Feb 27 2017

The Death of Expertise

fox-globalwarmingTom Nichols’ book, “The Death of Expertise: The Campaign Against Established Knowledge and Why it Matters,” is currently on the Amazon bestsellers list. The book discusses a topic I have delved into many times here – what are the current general attitudes of the public toward experts and expertise, and how did we get here?

He mentions various aspects to this war against experts:

“The United States is now a country obsessed with the worship of its own ignorance. Many citizens today are proud of not knowing things. Americans have reached a point where ignorance, especially of anything related to public policy, is an actual virtue.”

The culture and our educational system have created a generation that has little experience being told they are objectively wrong. Everyone feels they are entitled to be right. Combine this with the illusion of knowledge provided by Google, and everyone thinks they are their own expert in anything.

Interestingly, as Nichols also points out, people are arbitrarily selective in which experts they respect. Sports is a great example. No one really thinks they should play for the NFL and begrudges recognizing that NFL players are the result of a combination of natural talent and years of developing physical ability and specific skills.

There are also many highly technical jobs where expertise is so obvious it cannot be denied. Most people would not try to fly a jet, wire their own house, or even fix their computer without the appropriate knowledge and skill in these areas.

I think that is the key – is there an immediate and obvious effect of the expertise? Would you watch a tutorial on Youtube, and then attempt to do coronary bypass surgery on a family member?  The outcome is immediate and often binary – the plane lands safely or crashes, the patient lives or dies, the computer works or doesn’t work.

When there isn’t an objective outcome on the table, however, people are more likely to substitute their own ignorance for expertise that has taken years to develop. Do you really know how to interpret ice-core data? Can you read the primary literature and understand how best to determine the safety and efficacy of vaccines? You won’t do surgery, but you will diagnose yourself and prescribe a course of treatment, even though these two tasks require the same level of training and experience.

In these situations people are often confronted with the fact that the experts disagree with them. That should give a reasonable person pause. I always check my own understanding against the experts, and if they differ I assume I am wrong or missing something. Too often, however, the reaction is to either assume that the experts are incompetent or there is a conspiracy (or both). That is the war on experts and the death of expertise.

Of course, as a physician, I encounter this all the time. I once had an acquaintance “explain” to me, after I disagreed with them over a medical topic (and here I am paraphrasing a little), “I know that is what you were trained to think, but I read in a magazine that the opposite is true.”

Think about the implications of that conclusion. I was just mindlessly “trained” (you can substitute “brainwashed”) to uncritically accept the party line, which must exist for nefarious purposes that don’t actually serve patients. They, without even a college education let alone a medical education or any experience interpreting the medical literature or practicing medicine, knew better because they read an article in a popular magazine (or on a website).

So how did we get here?

I think Nichols hits all the big factors. He places part of the blame on the internet and social media. He argues that we don’t just have access to lots of information, we are overwhelmed with low-grade information. This is crowding out high-grade curated information.

He argues that the public was better informed when we had three networks than they are now with hundreds of channels and millions of websites.

“I’ve been asked, do I really think people were better-informed when there were only three television networks. And my answer is emphatically ‘yes,’ in part because there was a filter on the news. Arms-control treaties with Russia were not competing with which Kardashian is pregnant. It was not a constant stream.”

While he has a point, I think the situation is more nuanced. A recent Pew survey finds that the public thinks they are better informed. This, however, is probably just the illusion of knowledge the internet creates.

A 2007 study comparing knowledge of current events between 1989 and 2007 (pretty much before and after the information explosion) found no overall difference.  A 2012 update found the same thing.

So the overall effect seems to be – no change in actual knowledge but with people falsely feeling they are better informed.

My read of the data is that there are two big things going on here. The first is that the internet has been like jet fuel to the Dunning-Kruger effect – which is a disconnect between one’s self-assessment of knowledge and their actual knowledge.

The other factor is that people are more separated. We are no longer all watching the same curated news. People are separating out into various groups depending on how they access information.

In a widely cited study, researchers found dramatic differences among groups of people depending on their primary news source. This became known as the “Fox News Effect” because of the amazing result that those who watch Fox News had worse knowledge of current events than people who said they don’t follow the news at all. In other surveys Fox News watchers did score at the bottom, but not lower than those who do not watch the news at all.

Of course, this is correlational data, and we cannot infer causation. These are self-selective groups. I do think this data is tapping into a core feature of our modern internet and mass media society, however.

While average knowledge may not have changed in the last 30 years, the data suggests there is a greater difference among groups. Those who have critical thinking skills, and internet skills – those who know how to access and evaluate information, are probably better informed than they were 30 year ago. Access to detailed information is immediate. I lived before and after the web revolution, and the difference is stark.

But – people are curating their own information by choosing outlets that serve their existing biases. There are people in my life with whom I was able to politely disagree over political issues, or we could come to some understanding based on facts. Now, we are literally living in different worlds. We no longer share a common frame of reference. We cannot agree on basic and easily verifiable facts. There is no longer any common ground for discussion.

I don’t think the internet is entirely to blame either. I do wonder about the changes I have seen in our educational system. As faculty, I teach students, which means I regularly have seminars about how to do so. They teach a lot of useful information and skills and I do feel it has helped me become a better teacher.

However, one aspect of the current educational culture is that students should never be told they are wrong. In fact we are told to never ask straight factual questions where there is a right or wrong answer. Just ask them what they think. Don’t praise a student for giving a good answer, because then other students will feel slighted if they are not equally praised.

This is in stark contrast to my own medical education (I graduated in 1991), which was perhaps too far the other way. We were “pimped” – asked a series of increasing difficult factual questions, and then told in no uncertain terms when we were wrong. We were often publicly embarrassed by our errors, and informed that we just “killed the patient.”

I am not advocating for this former standard, but something in the middle feels right. I do not doubt the studies which show that when students are taught according to the current non-confrontational standard they learn the material better. Let’s assume that is correct. I also see no reason to strike terror in students.

But I think the current standard is missing something – teaching students what it feels like when they are wrong. They need to learn how to accept and correct their errors, and not be made to feel that whatever they think about a topic is equally valid to what anyone else thinks. They may be learning the lesson better, but are failing to learn the meta-lesson about knowledge and expertise itself.

We then see the results of this non-confrontational style later in their educational arc, when they are actually practicing medicine. Now we are getting closer to the objective and immediate outcome situation. The meta-lessons about expertise have to be taught at this later stage, because the first 21 years of their education did not prepare them for it.

I have had this experience outside of medicine as well. I have often had the experience of discussing an issue with an acquaintance or even stranger, and when I politely and without judgement make a simple statement of fact, I am met with outrage and the accusation that I have just personally attacked them. Being told that you are factually wrong is now a personal insult of the highest order. It’s as if no one had ever told them they were wrong before.

I don’t have the quick or magically solution to all of this. These are complex cultural trends that are changing quickly. We do need to closely examine what is happening in our society, however, and think carefully about how best to balance all of the forces at work. I do not think we are in a good place right now collectively. We need to do better.

At the very least we need to each work individually to be more critical and less defensive. At least recognize the Dunning-Kruger effect (which applies to everyone), the effects of bias and the echochamber effect. Back up, slow down, and think critically.

134 responses so far

134 thoughts on “The Death of Expertise”

  1. Kabbor says:

    I agree that people should be able to accept the concept that they are incorrect on a point. I feel like the concepts ‘right’ and ‘wrong’ are problematic because those two concepts can be used to tell if someone is correct or not, but can also be used to say if someone is morally right or wrong. Saying you are wrong is fine, but the sensation of being wrong would probably benefit from being divorced from the moral undertones of the word. It would be wonderful if people could detach their being right or wrong in a given instance from their own sense of self worth. Getting angry/upset with a correction or an alternate perspective appears to be the default behaviour.

  2. MWSletten says:

    Something you didn’t touch on, but which I believe is a big factor: Experts know that their opinions can change when new information becomes available. Comedian Lewis Black has a bit in one of his shows about diet. In so many words he says he doesn’t pay any attention to the diet recommendation of experts because it’s always changing. To emphasize his point he asks, “Milk: good for you or bad for you?” When the audience seems ambivalent he says, “I rest my case.”

    Instead of recognizing that it’s working as it’s supposed to, when people with little understanding (or active mistrust) of the scientific method hear that a widely accepted scientific “truth” has been turned on its head by new information they lose confidence in experts.

    Another issue is that of so-called soft sciences, such as economics and sociology. These two in particular highlight two different, but equally damaging problems plaguing anyone granted the title of “expert.”

    First, there is a distinct lack of consensus among economists, who often draw very different conclusions using the same data. This very real problem lends itself too easily to cherry picking.

    Second, the social sciences suffer from an extreme lack of diversity among the scientists engaged in their study, and a growing problem of studies that don’t yield reproducible results . According to Scientific American:

    >A 2015 study by psychologist José Duarte, then at Arizona State University, and his colleagues in Behavioral and Brain Sciences, entitled “Political Diversity Will Improve Social Psychological Science,” found that 58 to 66 percent of social scientists are liberal and only 5 to 8 percent conservative and that there are eight Democrats for every Republican. The problem is most relevant to the study of areas “related to the political concerns of the Left—areas such as race, gender, stereotyping, environmentalism, power, and inequality.”

    In 2015, the American Association for the Advancement of Science “conducted replications of 100 experimental and correlational studies published in three psychology journals using high-powered designs and original materials when available.” Their conclusion:

    >A large portion of replications produced weaker evidence for the original findings despite using materials provided by the original authors, review in advance for methodological fidelity, and high statistical power to detect the original effect sizes.

    Again, I understand this is science doing it’s thing: finding and correcting errors. But it’s not hard to understand where the mistrust among “anti-science” Republicans originates when Democrats push for social programs based on experts whom the overwhelming majority self-identify as Democrats, and whose studies seemingly cannot be reliably reproduced.

  3. mlegower says:

    MWSletten
    “First, there is a distinct lack of consensus among economists, who often draw very different conclusions using the same data. This very real problem lends itself too easily to cherry picking. ”

    I have to defend my profession a little here. Obviously this is true occasionally, e.g. the disemployment effects of the minimum wage, where you have the Card/Dube faction and the Neumark/Wascher faction. But that is also true occasionally in hard science. Presumably, as data and methods improve, these studies will approach the truth in the limit. Bear in mind, the so-called “credibility revolution” in economics, when causal inference and careful empirical research designs became focal, only started in the 1980s. Careful empirical microeconomics of the kind on display in the minimum wage debate is fairly young.

    https://www.aeaweb.org/articles?id=10.1257/jep.24.2.3

    Maybe that makes cherry-picking easier in social sciences than in other disciplines, which is the hear of your claim. I’m not necessarily here to dispute that.

