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EVIDENCE-BASED-HEALTH  November 2004

EVIDENCE-BASED-HEALTH November 2004

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Subject:

Re: Epistemology and EBM

From:

Ted Harding <[log in to unmask]>

Reply-To:

Ted Harding <[log in to unmask]>

Date:

Fri, 26 Nov 2004 15:49:29 -0000

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text/plain

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Hi Ronan,

On 26-Nov-04 Ronán Conroy wrote:
> Fascinating how a moral dimension immediately enters. People
> ought to think, and to base their actions on the conclusions
> of logical thinking. Why should this be so? Would anyone ever
> fall in love, or play a Beethoven sonata again if this were so?

Your point is good, but you are arguing somewhat outside the
domain I had in mind.

I'm not saying that people should base all their actions, or
even attitudes, on the conclusions of logical thinking. I can
grant that epistemology, etymologically and in the dictionary,
means the study of "what we know and how we know it" -- or,
more abstractly "the theory of knowledge", though it has itself
to grapple with the meaning of "know" and "knowledge". (In so
far as it remains descriptive, the latter can to some extent
be avoided.)

Action is a response to an urge or to a need, the consequence
of a decision or of following a rational or irrational preference,
or even "involuntary". This can be *influenced* by the conclusions
of logical thinking, but in real life (as you exemplify) is
often not *governed* by it. Even after falling in love (which
can be involuntary) one may still agonise quite logically
over whether one should allow oneself to pursue that state to
its natural conclusions. A part of the "data" in this agony
will be the powerful urge arising from the state, and one may
yield to this despite powerful logical misgivings.

I play Beethoven sonatas because I enjoy doing so, but would
(without great agony) avoid doing so at 3 a.m. in the morning
if it would be likely to wake the neighbours. My judgment on
that likelihood would be, broadly speaking, evidence-based
(either based on my knowledge of the behaviour of sound in
the building where I live, or even on the outcome of a visit
from the neighbour ... ).

The situation I was addressing was one where, in that example,
a young doctor had consciously, therefore potentially rationally,
contemplated a problem described by her neighbour, and had
deliberately proposed a course of action. In that case, one
would expect that rationality was playing a substantial part.
Unless of course that young doctor was somehow "in love" with
herbal remedies ...

A physician is in the position of an "authority" -- someone
expected to be well informed about what's good to do, or at
least be aware that they're not well informed, and reliable
in their judgment.

> [...]
> The idea that human behaviour is shaped by the application
> of logic to knowledge is a comfortable fib for which there
> is no evidence. Learning logic does not make humans wiser or
> act more compassionately. But a lobby of the medical profession
> sometimes seems to believe that logic and rational behaviour
> should be promoted with the vigour of a religion.

I would not, any more than you, go along with the proposition
that "logic and rational behaviour should be promoted with the
vigour of a religion." It's entirely natural for behaviour to
be irrational: indeed one may naturally act contrary to the
dictates of logic, and I would not necessarily say that this
was wrong.

But to draw from this the conclusion that logic should generally
not be taken into account would be to condone acting recklessly .

In a context where there are aspects which (in principle) are
based on logical principles, then one should, for the sake of
one's own efficacy, examine if one can the logical aspects in
order to evaluate them. But logic can only be guaranteed to give
the right answer (if then) when it is based on all relevant
available information. When based on incomplete (or, even worse,
irrelevant) information, apparently "logical" conclusions can be
false. When you are aware that the information is incomplete
(and often it is simply not available) then it is good to be
aware that one's beliefs about the situation are uncertain.

To come back to the playing of Beethoven sonatas, there is
a logic (mechanical and musical) to the execution of the
performance. I wouldn't object to someone who had neither any
mechanical technique nor yet good musical appreciation sitting
down at a piano and laboriously and painfully trying to pick
out the notes: if they're enjoying themselves that's OK, and the
experience may lead on to learning the skills and appreciating
the music better.

Indeed, I would hope that this would lead them to the conclusion
that they could usefully take lessons to improve their technique
and understanding, for the sake of producing something that's
closer to the performance thay have in their head. As anyone
who's been through that will know, there's a very strong logical
aspect to this process: you have to do a lot of working out, in
your head, before it begins to become fluent.

However, if someone who claimed to be a trained pianist played
in a way which indicated that they didn't care about these
things, then I think I'd be offended by it (even if it did
sound better than the clumsy fumblings of the complete beginner).

The point is that it's not only a question of pure musical
experience: it's also, intricately, a technical matter.

Likewise, I believe, for medicine in its scientific aspects.

I'm not excluding "human-based medicine". A shrewd physician
could in certain cases solve a problem by pure sympathy.
But that's not going to cure a case of syphilis on its own
(even if it helps the patient to maintain contact and stick
to the treatment).

When it comes to technical matters, there are right ways and
wrong ways, and these are what are amenable, in principle, to
rigorous examination and the application of logic.

Best wishes to all,
Ted.


--------------------------------------------------------------------
E-Mail: (Ted Harding) <[log in to unmask]>
Fax-to-email: +44 (0)870 094 0861  [NB: New number!]
Date: 26-Nov-04                                       Time: 15:49:29
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