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A brief case for evidence-based medicine

Few people would openly admit that they prefer irrational treatments and doctors.  But most people do in fact advocate irrational health practices – using pseudonyms for “irrational” as “holistic,” “alternative,” “homeopathic” and the deadly “natural.”

Medicine requires reason

The human body operates according to certain causal principles. If we wish to make a change in our health, we must understand some of those causal principles and act according to our understanding. To act without a rational basis is to disconnect our goals from their achievement. Irrationality does not guarantee failure — it just means that success, to the extent that it happens, will be due to other factors that our goals.

The study of human health is especially difficult

In the field of health, especially rigorous rationality is necessary for at least five reasons:

  1. The human body will solve, or at least try to solve most problems on its own. This makes establishing causality due external factors quite difficult and introduces biases such as the placebo effect and the regression fallacy.
  2. The body is very complex! Because it evolved over billions of years, the causal relationships in the body are extremely complex and interdependent.
  3. For example, even if we know that the body has too little of a certain substance, taking that substance may: a: not do anything b: cause the body to produce even less of the substance or c: cause an unpredictable side effect. On the other hand, if the body has too much of something, then the solution may be to a: consume less of that substance b: consume more of that substance or c: the consumption has no relationship at all to the level of that substance.
  4. It can be difficult to measure the extent to which medical problems are solved. While some things can be measured, many things, such as pain levels are very difficult to quantify.
  5. It is difficult to isolate causal factors in human beings since changes in health take time to develop and we can’t control every factor during an experiment or dissect human subjects when it is over.
  6. Humans tend to be irrational when it comes to their own mortality! We fear death, leading us to irrational over or under spending on health as well as being especially vulnerable to all the logical fallacies.

In medicine, rationality requires quality science research

There is a name for the field that applies rigor to the discovery of facts about nature: science. Science has been so successful in improving the state of human knowledge that many irrational, anti-scientific quacks have begun to use the term “scientific” to describe anti-scientific practices and ideas. In response to this, the medical community has come up with a term which identifiers the distinguishing aspect of rationality: “evidence based medicine.” This phrase is a necessary redundancy that identifies the essential characteristic of science: that it is based on sensory evidence. The alternative to non-evidence based science is not science at all, but emotionalism – “I feel it is true, so it must be.”

In the last hundred years, we have discovered certain practices for ensuring the conclusions of our medical experiments are valid. We know experimentally that observing these practices leads to more accurate conclusions. Let me emphasize that: the truth of medical claims is strongly correlated with the degree to which experiments follow accepted scientific standards. There are a number of objective scales for measuring the quality of an experiment.

Five characteristics of quality medical studies

  1. The experiment and its results are fully described in enough detail to reproduce and compare the results
  2. There is a randomized control group
  3. The selection of control subjects is double blind
  4. The methods of randomization and blinding are accurately described and appropriate
  5. There is a description of withdrawals and dropouts.

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Addendum: How to judge health claims

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The One Minute Case For Technology

What is technology?

Technology is the sum of material entities created by the application of mental and physical effort to nature in order to achieve some value. Technological progress is made possible by engineering, the field which applies scientific knowledge to solve practical problems by developing and applying new tools, machines, materials and processes.

The history of technology.

The evolution of technology has been a progression from reliance on physical effort to a growing role for the mind. The first tools, such as chisels and hammers, augmented raw muscle power. The creation of powered machines eliminated the reliance on muscle and allowed much more powerful mechanisms to be built than with human or animal power alone. The introduction of the automaton in the twentieth century embedded human knowledge in machinery. The trend continues as human beings improve their ability to exploit nature to meet their values through the use of automation and achieve more and more material values by mental effort.

Does technological progress cause unemployment?

In 1811, the Luddites became alarmed that technological innovations introduced by the Industrial Revolution threatened their livelihood. In a sense, they were right – most jobs that existed in 1811 have made superfluous by technology, and this process continues today. Yet outside of wage and price controls and other forms of interventionism, large-scale unemployment has never been a threat. Technology has not made most people permanently idle because it not only eliminates dreary, labor-intensive jobs, but also frees us to pursue more activities. The tremendous improvements in productivity that came with the Industrial and Information Revolutions gave us more free time and created opportunities to allow us to discover and pursue new passions. Highly repetitive agricultural and manufacturing jobs have been replaced by service industry and technical jobs. Entirely new institutions, such as professional and amateur sport leagues, museums, and online multiplayer clans have evolved as the public’s free time has grown.

