On Babies and Bath Water

On Babies and Bath Water

I have spend the last 5 days wandering the NE:  Boston, Newport, Plymouth, back to Boston, Salem and now home. I was invited to give a talk on influenza and participate in a panel discussion about low back pain.  The panel consisted predominantly of those who take care of backs for a living and I felt a bit like an Alzheimer’s patient who wandered into the room my mistake.

The panel was asked about using pseudo-medicines and I have my best 3 minute summary as one of the militant members of the science-based medicine community. Then one of the members of the audience made a comment that due to time constraints I was unable to respond to.

So here is a paraphrase of the comment 5 days later and my response.

He started by saying he was a big believer of Science-Based Medicine but...

But. Beware the but. That often means the speaker is about to endorse some bit of pseudo-medicine that deserves our consideration.  I was not disappointed. 

 

He continued, mentioning that he has treated plantar fasciitis for years, usually with a single needle, often with only one or two treatments and it works more often than not.

This is, I suspect, the greatest reason that pseudo-medicines continue to thrive.

First is the relying on experience as a valid criteria for deciding on a therapeutic intervention. Experience makes us better heath care workers in so many mays it is virtually impossible for HCW's to recognize that the three most dangerous words in medicine are not "I lack insurance" but "In my experience." They are a powerful meme for the speaker and totally useless to the listener.

Variations of the concept are found in the ideas that

the plural of anecdotes is anecdote, not data

and the Richard Feynman quote:

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.

The problem is that Dunning-Kruger appears to be the default mode for most health care workers, the

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.

So to my mind the speaker personified what may be the primary issue with pseudo-medicines in health care: the reliance on experience and the inability to recognize that it is useless.

He concluded with the usual chestnut about not throwing out the baby with the bath water.

Me? When it comes to pseudo-medicine I would throw out the baby, the bath water, the tub, the soap, the shampoo, the washcloth and the towel.

Points of Interest 12/12/2014
Points of Interest 12/08/2014

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