Oct 23 2012

Guilty Verdict for Italian Earthquake Scientists

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94 Responses to “Guilty Verdict for Italian Earthquake Scientists”

  1. uncle_steveon 23 Oct 2012 at 9:05 am

    This is very disturbing indeed. Is there a precedent for this in Italy or any other country? I have a feeling these same scientists would have ended up in trouble if they had sounded the alarm bells and nothing happened, especially if it led to a mass evacuation for nothing.

    More troubling still, is how Italy has the least amount of press freedom in western Europe(and even less press freedom than some formerly communist countries in eastern Europe), so this may make it more difficult for native Italians who understand science to help reverse this decision. It was only during the Amanda Knox trial that I started to understand that Italy has many laws that are borderline fascist when it comes to ordinary citizens or journalists criticizing public figures or the police. Criticizing the police in Italy is a serious offense, based on what I have read. It is also one of the most corrupt countries in western Europe.

    I really hope the entire Italian scientific community comes to the defence of these scientists, and I also hope this decision is reversed on appeal, but based on my readings I have little faith in the Italian judicial system to do the right thing.

  2. Kawarthajonon 23 Oct 2012 at 9:25 am

    I am not only disturbed by the verdict, but also the length of the sentence! 6 years is a very long time for someone to spend in jail, especially when there was no criminal intent. I have no idea how the criminal justice system works in Italy, but in Canada, that would be a federal sentence that your typical repeat offender would get after their 4th bank robbery, or a major drug dealer after getting caught several times and working their way through the system. Jail is not the place for these scientists!!! They should be in the lab, the university or the research institute, when they are not out in the field of course.

    I hope that they appeal and win this case. If they do not have the money for an appeal, I would gladly donate money to the cause, as I sure many others would.

  3. Ori Vandewalleon 23 Oct 2012 at 9:55 am

    Let me preface by saying that it’s absolutely ridiculous that the prosecution of these scientists has made it this far. I wonder if, once they’re out of appeals, they can seek asylum in a country that understands science a little better?

    That said, 6 years for supposedly causing the deaths of 309 people actually seems like an extraordinarily light sentence. That’s about a week per death.

  4. Cattuson 23 Oct 2012 at 12:39 pm

    Ludicrous! In fact, there are no superlatives that adequately describe this insanity.

    If only someone had the Cojones to take the obvious next step: Now according to most legal documents such as insurance policies, an earthquake is described as an “Act of God”. That being the case, I submit that all priests and other clergy who are in regular ‘contact with god’ (don’t they all claim to be?) be brought up on the same charges. They should have known and should have told the public.

  5. Kawarthajonon 23 Oct 2012 at 1:25 pm

    Ori, I’d have to disagree with your second statement. The scientists were not directly responsible for the deaths. That would be like throwing a public health worker in jail every time they told people not to panic about the flu, and then someone dies of the flu. In my opinion, the sentence is incredibly harsh given the circumstances.

    The people who are directly responsible for most of the deaths would be the corrupt construction workers who did not build the buildings to code and the corrupt officials who were lax in their inspections of buildings. It was their actions that led to the deaths of most, if not all of those people. Yet, they have not been charged with anything. Their actions, or lack of actions, directly led to people being killed. It would have been easy to predict (had the inspectors done their jobs) that shoddy buildings in an earthquake zone would have had the potential to kill a lot of people.

  6. Ori Vandewalleon 23 Oct 2012 at 2:59 pm

    I agree that the scientists are not responsible. The point I’m making is that they are, according to the Italian government, guilty of manslaughter. From that point of view, 6 years for 309 deaths doesn’t make any sense.

  7. Tom Nielsenon 23 Oct 2012 at 5:28 pm

    Just four days ago, the Italian supreme court ruled on another scientific matter, i.e. on the link between cellphone use and brain tumor:

    http://www.reuters.com/article/2012/10/19/us-italy-phones-idUSBRE89I0V320121019

    Italy’s scientific reputation is plummeting at the moment!

  8. pseudonymoniaeon 24 Oct 2012 at 1:24 am

    Another way to look at it is at 100% responsibility and 20 years/death that’s 618 years. Which suggests that the Italian government is ascribing ~ 6/618 or ~1% of the blame to these scientists.

    I wonder what the margin of error is on that calculation? Normally I would ask a statastician to figure it out but you never know what trouble she might get into for that….

    Maybe it’s just best to let the Italian courts meditate on this one while they share a seance session with the Pope.

  9. NewRonon 24 Oct 2012 at 1:34 am

    The judgement appears to be a consequence of the cult of scientism. Scientists should not use their scientific status to comment on issues about which they have no knowledge. The “unlikely” prognosis is such a comment. Rather than “unlikely”, perhaps “we don’t know” would have been appropriate; but in this age where science is put forward as a means to provide answers to everything, next to impossible for the scientists to give.

  10. skeplankeron 24 Oct 2012 at 2:04 am

    Perhaps to “properly” communicate, earthquake scientists should run daily graphic ads (just like tobacco), showing gratuitously gruesome flattened meat, warning of a non-zero chance of death by earthquake. Italians dig that.

    I think the Pope should issue a 5 level, color-coded alert system for various adverse natural events and some imaginary events (e.g. Rapture). Nobody should take the hit for his boss unless it’s organized crime, despite the similarities.

  11. BillyJoe7on 24 Oct 2012 at 6:57 am

    NewRon,

    “The judgement appears to be a consequence of the cult of scientism”

    There is no such cult.
    You just don’t understand science.

    “Scientists should not use their scientific status to comment on issues about which they have no knowledge.”

    Scientists have no knowledge about earthquakes?
    Is that what you are trying to say?

    ” The “unlikely” prognosis is such a comment. Rather than “unlikely”, perhaps “we don’t know” would have been appropriate”

    If these scientists had said “we don’t know”, they would actually have been lying.
    They said that a major earthquake is “unlikely”, and they were exactly correct in that statement.

  12. Steven Novellaon 24 Oct 2012 at 8:31 am

    BillyJoe is correct – since few tremors are followed by a major quake, the probability of those tremors being followed by a major quake was unlikely (but non-zero).

    If you correctly characterize an outcome as unlikely, eventually the unlikely will happen anyway. That doesn’t mean you were wrong.

    Also – think about all the times the government did warn about a possible bad event or outcome that did not manifest or was much milder than predicted (like H1N1). They are soundly criticized for that as well. I guess giving accurate information to the public is a lose-lose proposition. The public seems to want crystal balls, not statistics.

  13. sonicon 24 Oct 2012 at 10:54 am

    I’m willing to play devil’s advocate. In this case the devil might just have a winning argument–

    Apparently one of the scientists made a specific recommendation not to leave.
    http://www.cbc.ca/news/world/story/2011/05/26/italy-quake-arrests.html

    “In one now-infamous interview included in the prosecutors’ case, commission member Bernardo De Bernardis of the national civil protection department responded to a question about whether residents should just sit back and relax with a glass of wine.
    “Absolutely, absolutely a Montepulciano doc,” he responded, referring to a high-end red. “This seems important.” ”

    I’m not sure that saying there is no way to predict earthquakes is a good defense of someone who made such a recommendation.

    If he had said everyone must leave, then would everyone have had to leave? I mean, what would you think of someone who told the scientist to take his predictions and shove them?

    If one mustn’t question scientists, then one must believe what they say.
    If one must believe what they say, then they must be infallible.
    If they are infallible, then any mistake is malicious.
    If a mistake is malicious, then sometimes one gets punished for it by court order.

    Seems a reasonable line. I’m not sure that’s the one taken, but I think it would probably work with a number of the jury members. (Perhaps newron is hinting at this.)

    So the scientist made specific recommendations that were not “I don’t know,” or “Perhaps there will be one…”
    That’s probably the difficulty.

  14. Steven Novellaon 24 Oct 2012 at 11:32 am

    sonic – scientists, however, give answers in probability, not certainty. They make no pretense to infallibility. The public thinking them infallible or able to make specific predictions is a problem of scientific illiteracy.

    The best answer probably depends on what you think the question is, and this appears to be where the disconnect was.