    What I am here to dispute is the initial claim of a lack of consensus among economists. I think this claim is often overstated. I would like to call attention to the IGM Economic Experts panel, which provides direct evidence as to your claim about consensus.

    http://www.igmchicago.org/igm-economic-experts-panel

    There are many questions upon which there is a great deal of consensus among economic experts. See e.g. the questions about high-skilled immigrant visas from 2/14. The experts are almost universal in their opinions that lowering H1-B visas now will neither increase tax revenue nor increase employment for American workers over the next four years. Or check out 3/7, regarding the impossibility of a perfect voting system, a result due to the recently deceased Nobel Laureate Kenneth Arrow (and yes I know that there is no economics Nobel prize, but it is close enough and it remains the highest honor in the profession). Zero— that’s right, zero— of the economists surveyed believed that there exists a voting system that ensures that the winner will be the person who best represents voters’ wishes, including how intensely they favor or disfavor each candidate. Do you believe that non-experts would have that kind of monolithic response to that question? Granted, that is less an empirical question than a purely mathematical one, but economics is not a purely empirical discipline either.

    In fact, if you go back to 12/21, you find a very relevant comment from Daron Acemoglu re: the importance of academic training for the members of the President’s Council of Economic Advisers:

    “At least familiarity with nature of econ evidence and recent research is a must. Nonacademics often underestimate uncertainty all evidence.” (emphasis added).

    So I think your point about cherry-picking is probably right; causal inference in empirical economics is young and so you are sure to find conflicting results. But I think you may overstate the lack of consensus on many important issues. Probably because many policy debates revolve around the issues for which there is no clear consensus; you can see where there might be a selection effect there 🙂

  4. hardnose says:

    Our society has worshiped experts for too long, and we now see a correction taking place.

    We had the financial crisis, and the bailouts, mostly thanks to financial experts.

    Many people have been disappointed with mainstream medical expertise, often for good reason. They have seen how the drug experts and the medical experts conspire to get almost everyone on useless harmful drugs.

    We have seen expert agencies like the FDA, EPA and CDC in collusion with giant companies that sell us poison food and pollute the environment.

    We are tired of the tyranny of experts, and that is why the Democrats lost power.

    Progressives, elitists, expertise worshipers — they are all very unhappy right now. GOOD.

  5. hardnose says:

    [Think about the implications of that conclusion. I was just mindlessly “trained” (you can substitute “brainwashed”) to uncritically accept the party line, which must exist for nefarious purposes that don’t actually serve patients. They, without even a college education let alone a medical education or any experience interpreting the medical literature or practicing medicine, knew better because they read an article in a popular magazine (or on a website).]

    It sounds like you miss being worshiped as an expert. It probably was nice, but those days are over.

    Many of us have noticed that medical doctors often stick with “facts” they learned decades ago in medical school. For example, that salt can cause chronic hypertension. Or that lowering cholesterol with drugs prevents heart disease. Or that patients with advanced cancer can benefit from chemotherapy.

    And lots more.

    We have learned that we have to fact-check, and fortunately that is possible because of the web. Yes it is difficult and it’s easy to be misled or confused. But it’s a heck of a lot better than worshiping your doctors and doing whatever they say.

  6. hardnose says:

    “However, one aspect of the current educational culture is that students should never be told they are wrong. In fact we are told to never ask straight factual questions where there is a right or wrong answer. Just ask them what they think. Don’t praise a student for giving a good answer, because then other students will feel slighted if they are not equally praised.”

    That’s an insane way to “educate” students.

    But I really doubt that explains why there is currently so much distrust of experts. I did not grow up in the leftist education era, where you have to make sure everyone is equal even if they aren’t. Yet there are lots of old people like me who are skeptical of mainstream news, and mainstream medicine.

  7. The Sparrow says:

    One small point I’d like to respectfully disagree on is the effect the current education system has had on this effect. In my experience, which of course isn’t necessarily representative, older individuals are nearly as vulnerable to this effect as younger ones. I have often talked with people in their 40’s or 50’s who refuse to listen to facts because Natural News or Fox or Breitbart (depending on their political leaning of course) told them those facts are wrong and their ‘Alt Facts’ are equally or more valid. In contrast, I’ve met many people my own age who are willing to revise their position when presented with expert evidence. I’m definitely not claiming these individuals are representative of the whole but I think age plays a smaller role than it may seem at first blush.

    And as always thanks for the great article Dr. Novella.

  8. MWSletten says:

    @ mlegower, I believe your point—that “many policy debates revolve around the issues for which there is no clear consensus”—is spot on. As a layman, most of what I read about economics is in the news surrounding such policy debates, so lack of consensus can give the appearance the science of economics suffers from a lack of rigor and objectivity.

    Thanks for setting me straight.

  9. string puller says:

    Wow- Hardnose is still here? I haven’t visited in many months.

  10. Willy says:

    It’s nice that hardnose showed up with a real life demonstration of the points made in Dr. Novella’s article. Too bad is isn’t bright enough to realize he was of service.

  11. bachfiend says:

    Willy,

    Agreed. Hardnose has just confirmed every single one of the points that Steve Novella was making. I laughed at his claim that doctors are mindlessly believing facts they learned decades earlier. On my first day at university in pre-clinical medicine my class was told by not one but two lecturers that 50% of what we were going to be taught in the subsequent 6 years was just wrong. And that our teachers have no way of knowing which half was wrong.

    It’s a lesson which managed to ‘stick’ for over 40 years.

  12. hardnose says:

    “On my first day at university in pre-clinical medicine my class was told by not one but two lecturers that 50% of what we were going to be taught in the subsequent 6 years was just wrong. And that our teachers have no way of knowing which half was wrong.”

    And it turned out that salt does not cause hypertension. Yet doctors are still advising their patients to avoid salt.

    And it turned out that that dietary cholesterol does not cause heart disease, and that lowering cholesterol with drugs does not improve health. Yet doctors are still giving patients cholesterol-lowering drugs.

    Etc.

  13. tb29607 says:

    bachfiend,

    I am with you. We were told the same thing and had a month long class at the end of our fourth year of medical school to teach us what had changed since we started four years earlier. The lesson has stuck for 15 years and hopefully still will at 40 years for me as well.

  14. hardnose says:

    Why do some people still worship experts? That natural human need to have faith in something.

    Some have faith in god or gods, others have faith in various kinds of human experts and leaders. Some have faith in a reality TV star.

    But I think the less spiritual faith you have, the more faith you have in scientific and financial experts.

    The anti-Hillary voters tended to be more spiritual, and/or more libertarian.

    It could almost be described as a volcanic explosion of the repressed subconscious of our society. A raging adolescent-like rebellion against the elitist, hypocritical, corrupt, pseudo-parental experts and rulers.

  15. I know, I couldn’t have scripted a better demonstration of the exact points I was making. Perfect.

    To illustrate further, the question of dietary salt and blood pressure is one doctors have been studying and following closely for years. Actually chat with an expert on it and they will quote you the evidence chapter and verse. The actual story is more complex than the simplistic narrative HN serves. Here is a 2013 review: https://www.ncbi.nlm.nih.gov/pubmed/23558162

    “A modest reduction in salt intake for four or more weeks causes significant and, from a population viewpoint, important falls in blood pressure in both hypertensive and normotensive individuals, irrespective of sex and ethnic group.”

    The story with cholesterol is also very complex. Here is a recent overview: https://sciencebasedmedicine.org/update-on-cholesterol-and-statins/

    The guidelines change as new evidence comes in.

    As usual HN and reality are not even in the same ballpark.

  16. tb29607 says:

    And does anyone else remember a survey done in about the mid 90s discussing the “information superhighway”. Apparently 90% of people surveyed thought it would be a good thing but only around 80% had any idea of what this “superhighway” actually was. This discussion reminded me of the study which I am having trouble finding (I collect studies which make me laugh).

  17. RickK says:

    Ah how wonderful it is to be free of the tyranny of experts. It is so much more convenient to have my car serviced, my daughter’s asthma treated, my eyeglasses fitted and my taxes calculated by the same guy who cuts my lawn.

  18. hardnose says:

    The reductionist approach to medicine has created the myth that dietary salt is a causal factor in hypertension and CVD.

    Hypertension is more likely to be a response to artery disease, a result, rather than a cause.

    Has a low salt diet been shown to improve health? Not very likely.

    https://well.blogs.nytimes.com/2016/05/25/a-low-salt-diet-may-be-bad-for-the-heart/

  19. hardnose says:

    High cholesterol is more likely a result than a cause of CVD. This is another example of the reductionist approach so common in mainstream medicine.

    An extremely large percentage of Americans are on statins, even though the supposed benefit is small and unpleasant side effects are common.

    Statins interfere with important natural processes, and can cause high blood sugar. That is the last thing a person at risk for CVD needs, since type 2 diabetes is a major cause of heart attacks and strokes.

    Statins are great for the drug companies, but very bad for most of the Americans who are obediently taking them.

    If your cholesterol is high there is probably a reason, and the reason is probably not genetics.

  20. hardnose says:

    The idea of metabolic syndrome came from alternative/holistic medicine and is, very slowly, starting to become mainstream. Except at Science Based Medicine, where mainstream myths never die.

    Metabolic syndrome involves the whole system, and is usually a result of the unnatural modern lifestyle. Metabolic system can lead to high blood sugar, high cholesterol, hypertension, CVD and type 2 diabetes.

    Mainstream medicine, usually, makes no attempt to correct the syndrome and restore balance and health. Instead, it tries to restore an illusion of balance by using harmful chemicals, such as statins.

    If high cholesterol and high blood pressure are a result of a systemic imbalance, then trying to correct them with drugs makes very little sense.

    Yes, there are individuals with genetic disorders that cause extremely high cholesterol, but that is not common. It is pretty darned silly to treat everyone with high cholesterol as if they had a genetic disorder. But that is what often happens.