Is technology good?

While the industrial revolution greatly improved the quality and longevity of human life, war and threat of nuclear annihilation have demonstrated the destructive power of technology. Rapid technological progress makes it likely that future inventions will increase both its creative and destructive potential. Yet there is reason to be optimistic that technology will be used for good.

While technology can be subverted and copied to serve evil, societies which enslave the human mind cannot sustain the capital stock or the intellectual base necessary for progress. Technological progress requires a society which values rationality, initiative, and voluntary cooperation. Most important is the need for freedom: inventors must be free to propose new ideas, and entrepreneurs must be free to turn them into reality. The failure of Fascism and Communism, and the success of the United States in the 20th century is a powerful testament to the power of a free society.

What is the future of technology?

Technological evolution follows two trends: the replacement of physical labor with more efficient mental labor, and the resulting greater degree of control over our natural environment, including our ability to transform raw materials into ever more complex and pliable products. This process culminates with man’s ability to achieve all of the material values technologically possible to him by mental effort. The growing importance of intellectual activity implies that intellectual property will become increasingly more important relative to material labor and physical goods. The current system of patent laws and copyrights will evolve dramatically as intellectual transactions evolve to meet the requirements of a civilization with rapid innovation on a global scale.

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The One Minute Case For Science

Science is an epistemological method

Science is the field which applies reason to the study of nature. Science is necessary because knowledge of how nature works is not self-evident, but requires a systematic method to collect evidence and correctly interpret it. Science is different in degree from informal empirical methods such as “trial and error” and in kind from non-empirical methods such as revelation, astrology, or emotionalism.

Science is the application of philosophy to specialized fields

Science is made possible by the acceptance of certain philosophical axioms in metaphysics and epistemology. In metaphysics, science requires recognizing that all entities behave in a causal manner according to their nature. In epistemology, it recognizes that man is capable of perceiving and understanding reality by the use of his senses, and because his consciousness is fallible and not automatic, he needs to actively adhere to reason and logic to reach the right conclusions.

Science is empirical

The scientific method is a formal methodology for using reason to study nature. Proper application of the scientific method can produce a scientific theory — a unifying and self-consistent explanation of fundamental natural phenomena derived from the evidence. Some essential principles of science are:

  • Observation: scientists attempt to sample and describe the full range of observed phenomena, ideally including the use of controls which counterbalance the risk of empirical bias.
  • Causal explanation: a scientific theory must provide a causal identification of the underlying processes of particular phenomena.
  • Prediction: scientific theories must explain nature in a replicable way, so that hypothesized causes correlate with observed events.
  • Falsifiability: the ability to eliminate plausible alternatives by repeated experimentation of observation. This requires scientific theories to be formulated in a way which can be independently tested and corroborated by others.
  • Integration: new theories must integrate with the existing body of scientific knowledge. When a contraction is found, the theory must be amended or discarded if not compatible with the evidence.

Science is hierarchical

Scientists build on existing work to form a hierarchical body of knowledge. Sometimes new evidence disproves existing theories. In other cases, new evidence may show that an existing theory is not a complete explanation in all contexts. For example, Einstein’s relativity theory did not prove Isaac’s Newton classical mechanism wrong. Classical mechanics is valid in the context of non-relativistic speeds, whereas general relativity theory explains for a wider range of behavior. Quantum mechanics provides evidence that a new theory is necessary on the sub-atomic scale. As scientific knowledge delves ever deeper into the fabric of the universe, new theories build on existing knowledge.

Pseudoscience versus science

The tremendous success of science in learning about the material world and applying that knowledge to benefit mankind has encouraged some anti-scientific movements to adopt a façade of scientific verbiage to mask an anti-scientific, anti-reason ideology. Some indicators of non-scientific reasoning are:

  • Use of vague and untestable claims which cannot be independently corroborated.
  • Reliance on testimonials and anecdotes rather than carefully structured, large-scale studies.
  • Argument of ignorance: placing the burden of proof on skeptics.
  • Evasion of peer review combined with claims of institutional conspiracies to suppress results.
  • Lack of progress beyond the initial theory. For example, in the case of astrology and religion, claims can remain unproven for thousands of years.

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