    Question – will there be an earthquake soon? Answer – no one knows.
    Question – What is the probability of a major earthquake? Answer – unlikely.
    Question – Are these tremors worrisome? Answer- not particularly.
    Question – Should we evacuate because of the tremors? Answer – no.

    Answering “I don’t know” to each of those questions is not accurate or truthful. In the end the scientists gave reasonable answers and are being blamed for a low probability event. Experts give statistical advice that turns out, through no-one’s fault, to lead to a bad outcome.

    The chilling effect from this case is exactly that scientists and experts will be unwilling to give such information or advice in the future. Your playing Russian Roulette with your career every time.

  15. locutusbrgon 24 Oct 2012 at 12:56 pm

    @sonic
    Science by its nature is a learning process if there is no question about the answer, it is not science it is dogma. If you want the best answer possible by the best known method to determine the truth then you must accept probability not certainty. If you want certainty and the security that rises from that then look for believers not scientists. If you want answers that you can use you must accept the error bars. They are not asking the pope why he couldn’t properly warn the population about the dangers given his divine perfect knowledge.

  16. Jacob Von 24 Oct 2012 at 3:34 pm

    So, it’s surprising that Italian jurisprudence seems to lack a reasonable and rational approach to factual scientific evidence and appears to gives more credence to the conjecture and speculation of prosecutors’?

  17. BillyJoe7on 24 Oct 2012 at 4:29 pm

    Sonic,

    “I’m willing to play devil’s advocate. In this case the devil might just have a winning argument….

    If one mustn’t question scientists, then one must believe what they say.
    If one must believe what they say, then they must be infallible.
    If they are infallible, then any mistake is malicious.
    If a mistake is malicious, then sometimes one gets punished for it by court order.”

    I can’t believe that you think this might be a winning argument.
    All your premises are wrong.
    I mean, even the devil would be embarrassed.

    But, knowing you, you probably meant something entirely different from what you have actually written, so perhaps I’ll just wait for a clarification.

  18. NewRonon 24 Oct 2012 at 5:17 pm

    BillyJoe is incorrect. Scientism abounds. Barring some incredible conspiracy theory, the probability the earthquake occurred is 1. The proof of the pudding is in its eating. Its victims would have done better, certainly no worse, to have consulted the Oracle at Delphi or made offerings to Poseidon than to have expected scientists to provide them with answers. I do not believe anyone is suggesting that the scientists should have predicted the earthquake but, rather, that they should have stuck to their science and not strayed into the business of issuing reassuring statements.

    More disturbing than the L’Aquila earthquake is the almost certain future eruption of Vesuvius and the resultant devastation – it is hoped the inhabitants of Naples don’t expect to be saved by scientific prediction. Indeed groups of scientists disagree on the nature of any blast and the extent of possible damage (Nature 473, 11 May 2011). If practitioners more freely acknowledged the limits of science, perhaps social expectations may change.

  19. raylideron 24 Oct 2012 at 10:21 pm

    Dr. Novella,

    “Also – think about all the times the government did warn about a possible bad event or outcome that did not manifest or was much milder than predicted (like H1N1). They are soundly criticized for that as well. I guess giving accurate information to the public is a lose-lose proposition. The public seems to want crystal balls, not statistics.”

    —I think it’s typically the news media that misrepresents the predictions of the scientists with something like “What the scientists are saying about what the next disaster may be, and what you need to do about it. Coming up next.” So the people’s criticism is probably warranted.

    “Question – will there be an earthquake soon? Answer – no one knows.
    Question – What is the probability of a major earthquake? Answer – unlikely.
    Question – Are these tremors worrisome? Answer- not particularly.
    Question – Should we evacuate because of the tremors? Answer – no.”

    —I’d say the answer to the last question is “Up to you” or “It’s your decision.” Decision to evacuate is ultimately a personal choice that depends on everyone’s unique circumstances. Scientists are there to make predictions based on their knowledge of science, not to tell people what to do despite not knowing their personal circumstances. Similar things quite often happen in medicine – the doctor makes all the decisions rather than involving the patient, giving them all of the information, laying out their choices and allowing them to decide.

  20. Steven Novellaon 24 Oct 2012 at 11:32 pm

    raylider – that’s why I added “because of the tremors.” They are not a good reason to evacuate. That would mean it’s reasonable to evacuate every city after every tremor (or at least ones in earthquake areas).

    If a patient asks me, “should I get an MRI scan,” and the official evidence-based recommendation is no, I tell them no, not “it’s up to you.” They may have a tumor – anyone might – and that absolutely opens me up to lawsuits. But I’m relatively safe if I am following the science and the standard of care.

  21. sonicon 25 Oct 2012 at 12:05 am

    Guys– I know what a scientist should say. That’s not what was said.
    It doesn’t matter what he was supposed to say, or what a ‘scientist’ would say– what he did say matters.
    And the guy basically said to go home and have a glass of wine– no earthquake coming.
    Obviously the answer- unlikely- would be fine. That’s not what was said. And I take it this is representative of what the scientists were saying on the radio and so forth before the big one hit.
    That’s the problem.
    Read the article.

    BillyJoe7-
    I know all the premises are wrong.
    But I bet Dr. N. recognizes this reasoning from medical malpractice suits.

  22. raylideron 25 Oct 2012 at 1:06 am

    Dr. Novella,

    Thanks for the reply, but I have a further inquiry regarding the ethics of the following:

    “If a patient asks me, “should I get an MRI scan,” and the official evidence-based recommendation is no, I tell them no, not “it’s up to you.” They may have a tumor – anyone might – and that absolutely opens me up to lawsuits. But I’m relatively safe if I am following the science and the standard of care.”

    — Shouldn’t it be up to the patient? Yeah, the headache is 99% likely to not be a tumor. But if your prescription is to always not get an MRI, you will have a 100% chance of being wrong at least in the instance of the 1% chance that it is the tumor. I would guess the reason that you don’t say “it’s up to you” is because it’s not the patient’s money/resources to be commanding because insurance/government are paying. Given that the patient comes in with cash and their own money, shouldn’t it be up to the patient to decide whether he wants to investigate unlikely scenarios? Is it likely that it’s a tumor? No, it’s highly unlikely. Do you know for sure: no. Caveat: there are instances where unwarranted diagnostic tests are harmful by increasing the likelihood of a false positive, as in the case of a low prevalence disease and a test that isn’t specific enough, but let’s assume that was not a factor for the purposes of this argument.

  23. raylideron 25 Oct 2012 at 1:08 am

    P.S. Can you clarify what opens you up to lawsuits? Saying “no” or saying “it’s up to you”?

  24. dvd.grb.eron 25 Oct 2012 at 3:32 am

    Hi all,

    here’s a summary in english of the interview (and the interview itself in italian) that is believed to be the cause of the verdict. The author, an italian astrophysicist also shares his own views on the matter.
    http://luigifoschini.blogspot.de/2012/10/the-perception-of-risk.html

  25. Aardwarkon 25 Oct 2012 at 4:54 am

    Newron,

    The a posteriori probability (which, of course, DOES equal 1) is not to be confused with a priory probability of an event (“unlikely”). This estimate was based on prior knowledge and (inevitably incomplete, to be sure) understanding of tectonic processes – and the fact that the unlikely outcome actually happened does not make the estimate any less (or any more) correct. All this is pretty basic ground in any risk analysis.

    The point being, we should not judge past assessments solely on what actually happened. If we could go back to that day when the unfortunate commission member suggested staying home with a good glass of wine, and then “replay the tape” many times – how often would a devastating earthquake be the outcome? Probably not in the majority of these “re-runs”. In other words, people who agree with the prosecution’s case appear to exercise what is, in heuristic analysis, termed “bias of hindsight”.

    Of course that science is unable to predict everything! Scientists (and all who understand science) are extremely rarely the ones to suggest otherwise. Much more often it is the press and various other aspects of “public opinion” that go for the (obviously wrong) image of scientific opinion as claiming to be “infallible”.

