I am on a tighter than usual schedule this week because I have to produce two SGU podcasts, as I will be away next week for the Thanksgiving holiday. Further, there were some interesting reader comments I wanted to respond to at length, so I will need to make that into my post for today. (Fear not, I should be able to keep my usual posting schedule through the holiday.)

Back from the Dead

DrDirk wrote this comment on my post about Zak Dunlap, the boy who was pronounced brain dead but ultimately recovered, in my opinion because a serious mistake was made in reading a brain scan. DrDirk relates his personal and recent experience with a brain death issue at the same hospital and with the same doctor.

First, I do want to express my sincere sympathies for DrDirk, who is relating a personal recent tragedy – the death of his son and his son’s friend (both 20) last week after a 4 wheeler accident. Both boys were treated at Witchita General Hospital, where they were treated for severe brain injuries, without other significant injuries.

It’s always difficult to respond to a topic when someone is discussing it in the context of a personal tragedy. Also, I am often told stories about a person’s experience with another physician. It is impossible for me to make specific conclusions about such cases because I have no first hand knowledge. I can only speak in general terms, or speculate about what possibly happened, but I cannot explain (as I am often asked to do) the actions of another, especially based upon second-hand report.

Therefore, I will only address some of the ponits raised by DrDirk in general terms, without directly challenging his report of what happened. DrDirk’s main point is that when it was learned by the hospital staff that the two boys were organ donation candidates, aggressive treatment stopped. He concludes: “THEY KILLED OUR BOYS FOR THE DONATIONS AND THATS THE BOTTOM LINE.”

Generally speaking, it is certainly unethical to alter the care given to any patient based upon their organ donation status (other than to give more care in order to preserve organs).  I would be shocked to learn that this was happening.  It is plausible that judgment calls made about treatment may be biased by the knowledge that a patient is an organ donor, but it is certainly the standard of care to be aware of any such potential biases and to make specific attempts to filter them out.

In short, the behavior the DrDirk is alleging is not condoned within the medical community. In fact it is a behavior that physicians are specifically trained to avoid, and is a violation of the standard of care.

I would also observe, based upon being in the middle of such situations many times myself, that it is very easy for communication to break down – or rather it is very challenging to communicate in an accurate and timely manner to all family members the status of a critically injured patient. Many medical decisions are made in real time, and the decision-making process may seem mysterious and confusing to the family, especially through the fog of emotional shock. (Again, I emphasize I am speaking in general terms, and not reaching conclusions about this case.) I have had the personal experience as a physician of very carefully explaining a complex and difficult situation to family, only to later learn that they completely misinterpreted what I said. I take full responsibility for making myself understood – I only point out that it can be extremely challenging.

What this means is that it can be very difficult for a family to follow and understand everything that is happening with an acutely injured loved-one. This opens the door for misinterpretation. It is also very common for anger to be displaced onto the process and people involved. And finally, while physicians are trained to be professional (to step back from the emotions of the situation so they can make objective medical judgments), we often fall short of the professional ideal. When this happens, the situation becomes even more difficult.

Evolution and Creationism – Can’t We All Just Get Along?

Reader howihealed asked: “I don’t understand why Evolution and Creationism/Intelligent Design can’t both be correct?”

Well, the simple answer is because they are mutually incompatible. However, this depends upon what kind of creationism you believe in. At one end of the creationism spectrum are those who believe that a god set the universe in motion, but then let it play out according to its internal physical laws. This belief limits the notion of creation to an unfalsifiable faith, but does not intrude on the science of evolution. Once you depart from this minimalist version of creationism, however, you come into direct conflict with the science of evolution.

At the other end of the spectrum are the young-earth creationists (YEC). They believe that the earth and all life were created in 6 literal days about 6-10 thousand years ago. According to YEC evolution does not happen (except perhaps for some “microevolution”, which they cannot meaninfuly define). Of cours, the belief that evolution did not happen is incompatible with the scientific conclusion that it did.

