Lies, Damned Lies, and Medical Science

The following article from 2010 is extremely interesting.

Lies, Damned Lies, and Medical Science.

To quote some of the more salient parts:

[Dr John Ioannidis is] what’s known as a meta-researcher, and he’s become one of the world’s foremost experts on the credibility of medical research. He and his team have shown, again and again, and in many different ways, that much of what biomedical researchers conclude in published studies—conclusions that doctors keep in mind when they prescribe antibiotics or blood-pressure medication, or when they advise us to consume more fiber or less meat, or when they recommend surgery for heart disease or back pain—is misleading, exaggerated, and often flat-out wrong. He charges that as much as 90 percent of the published medical information that doctors rely on is flawed. His work has been widely accepted by the medical community; it has been published in the field’s top journals, where it is heavily cited; and he is a big draw at conferences.



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In poring over medical journals, [Ioannidi] was struck by how many findings of all types were refuted by later findings. Of course, medical-science “never minds” are hardly secret. And they sometimes make headlines, as when in recent years large studies or growing consensuses of researchers concluded that mammograms, colonoscopies, and PSA tests are far less useful cancer-detection tools than we had been told; or when widely prescribed antidepressants such as Prozac, Zoloft, and Paxil were revealed to be no more effective than a placebo for most cases of depression; or when we learned that staying out of the sun entirely can actually increase cancer risks; or when we were told that the advice to drink lots of water during intense exercise was potentially fatal; or when, last April, we were informed that taking fish oil, exercising, and doing puzzles doesn’t really help fend off Alzheimer’s disease, as long claimed. Peer-reviewed studies have come to opposite conclusions on whether using cell phones can cause brain cancer, whether sleeping more than eight hours a night is healthful or dangerous, whether taking aspirin every day is more likely to save your life or cut it short, and whether routine angioplasty works better than pills to unclog heart arteries.But beyond the headlines, Ioannidis was shocked at the range and reach of the reversals he was seeing in everyday medical research. “Randomized controlled trials,” which compare how one group responds to a treatment against how an identical group fares without the treatment, had long been considered nearly unshakable evidence, but they, too, ended up being wrong some of the time. “I realized even our gold-standard research had a lot of problems,” he says. Baffled, he started looking for the specific ways in which studies were going wrong. And before long he discovered that the range of errors being committed was astonishing: from what questions researchers posed, to how they set up the studies, to which patients they recruited for the studies, to which measurements they took, to how they analyzed the data, to how they presented their results, to how particular studies came to be published in medical journals.



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Imagine, though, that five different research teams test an interesting theory that’s making the rounds, and four of the groups correctly prove the idea false, while the one less cautious group incorrectly “proves” it true through some combination of error, fluke, and clever selection of data. Guess whose findings your doctor ends up reading about in the journal, and you end up hearing about on the evening news?



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When a five-year study of 10,000 people finds that those who take more vitamin X are less likely to get cancer Y, you’d think you have pretty good reason to take more vitamin X, and physicians routinely pass these recommendations on to patients. But these studies often sharply conflict with one another. Studies have gone back and forth on the cancer-preventing powers of vitamins A, D, and E; on the heart-health benefits of eating fat and carbs; and even on the question of whether being overweight is more likely to extend or shorten your life. How should we choose among these dueling, high-profile nutritional findings? Ioannidis suggests a simple approach: ignore them all [emphasis added].



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On the relatively rare occasions when a study does go on long enough to track mortality, the findings frequently upend those of the shorter studies. (For example, though the vast majority of studies of overweight individuals link excess weight to ill health, the longest of them haven’t convincingly shown that overweight people are likely to die sooner, and a few of them have seemingly demonstrated that moderately overweight people are likely to live longer.



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nutritional studies aren’t the worst. Drug studies have the added corruptive force of financial conflict of interest. The exciting links between genes and various diseases and traits that are relentlessly hyped in the press for heralding miraculous around-the-corner treatments for everything from colon cancer to schizophrenia have in the past proved so vulnerable to error and distortion, Ioannidis has found, that in some cases you’d have done about as well by throwing darts at a chart of the genome.



