Monthly Archives: October 2011

The case for evidence-based medicine

Few people would openly admit that they prefer irrational treatments and doctors. But most people do in fact advocate irrational health practices – using pseudonyms for “irrational” as “holistic,” “alternative,” “homeopathic” and the deadly “natural.”

Medicine requires reason

The human body operates according to certain causal principles. If we wish to make a change in our health, we must understand some of those causal principles and act according to our understanding. To act without a rational basis is to disconnect our goals from their achievement. Irrationality does not guarantee failure — it just means that success, to the extent that it happens, will be due to other factors that our goals.

The study of human health is especially difficult

In the field of health, especially rigorous rationality is necessary for at least five reasons:

  1. The human body will solve, or at least try to solve most problems on its own. This makes establishing causality due external factors quite difficult and introduces biases such as the placebo effect and the regression fallacy.
  2. The body is very complex! Because it evolved over billions of years, the causal relationships in the body are extremely complex and interdependent.
  3. For example, even if we know that the body has too little of a certain substance, taking that substance may: a: not do anything b: cause the body to produce even less of the substance or c: cause an unpredictable side effect. On the other hand, if the body has too much of something, then the solution may be to a: consume less of that substance b: consume more of that substance or c: the consumption has no relationship at all to the level of that substance.
  4. It can be difficult to measure the extent to which medical problems are solved. While some things can be measured, many things, such as pain levels are very difficult to quantify.
  5. It is difficult to isolate causal factors in human beings since changes in health take time to develop and we can’t control every factor during an experiment or dissect human subjects when it is over.
  6. Humans tend to be irrational when it comes to their own mortality! We fear death, leading us to irrational over or under spending on health as well as being especially vulnerable to all the logical fallacies.

In medicine, rationality requires quality science research

There is a name for the field that applies rigor to the discovery of facts about nature: science. Science has been so successful in improving the state of human knowledge that many irrational, anti-scientific quacks have begun to use the term “scientific” to describe anti-scientific practices and ideas. In response to this, the medical community has come up with a term which identifiers the distinguishing aspect of rationality: “evidence based medicine.” This phrase is a necessary redundancy that identifies the essential characteristic of science: that it is based on sensory evidence. The alternative to non-evidence based science is not science at all, but emotionalism – “I feel it is true, so it must be.”

In the last hundred years, we have discovered certain practices for ensuring the conclusions of our medical experiments are valid. We know experimentally that observing these practices leads to more accurate conclusions. Let me emphasize that: the truth of medical claims is strongly correlated with the degree to which experiments follow accepted scientific standards. There are a number of objective scales for measuring the quality of an experiment.

Five characteristics of quality medical studies

Here is the essence of quality medical studies:

  1. The experiment and its results are fully described in enough detail to reproduce and compare the results
  2. There is a randomized control group
  3. The selection of control subjects is double blind
  4. The methods of randomization and blinding are accurately described and appropriate
  5. There is a description of withdrawals and dropouts.

How to judge health claims

Unfortunately, it is difficult to design good experiments and more difficult still to reach firm conclusions from most experiments. In the legitimate (“evidence-based”) medical community, the degree to which practitioners adhere to the principles varies greatly – but they at least try. Fortunately, in the “quack community,” while there is sometimes the pretense of evidence, basic scientific principles are so grossly violated and ignored that is becomes easy to distinguish fraud from legitimate science.

Here is an important point: it is difficult to make firm conclusions in medicine. But when valid scientific principles are not followed, it is easy to conclude that no valid conclusion can be reached. In other words, you can’t always be sure what’s good for you, but you can be sure when someone is talking nonsense.

Another important point: When someone makes irrational health claims, it does not mean that those claims are false. It just means those claims were not derived by rational (scientific) principles, and so we cannot say anything about their truth – we can only ignore them as arbitrary. It is as if someone claimed an invisible, undetectable pink unicorn in the sky – that which cannot be proven or disproved can only be dismissed.