There are also many permutations of creationism in between these two extremes, but all introduce unscientific ideas into the science of evolution. This gets down to the methods of science. Any creationist notion, even those that try to accomodate some or even all of the evidence for evolution, do not follow the methods of science. Science is all about method – it is not a set of conclusions or beliefs. Therefore, if you violate scientific methodology, you are being incompatible with science, no matter what your conclusions or beliefs.

Intelligent design is basically warmed-over creationism, simply recast in more sciency jargon. ID proponents make specific claims that violate logic or evidence – the methods of science, and therefore are also incompatible. For example, ID proponents claim that life is irreducibly complex. But they ignore the answers to this challenge that have already been proposed by evolutionary scientists – exaptation and gene duplication, for example.  In effect their formulation of irreducible complexity is nothing more than a god-of-the-gaps logical fallacy, and is not practically falsifiable. It therefore fails to meet the minimum criteria for science. Not science is incompatible with science.

CAM and Evidence

Howihealed, as the name implied, is also a proponent of so-called alternative medicine (CAM). They wrote:

Tax payer money is a lot better going to Alternative and Holistic Medicine then to Academics and Institutes where people just study and “research” all the day long and then finally come up with a correlation related to the common sense we knew all along.

Cancer will never be cured by science until they admit that belief and intention have a role in healing the human body. That is what a lot of Alt Medicine is about. It is also looking at the body and its healing capacity from various perspectives. The body is divided into parts that speak with each other whether we believe it or not. The parts then equal the whole.

That’s is a great example of anti-intellectual and anti-scientific propaganda in defense of CAM. Notice the scare quotes around “research.” Howihealed clearly does not understand science, has disdain for science, and sees it as just egg heads amusing themselves. This is a profound level of denial of the last 100 years of history. This stands as an extreme example of a basic principle we should all remember – be careful before you entirely dismiss something you clearly do not understand.

Howihealed then informs us that belief and intention are the real sources of healing, but the medical community just refuses to admit it. This claim, however, just leads to the question of how they, or anyone, knows this. Why should I or anyone else believe that intention (i.e. wishing) can heal? My general experience (and basic common sense) is that wishing for something does not make it true, regardless of those idiots say in The Secret.

I would offer that if the power of intention could be demonstrated reliably then we would accept it – but that is sounding awfully close to doing science, and clearly howihealed would not want that. They do tell us what they prefer:

I generally don’t think large scale studies are the most reliable way to measure truths.. I usually prefer anecdotal evidence to be honest.

Of course you do. Anecdotal evidence is poor quality, uncontrolled, subject to confirmation bias and cherry picking. In other words, you can use anecdotal evidence to confirm any belief you want to have. Large scales well-controlled studies are only for those who want to believe what is really true. It’s not for those who want to cherry pick evidence to support their existing beliefs.

It may seem as if I am picking on someone who has silly beliefs that are not representative of CAM in general. To that I say two thing: First, if you leave a comment on my blog, you are fair game. But second and more importantly – howihealed’s comments are in fact absolutely representative of the mainstream of CAM belief. They are just stating these beliefs in a more direct and less concealed way.

Reader of this blog or of other similar science blogs, like Science-Based Medicine, will already be familiar with the many cases in which more sophisticated CAM advocates make essentially the same claims as howihealed, just in more subtle and deceptive ways. But at the end of the day, all the hand-waving arguments of the CAM proponents amount to favoring low-quality evidence over higher-quality evidence – because it’s the low-quality evidence they can more easily manipulate to conform to their biases.

Andrew Weil calls anecdotes “uncontrolled clinical observations.” Acupuncture proponents are now doing “pragmatic” studies – i.e. without blinded controls. Applied kinesiologists gave up long ago on blinded studies, because they could not show that AK worked.

The entire field of CAM is based upon favoring poor-quality evidence over high-quality evidnece – bias over objectivity. It was actually quite refreshing to read howihealed state it so directly.