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The ultimate protection against research error and bias is supposed to come from the way scientists constantly retest each other’s results—except they don’t. Only the most prominent findings are likely to be put to the test, because there’s likely to be publication payoff in firming up the proof, or contradicting it.

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Doctors may notice that their patients don’t seem to fare as well with certain treatments as the literature would lead them to expect, but the field is appropriately conditioned to subjugate such anecdotal evidence to study findings.Yet much, perhaps even most, of what doctors do has never been formally put to the test in credible studies, given that the need to do so became obvious to the field only in the 1990s, leaving it playing catch-up with a century or more of non-evidence-based medicine, and contributing to Ioannidis’s shockingly high estimate of the degree to which medical knowledge is flawed. That we’re not routinely made seriously ill by this shortfall, he argues, is due largely to the fact that most medical interventions and advice don’t address life-and-death situations, but rather aim to leave us marginally healthier or less unhealthy, so we usually neither gain nor risk all that much.

A Viking Poo

 Just read this article about a Viking Poo.  Picture below.

Little
did the Viking realise when he was squatting down that people would
gaze at his poo in rapt attention a 1000 years hence. Just as we don't
consider that possibility.

Philosophy has been accused of making no progress, does it therefore make it pointless?

 

Science makes progress so why doesn't Philosophy?

Since the scientific revolution of the 17th Century, the progress of science has been a relentless triumphant one. This is vindicated by the fact that it has been extraordinarily fruitful in terms of the prediction and manipulation of our environment, as well as in the creation of our technology. The same cannot be said for philosophy. Why has there been such a lack of progress in philosophy, especially when we compare it to science?

We first have to recognize the difference between science and philosophy. Both disciplines seek to establish the truth. But, although there is overlap, in general, I would suggest that the nature of the truths that each of these disciplines seeks to establish are of differing types.

At a minimum, science seeks to accurately describe how the physical world unfolds and to manipulate the environment in the creation of our technology. Here we can easily see why progress is relatively easily achievable. For if someone proposes a scientific theory that describes some aspect of the world, it is in principle susceptible to being tested through our observations. A theory that fails to mirror what we actually observe can be discarded.

Now, let's consider philosophy and specifically the most important questions we can ask ourselves. Questions such as, 'what is the world', 'why is there something rather than nothing', 'does a creator exist', 'do we have free will', 'is there a purpose to our existence'? Or in the realm of ethics where we ask practically important questions such as, 'what is the Good', 'how should we live', 'should society seek to maximise happiness', and so on. All these questions appear to be purely philosophical since it seems there are no empirical investigations we can carry out that can help us to establish the answers to them. The resolutions to such questions have to rely upon arguments alone.

So, what generally (but see the next section) demarcates scientific issues from philosophical ones, at least for a lot of the deeper philosophical questions, is that the former can be tested, the latter has to rely upon arguments.

There's a problem with just exclusively employing arguments though, and it is this. Even if the arguments are sound, other people have to be able to understand them, and a sufficient number of people at that to
overturn prevalent pre-existing beliefs.
Compounding this problem, people have to be motivated to read
the arguments in the first place. How many people are motivated to read
an argument that contravenes their implicit beliefs? And, even when they
do, might they not be doing so in order to try and pick holes in it rather than adopting an attitude of an open-minded enquiry and a dispassionate search
for the truth? If that were not enough, philosophy is extremely
difficult. It includes asking the most important questions we humans can
ask ourselves, and the process of reasoning to certain conclusions can
engender no end of misunderstandings and confusions. Sound reasoning is frequently heavily outweighed by erroneous reasoning that comes to incorrect conclusions.

