Why we need to think and assess before blindly following instructions

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Image credit: History Extra

I’m firmly in favor of evidence-based medicine. Empiricism is the means whereby we learn about reality. Assertions and beliefs are worthless unless they’re supported by hard evidence that remains the same regardless of who does the experiment.

Unfortunately, medical practice is still too often based on assertion and belief rather than on empiricism. This is not surprising given that the origins of medicine predate science by millennia. In many parts of the world, even today, superstition and other folk beliefs predominate. It’s not uncommon in the developing world to see people resort to witchcraft to cure ailments; Chinese medicine is largely spurious and ineffective yet is much employed; and in the West a great many gullible people believe in crystals and “essential” oils and other such nonsense.

Much contemporary medical practice has survived largely unexamined since its origins, so it is not surprising that in many cases there’s no real basis for the recommendations doctors routinely provide. It takes a very long time, and a very great amount of empirical evidence, for doctors to change their minds. After all, when you’re the expert, it’s more than just a little embarrassing to discover you’ve been doing it wrong for decades.

It’s worth looking back at just a tiny number of examples of where medical advice has been not just a little off but totally wrong.

Doctors imposed the “lie on your back to give birth” methodology based entirely on the fact it made life more convenient for them. No more kneeling on the floor to see what was happening when a squatting woman was delivering her baby with the help of gravity; no, far easier for the doctor to stand at the bedside and merely tilt his head. Forget about the fact the baby is fighting gravity in order to emerge, thus making the process more painful and difficult for all concerned.

It took over a century for doctors slowly to change their minds over the “best” way to give birth and even today the business of birth in the USA is designed to produce revenues rather than beneficial outcomes for mother and child. For example, the rate of caesarian section in the USA remains around 30% whereas hard evidence from the rest of the world indicates that the real level ought to be between 0.2% and 2%. US doctors continue impose surgery on births that ought to have been normal because that’s what they’ve been trained to do. And they don’t question their training.

Doctors used to remove the tonsils and adenoids of young people “as a precaution” despite the fact these are essential elements of the human immune system and removing them makes people far more susceptible to disease. There are still parts of the USA where doctors recommend removal to “treat” the slightest inflammation, despite hard empirical evidence showing that the procedure is in almost every case totally unnecessary and in fact harmful to the long-term health of the patient concerned.

Doctors massively over-prescribed antibiotics throughout the 1960s, 1970s, and 1980s despite pharmacologists warning this would inevitably lead to the rapid emergence of antibiotic-resistant “superbugs” which, as we all know, is precisely what happened.

Doctors “explained” their over-prescription by claiming that “when you have a viral infection, you may possibly be more likely to get a bacterial infection as well, so the antibiotics are there to help prevent this.” The reasoning was spurious and the downside enormous, but doctors hate to feel powerless and so prescribing drugs feels a lot better than doing nothing. As a result, we now have very few antibiotics left in the arsenal and some bacteria have evolved to be resistant to every antibiotic, even in combinations.

Doctors routinely recommend fusing vertebrae to “cure” back pain, even though there is overwhelming evidence to show that fusing (a) does nothing to diminish the pain, and (b) usually makes the situation worse by inflicting additional stress on the remaining vertebrae.

In the UK, doctors and dentists alike during the period 1900 to 1960 used to recommend the removal of all teeth at age 21 in order to “save time” later. The assumption was that all teeth rot, so it’s better to pull them all out at the beginning of adulthood than to fuss with trying to keep teeth and gums healthy.

OK, that’s enough to make the general point: just because a doctor tells us something, there’s no a priori reason for us to take the statement at face value, any more than we’d automatically believe a used-car salesperson when they assure us that the vehicle we’re considering has no problems and will last for decades. Perhaps it is true, perhaps not: the onus is on us individually to assess the claims by reference to available empirical data. Today the Internet makes this task possible; before the Internet it would often be impossible for ordinary people to access the information required to enable them to reach their own data-driven conclusions.

Data is not opinion or assertion.

Reliable data comes from empirical investigation that yields similar results for a variety of different investigators at different times. An ignorant doctor writing a best-seller that claims wheat is harmful based on an appallingly stupid premise naturally attracts attention and fools the credulous. Hard science, however, reveals such claims to have no basis in fact. Another foolish doctor claiming that vaccines cause autism, once again without any empirical evidence to support the notion, deceives the ignorant and credulous but real data shows there is no connection whatsoever between vaccination and any autism-spectrum disorder.

We are fortunate to live in an age when hard data is, very slowly and very imperfectly, improving medical practice. But we’re only a short distance down a very long road. Much medical practice and therefore a great deal of medical advice is based more on wishful thinking (to which doctors are by no means immune) than on real-world evidence.

We may want to bear this in mind when the mass media tells us what doctors are recommending this week for our “protection.” It’s not so long ago that their forebears were advising us to consume quantities of arsenic “for our health.”

We all need to acquire the habit of reasoning from facts, not rushing to embrace things because doing something feels better than doing nothing or because a purported authority figure assures us that it’s the right thing to do. Evolution has provided us with a rudimentary capacity for reason; perhaps it’s time we all attempted to make use of it.

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