    That being said, I agree that the commission’s statement may have been a bit “too” reassuring. However, in no possible way can this be equated with manslaughter. I also agree that people should (and do) make their own decisions, and that risk-assessing scientists are there to provide exactly what the term implies: to assess the risks. No more and no less. Scientists are completely responsible for the quality of their risk assessment. But not for ALL the possible (and unlikely) consequences of ALL actions that the assessment has influenced.

    But in this case it is 1) not perfectly clear that the assessment had really been wrong and 2) not the faulty assessment that was the charge, but killing people.

    Improbable events happen all the time. Rational and thorough extension of arguments that support the verdict that was pronounced would, sooner or later, find not just all scientists in the world, but almost everyone (or, at least, everyone who can speak) guilty of some “involuntary manslaughter” in some way, somewhere.

    Oh yes, and remembering how Pliny the Elder acted (before becoming a victim himself) during the Mt. Vesuvius eruption that obliterated Pompeii and Herculaneum, should history judge this great man as well similarly as his present-day Italian colleagues? I honestly don’t think so. The naturalist, who was also a senior official of Rome, acted exactly as a good public official should. Even though he gave some reassurances to people at the outset of the eruption. As we all know, panic also costs human lives, all too often many more lives than the disaster itself.

    Bottom line – I agree with Dr Novella that giving accurate information to scientifically illiterate people (in any future reference: “the people”) not used to critical thinking and rational risk assessment is, at least in a certain very real (and legally binding) sense… a lose-lose proposition. And it is inevitable that this makes all rational persons (ever since Pliny’s time) rather upset.

  26. BillyJoe7on 25 Oct 2012 at 6:12 am

    Raylider,

    “Shouldn’t it be up to the patient?”

    No, it should not. Resources are limited. If everyone with a headache wanted, and got, an MRI, patients who have real indications for an MRI will be pushed to the end of a very long queue. They are the ones who are more likely to have a brain tumour and they will have a delayed diagnosis.

    “Yeah, the headache is 99% likely to not be a tumor.”

    Try 99.999%

    “But if your prescription is to always not get an MRI, you will have a 100% chance of being wrong at least in the instance of the 1% chance that it is the tumor.”

    Clearly, Steven Novella is not going to miss 100% of brain tumours that cross his desk.
    Obviously, if the headaches are accompanied by other suggestive symptoms, or if there are abnormal neurological signs, that would probably constitute a science-based ndication to do an MRI.

    “Given that the patient comes in with cash and their own money, shouldn’t it be up to the patient to decide whether he wants to investigate unlikely scenarios?”

    They would still be using up scarce resources (manpower, MRI machines), and some poor individual is going to miss out on his science-based indications for the scan or have a delayed diagnosis. If you think that is ethical, you have a different ethical sense than most doctors (I hope).

    “there are instances where unwarranted diagnostic tests are harmful by increasing the likelihood of a false positive, as in the case of a low prevalence disease and a test that isn’t specific enough, but let’s assume that was not a factor for the purposes of this argument.”

    Done.

  27. BillyJoe7on 25 Oct 2012 at 6:24 am

    Sonic,

    “I know all the premises are wrong.”

    So I was correct, you were saying something other than what you wrote:
    “I’m willing to play devil’s advocate. In this case the devil might just have a winning argument”

  28. BillyJoe7on 25 Oct 2012 at 6:32 am

    NewRon & sonic,

    You are basically saying that scientists may only present evidence, but that they must not interpret the evidence or recommend action.
    Who else is gong to interpret the evidence and make recommendations.
    You call it scientism.
    I just call it science.

  29. dandoveron 25 Oct 2012 at 10:16 am

    “First, it seems the scientists were not convicted for failure to predict the quake, but for how they communicated to the public about the risk of the quake occurring.”

    That is a distinction without a difference. The court has taken issue with the scientists’ “reassuring” statements, such as the low probability that the swarm of minor quakes heralds a major quake, or that the swarm is not by itself reason to evacuate the town. But those statements are 100% accurate and reflect the best advice that the science could have given. The reason the court has taken issue with the statements is because the court believes that the advice given was bad advice. And the court believes it was bad advice only because an earthquake did in fact occur. In other words, it was bad advice only because the scientists failed to predict the quake.

    Another way of looking at it: in hindsight, what action must the scientists have taken in order to avoid this conviction? It seems the only way to avoid the conviction would have been to have stated something like, “These swarms represent an unacceptably high risk of an impending major quake. Prudent residents should evacuate the town immediately.” However, without the ability to accurately predict quakes, the scientists would never be able to make such statements without lying.

    The court’s and prosecutions’ long-winded arguments insisting that this isn’t about a failure to predict the earthquake are unconvincing. The scientists were convicted for failure to predict the quake (or for failure to lie and exaggerate the risks).

  30. skeplankeron 25 Oct 2012 at 10:26 am

    Raylider and BillyJoe,

    If public resources are to be spent on an unlikely tumor expedition against the current standard of care, then it is clearly unethical.

    However, if the patient is sufficiently informed of the risks and benefits, false positives and negatives, and is still willing to devote his resources to get the optional MRI, unless a public hospital will bump a patient in need for an optional scan, I see no ethical problem with this.

    For example, in many parts of Asia, private MRIs are quite affordable and not uncommon. It is often less than a co-pay in the US (USD$200-$400 all inclusive, http://www.cth.org.tw/02department/depa02_5center8.html). Disclaimer: just an example, I am not associated in any way with this organization.

    On a tangent, I believe that a greater ethical problem arises when the cost of health care is artificially inflated due to an inefficient insurance system, and rendered inaccessible to millions as a result. When a health care provider will gladly accept self-pay for 1/10 of the price they bill the insurance company, something is seriously wrong.

  31. raylideron 25 Oct 2012 at 12:23 pm

    BillyJoe7,

    “They would still be using up scarce resources (manpower, MRI machines), and some poor individual is going to miss out on his science-based indications for the scan or have a delayed diagnosis. If you think that is ethical, you have a different ethical sense than most doctors (I hope).”

    MRI’s are scarce? Why are they scarce? I don’t think a person who brings their own money is using anyone’s resources other than his own. It’s not as though a unit of MRI disappears because he used it. The patient traded his money, which can then be used to create more MRIs. It’s not as though when you buy an iPhone, there are less iPhones to go around. No, Apple uses the money to make more iPhones that are cheaper and better. So I’m not sure why that doesn’t apply to MRIs.

    May be I’m focusing too much on the hypothetical here, since we have a government controlled healthcare system and few people actually pay for their services. But given the exception when it is the patient’s personal resources at stake, it is absolutely ethical for him to trade his resources for other’s products. No one else is anymore entitled to someone else’s property.

    I’d say it would be unethical for the doctor to be the one that decides how to ration resources and place prices on other people’s lives. Yeah that’s great that the chance is 99.999 in the patient’s favor, but tell that to the family of the patient who went home with a tumor. The fact of the matter is, when the patient presents, the probability of him having a tumor is actually either 0% or 100%. And the 99.999 is the epidemiological figure derived from past populations, it does not apply to the individual. Also, it may be that in the case of the headache, the likelihood of a tumor is low, but the general cut off for most can’t-miss-Dx’s is what? 98%? You’re at 98% confidence that the patient didn’t have an MI, or PE, or whatever else? So you’re going to miss 2% out of every hundred and send them home? This happens all the time. Now, in the current system there is no other way, but I don’t see a problem with a person deciding how to care for themselves and using their own resources.

  32. raylideron 25 Oct 2012 at 12:31 pm

    In fact, as you say “if every patient came in and got an MRI.” How AWESOME would that be? You would have tons of patients, paying out of pocket for MRI scans. The industry would boom, and the economy of scale would reduce the prices of MRI’s for everyone, while increasing quality.

  33. sonicon 25 Oct 2012 at 4:06 pm

    BillyJoe7-
    No, I think that the premises are wrong.
    But billions of dollars have been and are being spent here in the USA on medical malpractice suits and insurance that basically subscribes to the logic I listed.
    Sounds like a winner in that sense. You know, stuff that judges and juries go for.