    Great for the drug companies, very bad for the patients.

  21. FuzzyMarmot says:

    I think one key driver of public mistrust of experts is the misuse/misrepresentation of mathematical and statistical models.

    Events like the 2008 financial crisis and the 2016 US presidential election are prime examples. Complex mathematical models yielded results that gave everyone a false sense of certainty about the behavior of extremely unpredictable systems. When these models proved to be flawed, people became disenchanted. Hard to blame them.

    I’d call it “quantitative hubris”. The introduction of numbers (even if they are generated by flawed models) gives the false impression of certainty. Perhaps if experts did more to communicate their *lack* of knowledge, it would increase public trust.

    Dr. Novella’s key point is a great one, though: we all need to learn that being wrong isn’t bad, as long as one is willing to update one’s beliefs. My general impression is that the current problems stem more from ideological polarization than pedagogical approaches in our educational system.

  22. bachfiend says:

    Hardnose,

    ‘The idea of metabolic syndrome came from alternative/holistic medicine and is, very slowly, starting to become mainstream. Except at Science Based Medicine, where mainstream myths never die’.

    References please.

    The term ‘metabolic syndrome’ was first used by the French physician Jean Vague in 1947. I was taught about it as a medical student in the ’70s. I haven’t bothered to see if there’s anything on it in Science Based Medicine. Maybe I should – you’re not particularly reliable with regard to your sources.

  23. hardnose says:

    I have never seen anything about metabolic syndrome at the sciencebasedmedicine blog. When Harriet Hall writes about heart disease and statins, for example, she never mentions it. And she neglects to mention that cholesterol lowering drugs can raise blood sugar and cause type 2 diabetes — a major cause of heart attacks and strokes.

    If a patient has high cholesterol, in most cases they should be treated for metabolic syndrome, NOT for high cholesterol.

    And metabolic syndrome is not treated with drugs.

  24. bachfiend says:

    Hardnose,

    After a 30 second search of Science Based Medicine, I found an article ‘Metabolic Syndrome: A Useless Construct?’ dated June 8, 2010 by Harriet Hall.

    LOL

    How do you think that the metabolic syndrome is treated without drugs? Besides the obvious lifestyle choices all physicians advise such as losing weight, engaging in regular physical activity, watching one’s diet (including alcohol) and modifying it if necessary.

  25. hardnose says:

    And SN ignored what I said about chemo for patients with advanced cancer.

    It can be a big mistake to have blind faith in medical doctors. Or any kind of experts.

    Even when you take your car to a mechanic, you don’t have blind faith, or you shouldn’t. But fixing your car is a lot more straightforward than fixing your body. Medical doctors have more opportunity for misusing their expertise and taking advantage of trusting patients.

    And even granting that most MDs might have good intentions, medicine is complex and confusing, to everyone, including the experts.

    The same can be said of other fields, such as finance, where things just aren’t cut and dried. Do you have blind faith in a financial advisor? I hope not.

    I am not saying that non-experts are more qualified than experts. I am saying we should be skeptical. This is just common sense, but the elitist expert-worshipers don’t believe in common sense.

  26. hardnose says:

    [I found an article ‘Metabolic Syndrome: A Useless Construct?’ dated June 8, 2010 by Harriet Hall.]

    Well sure, Harriet Hall would call it useless, without understanding it. I think that just supports what I said.

    [How do you think that the metabolic syndrome is treated without drugs? Besides the obvious lifestyle choices all physicians advise such as losing weight, engaging in regular physical activity, watching one’s diet ]

    It is mostly caused by the unnatural modern lifestyle, so of course improving lifestyle is the most obvious treatment.

    But I really doubt that most mainstream doctors understand just how much lifestyle needs to be improved. The current recommendation for exercise is about two and a half hours per week.

    And the mainstream dietary recommendations are very often wrong — limiting salt and cholesterol, for example. Low fat diets, and unnatural processed plant oil, just make metabolic syndrome worse.

    If physicians really were giving patients good advice about lifestyle, the percentage of Americans on statins would not be so ridiculously high.

  27. mark4nier says:

    An interesting note on this: I thought that this was post-modernism crossing over into conservative politics, but an article I read last week argues that this tendency was established in the early 20th century amongst Christian Fundamentalists (http://religiondispatches.org/the-religious-origins-of-fake-news-and-alternative-facts/), who found themselves in conflict both with science and with established Christian theology (Christian Fundamentalism is a movement largely ignorant of Christian tradition, going back to Augustine in the fourth century, which rejects biblical literalism—some of you may be surprised by this, but it’s true, and the reason the Catholic Church never challenged evolution. I’m an atheist, but I know my theology.) To defend their amateur theology, fundamentalists rejected expertise of all kinds (elites) and science, and more specifically, evidence and reason. You can see where this is going.

    This explains something else I’ve noticed. Cults establish control over their members by establishing epistemological isolation, by which all trust is broken between cult members and those outside the cult. This is done at first by physical isolation, but then by sowing distrust of all sources outside the cult, painting them as the agents of the Enemy (Satan for Christians, Repressives for Scientology, Capitalists for Marxists, Socialists for Libertarians, etc.) I’d noticed the cult-like behaviour in the alt-right before I read the article I cited above, but the article explains the origin of epistemological isolation on the right, as a tried and true technique passed along throughout the right through it’s early ties with the Moral Majority. Essentially, a broad range of internet media on the right have linked together to form a coordinated attack on critical thinking, but this is not something that has been planned by some evil mastermind, but is in fact an emergent effect of the internet itself and its ability to link like-minded communities. The problem is epistemological isolation, not the linking itself. Oddly enough, attempts to do the same thing on the left have failed. People who have tried it for fun and profit get quickly debunked in the comments, the word gets out, and the site dies. The strategy that works best on the left is the one pursued by the Huffington Post, where they don’t lie, they just don’t cover what their readers don’t like.

    One last thing. This was possible even before the internet. My father got on to a conservative mailing list in the early 70’s. But the 80’s I noticed a distrust of expertise (“These scientists think they know everything, but I know more than they do.”). But I also noticed something stranger—though a staunch Catholic who went to Church at least once a week, if not more, he had become a biblical literalist, and in particular, had rejected evolution. This has been going on a long time.

  28. bachfiend says:

    Hardnose,

    You still haven’t provided a source for your claim that the concept of metabolic syndrome came from alternative/holistic medicine. Care to do so?

    The point Harriet Hall was making was that the definition of what comprises metabolic syndrome varies from authority to authority, so it’s not a robust diagnosis. It’s better to detect diabetes, hypertension, central obesity, hypercholesterolaemia if present and treat them appropriately. All of which include lifestyle changes.

    The recommended 2 and a half hours of exercise a week is the minimum. There’s nothing stopping a person doing more (I manage 10 hours in the gym a week). There’s no point recommending a larger amount. Al it would do is to discourage people from doing anything.

    I personally am on a low salt and low cholesterol diet (I’m a lacto vegetarian and consume almost exclusively skim milk products), and it’s not a problem for me. I enjoy it, and it hasn’t done me any harm. Where’s your evidence that a low fat diet makes the metabolic syndrome worse? Unless it’s because dietary fat is being replaced with sugar?

  29. bach – HN is continuing his effort to prove my point. He has no idea what he is talking about, but he thinks he can condemn the entire medical profession, and he only links to popular press. He does not understand the literature, he misrepresents what mainstream physicians believe and do. He is driven by ideology, and speaks directly out of his ass. He is the living embodiment of Dunning-Kruger, with a generous helping of the arrogance of ignorance.

  30. Willy says:

    Thank God (LOL) for hardnose! One couldn’t ask for a better better demonstration of stupidity–and lack of self-awareness, or intelligence, or… (fill in the blank).

    Please, Dr. Novella, do not capitalize “hn”! And, fer cryin’ in the beer, DO NOT mentions his ass! LOL

  31. bachfiend says:

    Willy,

    I don’t know. I actually thought ‘speaks directly out of his ass’ was pretty good. Almost as good as ‘a generous helping of the arrogance of ignorance’.

  32. SteveA says:

    FuzzyMarmot: “Perhaps if experts did more to communicate their *lack* of knowledge, it would increase public trust.”

    I think most professionals are careful to place their conclusion and predictions within error bars and to include caveats. The problem is often how these issues are reported. In most cases, the media don’t want ‘fuzzy’ stories packed with nuance; they want hard ‘simple’ facts, so they tend to drain the complexity out of these issues, turning up the contrast to produce a black and white image. Then, when new evidence suggests that salt might not be that awful, or that blueberries don’t cure shingles or piles (or whatever), the same people turn around and launch a new story of the ‘experts get it wrong again’ variety, to which the professionals answer (usually unheard) that they didn’t get it wrong, and that it was the media that took the original information out of context, or misinterpreted the information, or dumbed-it down to inanity.

    In fairness, some news outlets will make an effort to cover a story in detail, but they will also choose a dramatic headline and first para that will squeeze the maximum drama out of a subject – the one that will help them make that sale or elicit a click. If you’re skimming the headlines on a news-stand or surfing the Web, the cut-down BS version is usually the only one you’ll ever see

  33. RickK says:

    FuzzyMarmot – there were plenty of people who knew MBS and related derivatives were basically junk. At our bank the head mortgage traders cashed out well before 2008 leaving devastation in their wakes. One of my favorite lines (in retrospect) from a trader in ~2005 was “The financial controllers don’t have a clue. Sometimes we get a financial control guy who is smart enough to understand what is going on. We just hire him onto the desk and give him a portfolio – problem solved.”

    There was a healthy dose of heads-up fraud and intentional blindness driven by greed behind the financial crash.

  34. Lobsterbash says:

    hardnose appears to be the Donald Trump of medicine. Alternative facts, legit information being fake news, Dunning-Kruger as fuck, wanting to shake up the medical establishment…

    This whole conversation kind of makes you take notice of that movie Idiocracy. But instead of dumb people multiplying and taking over the world, shitty thinking and dumb ideas are multiplying and taking over the world.

  35. hardnose says:

    “HN is continuing his effort to prove my point. He has no idea what he is talking about, but he thinks he can condemn the entire medical profession, and he only links to popular press. He does not understand the literature, he misrepresents what mainstream physicians believe and do. He is driven by ideology, and speaks directly out of his ass. He is the living embodiment of Dunning-Kruger, with a generous helping of the arrogance of ignorance.”