So the reason why philosophy doesn't progress is due to the fact that on the few
occasions where someone has an insight and produces a sound argument for
something or other, it does not have sufficient influence amongst other people to gain sufficient traction. People will frequently not be able to comprehend the argument. Or they may feel antipathy towards the conclusion of the argument if it contravenes their entrenched beliefs. More often still, though,
philosophical arguments are simply ignored. Contrast this with science. For example, consider the science behind powered flight. Would such science have been convincing in the absence of a practical demonstration? It seems not since the stories regarding the success of the Wright brothers were met at first with ridicule. But seeing is believing. In short, science progresses because people are convinced by what they can see with their eyes. Philosophy generally lacks this validation.

Is philosophy therefore pointless, or even meaningless?

It is commonly felt that because philosophy doesn't progress, at least in the form of universal assent, then it has no use at all. That is to say, it is pointless. Indeed, there are even some that suggest that the questions philosophy asks are meaningless. I suppose the idea here is that if no progress is made, then this implies no progress can be made because the questions themselves are, in principle, unanswerable. And they presume they are unanswerable since they are, quite literally, meaningless.  

I do not think this charge passes muster for one second. First of all, the lack of progress will be for the reasons I mention above. Moreover, clearly many philosophical questions have at least meaning, even the deepest questions. For example, either there is a creator (however conceived), or there isn't. If the latter, then the whole shebang came into existence by blind fortuity, or by happenstance, or by however one chooses to frame it. But, even when rejecting a creator, the question of whether or not there is a creator still has meaning. So, whatever the truth is here, whether there is a creator or not, there is a fact of the matter, even if it is a fact that forevermore lies beyond the ability of human beings to fathom.

There are further reasons to reject the contention that philosophical questions are meaningless, or at least pointless. I mentioned above that what demarcates scientific issues from philosophical ones is that the former is decided by empirical investigations, the latter by arguments. But that was a bit simplistic. It is somewhat more involved and nuanced than this. In fact, there is no rigid demarcation between science and philosophy.

For example, consider Galileo's argument that demonstrates that objects of different weights must fall at the same acceleration (see my post Thought Experiments in my other blog). Thought experiments, such as this are, strictly speaking, philosophical. But Galileo's argument is an example of a thought experiment that can be empirically investigated -- namely by dropping two objects of different weights from a high height and seeing if they reach the ground at the same time.

There are also examples of philosophical reasoning or thought experiments that although cannot be empirically established at the time they are articulated, are eventually susceptible to empirical investigation. So, for example, George Berkeley back in the 18th Century in his essay Du Motu produced sound arguments against the notion of absolute space, although his argument was ignored by virtually everyone. Berkeley's insight foreshadowed the rejection of absolute space in the 20th Century that came with the general acceptance of Einstein's special theory of relativity. 

So we can definitively conclude that at least some philosophy is able to establish truths about the world. And what is pivotal to their widespread acceptance is whether they can be empirically investigated -- sound arguments alone are generally insufficient. But whether some sound philosophical argument or insight can be empirically investigated or not is incidental to an argument's soundness. That is, a philosophical argument can be sound, even if it can never be empirically validated.

Should we exclusively refer to science to establish truths about the world?

It seems to me to be clear that our empirical investigations of the world do not always overturn those reached by a process of reasoning. To give one example, if we measure the area of a circle and it differs from πr², we wouldn't conclude the geometrical reasoning establishing it is πr² was incorrect. Rather, we would assume our measuring was inaccurate, or alternatively that it wasn't a perfect circle. Likewise, if we had measured objects of different weights falling at differing accelerations, would we conclude that Galileo's thought experiment was flawed and even pointless? No, because given the crucial proviso that Galileo's reasoning was sound, we should conclude there must have been some mistake in our empirical investigations that only seem to suggest that the heavier an object is, the faster it falls. Perhaps the experimenter was dropping a stone and a feather! 