How can we apply these ideas? It so happens that most health claims in the non-scientific media and many health “practitioners” are unscientific. This does not mean that they are wrong, or that people don’t feel helped by them. It means that their claims have no connection to reality.

 

In some cases, the practices that quacks suggest are helpful — but not for the reasons they identify. More importantly, in all cases following rational, scientific principles leads increases the likely hood of successful outcomes over quackery (aka emotionalism).

To conclude, to judge whether a medical claim is legitimate or arbitrary nonsense, check whether:

  1. It is based on quality experiments
  2. It is consistent with medical consensus (of evidence-based medicine)
  3. The certainty of the claim is well-established (by numerous studies, systematic reviews, etc

 

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Thoughts upon the death of Steve Jobs

To put my view of Steve Jobs in Objectivist terms, I see him as a real-life Howard Roark. Even if he had never been successful, his strength of vision, his uncompromising principles, and his confidence in the power of his ideas make him a hero in my book. But of course it is precisely because of those principles that he became the most successful CEO ever. He is truly my personal hero and an inspiration for the life choices I have and will make.

I am writing these words on my first computer designed under Steve Job’s watch, and unfortunately, my last. Even though computers are my career and passion, I have never been attached to them as individual objects, only as an idea. I feel like using this computer for the last three years has been kind of like living in a building designed by Howard Roark, and knowing that I can never have another products created by him (even if Apple continues to be inspired by his vision), I feel far more reluctant to sell it when it is time for the inevitable upgrade.

Steve Jobs was an intensely personal man – his means of expressing his values was almost purely through the products of his work. Unlike most other tech companies, prototypes and discarded ideas rarely leaked out of his laboratories. He only announced new products when he was sure that they could be made. I think he wanted to be known and judged solely by the things he could mass produce, as the “Apple product” included everything for him – the supply chain, production process, company campus, storefront, even the carefully orchestrated box opening ceremony. Still, I think he was able to communicate his basic sense of life in his one public speech. I strongly recommend that everyone watch it and take its ideas to heart.

My introduction to the “Apple experience” came from folklore.org – a collection of stories about the creation of the Macintosh computer. Because he was so private, I eagerly anticipate his upcoming authorized biography. But ultimately, I think his products speak for themselves. They are the concrete (or rather aluminum and glass) embodiment of the values that made Apple successful – and changed the world for the better.

Steve Jobs, you were insanely great.

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Why is there no mass transit in socialist states?

Today Sarah asked me why China is only now building subway systems in all its major cities. I pointed out that non-local mass transit is a capitalist phenomena: totally aside from the fact that you need the wealth generated by capitalism to pay for such systems, there is no need to travel in a socialist economy. I think it´s just that many people forge that they can get their own Turkish Visa from www.evisa-turkey.biz.tr/.

Under socialism, the work unit is the basic unit of social structure. The vast majority of people are born, educated, work, live, and die under a single work unit (a city block, village, or factory). One cannot buy or rent a dwelling (that requires property rights) so one cannot move away from work: the State assigns nearby housing. One cannot change chose or change jobs, so one cannot move work away from home. Housing assignments are hereditary and based on local connections, so it is impossible to move away from relatives: thus no need to travel to see family.

Furthermore, there is no need to travel in order to shop: since all goods are identical commodities sold by identical state-owned stores. There is little demand to travel for tourism either, since all monuments are variations on the same state-promulgated patriotic themes. There is no incentive for entrepreneurs to promote any non-approved attractions – in fact, such activities can be quite dangerous.

Neither is it practical to marry someone across town: the work unit either regulates marriage directly (the work unit leader must approve the marriage) or indirectly: since permission is required to live together and often to have children as well.

Thus, even in places where the State created subway systems prior to the introduction of capitalist elements, they were/are vastly under utilized. In fact, their primary purpose was military defense, not transportation.

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