One thing that has fascinated me is how we form, modify, and reject beliefs. This, of course, is central to western philosophy; Rene Descartes in Meditations on First Philosophy asks us to doubt every single one of our beliefs until we can justify that they are on a solid rational foundation. And as purveyors of logic, philosophers inherently believe that argumentation based on scientific principles can sway opinion.
We know, of course, that this is not always the case. New data, studies, analyses, guidelines, and recommendations are coming out all the time, yet the practice of medicine is slow to change. Certainly, we are resistant to adopt new practices based on limited, unconvincing, or preliminary results, and many previous sagas such as hormone replacement therapy have taught us to move cautiously. But I think there is more than that. Part of our inertia is that emotions, anecdotes, fear, and irrationality weigh in on our decisions whether or not to change our practice. That is, science is all science, but medicine is not purely an application of logic, numbers, and rationality.
For example, say a new prevailing all-encompassing study demonstrated that mammograms before age 50 are not useful at all for the general population. Imagine that it were definitively proven that they don't catch enough cancers, they have too many false positives, and indeed, they create more pain, cost, and trouble than the cancers they do catch. How many physicians would change their practice? How quickly would such a change take hold?
Stephen Colbert made up the word "truthiness" during the pilot episode of his program to mean an appeal to emotion and "gut feeling" without regard to evidence, logic, or facts. "We're not talking about truth, we're talking about something that seems like truth - the truth we want to exist." When facing a patient who may have cancer, we want to be able to detect it and cure it and that gut drive may overwhelm any number of statistics and evidence pointing to the contrary.
This might be a problem. If we aren't listening to the dictates of research and remain entrenched in convention and hearsay, we aren't doing our patients any good. If we are unduly swayed by emotion and "truthiness," we aren't practicing optimal medicine. The time, effort, money, and minds contributing to research only pay off if they change the way physicians practice medicine. In the absence of open minds, medicine remains stagnant.
And yet, a counterargument is that medicine is the finessing of both science and art; we must weigh the strength of the research coming out, we must balance it against patient preference and subjective feel, we must interpret all these signals - both truth and truthiness - to come up with a coherent plan that makes sense. No matter how much my philosophy-trained self would like it, rationality is not everything; if it were, we could be replaced by automatons that fit people into boxes and guidelines and recommendations. No -- medicine is a tad more complicated than that. How do we change our beliefs and decision making schema? I don't know. I don't think discovering the evidence is enough; we must use it to persuade our colleagues, teachers, and students. We need to understand how new facts and data fit in pre-existing frameworks. But even more importantly, we need to understand the importance of emotion, convention, and "truthiness" so we neither discount nor give free reign to those influences.
We know, of course, that this is not always the case. New data, studies, analyses, guidelines, and recommendations are coming out all the time, yet the practice of medicine is slow to change. Certainly, we are resistant to adopt new practices based on limited, unconvincing, or preliminary results, and many previous sagas such as hormone replacement therapy have taught us to move cautiously. But I think there is more than that. Part of our inertia is that emotions, anecdotes, fear, and irrationality weigh in on our decisions whether or not to change our practice. That is, science is all science, but medicine is not purely an application of logic, numbers, and rationality.
For example, say a new prevailing all-encompassing study demonstrated that mammograms before age 50 are not useful at all for the general population. Imagine that it were definitively proven that they don't catch enough cancers, they have too many false positives, and indeed, they create more pain, cost, and trouble than the cancers they do catch. How many physicians would change their practice? How quickly would such a change take hold?
Stephen Colbert made up the word "truthiness" during the pilot episode of his program to mean an appeal to emotion and "gut feeling" without regard to evidence, logic, or facts. "We're not talking about truth, we're talking about something that seems like truth - the truth we want to exist." When facing a patient who may have cancer, we want to be able to detect it and cure it and that gut drive may overwhelm any number of statistics and evidence pointing to the contrary.
This might be a problem. If we aren't listening to the dictates of research and remain entrenched in convention and hearsay, we aren't doing our patients any good. If we are unduly swayed by emotion and "truthiness," we aren't practicing optimal medicine. The time, effort, money, and minds contributing to research only pay off if they change the way physicians practice medicine. In the absence of open minds, medicine remains stagnant.
And yet, a counterargument is that medicine is the finessing of both science and art; we must weigh the strength of the research coming out, we must balance it against patient preference and subjective feel, we must interpret all these signals - both truth and truthiness - to come up with a coherent plan that makes sense. No matter how much my philosophy-trained self would like it, rationality is not everything; if it were, we could be replaced by automatons that fit people into boxes and guidelines and recommendations. No -- medicine is a tad more complicated than that. How do we change our beliefs and decision making schema? I don't know. I don't think discovering the evidence is enough; we must use it to persuade our colleagues, teachers, and students. We need to understand how new facts and data fit in pre-existing frameworks. But even more importantly, we need to understand the importance of emotion, convention, and "truthiness" so we neither discount nor give free reign to those influences.
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