In my field of medicine, for the past century or so, there has been a concerted effort to connect scientific research (both basic and applied) to actual practice. What’s the point of having a lot of scientific knowledge collecting dust in journals and books if it doesn’t affect what people do? In the last couple of decades, in fact, the medical profession has re-dedicated itself to evidence-based medicine and even formalized this process. Some of my colleagues and I even want to go a bit beyond EBM to science-based medicine, to make the connection between science and practice more effective (and to oppose the counter-movement to disconnect practice from science).
But strangely in many other fields the connection between published science and practice is not strong. Richard Wiseman, for example, just published a book called 59 seconds (out in the UK, and will be released in the US in January) in which he points out that there is a rich psychology literature full of practical advice that is simply not getting to the public. Instead we have a self-help industry peddling advice which is largely made-up and not evidence-based. (You can hear us discuss this issue on a recent SGU episode.)
It is also generally true that the common knowledge that most people absorb from the culture is largely false, or at least off in some significant way. Think about any topic that you happen to either be an expert in or at least highly interested and experienced in and compare your knowledge to what most people believe about that topic.
One area where we could use more of a connection between science and practice is education. This is especially true as our knowledge of how the brain works and learns rapidly increases. What knowledge we do have is not systematically applied to education. It further seems to me that we need more translational research – studies focusing on long-term outcomes of specific interventions.
I hate it when a side comment or example completely takes over the main point of a blog post. In my post on ADHD I made what seemed to be a very straight-forward analogy to feminism:
Some feminists insist, against the evidence, that there are no significant differences between the sexes.
My point was only this – that it is a mistake to base a moral position on scientific facts, for then either you must insist that the facts conform to your moral desires, or your moral position is vulnerable to falsification. I specifically referenced Steven Pinker who made this point in The Blank Slate. Pinker also, by the way, gives numerous examples of feminists committing this fallacy in his book – so this is a secondary reference, but sufficient for the minor side point I was making.
A few, however, have completely missed my point, despite my later clarifications in the comments. I will pick on M. Davies since he wrote such a long comment. He writes, regarding my claims that some feminists hold this position:
Do you have some citations for this, some evidence that a distinct philosophy within feminist theory adheres to this claim?
First I must point out that whether or not any feminists actually hold this position is not relevant to my point – it was an analogy. To the extent that anyone takes the position that there are no significant difference between the sexes, they are committing the fallacy I am discussing. But I do hold that this is a distinct philosophy within feminism, and as I said I gave Pinker as one source.
In my opinion, Kevin Trudeau is one of the most notorious snake-oil pushers of our generation. After spending time in prison for bad checks and credit card fraud, he would have us believe that he somehow hit upon “cures they don’t want you do know about.” Isn’t it interesting that convicted con-artists always seems to hit upon such well-guarded secrets. Dennis Lee claims to have found the secret of limitless energy, if only he were not attacked by Big Oil and a corrupt government. Kevin Trudeau claims to have found the cures for just about everything, but The Man is trying to shut him down.
What is even more amazing than the audacity of these claims is that a sufficient portion of the population is credulous enough to throw millions of dollars at the likes of Trudeau and Lee. Thankfully in most civilized nations it is a crime to lie to people in order to take their money. The problem has always been enforcement – authorities don’t have the resources to keep up with the constant whack-a-mole game against con artists. Sometimes they lack adequate authority to hand out punishments that would serve as a true deterrent.
Last week I wrote about some new evidence regarding the biological basis for ADHD. As commonly occurs with such pieces, the comments attracted some discussion of what I call mental illness denial. For those who are interested in this topic I recommend reading my five-part blog series on this topic beginning here. But I would also like to address some of the specific points raised.
Commeter Pious Fraud relates feedback from a friend who is a follower of Thomas Szasz. Szasz is definitely the father of mental illness denial. Forty years ago he had a point, and I admire his defense of autonomy, informed consent, and universal human rights. At the time a psychiatric diagnosis was akin to a loss of rights and autonomy. But there are two major malfunctions of the Szasz position today.
The first is that whatever legitimate points he had forty years ago were fought and won. He should just accept his victory – psychiatry has been reformed, partly from a series of legal precedents that reaffirm the rights of the patient. Second, Szasz committed a fallacy that is all-too common – making the scientific facts fit his ideology. Even when the ideology is a good one, like human dignity and autonomy, nature does not have to comply to our moral wishes.
Nicholas Gonzalez is a controversial doctor practicing in New York. He has been promoting for years a largely dietary treatment for cancer including an individualized organic diet, large amounts of supplements, and pancreatic enzymes. He is a case study in why we need rigorous science to decide which treatments are safe and effective, of the lure of quack claims, the power of bias, and the inadequacy of our current regulations.
Dr. Gonzalez has managed to have a thriving practice despite, in my opinion, violating the basic standard of care and medical ethics. He has done so partly by riding the wave of so-called “health care freedom” which confuses (I think deliberately) the public about the nature of standards in medicine.