    In this case the guy was getting paid by the people to give scientific advice and he gave advice that is contrary to science. As he was getting paid to give best scientific advice- something that we know he knew- then when he gives something else– hmmm- open and shut case of malpractice it seems to me.

    Is it chilling the scientific community to say that you will be held responsible for your pronouncements and actions, like everyone else?
    Perhaps they need a bit of hilling then.

  34. BillyJoe7on 25 Oct 2012 at 4:48 pm

    Raylider & skeplanker,

    You are talking about a different category or resources than I am.
    I’m not talking about personal financial resources, I’m talking about the world’s resources in time, money, and manpower.

    Not everyone can become a radiographer or radiologist. Of those who can, not all would want to be one. So there’s a limit already. Also governments, quite rightly, regulate to some extent how many go into the various professions. And there are market forces, but they don’t work as you suggest. If there is a siphoning off of a large section of they population into the lucrative fields of radiography, radiology, and MRI machine manufacturing (because everyone with a headache wants an MRI), there will not be enough farmers to feed us, carpenters to build our houses, and teachers to teach us how to do all these things.

    So there’s no choice. Radiographers, radiologists, and MRI machines are going to be rationed, whether we like it or not. The question is how do we ration them. The obvious answer, at least for readers of this blog, is based in science, not personal financial resources. It is also the ethical solution.

  35. BillyJoe7on 25 Oct 2012 at 4:54 pm

    Sonic,

    “In this case the guy was getting paid by the people to give scientific advice and he gave advice that is contrary to science. As he was getting paid to give best scientific advice- something that we know he knew- then when he gives something else– hmmm- open and shut case of malpractice it seems to me.”

    I disagree.
    The facts were presented, the facts were interpreted, and recommendations were made based on those facts and the interpretations of those facts.
    In any case, why where the other six found quilty?

  36. NewRonon 25 Oct 2012 at 6:02 pm

    BillyJoe:
    I don’t know if the expression “verballing” is one that has coin within your culture, but in my culture you have “verballed” me and on top of that you deign to ask me a question, albeit without a question mark. You have also arrogated to yourself a position from which you pronounce that I just do not understand science. I am unable to participate in a dialogue with anyone on that basis.

  37. skeplankeron 25 Oct 2012 at 9:14 pm

    BillyJoe,

    We are talking about the same resource, specifically the alleged scarcity of MRIs and radiologists. From my previous post, “For example, in many parts of Asia, private MRIs are quite affordable and not uncommon.”, the market forces have already brought the pricing down to an affordable level in those regions, where there had been, but no longer is, a rush of capital flowing into MRI imaging equipment investment, specifically self-pay private comprehensive health check-up clinics in Asia. The cost of a self-pay comprehensive 2-day health check was cut more than half to a bit over 1k as the number of clinics flourished. The public health system and resources were not impacted significantly as the clinics are private, for-profit organizations or branches. THAT is how the market really works. There have been no reports of people on public health care systems being denied MRI scans because the hardware and personnel were snatched up by private clinics.

    “A siphoning off of a large section of the population” is a strawman argument. A large section of the population woud also love to be the CEO of Mycrowsoft and make obscene amount of money. I’m sure most of them didn’t become CEO so they could be farmers and feed everybody to avoid extinction of the human race.

  38. BillyJoe7on 26 Oct 2012 at 6:13 am

    NewRon,

    I suppose I should take seriously someone who makes a big deal about a missing question mark.
    And there is no such thing as scientism. There’s just science. Scientism is just a word made up by those who take exception when science refutes their favourite unevidenced beliefs.

  39. BillyJoe7on 26 Oct 2012 at 6:22 am

    skeplanker,

    ” The cost of a self-pay comprehensive 2-day health check was cut more than half to a bit over 1k as the number of clinics flourished. ”

    A useless health check is still a useless health check when it is half-priced.

    Medical practitioners should be deciding what investigations should be performed. If there are clear evidence-based indications to do an investigation, it should be done unless the patient refuses. If there are clearly no evidence-based indications to do an investigation, then it should not be done and the patient should have no say in the matter. In the grey area between these two clear cut cases, then and only then should the patient have an input to the decision to do the procedure.

  40. dadredgeon 26 Oct 2012 at 6:58 am

    Lets be clear. The general level of education and science knowledge is very high in Italy, certainly higher than the US. Also we do not know all the facts in this case but clearly there IS a case to answer, if only in the way the scientists communicated a level of complacency about earthquakes. I suspect, however, their appeal will be successful.

  41. sonicon 26 Oct 2012 at 12:21 pm

    BillyJoe7-
    The article I linked to made it clear that at least one of the scientists gave advice that goes directly against standard scientific practice. He predicted that no earthquake would happen and he predicted that rather forcefully and clearly.
    That is why he is found guilty– he gave advice opposite of what was scientific and what he was paid to give.

    Do you agree that this occurred?
    Perhaps the others were doing similarly. That was hinted at in the article.

    What do you know about the other’s actions that the judge in the case doesn’t?

  42. skeplankeron 26 Oct 2012 at 1:05 pm

    BillyJoe,

    “A useless health check is still a useless health check when it is half-priced.”

    Your assumption is that a comprehensive health check is useless. Assuming it is a long shot (which arguably it is not), as long as the patient is properly informed, sometimes a hunt down a rabbit hole yields a rabbit.

    For example, a lottery ticket is a tax on those unfamiliar with the concept of expected value, and is one of the worst government-sponsored investments one can make. However, one should be free to squander funds on lottery tickets, despite what the mathematician recommends. Informed or not, it is the concept of free will. And in my opinion, this is exactly how CAM thrives minus the payout.

    “In the grey area between these two clear cut cases, then and only then should the patient have an input to the decision to do the procedure”

    I disagree with this viewpoint. In an extreme case, if Bill Gates wanted to buy an MRI machine and do MRI’s on himself, his dog, and dead fish, for any reason (health investigation, reclaim the Ig Nobel prize, etc.), nobody should have a say in how he spends his money, since an MRI machine is a commodity and not in short supply.

    Another distasteful example: People are free to purchase as many wasteful SUVs as they wish, and drive around in circles just for fun, even though this arguably wastes a limited resource (oil) and affects other (emissions).

    Unless one’s decision is clearly and directly affecting other’s well-being by depriving limited resources (e.g., monopolizing a resource), in my opinion one should have full agency of his own body, including how to utilize his available resources, and how and when to end his own life. It’s called freedom, and last time I checked, it was in the Constitution of the United States.

  43. BillyJoe7on 26 Oct 2012 at 2:16 pm

    Sonic,

    The statement issued by the scientists was clearly based in science.

    In the question and answer session after the statement, a reporter seemed to be probing for an more explicit message and one of the scientist seemed to give him what he seemed to be after. It was a reasonable take home message, but it was probably a mistake to have given that un-nuanced take home message.

    I once gave a response in court that carefully included the word “possible”. In follow up questioning, the answers I gave seemed instead to imply “probable”. When I was then asked “well which is it, possible or probably”, the judge stepped in and told the interrogator to stop badgering the witness.

    “Perhaps the others were doing similarly. That was hinted at in the article.
    What do you know about the other’s actions that the judge in the case doesn’t?”

    You are the one implying that this is the case, so it’s up to you to provide the evidence.
    I will assume their innocence until provided with that evidence.

  44. BillyJoe7on 26 Oct 2012 at 2:31 pm

    Skeplanker,

    It is not my assumption. Routine health checks are not evidence based activities. In fact, the evidence is that they are not beneficial and do not save lives. On the contrary, they tend to lead to further useless chases down rabbit holes. The fact that occasionally a treatable problem is picked up is not a justification for their use.

    I don’t buy lottery tickets for that very reason, but if you want to buy one on a whim, go right ahead. But please do not waste limited medical resources on a whim. Medicine is not a commodity to be bought and sold on a whim, it is a scientific activity. Or it should be. Or don’t you support the purpose of this blog which is to promote science-based medicine.

  45. sonicon 26 Oct 2012 at 6:34 pm

    BillyJoe7-
    The common phrase around here is-
    ‘assumed innocent until proved guilty in a court of law’.