    When you don’t have an logical answer for someone who disagrees with you, just call them stupid.

  36. hardnose says:

    “I personally am on a low salt and low cholesterol diet (I’m a lacto vegetarian and consume almost exclusively skim milk products), and it’s not a problem for me. I enjoy it, and it hasn’t done me any harm. Where’s your evidence that a low fat diet makes the metabolic syndrome worse? Unless it’s because dietary fat is being replaced with sugar?”

    Avoiding salt, cholesterol and fat is not going to benefit your health. If that’s how you like to eat, I guess it won’t kill you. But if you are actually denying yourself things you body wants, because of mistaken mainstream medical guidelines, then you should be more careful and skeptical about what you believe.

    Most importantly, don’t fall for the lie that soybean oil, canola oil, etc., are healthy substitutes for butter.

    Look into the research on salt and hypertension, and you will see how inconclusive it is. Once certain myths get started, they just won’t die, regardless of the evidence.

    Yes it’s true that food advertised as low fat is often full of refined sugar, and refined sugar is much worse than fat.

    But a low fat, low cholesterol (and low salt) diet is bad for other reasons. You can look it up, but you have to go beyond exclusively mainstream sources.

  37. bachfiend says:

    Hardnose,

    If you ever, just for once, managed to produce a logical argument, then you’d deserve to be treated as a non-ignorant person. Until you do so, we’re perfectly entitled to treat you as being ignorant.

    And anyway. You still haven’t answered my question asking you to justify your assertion that the metabolic syndrome was a concept originating from alternative/holistic medicine.

  38. hardnose says:

    “The recommended 2 and a half hours of exercise a week is the minimum. There’s nothing stopping a person doing more (I manage 10 hours in the gym a week). There’s no point recommending a larger amount. Al it would do is to discourage people from doing anything.”

    You must be aware that 2 and a half hours a week is ridiculous. Recommending that amount will cause people who trust experts to do that amount.

  39. hardnose says:

    “You still haven’t answered my question asking you to justify your assertion that the metabolic syndrome was a concept originating from alternative/holistic medicine.”

    It has been much more common in holistic medicine. For example, Robert Atkins (a holistic MD) was saying, in the 1980s, that refined carbohydrates are a major cause of heart disease, NOT dietary fat.

    This was not accepted by mainstream medicine and as a result we had decades of low fat diet fads, as metabolic syndrome became a deadly epidemic.

  40. bachfiend says:

    Hardnose,

    You’d claimed that the concept of the metabolic syndrome came from alternative/holistic medicine. You’ve attempted to justify it with Dr Atkins in the ’80s. The metabolic syndrome was first described by the French physician Jean Vague in 1947, so your claim is falsified.

    I doubt that the current epidemic of the metabolic syndrome – however it’s defined, whether it includes diabetes, central obesity, hypertension, hypercholesterolaemia, gout (which Jean Vague included in his definition) – is due to a low fat diet. You’re committing the ecological fallacy, assuming that characteristics of a group (people on a low fat diet) are the same as the entire population (with its incidence of central obesity, etc).

    I suspect it’s always been with us, except that there weren’t as many people as now who could afford a sedentary lifestyle with unrestricted access to food, and the resulting obesity.

  41. RickK says:

    “When you don’t have an logical answer for someone who disagrees with you, just call them stupid.”

    No, when you speak directly out of your ass, Steve tells the truth. hardnose, don’t try to play the victim just because you get called on your BS.

    I and millions of Americans (millions of people world wide) lead much better, healthier lives thanks to the stunning advancements in medicine and the experts that deliver it. No holistic doctor could have energy-healed my father’s shattered knee or daughter’s broken collarbone. No holistic doctor could have desensitized my daughter’s allergy or removed my cousin’s blood clot. Show me ONE “holistic” treatment that has been critically reviewed by the alt-med profession and removed due to lack of efficacy.

    And, hardnose, when you get some weird pain in your gut or suddenly your legs swell up or you shatter your pelvis by falling off your cherry-picking ladder, you will demand and benefit from all the expertise you so despise.

    So, you are indeed talking out of your ass, we know it, and I think somewhere you know that you’re only motivated by emotion and ideology, not by anything rational.

    But I will echo what others have said and thank you for providing such a stark and useful illustration of precisely what Steve blogged about.

    I mean – you actually said this: “We are tired of the tyranny of experts”

    And, when we have a government in the pocket of big oil and a cabinet full of billionaire, you actually said this: “Progressives, elitists, expertise worshipers — they are all very unhappy right now. GOOD.”

    Yes, thank you for that. You provide the tangible embodiment of what Neurologica and SGU are fighting.

  42. Ivan Grozny says:

    mlegower,

    as a fellow economist I don’t believe the notion of “consensus” as a sign of expertise among economists makes any sense at all. As a student of the history of economic ideas I saw how many theories and conceptual frameworks considered “heterodox” or non-consensus right now were orthodoxy in the 19th or early 20th century. And how the changes from latter to former have not always been for the better; moreover, I am convinced in many cases we witnessed a staggering loss of knowledge amidst the misplaced ambitions to emulate the method of natural sciences in their success in the 20th century. Economists of the late 19th century understood many of the economic problems better than modern economists with all their econometric and statistical tools. Just a few examples: I think that economists of the early 20th century had a much better theory than any contemporary theorist (who in 99% follow the wrong side of the great early 20th century debate about the nature of capital. A huge part of modern macroeconomics depends on this, and most modern experts, I am convinced, accepted the wrong and rejected the correct theory of capital, Fischer;s mythical homogeneous “fund of value” vs Bohm Bawerk’s heterogeneous capital). Concepts of competition as rivalry developed by French thinkers of the 18th century is clearly superior to modern competitive equilibrium theories; or subjective marginalist theory of value pioneered by Menger, Jevons, Bohm-Bawerk and Walras is clearly superior to Marshallian ‘synthesis’ which is taught to modern students of microeconomics as the only theory (take a look at any micro textbook!). And I did not even start with methodology, and complete novelty as well as spectacular failure of all attempts to model economic methodology on natural science, with its criteria of prediction and verification-refutation.

    I would say that in microeconomics the “death of expertise” took place much earlier, when Marshallian muddle replaced marginalist subjectivism of Vienna and Lausanne schools, and in macroeconomics when Keynesian crude neo-mercantilism replaced sophisticated classical-Austrian-Wicksellian theories of money, banking and the business cycle. You may disagree wit that, but you need something more than “experts NOW agree with me” in order to make your view convincing.

  43. “I have a foreboding of an America in my children’s or grandchildren’s time — when the United States is a service and information economy; when nearly all the manufacturing industries have slipped away to other countries; when awesome technological powers are in the hands of a very few, and no one representing the public interest can even grasp the issues; when the people have lost the ability to set their own agendas or knowledgeably question those in authority; when, clutching our crystals and nervously consulting our horoscopes, our critical faculties in decline, unable to distinguish between what feels good and what’s true, we slide, almost without noticing, back into superstition and darkness…

    The dumbing down of American is most evident in the slow decay of substantive content in the enormously influential media, the 30 second sound bites (now down to 10 seconds or less), lowest common denominator programming, credulous presentations on pseudoscience and superstition, but especially a kind of celebration of ignorance”

    A Demon Haunted World, Carl Sagan

  44. Lobsterbash says:

    Fantastic quote, John Mc. I’ve been wondering for years if perhaps hyperspecialization is mostly to blame. The Rennaisance man is dead. Polymaths are actually dilettantes. One must commit a lifetime to a narrow field to achieve anything of note. Steve Novella might disagree, but people who dedicate their lives to broad erudition, deep understanding and thinking are not the norm, nor will they probably ever be. The level of understanding needed to be “elite” or at least not exploited, is absolutely enormous and will only grow. The human brain struggles with the monumental effort of being informed in every way necessary in today’s world.

  45. mlegower says:

    @ Ivan Grozny-

    I was responding directly to an allegation of a lack of consensus among economists. MWSletten said:

    “First, there is a distinct lack of consensus among economists.”

    I provided evidence that there is meaningful consensus on many issues, at least amongst orthodox economists. You raise the issue of the existence of heterodoxy in economics. This is obviously true. But I would argue that the experts on the IGM panel are probably close to representative in the population of academic economists. Whether a consensus amongst serious thinkers grants that consensus elevated status epistemologically was not something I meant to comment on (although I do believe that).

    I’m not hijacking this thread with a discussion of heterodox vs. orthodox economics, both because that’s not what the original post is about and because, quite honestly, my expertise does not lie in the history of economic thought.

  46. hardnose says:

    “I and millions of Americans (millions of people world wide) lead much better, healthier lives thanks to the stunning advancements in medicine and the experts that deliver it.”

    Advances in medicine have not been a major factor in improving health. Americans, in general, are not healthy, first of all. We are probably one of the less healthy societies that have lived on earth.

    A small number of medical advances, mostly surgical, have saved or improved some lives. It seems like everyone my age is getting knee replacements now. That’s nice, but they wouldn’t need it if they had a better lifestyle.

    The new drugs are not contributing much at all to longevity and, might be damaging health more than improving it.

    Average lifespan has increased, but you have to look more closely at the data, it is very confusing and deceptive.

    Medical doctors have started recommending lifestyle improvement (supposedly).

  47. arnie says:

    “Medical doctors have started recommending lifestyle improvement (supposedly).”

    Alright all we medical doctors reading this blog, let’s raise our hands if lifestyle improvement (where applicable) was being recommended when you entered medical school (that would be 1963 for me). Hey, 100% hands raised! Well, I guess that means one of our trolls is talking out of his ass again. But then, wasn’t that entirely predictable………..

  48. Willy says:

    Hey, hn: What is your area of “expertise”? Education? Can just any old fool do what you? Are you just another dumb expert to be ignored? Or, perhaps, your Google U degree confers upon you a special kind of wisdom not available from “main-stream” education?

    I recommend you study the chem trail thing. It’s tied into lying politicians AND lying scientists. A two-fer!

  49. hardnose says:

    The people I know who trust medical doctors have been told they need drugs for hypertension, high cholesterol, high blood sugar, etc. When doctors recommend lifestyle changes they usually mean avoiding salt, fat and cholesterol. Maybe a little exercise. It’s useless advice.