The Gonzalez treatment, which is based on prior claims made by James Beard and William Kelley, lacks plausibility or basic science support. While you can find studies to show that an individual supplement may have some effect that potentially could have some clinical effect, you have to extrapolate wildly and recklessly from such information to clinical claims. Such information is at best a source of hypotheses – not treatments.
And in the final analysis Gonzalez’s claims are just recycled CAM propaganda – claiming that supplements will boost the immune system and detoxify the body.
ADHD (attention deficit and hyperactivity disorder) is somewhat of a beleaguered and misunderstood disorder. The key controversy (and it is mainly a public, not a scientific, controversy) is whether ADHD is an actual brain disorder, a product of environmental factors (bad parenting, too much TV), or a cultural fiction. As is often sadly the case, I find the public debate largely disconnected from the scientific research.
I have no particular bias toward any kind of explanation – whether ADHD is a hardware or software problem, or an observational artifact. I believe all three kinds of entities exist. My only interest is to understand what the science says about ADHD. My reading of the literature is that the evidence strongly supports the conclusion that ADHD is a brain disorder. Of course it is modified by the environment – but at its core, it’s a problem of brain function.
A new study supports this conclusion, but before I get to that let me go over some background. The clinical definition of ADHD, like all behavioral diagnoses, is based upon having a minimum number of a list of characteristic symptoms. This kind of “squishy” diagnosis often fuels the fire of ADHD denial – but in reality many medical diagnoses are made this way. Migraine, which is not a controversial disorder, is diagnosed the same way.
As the H1N1 flu pandemic of 2009 continues we are slowly learning more and more about it. The challenge is that health organizations and governments are trying to optimize their response to this flu strain in the midst of the pandemic unfolding. It’s like preparing for a hurricane as it’s happening, without knowing where it will make landfall, how strong it will be, how much water it will drop, and if the levies will hold. The best option is to prepare for the worst while hoping for the best.
There are two key features of flu strains that we track – infectiousness (how easily it spreads) and virulence (how severe an infection it causes, and specifically what is the percentage of hospitalizations and deaths). What we can say at this time about the current H1N1 strain is that it is about as infectious and virulent as the regular flu-season flu. This may make it seem like not such a big deal, but of course the regular flu season kills 36,000 people in the US alone, and about 400,000 world wide.
But as the pandemic unfolds we are learning some more details. Most flu deaths in regular flu seasons are among the elderly or in susceptible populations due to a chronic illness. The current H1N1 flu, however, disproportionately kills pregnant women and young children. Another pattern is also emerging – while in most people this strain causes a mild flu, in about 1% it results in a very severe flu with a 50% mortality rate. The severe cases develop a form of ARDS (acute respiratory distress syndrome) that destroys the alveoli (air sacs) in the lungs.
There has been much talk in recent years about the ongoing discovery of exoplanets – planets around suns other than our own. The technology to detect these distant objects has been increasing recently. There are two primary methods for detecting exoplanets: One method is to look for the wobble in the parent star caused by the gravity of the planet. The planet and its star revolve around their center of gravity, which will not be in the dead center of the star itself, but off center, causing a wobble.
The second method is called the transit method in which we look for alterations in the amount of light we can see from a star because of a planet that moves in front of it. This requires that the view of this system from the earth is roughly in the plane the planet is orbiting – the planet has to move in front of (transit) the star from our perspective. The new Kepler telescope is designed to detect light from many stars with sufficient sensitivity that it can find small (earth-size) planetary transits.
With all the talk about exoplanets, there has been, until now, little talk of exomoons – moons around planets around other stars. Until Kepler it has simply not been possible to detect exomoons. David Kipping of University College London has now published a paper in which he says that this is feasible.
The unavoidable truth is that we are all mutants. This doesn’t mean that some of us can control magnetic fields at will while others have claws protruding from their knuckles (although it is fun to fantasize about what you would like your mutant power to be).
Rather, it means that mutations – random changes in the base pair sequence of our DNA brought about by copying errors in the reproductive process – are common. This is old news, but scientists have been trying to nail down exactly how common for years.
Now a new study, using the latest genetic sequencing techniques, gives us a more accurate estimate of the mutation rate in humans – 3 x10 -8 mutations per nucleotide per generation. This translates to 100-200 mutations per person. That means that you have 100-200 new mutations not present in either of your parents.
The Young Australian Skeptics will be publishing an anthology of skeptical blog posts. This is a great idea, and is another way to spread skeptical goodness throughout the world. What they need now are nominations. You can nominate your favorite skeptical blog post from 2009 here.
This is a similar project to the Open Laboratory, which has been putting the best science blogs into anthologies since 2006. You can buy these at lulu.com – an online, on demand publishing company.
Also, we are looking for similar ideas to promote skepticism, especially those that find new ways to repackage existing content for new venues – and therefore hopefully new skeptics. Leave any ideas in the comments.