    The judge found them guilty. In a court of law.
    Once that happens the burden of proof shifts, I believe.

    You seem to think you know more about Italian law and the evidence in this case than the judge who ran the proceedings.
    And I’ll bet you didn’t even read the article I linked to, did you?

    Eat a little crow. It’s good for a balanced diet. :-)

  46. skeplankeron 26 Oct 2012 at 8:25 pm

    BillyJoe,

    “Routine health checks are not evidence based activities. In fact, the evidence is that they are not beneficial and do not save lives.”

    I would be interested in seeing this evidence. The following is the opinion of the NIH:

    “Regular health exams and tests can help find problems before they start. They also can help find problems early, when your chances for treatment and cure are better.”

    “Medicine is not a commodity to be bought and sold on a whim”

    I should stop buying aspirin then. Medicine, medical equipment, and medical services are commodites. You can buy it with money, and not have to rely on an authority to determine what is best for you or what level of care you must receive.

    “Or don’t you support the purpose of this blog which is to promote science-based medicine”

    I support SBM fully. But above all I believe in freedom.

    I believe that better education in critical thinking to be the long-term solution, which I feel is better than the Darwin way.

    This discussion is WAY off topic and I apologize to Steve for that.

    BillyJoe, if you want to continue discussion about health freedom, I suggest we do it here: http://notsofoulmouthedrant.blog.com/2012/10/18/health-freedom/

  47. ccbowerson 26 Oct 2012 at 9:24 pm

    “There’s just science. Scientism is just a word made up by those who take exception when science refutes their favourite unevidenced beliefs.”

    I do not care for the term scientism, but mostly because of how it is used, not because it is “made up” – all words are made up. The way NewRon used the term is a good example of a poor use of the term. Scientism should be reserved to describe a situation in which science is being applied to nonscientific questions. This can be a real problem, but it simply doesn’t apply here…

    Estimating the probabililty of an earthquake is clearly a scientific question: if he objects to the use of science in regards to this problem, then I would like to know a better approach to answering this question. If the objection is that the scientist was overconfident in the ability to predict or was just simply wrong, then he should just state that- throwing in the term scientism says more about the person using the term than the scientists themselves.

  48. BillyJoe7on 27 Oct 2012 at 12:46 am

    Sonic,

    I was talking about YOUR lack of evidence about WHY they were guilty.
    Did they other six say the same thing as the person who was quoted in the article, or did they not?
    If you don’t know, then don’t say they are guilty for that reason.
    They are innocent of that charge in my eyes until you can provide those quotes.

    And, of course I read the article.

  49. BillyJoe7on 27 Oct 2012 at 1:01 am

    Skeplanker,

    The opinion of the NIH is not evidence.
    I’m not going to provide you with the evidence but, if you want to find the evidence for yourself, I will give you this reference as a starter:
    http://www.sciencebasedmedicine.org/index.php/re-thinking-the-annual-physical/

    And how is buying aspirin a whim?
    There is science-based evidence of benefit. Unlike an MRI for a headache.

    But health freedom?
    This is for health fraudsters to rip off the public without government interference.
    At least I know where you are coming from now.

  50. BillyJoe7on 27 Oct 2012 at 1:11 am

    Ccbowers,

    There are no non-scientific questions worth asking.
    And the answers to all questions worth asking are informed by science and confirmed by science.
    Thee is no other way to short the wheat from the chaff.

    This is what is often referred to as scientism, but it is merely a hopeless defence by people whose un-evidenced beliefs are threatened by scientific fact.

  51. ccbowerson 27 Oct 2012 at 10:35 am

    “There are no non-scientific questions worth asking. And the answers to all questions worth asking are informed by science and confirmed by science”

    First sentence is completely wrong. Second sentence is better, but does not save the first. Informed by science is not the same as scientific question. There are many examples, but many tend to involve values, which may vary from person to person, even if the science is agreed upon. Often these are questions on how to deal with specific problems given the science available on the issue. I’m sure you are aware of this, so I’m not sure how you are justifying the first sentence.

  52. ccbowerson 27 Oct 2012 at 10:40 am

    “There are no non-scientific questions worth asking”

    I wonder what all those colleges and universities are doing outside of their science departments, then. I guess simply wasting time and resources.

  53. skeplankeron 27 Oct 2012 at 12:02 pm

    BillyJoe,

    From the first line of the link you posted:

    “Please note: the following refers to routine physicals and screening tests in healthy, asymptomatic adults. It does not apply to people who have been diagnosed with diseases, who have any kind of symptoms or signs, or who are at particularly high risk of certain specific diseases.”

    I agree with that disclaimer. However a blanket statement saying a health check is useless, or that further investigation of a symptom is useless, I cannot agree with. An MRI for a headache, depending on the nature of the headache, in my view can be possibly construed as “further investigation”. I reviewed Steve’s original post and it actually did not mention headaches specifically, so it was presumptuous of us I guess.

    I mentioned aspirin as an example to illustrate the fact that medicine is in fact a commodity, and in most cases if one chooses to procure more than is reasonably recommended, it can be wasteful but does not materially affect others, and one should be free to do so, however ill-advised.

    And the last point on fraudsters ripping off the public under the guise of health freedom, I would completely agree with that. My position is that even though I do not like, much less advocate, people being ripped off, people should have the choice to *voluntarily* be ripped off with informed consent. There is a subtle difference.

  54. sonicon 27 Oct 2012 at 12:21 pm

    BillyJoe7-
    Examples of non-scientific questions worth asking-
    What is 2+2? What is 47 times 34? How many eggs in a dozen?
    Will you marry me? Do you prefer red or white wine?
    Where is the bathroom? Where did I park my car? How many drinks did I have?
    What time am I supposed to be at the meeting?
    Who won the game this afternoon?

    Your statement “There are no non-scientific questions worth asking. And the answers to all questions worth asking are informed by science and confirmed by science,” is obviously false.

    For a meaningful discussion of this topic–
    http://rationalwiki.org/wiki/Scientism

    BTW- claiming obviously false statements as the ‘answer to everything’ is sometimes thought of as ‘cult’ behavior.

    Oh, and are you allergic to crow or what? :-)

  55. ccbowerson 27 Oct 2012 at 12:51 pm

    “Where is the bathroom?”

    One could argue that this is an unimportant question, as we sit by our computers in soiled underwear, but questions like “which behaviors should we deem as criminal acts in our society?” cannot be so easily dismissed as unimportant. It is definitely not a scientific question, yet is an extremely important question to answer well

  56. BillyJoe7on 27 Oct 2012 at 3:33 pm

    Ccbowers,

    “First sentence is completely wrong. Second sentence is better, but does not save the first. Informed by science is not the same as scientific question…so I’m not sure how you are justifying the first sentence.”

    By the phrase at the end of the second sentence that you seem to have ignored:
    “And the answers to all questions worth asking are informed by science…
    …and confirmed by science”

    “I wonder what all those colleges and universities are doing outside of their science departments, then”

    Hopefully their activities are all informed by science and their conclusions confirmed by science.
    Even the arts. For example, the emergence of cubism is an historical question (and doing history is doing science). Why people appreciate cubism is a scientific question. And why some people are unmoved by cubism is also a scientific question.

  57. BillyJoe7on 27 Oct 2012 at 3:56 pm

    Skeplanker,

    It seems your area merely confused by the terminology.
    A “health check” in medical parlance is a “routine physical”, and any test done as part of a “health check” is a “routine test”. Doing an MRI for a headache falls into that category. There must be additional symptoms or signs that lead to an evidence based decision to do an MRI.

    “people should have the choice to *voluntarily* be ripped off with informed consent. There is a subtle difference.”

    I think you’re confusing subtlety with confusion. (;
    I must remember that sentence:
    people should have the choice to voluntarily be ripped off with informed consent.

