“Does it justify rejecting the current scientific consensus on CLD because having a longstanding consensus is not predictive, or does not reflect the actual evidence? I don’t think so.”
And you are probably right. But consensus could also be made to accomodate for experimental treatment in the absence of resolution with consensus treatment.

I am not a doctor, but I imagine the heuristic is to rule out conditions based on the product of their seriousness and likelihood. Serious and likely gets ruled out before serious and non-likely which gets ruled out before non-serious and non-likely. To come to a conclusion too soon is bad care. There may have been less awareness of CTS 20 years ago because computer mice hadn’t been in wide use before then. That lack of awareness goes both ways. Pain in the arm may have been looked at as more of a symptom of something else, like diabetes. There are much better tests now to diagnose CTS. When mine was diagnosed they measured the conduction velocity in the nerves and measured that it was decreased when the nerve went through the carpal tunnel. That was in the 1990s, not sure if that technique was available in the 1980s.

Arm pain may be a symptom of abuse too. There is a type of arm fracture that is virtually diagnostic of child abuse because there is essentially no other way for bones to be broken in a spiral fracture. Asking straight up about abuse is often problematic because patients lie.

This is not a reason to dismiss the current consensus on CLD.

And in any cases – I wish we could just focus on the evidence, rather than constantly having to argue about conspiracy theories and closed-mindedness. It is my contention that the latter is the refuge of those who do not have science on their side.

The little anecdote is btw from a visit I made more than 20 years ago.

And the most pertinent question would have been to ask me if I played some sport (e.g. tennis) or had some work that caused undue stress to one arm, not for bedwetting!

If you consider that the initial proposal was put forth in 1979, we can maybe agree that these sentiments of being resisted, and subsequent written tradition, may refer to the period 1979 to about 1983 (I speculate grossly), while the causality you suggest may be more relevant for the period from, say, 1986 and forward, when the “early adopters” are rushing in. (Lets call 1984-85 the pivotal years that were key to the success or failure of the idea.)

That way we are both sort of right

Correct

“all…delusions need to be treated with drugs or physical intervention ( surgery maybe)? …
Better reality through chemistry. Sounds good!”

We are already walking down that lane. (See e.g. Nature 2008;452:674-675,1157-1159. and the NAS report “Opportunities in Neuroscience for Future Army Applications”)

There are a plethora of substances and methods used to “improve reality”. Prozac, alcohol, cannabinoids, transcranial magnetic stimulation, but also psychotherapy and cognitive behavioural therapy, vitamin d stoss cures, cognition enhancing drugs and so on.

My point is that all these methods affect biochemical expression in the body. Yes a very reductionist view, but it still is so (unless you believe in the supernatural.)

(Link to NAS report press release http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12500)

It is, rather, that initial skepticism is typical and appropriate. Most new ideas are wrong – but when you look back at the ones we now know to be correct it can be made to seem as if the skepticism was excessive. But it is just part of the process.

What Atwood showed was that, despite initial skepticism, the research findings were taken seriously by some, the notion was explored, and because it was, in retrospect, correct – the research built to a consensus. More evidence led to more research which led to more evidence, until a threshold of acceptance was reached.

That is how science is supposed to work.

Then, looking back, the scientists who were vindicated tend to exaggerate their plight and resistance to their ideas. There is a tendency (I see this all the time) for scientific resistance to be interpreted as bias and closed-mindedness – but it’s just science.

Actually, scientists who are not vindicated also think this, and blame their failure on the resistance, not the evidence.

This is just human nature.

There is a certain wisdom of the crowds – individuals will be stuck in the past and will be closed-minded, but the scientific community in general flows with the evidence. What Atwood was arguing is that looking at the number of publications in the literature is a better barometer of skepticism/acceptance than individual instances, which will tend to be biased toward dramatic resistance to later vindicated ideas – that is dramatic story humans like to tell.

The bottom line is this – if you look at all the data, in most cases the scientific consensus tracks along pretty well with the evidence. There is initial skepticism to all ideas, which is appropriate, and opinion lags behind evidence a bit, which is unavoidable – but in robust evidence-based fields opinions overall track with the evidence.

I have CTS too (as did my mother and her father, they did’t get it from using a computer, but from milking cows by hand), so I have looked into the physiology of it. I think the reason CTS is associated with those other things is because of a final common pathway of low NO leading to increased inflammation.