There is another reason to reject this contention that we should just rely solely and exclusively on science to tell us about the world. Earlier, I said that at a minimum science seeks to accurately describe how the physical world unfolds and to manipulate the environment in the creation of our technology. But the vast majority of people -- and this also includes the vast majority of scientists -- regard science as doing much more than this. They regard science, or at least physics, as revealing to us the ultimate nature of reality. That our scientific theories depict literal states of affairs. That the plethora of subatomic particles and the four forces featuring in our theories in physics, all have a literal existence. There is also most scientists' belief that the success of science entails that materialism, indeed often reductive materialism, provides the correct depiction of reality.¹

As many of you will know, I question all of this. For example, see my What physicists claim exists can be doubted, my Self-floating books, my What philosophical questions does science answer?, and my Why the existence of consciousness rules modern materialism out.  

But whether you agree with me or not in any of these essays is simply not relevant. By all means, disagree with me, but this doesn't alter the fact that these issues are philosophical ones, not ones that can be decided by science itself. The problem here, though, is that most people, including scientists, do not appear to understand this. Our scientific education, which in turn smuggles in certain metaphysical suppositions, instils certain beliefs about the nature of the world. We soak up, almost by osmosis, western "wisdom" about what exists, what the world is and so on.

So philosophy, or more specifically metaphysics, is always implicitly involved in forming our conception of the nature of reality. It's just that many people, including scientists, are not aware that it is. They mistakenly think that science validates their metaphysical conception of reality. I regard this as highly undesirable. As those who have read some of my blog will be aware, this in my opinion had led to many fatuous conclusions regarding the nature of the world and what we human beings are.

Let me provide just one example of such fatuous conclusions. Consider the claim that physicists make that consciousness in and of itself lacks any causal efficacy. In reality, everything we ever do, and even think, is the result of the blind interactions of subatomic particles and their forces. But if we strip physics of its metaphysical assumptions and hold that physics merely describes changes in material reality that utilizes mathematical equations, we can see how silly this is. For, when we get right down to it, we are effectively saying that the patterns we observe in the subatomic realm serve to negate our immediate and direct experience of our own causal agency.

Let me go into more detail to try and explicate this further. Firstly, people are immediately aware of their own causal agency.  They then project this concept of causal agency into the material world in order to try and make sense of change within it (i.e. they don't like to suppose the patterns in the material world are just a brute fact). Crucially, they regard such material causes as accounting for all change in the world, this includes our brains too since they are material objects. Couple this with the belief that the brain produces consciousness, then it follows that it will be such material causes that account for the totality of our behaviour, including the progression of our thoughts.  Hence, they now deny their immediate experience that it is their own consciousness per se that is responsible for their behaviour.

Just reflect for one moment how crazy this is. First of all, it seems we were directly cognisant of the mental causal potency of our own consciousness as witnessed by our ability to move our own bodies and think our own thoughts. We thereby inferred the material world is also governed by causes, this time by material causes. We then turned this on its head.  For we now deny that our own immediately experienced causal agency exists, and in fact, only the inferred causal agency in the material world exists!²

Conclusion

Scientists enjoy a prestige only dreamt of by professional philosophers. Hence,
there is a disincentive for philosophers to advance ideas challenging scientists' metaphysical presuppositions. A philosopher doing so risks having their ideas labelled "absurd" and even being mercilessly
ridiculed. This in turn runs the risk of their careers being negatively impacted. Because of this, and due to other factors such as groupthink, professional philosophers tend to pander to scientists beliefs. Regretfully, as a consequence, philosophy lacks the impact it should and ought to have. Philosophy's lack of influence is not due to its pointlessness though, it's due rather to the unjustified hegemony of scientists' metaphysical beliefs.

 

 

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1 Note that materialism is independent from the question of whether our theories in physics depict a literal state of affairs -- one could be a dualist, for example, and be happy to hold that our theories in physics gives a literal representation of material reality^↩

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2 Of course, one can believe both in the causal efficacy of consciousness or mental causality, and material causality too. However, that would contravene physicists belief that the world is physically closed. Physically closed just means they believe that only material causes exist (see a relevant post in my other blog here)^↩

Advice on getting a girlfriend

Just read this: I’m fit and intelligent, but can’t get a date. Should I give up?