  58. BillyJoe7on 27 Oct 2012 at 4:04 pm

    Sonic,

    Stick to your topic.
    Where are the quotes from the other six scientists that make them quilty for the same reason as the seventh scientist that you quoted. The evidence so far suggests that they made nothing but scientifically correct statements. So I’m still waiting for those quotes…

  59. BillyJoe7on 27 Oct 2012 at 4:11 pm

    Ccbowers,

    “questions like “which behaviors should we deem as criminal acts in our society?” cannot be so easily dismissed as unimportant. It is definitely not a scientific question, yet is an extremely important question to answer well”

    How is that not a scientific question?
    It’s a scientific question through and through – or it should be.
    In fact, errors are usually a consequence of not considering this a scientific question.

  60. NewRonon 27 Oct 2012 at 4:48 pm

    Ccbowers, you are probably right. I should not have used the word “scientism” without properly explaining myself. Estimating the probability of an earthquake may well be a scientific question. It is the communication of this estimation to a nervous public of which many were trying to decide whether or not to leave their homes in the face of an impending disaster that is not a totally scientific matter. The scientists in making this pronouncement were, in my opinion, acting non-scientfically, or outside the province of science. Many people will say that everything is within the province of science and it is this attitude I call scientistic. Qualifying this, social psychology (a science) may provide some insight into the possible impact of their announcement. Using, say, the word “unlikely” in one context (perhaps within scientific discourse) will have a different effect than using it in another (to a bunch of nervous men and women trying to protect their children). Perhaps in a semiotic sense the illocutionary force of “unlikely”was not taken into account. Italy is a highly cultured and literate society well versed in science, the arts and religion and the answer may be to educate the total population into how it should receive scientific statements – I think not, it would be much easier to educate the scientists. My concern is the expectation being put upon scientists to answer questions that are, at least at the moment, not able to be answered and the pressure that scientists are under to provide an answer during conditions of extreme stress. The scientists should not be sent to gaol but surely lessons should be learned.

  61. ccbowerson 27 Oct 2012 at 8:47 pm

    “By the phrase at the end of the second sentence that you seem to have ignored”

    I ignored it because science cannot confirm nonscientific questions

    “How is that not a scientific question?
    It’s a scientific question through and through – or it should be.
    In fact, errors are usually a consequence of not considering this a scientific question.”

    It is not a scientific question because it involves balancing competing values. Again, science must be used to inform our answering of such questions, but even if a group of reasonable people were to agree on the science we would still end up with different answers depending upon what we deem important.

    Extending that example a bit further: a person who emphasizes individual liberties (e.g. libertarians) will likely want less behaviors to be illegal versus a person who emphasizes the effects of behaviors on the group. None of this is necessarily about the science, but which perspective a person has about the liberties of individual versus group. Of course, this is just one of many examples

  62. BillyJoe7on 28 Oct 2012 at 1:00 am

    ccbowers,

    If not scientifically…
    How do you assess values?
    How do you balance competing values?
    If not scientifically….
    How do you know you have assessed values correctly.
    How do you know you have balanced them correctly.

    What does science tell us about libertarianism?
    What makes someone a libertarian?
    What would happen if everyone was a libertarian?
    What if everyone fended for themselves and let everyone else fend for themselves?
    What would happen if there was no safety net.
    Would the destitute simply starve to death or would they fight for their survival.
    Would the resultant social disruption be worth it?

    How are these not scientific questions?
    Perhaps we have different definitions for science.
    But then, what else have we that can answer these questions?

  63. BillyJoe7on 28 Oct 2012 at 1:12 am

    NewRon,

    The odds of winning the lotto are one in one million. That means if you buy a lotto ticket every week, chances are you will win the lotto once every ten thousand years or so. In other words you have a vanishingly small chance of winning the lotto in your lifetime. If you had saved the money you would had had the million in half that time.
    Take home message: don’t buy lotto tickets.

    So, if you follow my advice and don’t put in your lotto numbers and your numbers come up next week, I guess I owe you a million dollars. So sue me.

  64. NewRonon 28 Oct 2012 at 3:00 am

    BillyJoe:
    OK, I can’t resist it. What the hell are you talking about (I am not inserting a question mark because I don’t really want you to answer)! I dont need or want your million dollars: in the vernacular of my culture, “stuff it up your fundamental”. Two weeks ago I won a prestigious and lucrative poker tournament. Most of my opponents relied on a mixture of statistical probability and (unscientific) intuition. So did I, but I put my success down to veering more on the side of intuition. Maybe, just maybe, you know more about statistics than my three years of studying the blessed subject has taught me. Maybe, just maybe, you even know more about modus ponens and modus tollens than my three years of studying formal logic has informed me. Even maybe you know more psychology than my six years of studying that subject … . I could go on and on and on, but like your post there is no point. We are on different planets – thank god.

  65. BillyJoe7on 28 Oct 2012 at 3:41 am

    All that education and you don’t understand a simple analogy!
    Oh dear…

  66. NewRonon 28 Oct 2012 at 4:33 am

    Oops BillyGoat you did answer after all. What the f are you comparing (NB. no ‘?’) – when I studied English Lit for …, an analogy required a comparison between two things. The post you addressed to me had no such dyad. Please address future comments to someone from your planet, mine will get along just fine without them and there will be no further attempt at communication from me.

  67. ccbowerson 28 Oct 2012 at 10:06 am

    “How are these not scientific questions?
    Perhaps we have different definitions for science.
    But then, what else have we that can answer these questions?”

    Most of those are scientific questions, but the point is that we could answer all of your questions and still be stuck with different answers to the original question depending on which of the competing factors we care about. I don’t think it is a question of differing definitions of science, I think you are failing to acknowledge the limits of what it can do for us.

  68. mumadaddon 28 Oct 2012 at 11:03 am

    I actually vaguely remember this: around this time of year in 1987 in the UK, BBC weather man Michael Fish assured viewers that while they may have heard reports of an approaching hurricane, they should not worry as “there isn’t”. He didn’t talk about probabilities or uncertainty, just flat out said it wouldn’t happen.

    http://www.youtube.com/watch?v=uqs1YXfdtGE

    This on national TV! Michael Fish and the met office were ridiculed for this failure, but there was no criminal prosecution.

  69. sonicon 28 Oct 2012 at 11:54 am

    BillyJoe7-
    You are requesting information as to what the others said that got them in trouble.
    You need to ask ‘science’.
    It seems only this ‘science’ thing can answer a question for you, and this is obviously a worthy question as you have asked it.

    I would direct you attention to the article I linked to and note that the other scientists actions were mentioned- this one is the example of the behaviors. And the judge on the case no doubt heard exactly what was said.

    But none of these things answers to the name ‘science’ so I will assume they are all meaningless to you.

    I’m not ‘science’. I can never answer any question you have. Sorry if there has been any confusion. :-)

  70. BillyJoe7on 28 Oct 2012 at 3:24 pm

    NewRon,

    “Maybe, just maybe, you know more about statistics than my three years of studying the blessed subject has taught me. Maybe, just maybe, you even know more about modus ponens and modus tollens than my three years of studying formal logic has informed me. Even maybe you know more psychology than my six years of studying that subject … . I could go on and on and on…”

    “Billygoat…”

    Oh dear, it seems the ivory has fallen off your lofty tower?
    All that education and all you can do is respond with childish name-calling.

  71. BillyJoe7on 28 Oct 2012 at 3:30 pm

    ccbowers,

    “I don’t think it is a question of differing definitions of science, I think you are failing to acknowledge the limits of what it can do for us.”

    But what else have we got? That was my point. If it’s not a scientific question, what sort of a question is it? If not science, what is it that helps us to answer these questions with any confidence that we are answering them correctly.

  72. ConspicuousCarlon 28 Oct 2012 at 3:36 pm

    Agreeing with its precision or not, the meaning of BillyJoe7′s lottery analogy is so obvious that I hope never to end up in a situation of declaring my inability to understand such an obvious thing while also bragging about my extensive education. The second part would make me look worse, not better.

    Back to the real subject, I thought I already posted this but it is not present:

    The prosecutor used multiple words like “generic/incomplete/conflicting” to describe the scientists’ statements. I can’t find a complete account of what they said, but regardless of any snippets presented about having wine, the prosecutor obviously did not interpret the totality of their statements as being a clear statement that there was zero risk of an earthquake. So his description is completely incompatible with the anti-scientism claims that the scientists were guilty of too-explicitly stating that there was no risk of an earthquake.