    I have a friend who got type 2 diabetes while in his thirties. It could have been cured by serious lifestyle changes, but his doctors only emphasized drugs. I told him, many times, to avoid refined carbohydrates and to exercise every day, but he ignored my advice because I am not a medical doctor.

    My mother had hypertension since early middle age. Her doctor gave her drugs, and never told her to stop smoking or to exercise every day. The only lifestyle advice she got was to avoid salt.

  50. bachfiend says:

    armies,

    Lifestyle changes were a big part of my curriculum when I started my medical training in 1972. Not that it seemed to do any good – when I was a GP, I don’t think I’d convinced a single patient to stop smoking.

    Hardnose with his anecdotes… he has a friend with type 2 diabetes whose doctor prescribed just drugs and didn’t advise dietary changes. Really? Any doctor worth anything would know that patients won’t take everything in with one hearing, will often get things completely wrong, and will need to be told and retold again. And even then, will still get things wrong.

    I tend to find that people want the easy quick solution, even if it doesn’t work.

    Being able to give patients printed information is necessary. The Internet can be extremely useful in providing useful information provided they’re reputable sources. Although, obviously there are a lot of dubious sources.

  51. bachfiend says:

    Curse Spellcheck – ‘arnies’…

  52. hardnose says:

    If you go anywhere in America and look around you will see that there are a lot of fat Americans. Is it because they are stupid and stubborn and won’t listen to their wise medical doctors? Or is it because their medical doctors aren’t all that wise?

  53. arnie says:

    bachfiend,

    I agree with you. Also, we must keep in mind that it is highly unlikely that HN was in the doctor’s office when his “friend” and his “mother” reportedly got little or no lifestyle advice. So such second hand anecdotes are only just that. No conclusions to be drawn from that.

  54. Willy says:

    “a lot of fat Americans”. LOL Sure, hn, it’s all the fault of those gol durned mainstream doctors. Every one of ’em is an evil, money-grubbing SOB that just wants the huge kickbacks they receive from “Big Pharma” for getting people hooked on drugs they know are worthless. I’m pretty sure they have to sign an agreement to prescribe worthless drugs before they are even admitted to medical school. Crooks! Every single one of them.

    Are you going to tell us what field your worthless expertise is in?

    I knew a fellow who thought like you do. When he received a cancer diagnosis, he hightailed his ass to Mexico for some herbal/”holistic” cure. By the time he got some sense and went to a REAL doctor, it was too late. He’s dead now.

    Regarding your beloved, “holistic” Dr. Atkins, he died at age 72. “A medical report issued by the New York medical examiner’s office a year after his death showed that Atkins had a history of heart attack, congestive heart failure and hypertension…”

    Bring on the bacon!

  55. Kabbor says:

    “If you go anywhere in America and look around you will see that there are a lot of fat Americans. Is it because they are stupid and stubborn and won’t listen to their wise medical doctors? Or is it because their medical doctors aren’t all that wise?”

    This is seriously funny, hardnose you are a gem. I guess dentists are useless because people still get cavities. If only they told people to brush and floss, we’d have great teeth. This is the level of logic applied here. Contrary to popular belief, doctors don’t have mind control and thus are not the number one influence on lifestyle habits.

    I don’t have any delusion that anything written here will change your mind. To you doctors and the practice of modern medicine are bad, and any and every counter example is just proof that people are easily fooled. This is sort of a baseline conspiracy mindset, and I can only hope that lay readers that have not fully invested in this mindset can avoid falling fully into it.

  56. tb29607 says:

    Haha!
    I was in medical school when Dr Atkins had his first heart attack during which he insisted, from his hospital bed, that his diet was not the cause of his heart disease. Interesting that when things got serious, he went straight to mainstream doctors for them to treat him.

    Willy,
    I also had a patient with metastatic cancer who went to a holistic hospital in Mexico. They substituted coffee enemas for the pain meds that he needed due to bone mets. He spent the last 5 days of his life suffering acute opiate withdrawal and in excruciating pain.

    And I think anyone who treats patients can attest to the fact that convincing people to make life style changes is at best difficult and rarely happens after one visit to their doctor. I know I have counseled people ad nauseum to stop smoking around their severely asthmatic child without results. And these same parents just can’t understand when their kid ends up on a ventilator or dies from an acute attack.

  57. SteveA says:

    HN: “I told him, many times, to avoid refined carbohydrates and to exercise every day, but he ignored my advice because I am not a medical doctor.”

    Hardnose, don’t you think that…how can I put it?…there might have been ‘other’ reasons why he ignored your advice?

  58. Bill Openthalt says:

    tb29607 —
    As a child in the late ’50ies and early ’60ies, I suffered from severe asthma. Both my mom and my dad (a professor of pediatrics) were smoking 1 to 2 packets a day. My dad only stopped smoking when needed aortic valve replacement.

  59. BillyJoe7 says:

    The game is over when you become a laughing stock, which is what happens when you lapse into self parody. Well, it’s funny and sad at the same time.

  60. hardnose says:

    “I knew a fellow who thought like you do. When he received a cancer diagnosis, he hightailed his ass to Mexico for some herbal/”holistic” cure. By the time he got some sense and went to a REAL doctor, it was too late. He’s dead now.”

    I had a friend, well several friends, who thought like you do. When they received a cancer diagnosis, they hightailed their ass to a REAL oncologist. They had surgery and chemo. They are dead now.

  61. hardnose says:

    No one knows the real reason Atkins died. Because the diet was always controversial all kinds of things have been said, and the truth depends on who you believe.

    But he was right about carbohydrate addiction, and its connection to metabolic syndrome. This was at a time when mainstream doctors knew nothing about it. The reason for the Atkins diet is to break the addiction.

    No, I never tried it myself because I am not addicted to carbohydrates. But millions of Americans are.

  62. hardnose says:

    And by the way I am 65 and never had hypertension or high cholesterol, never was overweight, and never followed a low salt or low fat diet.

  63. RickK says:

    So hardnose, I’m curious:

    If you had a disturbing symptom, like a sudden swelling in your legs, would you seek the opinion of an MD, a chiropractor, a naturopath, an auto mechanic, or …? Or would you just live with it and let it slide?

    If you had general weakness and an unusual pain in your abdomen, would you seek an opinion or let it slide? Whose opinion would you seek and why?

    If you were completely wiped out physically, wracked with an intense cough, having difficulty breathing and running a high fever, which kind of professional would you approach for assistance?

    If you were planning a trip into sub-Saharan Africa or rural Pakistan, would you seek any medical assistance before the trip? Who would you seek it from?

    If you found yourself suddenly in a shopping mall with no memory of how you got there, or you found yourself repeatedly paying the same bills twice, would you seek the advice of a neurologist, or would you just let it slide and chalk it up to a failing in your lifestyle?

    If your daughter and her husband, after 4 years of trying, were still childless, would you recommend they seek the advice of an MD fertility specialist, a homeopath, a naturopath, a midwife, or just assume it’s because of their lack of personal discipline and recommend they adopt?

    I’m just curious thoroughly you’ve severed your ties with the medical experts you so actively disparage.

  64. BillyJoe7 says:

    “…the truth depends on who you believe” 😀

  65. mumadadd says:

    “…the truth depends on who you believe”

    Yeah, that jumped out at me too. There are no actual facts, just differing opinions and no way to sort them out. WTF.

  66. Willy says:

    hn: My friend was told his cancer had been detected early enough and that he would likely survive. Like you, he didn’t think much of “experts” (he knew a lot cuz he was a car mechanic, you know, a guy who got his hands dirty and wasn’t a prissy white collar guy), so he went to Mexico and ended up dead. Sadly, a woman who influenced him to go “herbal”, was diagnosed with cancer shortly after his death. She opted for “mainstream” medicine. She’s still alive six years later.

    As for Atkins, the MEDICAL REPORT said he had suffered heart attacks and had hypertension. He actually died from blunt force trauma to the head as a result of a fall.

    I can’t help but notice you don’t care to reveal your particular (worthless) area of expertise. Could I do your job as well as you do? Are you no more capable, no wiser, than just any old schmuck when it comes to your job?

  67. Willy says:

    Sez hn: “I told him, many times, to avoid refined carbohydrates and to exercise every day, but he ignored my advice because I am not a medical doctor.”

    Maybe your friend is someone is skeptical of “experts”?

  68. hardnose says:

    “If you found yourself suddenly in a shopping mall with no memory of how you got there, or you found yourself repeatedly paying the same bills twice, would you seek the advice of a neurologist, or would you just let it slide and chalk it up to a failing in your lifestyle?”

    I would do what everyone does — go to a neurologist and find out they have dementia and there is no cure, and it will just get worse.

  69. hardnose says:

    [a woman who influenced him to go “herbal”, was diagnosed with cancer shortly after his death. She opted for “mainstream” medicine. She’s still alive six years later.]

    And this anecdote proves beyond any doubt that cancer can always be cured by mainstream medicine.

  70. hardnose says:

    Atkins did not have an autopsy, so the real cause of death is not known.

  71. hardnose says:

    “There are no actual facts, just differing opinions and no way to sort them out.”

    There are facts, but no one argues about those things. For everything that is controversial, there are differing opinions and it’s hard or impossible to sort them out.

  72. hardnose says:

    “you’ve severed your ties with the medical experts you so actively disparage.”

    I never said that I severed ties with medical experts. When I thought I had a broken bone I went to an MD and had an x-ray. He said it was broken and it would heal in 2 months. I need MDs if I need an x-ray or antibiotics, or something like that.

    But this blog, and other similar blogs, medical expertise is vastly over-rated. You think MDs can cure everything, can understand everything. They understand and cure only certain types of things.

    On the other hand, I have no definite opinion about naturopaths, homeopaths, etc. Maybe some of it works sometimes for some things, I do not know.

  73. tmac57 says:

    HN- “I would do what everyone does — go to a neurologist and find out they have dementia and there is no cure, and it will just get worse.”

    Or, you might find out that you are suffering from some blood sugar problem, or you have had a ‘silent’ TIA, or maybe some medications that you take are interacting in negative ways. All of those things can be treated potentially. And even if it turns out that you had Alzheimers, you would need to know that that was a possibility, so that they could advise you on how to proceed with the rest of your life by making plans for your decline, and make you wishes known to friends and family so that you can best manage the symptoms and eventual decline, rather than putting others in charge of your care ad hoc.

