Apparently Times columnist Gail Collins recently wrote a column lamenting the conflicting signals sent by the medical community. I didn’t read that column, but I saw the letters to the editor in response. They are pretty interesting–the piece (and a related one in the Week in Review section) seem to have struck a chord. Here’s one letter I liked:
The field of medicine is consumed by pseudoscience, by studies that go in circles and produce contradictory results that benefit only those who want to maintain the confusion that keeps the money rolling in.
Going in circles is something political scientists worry about a lot, but not really in this context. I think it’s true that the studies go in circles–a point beautifully captured by this cartoon. Whether the confusion benefits vested interests is an interesting question that I don’t know the answer to.
Then there is the counter point of view that comes through in these letters, that medicine should adapt as new information becomes available:
The underlying principle of contemporary medicine is that it is an empirical science. When new information is developed, physicians must re-evaluate their opinions in light of it. For ideologues, whose opinions are fixed, this philosophy must seem baffling.
I’m not sure I’d go so far as to say the truth is somewhere in between. What prevents me from saying that is that many medical studies just seem to be poorly done, which would account for the conflicting signals. And it doesn’t seem to be a matter of new methods or new information. Randomization in principle has been known for quite some time, as has the basics of causal reasoning. So I don’t think cycling can be explained away so easily.
So why the word “nihilism” in this post’s title? Another theme of the letters is expressed in the editor’s choice of title for the correspondence: “What to believe?” And it comes through in several of the letters, e.g.
The perception that medicine “on the move” produces confusion, distress and uncertainty is correct, but this reflects an intolerance of uncertainty and illusory confidence in one’s ability to control health through behavior. Diet, exercise, antioxidants and supplements can do only so much. What seems to be more important is one’s genetic makeup.
Americans have given up on trusting research produced by the health care establishment because contradictory studies are published so frequently, and it’s overwhelming to stay on top of the most up-to-date advice. Too many opinions influenced by drug companies and other special interests have muddied the waters and made it harder to know which studies to trust.
I blame the relentless advertising of health care products and regimens, some with little proven value, affecting a public that cannot accept disease as something that entails much uncertainty and less control than the health care industry would have us believe.
So the result of all this confusion seems to be people throw up their hands, admit that we can’t control our own bodies and that science is just an illusion. We’re all just pawns in the game played by the big health companies.
What is to be done? I think a basic semester course in statistics and causal inference would be a great start.