. .well at least the initial letter, I haven't bothered with reading the response from the agony aunt.

He says: 

I put a lot of effort into online dating, but the final straw was sending quality personal messages to 47 different women over six months and receiving nil positive replies.

In my experience I never got any responses for articulate thoughtful initial messages.  You have to put "Yo!" or whatever. And linking to my blog (my other one) virtually assured that they would either suddenly cease communicating with me, or I got some excuse.  I'm not kidding...

Having said that, I did meet someone before from this dating site.

Coming across as super intelligent is going to put them off.  As is being thick.  They want someone they can relate to, of about equal intelligence to them.   

My conclusion with my experience is you're most likely to succeed when you don't try too hard and not really too fussed if they don't respond again.  When you're flippant and "random" in your responses. When you perplex and intrigue them.

Oh yes, and I cannot stress how important is that you are smiling in your profile picture!  It is absolutely essential!  

I'm finding Resident Evil 4 boring

I've played resident evil 1 and 2, and the remakes of RE1, RE2 and RE3 (I started playing the original RE3 a couple of months ago, but ran out of ink ribbons so gave up about a third? of the way through the game).  See my blog posts here, here and here.  But I've never played RE 0, RE 4, RE 5, RE 6, RE 7, or RE 8 (village).

Anyway, everyone continually raves on about how great RE 4 is.  I even read someone who says he's been playing it about once a year ever since it was released in 2004!

The controls are abysmal.  I cannot "strafe" i.e move sidewards.,  The look around control seems very limited.  It's all very dark.  I don't think I can move when pointing a gun.  The first village was way too dark and I couldn't systematically look around everywhere because of this. Talk about a blind playthrough!

So I've just given up on it after that first village.

I find most computer games boring, although some of the old ones from 20 years ago are worth playing (but not RE 4).

I wonder what RE 5 and RE 6 are like?  RE 7, (which like RE 4 is also highly recommended) looks boring from watching someone play the first hour

My beliefs regarding a "God".

I'm not an atheist, at least not the modern western kind with the associated beliefs that the Universe is a brute fact, and we are just biological robots with no afterlife and simply create our own meanings to our lives. I do not think we have compelling reasons, or frankly any reasons, to believe any of this.

But I also reject this idea that there is this cosmic superhero type of God who is all powerful and tinkers with the laws of nature to bring about desirable ends. That is, I do not believe in the type of "God" that atheists tend to focus on and ridicule.

I'm not sure what I do believe, I only have a vague feeling. I think such a question is perhaps beyond what we human beings can understand or discern.

But, if pressed, I would say that I tend to gravitate towards the idea that there is a fundamental non-personal ‘spiritual presence’ that pervades and suffuses the entirety of reality. That reality as a whole is somehow infused with this conscious presence that we all somehow partake in. And that all conscious creatures -- indeed all things, all events, everything that has been, everything that will be -- is infused with ultimate meaning. But what such an ultimate meaning is eludes us in our present states.

Rishi Sunak (the UK chancellor) and his excuses

Rishi Sunak, regarding the UK's current cost of living crisis, has been reported as saying.

[T]he toughest part of this job is not being able to do everything that people would like you to do because we’re already borrowing quite a large amount of money, and I don’t think borrowing lots more would be sensible.

Why does he imagine he needs to borrow?  There's plenty of money out there.

The top 1% of the UK's population has the same wealth as the bottom 60% combined (i.e most of us).

The top 10% have almost half of all wealth (something like 47%).

In stark contrast, the bottom 50% of the UK's population have about 7% of all wealth (so the top 50% have 93% of all wealth).


I therefore simply have no sympathy for this "we have no money" line or references to "magic money trees".  This is an emergency. He is morally obligated to make the distribution of wealth ever so slightly more equitable so that people don't go hungry or cold (and sometimes both).