  74. Willy says:

    I am CRUSHED to learn that hn is 65! CRUSHED, I tell you! LOL

    And, no, I never claimed nor implied that going to a “mainstream doctor” was a guarantee of beating cancer. I did find it “odd” that a believer in quackery, and someone at least partially culpable for the death of a friend (although he’d likely have chosen herbalism anyway) opted for “mainstream” treatment after seeing my friend die.

    What are you going to do when you get diagnosed with a potentially fatal disease?

    What is your “useless” field of expertise? Do you feel guilty for being paid for something that any old schmuck can do?

  75. hardnose says:

    “What are you going to do when you get diagnosed with a potentially fatal disease?”

    If it can’t be cured by surgery or antibiotics, then mainstream medicine probably won’t help. And, as I already said, I have no opinion about any forms of non-mainstream medicine.

    If we are lucky we don’t get a serious disease, or we get one that can be cured. Otherwise, it just sucks.

    Lots of Americans worship experts and think MDs can cure them of anything. Then, if they actually get a serious disease, they are terribly disappointed when the MD can’t do anything for it. Maybe out of desperation they try a naturopath. Naturopaths sometimes promise miracles, as long as you hand over your life savings. And if the miracle doesn’t happen, no you won’t get your money back.

    So, as you can see, I am a skeptic and that means I am not in denial. I know that bad things can happen, and you can’t count on experts to have all the answers.

  76. tb29607 says:

    HN,
    If you have kids (or is it grandkids since you are 65?) under 18 years old I hope you do not apply your only surgery or antibiotics philosophy to them. The most common childhood cancer is acute lymphocytic leukemia and has a 90% cure rate vs the natural history which is universally fatal.

  77. bachfiend says:

    Hardnose,

    No one here ‘worships experts and thinks MDs can cure them of anything’.

    We respect experts’ opinions in subjects and areas in which they have expertise. We don’t necessarily think that they’re right all the time or that they have all the answers.

    You’re just making a straw man argument.

  78. Willy says:

    In what field are you an “expert”, hardnose?

  79. RickK says:

    hardnose said: “You think MDs can cure everything, can understand everything.”

    Total strawman. That’s just plain false. This blog constantly looks critically at research. How many HUNDREDS of times has this blog focused on some piece of research and concluded “it’s 5 to 10 years away from anything useful, and it may never work out.” How many times has the focus been on some piece of research that overturned prior assumptions? Personally, my family has been through a number of major medical issues and the doctors we’ve dealt with have ALWAYS talked in terms of multiple possible outcomes, percentages of success, and the need for getting multiple opinions.

    You’re painting a false picture – why can’t you stop?

    YOU are the one who seems most disappointed that doctors can’t cure everything. When I listed hypotheticals, all potentially treatable depending on the diagnosis, you focused on Alzheimers and how it is incurable. You’re obsessed with seeing only what medicine can’t treat.

    Why is nuance so difficult for you?

    hardnose, you can only maintain your narrative by portraying a false picture of those around you. You can only criticize the version of the medical profession found in magazine headlines in the supermarket checkout line.

    Are you introspective enough to see how dishonest you’re being?

  80. hardnose says:

    “When I listed hypotheticals, all potentially treatable depending on the diagnosis, you focused on Alzheimers and how it is incurable.”

    And the same for everything else you listed.

  81. RickK says:

    hardnose said: “And the same for everything else you listed.”

    Really? Abdominal pains, infertility and pneumonia are always incurable? There’s no value in immunization shots before foreign travel?

    hardnose – What are you saying? Are you saying doctors are useless for any of the situations I listed?

  82. hardnose says:

    Mainstream medicine can be good for certain things requiring surgery, or antibiotics, or certain kinds of diagnostic imaging and tests.

    It does not help with most chronic diseases and autoimmune disorders. Some limited help with certain types of cancer.

    It is not nearly as wonderful as you expert-worshipers believe.

  83. bachfiend says:

    Hardnose,

    I have an autoimmune disorder, and modern medicine has helped me enormously. It’s returned me to the normal state. It had resulted in my serum cholesterol being abnormally high too, which returned to the optimum range with treatment.

    We don’t worship experts. We respect their opinions in areas in which they have expertise (I’d even respect Michael Egnor’s advice in neurosurgery).

    You’re clueless regarding what experts can and cannot know in their fields of expertise.

  84. BillyJoe7 says:

    But you aren’t cured, bachfiend. Your endocrinologist has simply covered up your disease by giving you hormone replacement therapy. Symtomatic tretment. Nothing more. He has done nothing for you. You still have your fv<k1^g disease.

    😀

  85. bachfiend says:

    BillyJoe,

    Aha… you’re using the argument hardnose would be using if he had enough knowledge about a subject in which he’s clueless. Although your parady of his argument is pretty lame.

    LOL.

  86. RickK says:

    We couldn’t have children. Enter a fertility doctor. Now we have two wonderful kids.

    Sorry, hardnose, but your “tyranny of expertise” narrative is a failure.

    We ALL know medicine can’t cure everything. But that in no way diminishes the value of medical expertise. And YOU will continue to seek and value that expertise, just like the rest of us.

    Sadly, I don’t think medical science can stop your posterior from pontificating. It can’t stop you from endlessly repeating dishonest strawman characterizations of everyone else. It can’t cure you of your juvenile tendency to praise yourself for your great insight and wonderful health. In short, medical science can’t give you the maturity you somehow failed to achieve.

  87. HN continues to give us an excellent example of how a non-expert criticizes a topic he does not understand.

    His absurd and evidence-free summary of what modern medicine does and does not treat seems to be based entirely if pro-quackery propaganda.

    Counterexamples are legion. Here is just one – mysasthenia gravis. This is an auto-immune disease. It is perhaps one of the best understood neurological disease, very reductionist. 60 years ago MG was debilitating and often fatal (hence the “gravis”). Today, most patients can achieve remission with minimal manifestations and a normal life.

    In fact, auto-immune diseases as a category are highly treatable, and getting better all the time. 20 years ago we could only manage MS outbreaks, now we can put certain forms of MS into the equivalent of remission.

    Of course, if you know nothing you can read popular articles bashing medicine and accept it all uncritically because it fits your narrative, then you can lecture experts about their own field of expertise.

  88. RickK says:

    Wait for it – hardnose will drop a link to some article showing a bad outcome of a medical treatment or claiming treatment of MS doesn’t CURE it. Regular as clockwork.

  89. mumadadd says:

    This is still “we don’t know everything therefore we know nothing” — (real) medical expertise can’t cure everything therefore we can disregard (real) medical expertise.

    Up until the point we have a perfect theory of everything I am free to substitute my own bullshit for any science that contradicts my narrative; up until science/evidence based medicine can cure everything I am free to diagnose people on internet forums and suggest they treat their problems with quackery*.

    * hn once diagnosed the cause of my chronic insomnia (based only on my saying I suffered from chronic insomnia) and told me the only cure was chiropractic.

  90. Willy says:

    mumadadd: How silly of hn to recommend chiro. We all know homeopathic remedies are the only solution for insomnia.

  91. hardnose says:

    Most treatments for autoimmune disorders involve steroids or immune-suppressing drugs. Maybe sometimes that’s better than nothing, but it’s hardly a long-term solution.

    Allergies are another thing modern medicine can’t help much with. That is something I unfortunately know about.

    If you really try, as some of you did, you can find examples where modern medicine can help with a chronic condition. Type 1 diabetes is an example — but not at all recent.

    What has modern medicine been accomplishing recently? Improving toxic drugs that extend life, a little, for cancer patients; Better surgery for replacing joints that wore out because of the unhealthy American lifestyle.

    I think the best thing modern medicine has accomplished recently is imaging technology. But that is thanks to computer science, not medical science.

  92. hardnose says:

    By the way, since someone mentioned chiropractic — research has shown it can lower blood pressure.

    Of course, I know all of you here would rather take drugs.

  93. bachfiend says:

    Hardnose,

    Care to link to your research showing that chiropractic can lower blood pressure?

    I found an article by Roffers et al published in the Asian Journal of Multidisciplinary Studies in June 2015, reporting a slight drop in blood pressure following chiropractic manipulation in hypertensives, but the authors haven’t yet found whether their results were anything other than transient (and perhaps bogus anyway) and they want to extend their study (as they should, if they want chiropractic to be a recognised form of treatment for hypertension) to see if they can confirm it results in persistent lowering of blood pressure.

    Agreed – imaging technology in modern medicine is amazing, giving information of incredible detail. Perhaps too much detail, with abnormalities of very little significance being revealed. Henry Marsh, a retired neurosurgeon, gives an example in his book ‘Do No Harm’. One of his patients had a non-specific headache and her doctor did an imaging study revealing a 7 mm berry aneurysm on one of her cerebral arteries. The lifetime risk of it rupturing causing death or a stroke on statistics was around 2%. The risk of surgery for it causing death or a stroke (which would be immediate) on statistics was the same – 2%. The patient wasn’t willing to have a ticking timebomb in her head, so she opted for immediate surgery.

    She perhaps might have been better off not having the imaging study.

    Technologists might produce amazing technology but the significance of its results still have to be assessed by the expertise of the medical experts.

  94. Interesting denial techniques. Yeah, I have to think “real hard” to come up with examples.

    Immunosuppressive drugs for auto-immune disease ARE a long term solution. Their beneficial effects are sustainable. And we are getting more and more precise at how we manipulate the immune system.

    I just gave two examples. In the last 20 years the treatment of MS was revolutionized.
    We are now implanting wires in the brain to treat Parkinson’s and seizures.
    We have more and much better medications to treat this also, fewer side effects, better efficacy.
    The options for migraine are also much greater, and we are researching with electrical stim, and monoclonal antibodies.

    I have been practicing for about 20 years, and in the last 20 years the progress has been steady. The majority of my interventions these days are different and better than they were 20 years ago.

    There is steady incremental advance, but if you are simply ignorant of it you can easily deny it.

  95. I found two preliminary studies of chiropractic and blood pressure, one positive, and one negative.
    https://www.ncbi.nlm.nih.gov/pubmed/26693212
    https://www.ncbi.nlm.nih.gov/pubmed/27157678

    That’s it. If HN believes this is sufficient to conclude, “research has shown” than this really only shows:
    – HN cannot interpret the literature
    – HN is gullible
    – HN has two sets of standards. He will deny almost anything mainstream, and accept almost anything alternative.

