A Case for Skepticism

Unlike most people who had routine births, mine was far from routine. Born very early and alarmingly small, I struggled for months before becoming strong enough to even leave the neonatal intensive care unit. From the time I was old enough to understand, I heard stories of repeatedly being pulled from the brink of death during those formidable first months. As one can imagine, my appreciation of those who had worked so hard for my survival grew into something quite akin to hero worship.

While a bit more precarious than most people’s experiences, I don’t think I’m unique in developing a bit of hero worship for the doctors and nurses who care for us and our loved ones. This is only amplified by the air of authority bestowed by the news media, as well as by fictional television, movies, and books, which further elevate medical practitioners and scientists, sometimes to near sainthood. The reality, however, is that the medical practitioners, scientists, and researchers among us today are still human beings who are given to errors, political maneuvering, and self-deception.

One of the most difficult things I faced when adopting a lifestyle of preventive health was realizing that many of the so-called experts out there are incorrect about what ails us. Unfortunately, our tendency to see such individuals, and the organizations that they comprise, as infallible can blind us to the errors that they make and to the harm that following them will cause us. Forging a path to optimum health requires that we accept some medical advice and reject other. It requires that we abandon the notion that because someone graduated medical school, or has a PhD, that this person’s advice, opinion, or even peer-reviewed research, is correct. (Author David H. Freeman quotes a saying in academic circles that “for every PhD there’s an equal and opposite PhD.”)

In short, to forge a path to improved health, we must abandon the image of the infallible expert and become more skeptical. We must question advice, and motives, of all who purport to be experts.

What recently amplified my belief in skepticism are two books that complement each other nicely: “Wrong. Why experts keep failing us—and how to know when not to trust them” by David H. Freeman and “Mistakes Were Made (but not by me)” by Carol Tavris and Elliot Aronson.

Wrong resonates with my belief that experts, no matter their field, are often far from expert and Mistakes Were Made shows very clearly how and why organizations and individuals frequently believe unsupportable things, while quite effectively deceiving themselves that they’re right. Together, these two books provide a very good foundation for understanding why so much of the medical and scientific advice we hear today is flat-out wrong. The advice may be delivered by highly credentialed people who care very deeply and believe with utmost certainty that they’re right. But they’re usually wrong.

In Wrong, Freeman talks about breakthrough anti-arrythmia medications from the 1990′s that were responsible for killing more Americans than the Vietnam war. He quotes Dr. John Ioannidis, a doctor and researcher whose specialty is identifying whether medical studies are sound, as observing that two-thirds of the published medical research that makes it to the most prestigious medical journals is wrong. As Freeman points out, if this much of the research that makes it to the most prestigious publications is wrong, what does that say of the lesser reputed publications?

While Wrong isn’t focused solely on medical and scientific experts, [1] those were the examples that I found most compelling. For example, Freeman talks about a highly publicized 1999 study that reported to show that vitamin D levels have no effect on the risk of breast cancer. What the headlines never revealed, however, is that the researchers in this study didn’t perform a single blood test to measure vitamin D levels among study particpants.

Far from merely cherry picking flawed studies to make a case, Freeman describes how the entire system of research and peer-review is fundamentally broken. Freeman talks of “data cleansing” in which non-confirming data is discarded and “moving the goalposts,” in which researchers alter the intent of the study to ensure that they find something that the study “proved,” a practice that some research misconduct experts liken to “throwing darts on a wall and then drawing a dartboard around them.” Far from being reassured by group research efforts that produce healthful proclamations, Freeman makes an unsettling case for the prevalence of pack mentality among academic, financial, and clinical researchers, showing that these groups fall victim to such dysfunction as readily as most any other group does. According to Wrong, this “herd thinking” can keep researchers “trudging along in one direction for years, resistant to all kinds of contrary evidence…”

Mistakes Were Made addresses various aspects of human nature in order to understand “why we justify foolish beliefs, bad decisions, and hurtful acts.” The authors, Tavris and Aronson, talk about the core of self-deception being “cognitive dissonance,” which they define as a state of tension that occurs when a person is confronted with two beliefs or ideas that are physiologically inconsistent. An example would be the belief “I am a good person” combined with the knowledge that our actions just insulted, offended, or wounded another. As seemingly rational human beings, it’s our nature to resolve these two conflicting concepts, in this case typically by convincing ourselves that the other person wasn’t truly hurt or that the person somehow deserved it.

In Mistakes Were Made, the authors discuss how this dissonance theory also causes us to embrace evidence that supports a theory we hold while rejecting evidence to the contrary. Citing MRI studies, Tavris and Aronson show that these confirmation biases are hard-wired at the neurological level, causing reasoning areas to literally shut down when we are confronted with contradictory evidence and emotional areas of the brain that “lit up happily” when consonance was restored.

In the context of self-deception, Mistakes Were Made, talks about funding bias in which well-intenioned scientists are like plants that turn toward the sun and “turn toward the interests of their sponsors without even being aware that they are doing so.” Examples include the study of more than 100 controlled clinical trials designed to gauge the effectiveness of a new medication versus older ones. Of the studies that recommended the existing drug over the newer one, 13% were funded by drug companies and 87% by nonprofit institutions. The authors quote bioethicist Evan DeRenzo who states “Objectivity is a myth. I don’t think there is a person alive who is engaged in an activity who has absolutely no interest in how it will turn out.”

As for the ethical implications of doctors who accept gifts from the drug companies, the American Medical Association’s Council on Ethical and Judicial Affairs created an initiative to help educate doctors on this vital issue. How did the AMA fund the $590,000 ethics initiative? With gifts from eight drug companies.

As the authors of Mistakes Were Made state, “When confidence and convictions are unleavened by humility, by an acceptance of fallibility, people can easily cross the line from healthy self-assurance to arrogance.” Or, as they quote physicist Richard Feynman, “It doesn’t matter how beautiful the guess is, or how smart the guesser is, or how famous the guesser is; if the experiment disagrees with the guess, then the guess is wrong. That’s all there is to it.”

If you’re suffering from a bit of cognitive dissonance yourself (“Doctors and scientists are experts on we can be healthier” and “Virtually every disease is on the rise as the modern world becomes less and less healthy”) I suggest you pick up Wrong and Mistakes Were Made to better understand how even the most well-intentioned, highly-educated individuals and institutions can be so wrong about so much that ails us today.

[1] “Wrong” addresses the failings of “scientists, finance wizards, doctors, relationship gurus, celebrity CEOs, high-powered consultants, health officials, and more.”


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