BeauV wrote:Keith - OK, I'll read "Thinking, Fast and Slow" I'm always up for a good read.
OM - You've made good points about higher levels of discipline moving into fields that had been a bit squishy; which is a very good thing. I did read a lot of stuff from a Dr. Toga at UCLA a few years back that was quite interesting as he observed brain activity when people were doing certain things (like reading or singing). But, when I asked him if that part of the brain had "activity" roughly equal when the person wasn't doing those things, it got pretty squishy.
Here's another example from my own experience with my previous doctor. I had a very high PSA test result during a physical. My previous doctor immediately pushed me to visit a specialist who examined my prostate, ugh! He didn't find anything with a manual exam. They did the blood test again, it was still quite high. I went to another specialist who couldn't find anything with a "normal" exam and did a scan. Still nothing, but the PSA reading kept going up. Finally, a bike riding friend, who is now my doctor, asked: "Did you tell them you do about 10-20 miles a day on a bike?" Well, no, I hadn't mentioned that and no one had asked. My new doctors said something along the lines of: "Have your blood tested after you've been off your bike for a week and see what the PSA number is." I did that, after a two week break from the bike for vacation, and the PSA number was not only within normal readings it was actually quite low. Lesson learned: diagnostic tests can have multiple causes for a given reading. I do realize that this is entirely anecdotal, and that it is not an example of poor logic or experimental structure. But, sadly, it is also typical of many of the interactions I've had with the medical community. Correlation and causality are frequently confused, along with a number of other errors of logic, which can result in a great deal of frustration and in my case a significant amount of additional unnecessary testing and worry.
The PSA example is a pretty simple one, now image the difficulty in dealing with variable that appear to correlate with various psychological problems, where things seem less well understood and defined, where the patient is attempting to report on how they feel using a language with all its subtleties and complexities. I really don't mean to be disparaging well meaning folks, and every one of the folks in medicine I've ever dealt with are well meaning. It's just that this is an extremely difficult problem and at times folks tend to express a level of certainty about the "cause" of a problem that isn't really justified by the evidence.
Toga is a smart guy and a leader in functional neuroimaging. I have met him and know his boss, Mazziotta, a little. I think their greatest contribution has been to try to assemble big libraries of brain mapping data across institutions and modalities. This could have big payoffs.
Clinical medicine is a mess and full of the kind of cognitive errors that Kahneman made famous (and got a Nobel for). Medical schools do not not teach critical thinking and it is all too easy to get very bad care from smart, well trained, and well-meaning people, with the entire, double-edged, clinical armamentarium at their disposal. As my grandfather, a cynical old German doc, used to say, "There is no condition so benign or insignificant that, in the hands of a competent physician, cannot prove fatal". I have seen this borne out more than once.