  96. mumadadd says:

    “By the way, since someone mentioned chiropractic — research has shown it can lower blood pressure.”

    And since hn has no way of assessing the quality or quantity of research related to anything, except as a prop to support the position he’s already arrived at through other means, his position is self-defeating; and he is the only one who doesn’t see that.

    chikoppi hammered hn on this point and gave him ample opportunity to lay out a standard of evidence, but hn completely ignored the sustained attempt somehow.

    If hn does happen to lay out a reasonable standard, his beliefs will be defeated by it. So what is hn’s position worth? He’s constructed it in such a way that it can’t be other than worthless.

  97. RickK says:

    hardnose bleated from his behind: “What has modern medicine been accomplishing recently?”

    It gave us children.

    So STFU

  98. mumadadd says:

    hardnose right now is having a dinner party. He sprinkled iron filings over everyone’s food. The experimental protocol is — 20 years from now, whoever got cancer and lived, lived because iron filings; whoever died, ate too many refined carbs after the experiment. And there is no way, based on his set up, to conclude that he is wrong. So he is right.

  99. hardnose says:

    “I found two preliminary studies of chiropractic and blood pressure, one positive, and one negative.”

    This is not the kind of thing drug companies are going to spend money researching. Therefore, you don’t see it in mainstream journals. You would have to look at chiropractic journals, but of course you don’t believe research done by chiropractors.

    I would not be surprised if the drug companies found ways to stifle this research.

  100. mumadadd says:

    “I found two preliminary studies of chiropractic and blood pressure, one positive, and one negative.”

    This is not the kind of thing drug water companies are going to spend money researching. Therefore, you don’t see it in mainstream journals. You would have to look at chiropractic water divining journals, but of course you don’t believe research done by chiropractors water diviners.

  101. mumadadd says:

    “I would not be surprised if the drug companies found ways to stifle this research.”

    In my zeal to defend the practice of taking drugs to cure everything and defending both Big Pharma and Big Expert I didn’t notice this…

    Okay — sold!

  102. bachfiend says:

    Hardnose,

    ‘…but of course you don’t believe research done by chiropractors’.

    We don’t necessarily believe research done by mainstream scientists published in mainstream journals.

    Did you miss the threads on the reproducibility problem in scientific research?

  103. mumadadd says:

    hn: “By the way, since someone mentioned chiropractic — research has shown it can lower blood pressure.”

    SN: “I found two preliminary studies of chiropractic and blood pressure, one positive, and one negative.”

    hn: “This is not the kind of thing drug companies are going to spend money researching. Therefore, you don’t see it in mainstream journals. You would have to look at chiropractic journals, but of course you don’t believe research done by chiropractors.”

    The thing is, right, mainstream physics is all biased and that, right. I’ve read about this machine that just keeps on producing energy. This is not the kind of thing mainstream physicists are going to spend money researching. You would have to look at the Perpetual Motion journals, but of course you don’t believe in research done by Perpetual Motionsists.

  104. BillyJoe7 says:

    The funny thing is that probably all of us have passed through the troll’s situation at some time or another. My own immediate, non-evidence based, gut-feel opinion on Climate Change, GMOs, and Right To Try Laws, were subjectively seemingly commonsense views, but ultimately turned out to be objectively irrational and un-scientific opinions. It’s the actual scientific evidence that persuaded me otherwise. The Troll is caught in his subjectively biased opinions from which he is seemingly unable to escape no matter what evidence is thrown at him. In that sense only, I empathise with the troll but, at the same time, excoriate him for stubbornly refusing to learn anything from the considerable time he has spent here over the past five years or so. I am very pleased that I have not similarly managed to waste the efforts of our host to inform us regarding scientific plausibility and evidence and how to apply this to the real world.

  105. BillyJoe7 says:

    …of course, that will be interpreted as “blindly following” (which is so far from the truth as to be laughable, seeing that I started off with the contrary view and had to be dragged kicking and screaming to these scientifically based conclusions).

  106. Kabbor says:

    Yeah I’ve been meaning to ask you about the screaming. It’s a bit off putting.

    I find the concept of drug companies kicking down the doors of Chiropracters and destroying reasearch to be a very compelling argument. It’s too bad chiropracters have taken a vow of silence so they don’t go to go to the media or the law over these intrusions. If they did we’d finally have a group that gives us the unvarnished truth, what with their vow of poverty removing the profit incentive and all. Without their 5 vows Mother Gaia would not grant them mastery over Chi.

  107. HN – Obviously you did not click the links I provided. They are both to chiropractic journals, some of which are listed on PubMed (if they are peer-reviewed and meet quality standards).

    So – I do search chiropractic journals. Your assumption was demonstrably (and easily so) wrong. What does that say about your intellectual integrity and the process you follow? You should really think about this.

    You also immediately invoked a conspiracy theory, which you made up out of whole cloth on the spot. Well done. How, exactly, would a pharmaceutical company suppress such research, I wonder? Their power and reach must be far beyond what the public knows.

    Further, it is the responsibility of chiropractors to do research to support their claims and practice. They don’t.

    Finally, if you think I am missing quality studies which establish any chiropractic intervention to treat high blood pressure, please link to it or give a valid reference and I will happily adjust my opinion to the new evidence.

  108. hardnose says:

    “Immunosuppressive drugs for auto-immune disease ARE a long term solution. Their beneficial effects are sustainable. And we are getting more and more precise at how we manipulate the immune system.”

    This is the typical symptom-focused approach to chronic and autoimmune diseases. The assumption is that the causes are random genetic errors. There is no concern with trying to find and correct the causes, since the causes are considered to be random.

    Nature is considered unintelligent, and the body has no natural drive to restore health. Therefore, no attempt is made to help the immune system correct itself.

    The immune system is not seen as intelligent, therefore no attempt is made to find out what may be interfering with its intelligence.

    If these diseases are ever to be understood and cured, we need a systemic, rational, scientific approach to medicine. And we need to finally acknowledge that nature is intelligent and that living things naturally strive to maintain their health.

    This will never happen as long as mainstream medicine is dominated by an atheist/materialist ideology.

  109. hardnose says:

    “Obviously you did not click the links I provided. They are both to chiropractic journals”

    There is no point in trying to draw a conclusion based on those two articles.

    There is no reason to assume exactly the same technique was used in both studies, for one thing. Testing chiropractic is not like testing a drug, where you can give exactly the same substance and dose to all subjects, and double-blinding is simple.

    Different chiropractors use different techniques, and adapt their technique to each patient. At least, that’s what they should do.

    It would make more sense to evaluate individual chiropractors who claim to have clinical success with hypertension patients. No, it would not be double-blinded, that just is not feasible with this kind of treatment.

  110. chikoppi says:

    [hardnose] This is the typical symptom-focused approach to chronic and autoimmune diseases. The assumption is that the causes are random genetic errors. There is no concern with trying to find and correct the causes, since the causes are considered to be random.

    My god, the degree of transparent ignorance you have to maintain to cling to your narrative is astonishing. No concern with trying to find the causes of chronic and autoimmune diseases? Only in an alternate reality wherein the last sixty years of intense research never happened.

    Ideology is irrelevant. Either demonstrate that a treatment is effective or STFU.

  111. BillyJoe7 says:

    “My god, the degree of transparent ignorance you have to maintain to cling to your narrative is astonishing”

    In fact, every single sentence is transparent bullshit based on ignorance.
    I’ll chose just one and leave the rest to anyone else who can be bothered to point out the blindingly obvious.

    “It would make more sense to evaluate individual chiropractors who claim to have clinical success with hypertension patients”

    Yeah, just like it would make sense to ask individual lottery prize winners how they did it.
    I’m starting to think that the troll is suffering from a well known degenerative brain condition this is, in fact, incurable.

  112. bachfiend says:

    ‘The immune system is not seen as intelligent, and therefore no attempt is made to find out what might be interfering with its intelligence’.

    I’m astounded at the ignorance being displayed here. The immune system is a double edged sword – it can both protect and harm. It’s not intelligent. The immune cytokine storm produced by the 1918 influenza pandemic killed, and quickly, a disproportionate number of young fit adults leaving the young and elderly proportionately unaffected.

    Hardnose suffers badly from woo.

  113. tb29607 says:

    HN also underestimates progress and effectiveness of treatments in many areas that do not include antibiotics or surgery which have made advances as well.

    Recent advancements- hemangiomas treated with propranolol, targeted chemotherapy for neuroblastoma among other cancers, refining therapy to improve life span for cystic fibrosis and sickle cell disease to name just a few.

    And HN would only go to a doctor for antibiotics or surgery? Again, I hope he does not include any kids he is responsible for, I treat – severe dehydration, croup, toxic epidermal necrolysis, Kawasaki’s disease, anaphylactic shock, chronic neonatal lung disease, persistent pulmonary hypertension, tick bite paralysis, infantile botulism, intentional/unintentional poisonings…
    All have significant mortality without treatment, are completely curable, and none are treated with antibiotics or surgery.

    Has he ever said his area of training?

  114. bachfiend says:

    tb29607,

    Hardnose claims to have a PhD in computer science. With some sort of connection to language and psychology. He’s claimed that he wanted to further an academic career in parapsychology, but was advised against it because it doesn’t ‘pay’ so he went back to computer programming.

    I tend to find that computer scientists are the most credulous of all professions.

  115. hardnose says:

    “No concern with trying to find the causes of chronic and autoimmune diseases? Only in an alternate reality wherein the last sixty years of intense research never happened.”

    Steve Novella’s statement was that immune-suppressing drugs are the treatment for autoimmune disorders. He said nothing about trying to find better treatments that actually address the causes. The causes are not known, and they are usually assume to be random genetic errors. As I said.

  116. hardnose says:

    “The immune system is a double edged sword – it can both protect and harm. It’s not intelligent.”

    And you “know” this how? The immune system can’t be intelligent because nature is not intelligent? Nature is not intelligent because you are an atheist/materialist?

    Where exactly does all your certainty come from?

  117. chikoppi says:

    [hardnose] Steve Novella’s statement was that immune-suppressing drugs are the treatment for autoimmune disorders. He said nothing about trying to find better treatments that actually address the causes. The causes are not known, and they are usually assume to be random genetic errors. As I said.

