenceUtridge says:

      Agreed, no simple (particularly no short-term) solution. But I’m a fan of harm reduction, and I think this would go a long way towards it (in the US anyway). It’s not about preventing all CAM (if nothing else, you’d get the equivalent to CAM prohibition), it’s about making sure people have access to real medicine instead of only fake medicine.

  15. stanmrak says:

    “In the old days I simplistically thought people were just stupid, uninformed, or both… with 30% of Americans believing in UFOs.. it was just that people are ignorant dumb-asses, right? Give people the facts and they will realize that they are wrong and alter their opinion accordingly. Right?”

    I wonder if you have any actual data to back up your assertion that UFO witnesses are stupid? In truth, there is “overwhelming evidence” that UFOs are real, and that SOME of them are of unexplained origins. This is according to Stanton Friedman, a retired nuclear physicist who worked on secret government projects, including all types of space-age propulsion systems, for 14 years and has spent 40 years combing through UFO archives and government declassified documents on UFOs.

    20 to 30% of all UFO sightings have never been explained, debunked or refuted — because they couldn’t be. The evidence (both visual and physical) was too strong and offered no other explanation, so the military made up totally-implausable explanations that a nine-year-old could see through — talk about stupidity. Millions of sightings have been made, including documented reports by Ronald Reagan, Jimmy Carter, George Washington and Thomas Jefferson. Have you read any of the declassified US government files on UFOs? Have you read the U.S. Government’s Project Blue Book Report No. 14? Have you actually examined ANY of the evidence? I doubt it.

    stantonfriedman.com

    http://www.amazon.com/Flying-Saucers-Science-Investigates-Interstellar/dp/1601630115/ref=sr_1_2?ie=UTF8&qid=1374591491&sr=8-2&keywords=stanton+friedman

    Here’s an admission by the former Canadian Minister of Defense about the existence of UFOs and the world-wide government coverup:
    http://www.youtube.com/watch?v=XEQdvYFMBAU

    And if you think the government can’t keep secrets, well, Area 51 has been in existence for about 60 years and we still don’t know what goes on there.

    1. Harriet Hall says:

      Oh, good grief! This is off-topic. Let’s not go there.

  16. stanmrak says:

    Hey, I didn’t bring up the UFO topic — Mark dId. This is supposed to be a science-based conversation and his opening comments are

  17. WilliamLawrenceUtridge says:

    Wow, that’s a stretch even for you stan, but somehow you found something to criticize (and in your usual MO, picked the most credulous, least scientific way to do so). What next, a substantive criticism on the inappropriate use of hyphens?

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