    The consensus of other scientists seems to be that specific, complete, and totally consistent information can’t be given about earthquakes in a specific future place/time (i.e., they agree that the prosecutor’s description actually makes the scientists mystery advice sound scientifically correct).

    So:
    1. the prosecutor isn’t happy with general/incomplete/conflicting information,
    2. that gripe rules out the possibility that he is accusing them of giving explicit and actionable “absolutely no earthquake” predictions,
    3. obviously he wouldn’t have wanted #2 (since it would have been wrong), and yet
    4. they are charged with a crime.

    There really isn’t a whole lot left except to conclude that he expected them to predict the earthquake.

  73. BillyJoe7on 28 Oct 2012 at 3:46 pm

    sonic,

    Now you are telling me that collecting information is not science?

    “I would direct you attention to the article I linked to and note that the other scientists actions were mentioned- this one is the example of the behaviors. And the judge on the case no doubt heard exactly what was said.”

    My point is that YOU haven’t heard exactly what was said, so YOU are in no position to make pronouncements about WHY the other six were found quilty. You accuse these scientists of going beyond the scientific facts, yet you yourself are completely willing to go beyond the facts as known to you to come to a conclusion that they went beyond the scientific facts.
    I hope you see the irony.

  74. NewRonon 28 Oct 2012 at 6:50 pm

    BillyJoe:

    “Billygoat” was a correction made by my iPad (and later transposed to my computer). I apologise for not checking it and for any offence. The only reason I had mentioned some of my academic record was a response to your jibe that I did not understand science and your later imputation that I need a lesson in probability. I genuinely admit that you may know more about science and statistics than do I since my work and interests lie in other directions. I should not have written in anger. Some of my friends lost relatives in the L’Aquila earthquake and no doubt this has clouded my objectivity.

  75. raylideron 28 Oct 2012 at 8:21 pm

    BillyJoe,

    You ask “How do we assess values” if not scientifically. Explain to me which study scientifically assigns a value to a human life and figures out at which significance level it is no longer “worth it” for the individual to get an MRI for a headache? (or any medical test for any symptom)

    If everyone followed your recommendation to not gamble, no one would win.

  76. Davdoodleson 29 Oct 2012 at 1:12 am

    So these folk go to jail, while Ken Ring is free to ply his distressing nonsense?

    CrazyLand.
    .

  77. skeplankeron 29 Oct 2012 at 1:24 am

    BillyJoe,

    I agree that there was imprecision when I used the term “health checkup”. It is not a “routine physical” but a “comprehensive screening test”, as “routine physicals” do not generally include the advanced screenng tests performed. I originally brought up the cost of this optional screening package to point out the fact that MRIs are neither scarce nor uncommon, and without explicitly saying so, implying that one could get an MRI scan even if insurance did not cover the expense. I argue that all this is irrelevant for the key issue that we differ on, which is whether a patient has the right to spend his own money on a medical procedure (specifically, an MRI test). You state:

    “If there are clearly no evidence-based indications to do an investigation, then it should not be done and the patient should have no say in the matter”

    My stance is that a patient should be free to do whatever he wants to himself, subject to limitations stated previously. In other words, if it on his own dollar, the patient should absolutely have a say in what treatments he gets or refuses, whether it is SBM or quackery.

    If a company is subsidizing the gasoline in an employee’s personal vehicle, which is recommended to run on regular, it would be unreasonable to ask the company to pay for premium. However the employee is free to believe in whatever woo he wants and fill up on premium, add in octane boosters, miracle fuel pills, and whatever useless additives money can buy, possibly causing damage to his own car, if it is on his own dollar. The same concept applies.

    That is “the right to be ripped off”. The difference is although neither of us think people should be ripped off, you think that people do not have the right to be ripped off, and I do. That is the subtle difference I am talking about, which hopefully is less confusing.

  78. BillyJoe7on 29 Oct 2012 at 6:01 am

    NewRon,

    Thanks for that.
    I’ve had trouble with ipad as well. It helps if you can touch type because then you can keep your eyes on the screen.
    And sorry about your friend’s relatives

  79. BillyJoe7on 29 Oct 2012 at 6:25 am

    raylider.

    “You ask “How do we assess values” if not scientifically. Explain to me which study scientifically assigns a value to a human life and figures out at which significance level it is no longer “worth it” for the individual to get an MRI for a headache?”

    You have to take a broader view. Despite what you may wish, resources are limited. Therefore judgements must be made about how much time, money, and manpower to spend on various examinations and tests. If it costs $1000 per MRI, and a brain tumour is picked up in 1 in 10,000 tests on patients complaining of simple headache, it’s going to cost $10 million dollars to pick up one brain tumour. On top of that, if only 1 in 100 of brain tumours are curable, that adds up to a billion dollars to save one life.

    You might ask what is the value of one life? But the more appropriate question is: how many lives are lost saving that one life because of the diversion of time, money, and resources away from diseases that are easier to diagnose and cheaper to treat and that have a much greater chance of survival with early diagnosis. This is a question worth asking and its answer is based in science.

    “If everyone followed your recommendation to not gamble, no one would win.”

    999,999 people lose and 1 person wins.
    1 million people hope to win and 999,999 will be disappointed.
    The decision to buy lotto tickets is not a scientific one, but an emotional one.
    The reason people buy lotto tickets is also a scientific one.

  80. BillyJoe7on 29 Oct 2012 at 6:46 am

    skeplander,

    If you support the science-based medicine promoted by this blog, then “health freedom” is out the window. Only medical experts can decide what is science-based medicine because only medical experts have the background knowledge, and the specific knowledge, and the working knowledge to make those decisions. To go with the decisions of non experts like patients against the advice of medical experts means giving up on science-based medicine.

    An additional reason why patients should not be allowed to use limited resources against science-based medical advice just because they can afford to do so, is because others with well-defined indications for testing for diseases that can be cured if diagnosed early, will end up with delayed diagnoses and worse prognoses.

    ” you think that people do not have the right to be ripped off, and I do”

    Yes, I’m no libertarian. People should be protected against fraudsters. Everyone, you and me included, is or has been at some stage of their life, vulnerable to being defrauded. I see no logic in assisting fraudsters by refusing to protect their potential victims.

  81. skeplankeron 29 Oct 2012 at 8:42 am

    BillyJoe,

    I understand your viewpoint and although I respectfully disagree, I rest my case.

  82. sonicon 29 Oct 2012 at 9:03 am

    ConspicuousCarl-
    The example of the statement that got them in trouble was (paraphrasing)-
    “No earthquake. Go home, drink wine!”
    That is a specific recommendation- and not a scientific one.
    Note- that is an example of what was said. See the link I provided.
    We could imagine the judge who actually heard the case decided the other comments were similar enough, or the other scientists failed to correct, or whatever that would make them guilty as the other.
    But we would have to assume the judge actually saw the evidence and is aware of Italian law.
    Of course one could decide the judge disagrees with oneself and therefore the judge must be wrong.
    What do you know specifically that would make me think the judge- doesn’t know the evidence or the law?

  83. raylideron 29 Oct 2012 at 1:16 pm

    BillyJoe,

    Is your life worth $1 billion to you?

  84. BillyJoe7on 29 Oct 2012 at 1:56 pm

    raylider,

    “Is your life worth $1 billion to you?”

    I don’t have a billion dollars, so the question is not worth asking.
    Do you have a billion dollars?
    If you do, is my life worth a billion dollars to you?
    If not, are you and the other 250 million Americans willing to give $4 each to save my life?
    Or would you rather give that $4 to save the thousands of lives of patients who can be more cheaply and easily diagnosed and threated for their diseases?

  85. BillyJoe7on 29 Oct 2012 at 2:02 pm

    skeplander,

    I think I understand your viewpoint as well, but I find it hard to respect it.

    Everyone for themselves is not even the law of the jungle.
    The law of the jungle includes reciprocal altruism and kin selection.
    I think we can do better than that.

