Sep 12, 2017

It don't mean a thing

The Skeptics on confirmation bias,

Psychologists call this confirmation bias; where you look for and find confirming evidence to what you already believe and you ignore the disconfirming evidence. People want to believe and your clients will too.

What science is and how it works, including the role of confirmation bias in its process, has been heavily debated throughout history having major consequences affecting all parts of society. So it is reasonable why Imre Lakatos said the following on the problem of demarcation,

The problem of demarcation between science and pseudoscience has grave implications also for the institutionalization of criticism. Copernicus's theory was banned by the Catholic Church in 1616 because it was said to be pseudoscientific. It was taken off the index in 1820 because by that time the Church deemed that facts had proved it and therefore it became scientific. [...] All these judgments were inevitably based on some sort of demarcation criterion. And this is why the problem of demarcation between science and pseudoscience is not a pseudo-problem of armchair philosophers: it has grave ethical and political implications.

Although Abraham Flexner called for physicians to become scientific, the direction for medicine to become more science started before his report. The origins of evidence-based medicine were also founded on scientific principles and skepticism. But unfortunately, these days EBM means a different practice (see Ioannidis, PMID: 26934549) than it was originally intended.

Some physicians might say that medicine is not a science, but the application of science. Sometimes you might also hear that medicine is not a science, but an art. Some might not even care about this debate. Others, including Larry Weed who created the problem oriented medical record, have tried to state that medicine is a science. As stated before, the practice of medicine is full of uncertainty (of which I don't mean the feeling of uncertainty, but rather the technical term), uses measurements, and makes inferences from data collection using imperfect tools. Let's say it is an art (whatever that is) and it uses the products of science, this is what I would imagine Carl Sagan would say of this practice,

The recent criticism of a prevailing belief is a service to the proponents of that belief, because if they are incapable of defending it, they are well advised to abandon it. This self-questioning and error-correcting aspect of science is its most striking property, and sets it off from many other areas of human endeavor, such as politics and theology. The idea of science as a method rather than a body of knowledge is not widely appreciated outside of science or indeed in, I’m sorry to say, in some of the corridors inside of science. For this reason, I and some other of my colleagues in the AAAS have advocated a regular set of discussions at the annual AAAS meeting of hypotheses which are on the borderlines of science or which have attracted substantial public interest. The idea is not to attempt to definitely to settle such an issue, but to illustrate the process of reasoned disputation, and hopefully to show how scientists approach a problem which does not lend itself to crisp experimentation or is unorthodox in its interdisciplinary nature or otherwise evokes strong emotions.

Carl Sagan via Kerry and Sarah Crespi, Science, 12 Oct, 2012: Vol. 338, Issue 6104, pp. 274, DOI: 10.1126/science.338.6104.274-b


If you've never heard of science (to say nothing of how it works), you can hardly be aware you're embracing pseudoscience. (p.19)

If we teach only the findings and products of science - no matter how useful and even inspiring they may be - without communicating its critical method, how can the average person possibly distinguish science from pseudoscience? Both then are presented as unsupported assertion. (p.26)

The values of science and the values of democracy are concordant, in many cases indistinguishable. [...] Science holds to no special vantage points or privileged positions. Both science and democracy encourage unconventional opinions and vigorous debate. Both demand adequate reason, coherent argument, rigorous standards of evidence and honesty. Science is a way to call the bluff of those who only pretend to knowledge. (p.41)

Carl Sagan, The Demon-Haunted World: Science As a Candle in the Dark, 1996

The H&P and the SOAP note are frameworks to collect data, record inferences, follow-ups, communicate with other physicians, and more. If these notes are not frameworks of scientific investigations, what are they? In this respect Richard Feynman lectured about using a science framework while at the same time not being scientific,

In the South Seas there is a Cargo Cult of people. During the war they saw airplanes land with lots of good materials, and they want the same thing to happen now. So they’ve arranged to make things like runways, to put fires along the sides of the runways, to make a wooden hut for a man to sit in, with two wooden pieces on his head like headphones and bars of bamboo sticking out like antennas—he’s the controller—and they wait for the airplanes to land. They’re doing everything right. The form is perfect. It looks exactly the way it looked before. But it doesn’t work. No airplanes land. So I call these things Cargo Cult Science, because they follow all the apparent precepts and forms of scientific investigation, but they’re missing something essential, because the planes don’t land.

Now it behooves me, of course, to tell you what they’re missing. But it would he just about as difficult to explain to the South Sea Islanders how they have to arrange things so that they get some wealth in their system. It is not something simple like telling them how to improve the shapes of the earphones. But there is one feature I notice that is generally missing in Cargo Cult Science. That is the idea that we all hope you have learned in studying science in school—we never explicitly say what this is, but just hope that you catch on by all the examples of scientific investigation. It is interesting, therefore, to bring it out now and speak of it explicitly. It’s a kind of scientific integrity, a principle of scientific thought that corresponds to a kind of utter honesty—a kind of leaning over backwards. For example, if you’re doing an experiment, you should report everything that you think might make it invalid—not only what you think is right about it: other causes that could possibly explain your results; and things you thought of that you’ve eliminated by some other experiment, and how they worked—to make sure the other fellow can tell they have been eliminated.

Feynman, R., Cargo Cult Science., 1974

So, if the practice of medicine uses measurements, data collection, inferences, and other tools of science while not being scientific, what is it?

Ignorance may be bliss, but it's also dangerous. This next video is a scene from HBO's TV series Westworld, season 1 episode 7, which shows the hosts have been programmed not to recognize disconfirming evidence.

Dr. Robert Ford: They cannot see the things that will hurt them. I've spared them that. Their lives are blissful, in a way their existence is purer than ours. Freed of the burden of self doubt.

Medical education should not keep us ignorant of science's critical attitude while only teaching confirmation bias. This critical attitude as stated by Feynman in 1974 "But this long history of learning how to not fool ourselves—of having utter scientific integrity—is, I’m sorry to say, something that we haven’t specifically included in any particular course that I know of." continues not to be explicitly taught these days.

There are certain practices that can't just be faked.

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1. You should attempt to re-express your target’s position so clearly, vividly, and fairly that your target says, “Thanks, I wish I’d thought of putting it that way.
2. You should list any points of agreement (especially if they are not matters of general or widespread agreement).
3. You should mention anything you have learned from your target.
4. Only then are you permitted to say so much as a word of rebuttal or criticism.
Daniel Dennett, Intuition pumps and other tools for thinking.

Valid criticism is doing you a favor. - Carl Sagan