Monday, November 11, 2013

Scientific approaches without critical thinking

I blogged  before about the guy on the GO bus who was trying to convince me that I shouldn't use my anti-carsickness wristbands because he believed their effect was purely psychosomatic and had no scientific basis.

This is an example of something that's been irritating me for a while: people who are so dedicated to the scientific method that they don't think critically about whether it's necessary to approach a particular problem or situation from a purely scientific perspective.  Don't get me wrong, I'm a huge fan of science.  It's just that it isn't absolutely necessary to limit oneself to a strict, solely evidence-based, clinical, experimental approach to absolutely everything in the world at absolutely all times.

Here are some of the problems:

Unwillingness to make educated guesses

Sometimes, if you ask an evidence-based expert's opinion on something, they'll just say "There haven't been any studies conducted."  But, as someone who doesn't know much about a number of subject areas, I'd very much like their educated guess.

Using a blatantly fake example so as not to accidentally create googleability on something I don't know anything about, suppose I've read on the internet that jumping out of a second-storey window will cure your cancer. They probably haven't done any studies on this.  But we can still use our basic knowledge of how cancer and gravity and the world work to conclude "No, it doesn't work that way."  But suppose I say that I've read on the internet that if you jump out a second-storey window, you'll most likely survive but might injure the part of your body that you land on.  Without conducting any studies, we can look at our basic knowledge of the world and say "Seems about right."

This comes up and annoys me most often in websites dedicated to scientific analysis of beauty products. They'll say something like "The product claims to do X, Y and Z.  There have been no studies conducted on whether these ingredients would do X, Y or Z."   And then they leave it at that.  Okay, but is the claim plausible?  Is the claim ridiculous?  In the absence of clinical evidence, use your education and make an educated guess!  I'm reading you for expertise, not just for you to google up other people's studies so I don't have to.

The assumption that untested = harmful

When I was having my dysphagia incident, at one point during the long, scary weekend when I was waiting to see my doctor, I googled up the reflexology points that correspond with the esophagus, and massaged them. It helped a little.  If my esophagus was functioning at 10%, it felt like it was functioning at 15% after I did my little experiment in self-reflexology.

I don't know if reflexology has been clinically tested (the internet tells me it has and the internet tells me it hasn't). But even if it hasn't been tested, it's reasonable to assume I'm doing myself no harm by rubbing my own feet. If reflexology did serious harm, someone probably would have noticed by now.  (In fact, if it could do harm, it's better for me to google up the correct reflexology points and operate under the assumption that I'm doing a medical treatment on myself than to just rub my feet willy-nilly.)

The assumption that ineffective = harmful

When I was a teenager, I read or heard somewhere that duct tape can cure warts.  In the early 2000s, I had an opportunity to try it, and it worked fantastically where drugstore treatments had no effect.  Sometime later, someone did a study of duct tape as a wart treatment (although they used clear duct tape and I used silver) and they found that the results for duct tape were no different than the results for no treatment.

What I have a problem with is people who use this study to conclude that you shouldn't try to treat your warts with duct tape.  The study found that the results were no different from doing nothing.  So why not give it a try if you want to do it?  Basically the study proved that putting duct tape on your foot has no effect.  So if you want to do something silly-looking that the evidence found has no effect, why shouldn't you?

When it doesn't matter if it's scientific 

As I've blogged about before, I found significant, life-changing inspiration in the concept of Entitlement, which I learned about in Malcolm Gladwell's Outliers. A number of times I've mentioned this in discussions about things that inspired you, and been told that I shouldn't be inspired by that because Gladwell's methods aren't scientific.

But it doesn't have to be scientific for me to be inspired by it.  The book introduced me to a concept I needed in a way that made it clear to me why I needed it and how I could make it work for me.  So I tried it out, got good results, kept using it, and it was life-changing.  No science required.  It's like if someone says to you "You'd look good in red," or "Here, taste this food." They don't need to prove scientifically that you'd look good in red or that the food is yummy, you just try it out and either it works or it doesn't.  And if it turns out you do look good in red or the food is yummy, these positive qualities are not negated by their not having been proven scientifically.