  86. BillyJoe7on 29 Oct 2012 at 2:12 pm

    sonic,

    “The example of the statement that got them in trouble was (paraphrasing)-
    “No earthquake. Go home, drink wine!””

    The point is that YOU don’t know that this is the reason they were found quilty.
    You are just speculating without evidence.
    CC has provided evidence that this was probably NOT the reason they were found quilty.

    In other words, you have provided no evidence for your speculations and have now ignored contrary evidence. You are, guilty of making statements not grounded in the facts, the very thing you accuse those scientist of doing.

    Really, sonic, the irony burns.

  87. raylideron 29 Oct 2012 at 2:48 pm

    BillyJoe,

    Do you think Bill Gates would pay a billion to save his life?
    The question is definitely worth asking. This is because you are not asked to spend $1 billion on saving your life, the MRI does not cost that much, the effective question is – is it worth it for you to spend $1000 on 1 millionth of your life? I suppose you’ll say no, most people would say no – but who is it up to decide? Who do you entrust to make that decision? You say science – science does not place values on human life (which is why I asked you to find a study). Also, you cannot entrust science to make a decision – because science does not make decisions, articles and papers and equations do not make decisions. People do – and people are not infallible (though neither is science). So when you place “science” in charge of other people’s life decisions, you are placing other people in charge of other people’s life decisions. That may be OK when someone else’s(public) resources are at stake, not when I want to spend my money, that I earned, any way that I want to. Also, your economics are off – yes, resources are limited and people who own those resources are in charge of their distribution. Using your logic, people that buy iPhones take engineers away from medical fields and cause people to die. That’s not what happens. In fact, like I said before – if more people wanted to spend their own cash on medical resources – MORE resources would be diverted to medicine and MRIs and it would become CHEAPER. See: plastic surgery, LASIK eye surgery, etc (prices went down for those because people pay out of pocket for those). In fact, study the efficiency of use of resources for any field and you will see that efficiency of use of resources are greatest in fields with least government intervention. Why? Because promise of profit gives incentive for innovation. Creating deficits does not. In fact, profit means that an entreprenuer was able to use less resources than competitors to create the same problem.
    Going back to your other questions – which are all valid questions, but for some reason asked from the wrong perspective. “If you do, is my life worth a billion dollars to you? If not, are you and the other 250 million Americans willing to give $4 each to save my life?” Certainly, your life is not worth a billion dollars to me (no offense – I don’t know you). Which is precisely why no one is asking anyone else to pay for the MRI, the person is using his own resources.
    “Or would you rather give that $4 to save the thousands of lives of patients who can be more cheaply and easily diagnosed and threated for their diseases?” I would rather do that – that would be my CHOICE. What you are doing is forcing that choice upon others, against their will. Remember it’s not your billion dollars to decide what to do with and how to best spend it, it belongs to the one million people who would be getting the “unneeded” MRIs. But it is certainly valiant of you to take other people’s money and spend it in ways you think are more efficient.

    PS. science has no way of setting prices on anything. Price is by definition what someone is willing to sell something for.

  88. sonicon 29 Oct 2012 at 6:15 pm

    BillyJoe7-
    You are correct. I don’t know why the judge did what he did. I have failed to read his mind.

    With that said, if you read the link I provided, you will find the evidence that the judge did base his decision on the fact that the scientists gave this bad advice.

    All I am actually assuming here is that the article is correct and that the judge did his job correctly.
    I realize both of those things might be in error, but I have seen no evidence that would make me think so.

    What evidence do you have that the judge misapplied Italian law? Which law are you thinking he misapplied, specifically? What evidence are you saying he overlooked? What part of the testimony are you saying has been misunderstood? Can you please give me the exact quotes?

    Or should I just assume that the judge doesn’t know his business?

  89. steve12on 29 Oct 2012 at 10:31 pm

    Newron said:

    “The scientists in making this pronouncement were, in my opinion, acting non-scientfically, or outside the province of science. ”

    But they based their advice on the probabilities, so this is all nonsense.

    Essentially, you’re saying that it’s OK to say “it’s unlikely that the tremors portend to a bigger earthquake” but “scientism” to say “we recommend that you not evacuate because it’s unlikely that the tremors portend to a bigger earthquake”?

    This a meaningless distinction, and sounds like some sort of postmodern nonsense.

    The scientists gave a recommendation based on probabilities – that’s their job.

  90. BillyJoe7on 30 Oct 2012 at 4:29 am

    Raylider,

    I’m talking, not about MY resources, but America’s resources.
    And not just financial resources but time and manpower which are definitely limited. There is a limit to how many manhours that can be spent on any one human activity without other activities suffering from lack of resources. Money can’t buy manhours that are not available.

    If I have a headache and that headache is caused by a brain tumour and if that brain tumour is curable if picked up early with an MRI then, given my scenario above, America would need to spend ten billion dollars if my life is to be saved. I don’t expect America to do that. I expect that they will follow the evidence and save thousands of lives with the same resources that would spend to save one life. After all, in all probability, my headache is not caused by a brain tumour, and if it is, chances a my life will not be saved anyway. I am much more likely to be amongst those thousands of others whose lives are saved by the application of science-based medicine.

    A telling point is that nowhere in your post do you refer evidence or science-based medicine.
    …except where you say science does not make decisions, people do. Of course. But people should use science to make decisions. That is my whole point.

  91. ConspicuousCarlon 30 Oct 2012 at 12:10 pm

    sonic on 29 Oct 2012 at 9:03 am

    ConspicuousCarl-
    The example of the statement that got them in trouble was (paraphrasing)-
    “No earthquake. Go home, drink wine!”
    That is a specific recommendation- and not a scientific one.

    I already explained clearly enough why that cherry-picked line is not likely to be a reasonable summary of the overall message they conveyed.

  92. BillyJoe7on 30 Oct 2012 at 2:33 pm

    Sonic,

    The article quotes only one of the seven giving what I have characterised as a “take home” message after being prompted by the interviewer to provide one. Given what happened, and if he had his time again, he would probably not have done so, and simply stuck with the original statement.

    Imagine a person who has never bought a lotto ticket. He finds a dollar in the street and decides he will buy one. As he fills in his numbers, he hears a statistician on the television explaining the remote odds of winning lotto. After being prompted by the interviewer, he ends with the take home message: don’t buy lotto tickets. He tears up his ticket. On the weekend his numbers come up.

    Do you think it’s reasonable that the statistician be convicted of giving advice not based on statistics?
    Do you think it is reasonable that the law will require him to pay that person one million dollars?

  93. sonicon 30 Oct 2012 at 7:30 pm

    ConspicuousCarl-
    I am assuming the newspaper account is accurate and that the judge in this case followed the law.
    You are assuming otherwise.
    As I said before- I am being an advocate in this case and I am advocating that what you are claiming is extraordinary and what I am claiming is what one would expect.
    I have more evidence for my claim than you have presented for yours.
    Exactly how do you justify believing the extraordinary claim without evidence in this case?
    It seems the reasoning is rather motivated.

    BillyJoe7-
    If I paid a statistician to give me the best mathematical advice possible and he took the job as an expert and he said, “Throw away the ticket; ” then yes, it seems he should be liable for giving me bad advice. Not because he is wrong in a particular case, but because he didn’t give the best mathematical advice.
    The courts would hear the case if he was wrong– I have damages. They probably would not hear the case if he weren’t wrong. ‘No harm, no foul’, is the reasoning, I believe.
    But the person would be found guilty of not giving the advice he should have– not for being wrong.

    I believe that’s how these things work.
    In my perfect world there wouldn’t be any courts or laws– so what I think is reasonable is probably irrelevant about what is reasonable when it comes to the laws.

  94. BillyJoe7on 30 Oct 2012 at 11:35 pm

    Apparently scientists and statisticians are not allowed to give practical take home messages.
    If the public is confused about what they mean by their statements, it’s just too bad.

    In any case, I guess we’ll have to wait for the judges explanation. Apparently it’s going to take three months! Imagine that: the judge makes his decision and three months later he gives the reasons for his decision!
    I’d love for you to explain that one, sonic. (;

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