    So that’s what you’re sticking with? Medical researchers simply “assumed” chronic diseases and autoimmune disorders and were the result of “random genetic errors” and never conducted extensive and wide-ranging research, over many decades, into the pathology of these diseases (which continues unabated to this day)?

  118. bachfiend says:

    Hardnose,

    I know the immune system isn’t intelligent because the immune cytokinins storm induced by infection by the 1918 influenza pandemic killed a disproportionate number of fit young adults sparing a disproportionate number of the less fit elderly and young.

    The immune system wasn’t particularly intelligent.

    As Daniel Dennett noted in ‘From Bacteria to Bach, and Back’, natural processes often produce intelligent results without being intelligent. The immune system produces intelligent results because they’re usually protective. The immune system isn’t intelligent because sometimes it produces results which are deleterious, such as autoimmune diseases or the cytokine storm of the 1918 influenza pandemic.

    I assert that the immune system isn’t intelligent because that’s what the evidence indicates.

    You’re obsessed with demonstrating your ignorance. Autoimmune disorders aren’t assumed to be due to random genetic errors. Rheumatic fever is the autoimmune disease par excellence producing pancarditis, arthritis and chorea. And it’s an autoimmune disorder producing damage in the heart, joints and brain produced by previous infection with group A Streptococcus pyogenes. Not due to random genetic errors.

    You’re an ignorant fool.

  119. HN – You consistently twist what other people say, and your logic is laughable. See: https://en.m.wikipedia.org/wiki/Invincible_ignorance_fallacy

    There is a tremendous amount of research into what causes auto-immune diseases. It is not assumed to be genetic. There is evidence for a genetic predisposition (HLA types, family risk) but that is not the whole picture. There are also environmental triggers for some. Exact causes are still an area of active research.

    What I said is that current treatments are sustainable. They can put many patients with autoimmune disease into a sustained remission. For others, they reduce the outbreaks and morbidity, but not completely. There are patients with refractory disease, and researcher continues to find better treatments.

    Would you let an autoimmune disease ravage a patient and destroy their lives rather than give them effective immunosuppressive treatment, because we don’t yet understand the cause 100%?

    Your response to the chiropractic articles are a non sequitur. My point was that you cannot draw conclusions from them, two preliminary studies. You are the one that said the “evidence shows.” My point was, there are only two preliminary studies with mixed results, so the evidence does not show. So you are simply wrong there.

    You also said I do not look at the chiropractic literature, yet the two studies I cited were from the chiropractic literature. So you were wrong there too.

    You keep getting it demonstrably wrong, and never admit it or make any concessions. You just divert with a non sequitur based on some combination of abject ignorance and motivated reasoning. That is why you are a troll.

  120. arnie says:

    Wikipedia defines it (troll) as: “Someone who posts inflammatory, extraneous, or off-topic messages in an online community, such as a forum, chat room, or blog, with the primary intent of provoking readers into an emotional response or of otherwise disrupting normal on-topic discussion.”

    And it seems to me that HN has been the pre-eminently successful Troll on this blog for the past couple of years. In fishing, the only thing that will encourage a troller to move on to other sites is if the trollers targets stop taking the bait. Is it possible that might work in this case? Or are we, his targets, like fish, incapable of either recognizing or resisting the baited hook?

  121. hardnose says:

    “The immune system isn’t intelligent because sometimes it produces results which are deleterious, such as autoimmune diseases or the cytokine storm of the 1918 influenza pandemic.”

    So … in order to be considered intelligent, the immune system would have to be perfect and all-knowing.

  122. hardnose says:

    “Would you let an autoimmune disease ravage a patient and destroy their lives rather than give them effective immunosuppressive treatment, because we don’t yet understand the cause 100%?”

    No, I would try a different approach, instead of insisting on the same old reductionism that has not led to understanding or cures for these diseases.

  123. Pete A says:

    “So … in order to be considered intelligent, the immune system would have to be perfect and all-knowing.”

    The immune system has far more ‘expertise’ in immunology than do you. So in that sense, it is far more intelligent than you.

    Likewise, a photodiode has far more ‘expertise’ in quantum mechanics than do you, Deepak Chopra, Dean Radin, and Rupert Sheldrake combined.

    However, your level of intelligence is akin to that of a photodiode: an entity that is incapable of learning from its mistakes. Whereas, the immune system is an adaptive system.

  124. bachfiend says:

    Hardnose,

    ‘So… in order to be considered intelligent, the immune system would have to be perfect and all-knowing’.

    No. You missed the point that natural systems (such as the immune system) often produce results which are intelligent without themselves being intelligent.

    Immune systems which produce results that are frequently deleterious will be rapidly eliminated by the mechanism of natural selection.

    Regardless of how often you repeat yourself, there’s no possible mechanism by which the immune system can have intelligence. You continue with your delusional magic thinking, repeating over and over again – I don’t understand this, and I can’t be bothered doing some basic reading, so the answer must be – MAGIC! So scientists ought to stop what they’re doing and look for the MAGIC.

  125. HN – so you would let an autoimmune disease ravage a patient while you search for new approaches. Got it. Because you believe reductionism is a dead end, because it has only cured hundreds of diseases, but not all of them yet. And all the advances we have made in immunology through reductionist science amount to nothing because we haven’t cured everything yet. Got it. Your ideology is iron clad and immune to evidence – it must be nice.

    Your logic, such as it is, is spinning out of control.

    And you still haven’t admitted you were wrong.

  126. chikoppi says:

    [hardnose] No, I would try a different approach, instead of insisting on the same old reductionism that has not led to understanding or cures for these diseases.

    How many times have you been corrected now? How many times! Science is neither materialism nor “reductionism”. The fact that you continue to repeat this garbage is evidence that you need the stawman far more desperately than you care about facts.

    There is no lack of “alternative” practitioners. If there were a more effective “different approach” THEN WHERE IS IT?! Why hasn’t it been applied to produce demonstrable results? Is it a secret? Where is the evidence?

    Every time those mean-old scientists fail to validate your magic system you put on a pouty-face and show up to assure us that they must be doing it wrong. Maybe, and take a moment to consider this…maybe there’s no evidence for it because it really, truly, actually doesn’t exist.

  127. BillyJoe7 says:

    When genuine poster says “I would try a different approach”, it would be followed by a description of that different approach. When it isn’t, you know you have a troll with an empty cranial cavity and nothing to say.

  128. hardnose says:

    “You missed the point that natural systems (such as the immune system) often produce results which are intelligent without themselves being intelligent.”

    Well I have to admit that is interesting! Nonsensical, but twisted in an interesting way.

  129. hardnose says:

    “you believe reductionism is a dead end, because it has only cured hundreds of diseases”

    It’s hard to see why you think reductionism has cured hundreds of diseases. It would depend on what you mean by reductionism and what you mean by diseases.

    Your statement could be technically correct, in the sense that antibiotics can cure infections, and there are hundreds (more likely many thousands) of types of infectious diseases.

    You should not really classify all modern medicine as reductionist, however. Reductionism just means not considering the system as a whole, and only looking at parts in isolation. Mainstream science does that a lot, but not always.

    The approach to autoimmune diseases is often reductionist. The symptoms are often caused by inflammation, so decreasing inflammation is the focus of treatment. The cause is not found, mostly because it is not looked for. The cause is assumed to be genetic defects.

    In holistic medicine, you would consider that something has overwhelmed the immune system and thrown it out of balance. Although the immune system IS intelligent, it can be overwhelmed by environmental factors.

  130. bachfiend says:

    Hardnose,

    ‘The approach to autoimmune disease is often reductionist. The symptoms are often caused by inflammation, so decreasing inflammation is the focus of treatment. The cause is not found, mostly because it’s not looked for. The cause is assumed to be genetic defects’.

    You’re the perfect example of the Dunning-Kruger effect. Not only are you ignorant and don’t know that you’re ignorant, but you’re also not willing to learn and remove your considerable ignorance.

    Autoimmune diseases are not assumed to be due to genetic defects. Rheumatic fever is the autoimmune disease par excellence, producing pandcarditis, arthritis and chorea, following infection with group A Streptococcus pyogenes infection. Different strains can produce post-Streptococcal nephritis, another autoimmune disease.

    Looking for causes of auto-immune disorders is a necessary part of the work up. Distinguishing rheumatoid arthritis from Reiter’s syndrome from scleroderma from psoriatic arthritis for example

    Treatment of autoimmune diseases isn’t always with measures to reduce inflammation. I have an autoimmune disease, well managed, and I never once saw a single anti-inflammatory drug.

  131. hardnose says:

    “Treatment of autoimmune diseases isn’t always with measures to reduce inflammation. I have an autoimmune disease, well managed, and I never once saw a single anti-inflammatory drug.”

    So we have one anecdotal exception to the general rule. It is obvious you are yet another MD who has never once opened a research methodology textbook.

  132. chikoppi says:

    [hardnose] The cause is not found, mostly because it is not looked for. The cause is assumed to be genetic defects.

    In what world are the causes of autoimmune diseases not being looked for? Certainly not this one. A search of Google Scholar yields 40,000 results published in 2016 alone. Stop repeating this painfully transparent and easily demonstrable falsehood.

    In holistic medicine, you would consider that something has overwhelmed the immune system and thrown it out of balance. Although the immune system IS intelligent, it can be overwhelmed by environmental factors.

    Hey, that’s awesome! “Holistic” practitioners have figured out how to beat autoimmune diseases! WHERE ARE THE RESULTS?!

  133. bachfiend says:

    Hardnose,

    ‘So we have one anecdotal exception to the general rule. It is obvious that you are yet another MD who has never once opened a research methodology textbook’.

    Pot meet kettle… you always argue with anecdotes.

    BTW – you’re still wrong. Autoimmune diseases are not assumed to be caused by genetic defects, with the actual causes not being looked for. Rheumatic fever is just one example. Seeking an infectious cause for arthritis, including rheumatoid disease, is a long sought after field of research. Being able to prevent rheumatoid arthritis by being able to treat an infection would be just as welcome as preventing rheumatic fever by treating Strep sore throat.

    You’re still the perfect example of the Dunning-Kruger effect. You’re ignorant, don’t know you’re ignorant and are too lazy to inform yourself.

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