When it doesn't matter if it doesn't work

Shortly after my GERD diagnosis, in an informal conversation with someone with naturopathic training, I learned that apples are thought to be effective against GERD.  The pectin in their peel is thought to form a protective barrier on top of the contents of the stomach, making it more difficult for it to reflux back up into the esophagus.  To get the most out of this protection, I was told, an apple should be the last thing you eat at each meal and at the end of the day.

So I immediately started doing it.

 Is it scientifically proven?  I have no idea.  Does it work for me?  I have no idea - my GERD is silent so I don't feel heartburn.

But it doesn't matter.  I love apples and I eat at least one (and 2-3 during peak season) every day anyway.  Even with all the contradictory information I received from conventional and alternative medicine, apples were not contraindicated anywhere.  So I took something I eat anyway and started eating it at specific points in my day rather than whenever the hell I want (although I'm also free to have them whenever the hell I want too.)  If it doesn't work, nothing has changed and no harm has been done.  So why wait around for someone to do a study?

The right to self-experimentation 

One thing I hear quite often from people who are opposed to alternative medicine on the basis that it hasn't undergone clinical testing is that people shouldn't be experimenting on themselves or using themselves as test subjects for things that haven't been proven.

But why not?  Experimentation and test subjects are necessary for things to become proven. So if you feel it's promising or would rather be doing something than doing nothing, why not experiment on yourself?

Weirdly, because this comes from nearly an opposite place, I've also seen this from people who think prescription medicines are overused.  For example, when I had my dysphagia incident, my doctor offered me the option of taking a medication (Dexilant) while we waited for testing and referrals to go through.  His reasoning was that most things that could be hindering my swallowing had reflux as the root cause, and Dexilant would help with reflux and help heal any damage to my esophagus caused by reflux.  If reflux was a factor, it would help.  If reflux wasn't a factor, it would be informative.

At that point, I really wanted to do something proactive, so I decided that yes, I want to try the medication. I noticed an improvement within an hour of taking the first pill, and I was able to eat normally in three days (i.e. before any tests results had come back or referrals had gone through.)  It was an unmitigated success.  But I've gotten static from a surprising number of people for taking a prescription medication without being 100% certain it was necessary.

One thing I learned when I got sick was that being proactive is helpful for me.  I'm far less stressed when I feel like I'm doing something to make myself better.  I left the doctor's office that day with a to-do list: go to the lab and give them some blood; go to the pharmacy, take the pills they give you, monitor what happens; go to this address at this time and drink some barium; when the hospital calls you, do what they tell you.

Similarly, when I get a cold, I bring on the home remedies.  Vitamin C and echinacea and garlic and Cold-FX and zinc and juice and water and tea and broth and 12 hours of sleep a night.  If I'm not asleep, I'm intaking some kind of fluid literally at all times.  I have no idea if all of this stuff is proven (they keep coming out with studies changing what has been proven), I have no idea if all (or any) of it is necessary.  For all I know, the 12 hours of sleep a night is doing all the work for me. But I feel far better when I'm doing something about it, so I do something about it.

Why would you want to deny someone the relief of being proactive if that's what works for them?

Anecdotal = empirical when it happened to you

Sometimes when I mention something that worked for me in my own firsthand experience, people point out that this is just anecdotal, not experimental data, and therefore I shouldn't rely on it.

But it actually did work for me.  That's empirical evidence.  Duct tape did cure my warts, so I will use duct tape next time I get a wart.  Even if for some reason it doesn't work for anyone else in the world, I already know that it worked for me, so it will be the first thing I reach for next time.  My home remedy bombardment when I have a cold has worked for me for the past 20 years, so next time I get a cold, I will reach for it.  Even if it doesn't work for others, I know it works for me.

Everyone is their own best test subject for determining whether things work for themselves. If someone is willing to take the risk of playing guinea pig for themselves, why deny them that option?

1 comment:

laura k said...

This is an awesome post. I have thought all or most of these at various times but have never sat down and unpacked the whole issue.

These arguments come up all the time with so-called alternative medicine, and too often become an all-or-nothing argument - all conventional medicine or none, all alternative or none - which is nuts!

I am going to save this to read more carefully later. Brilliant.