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EVIDENCE-BASED-HEALTH  December 2004

EVIDENCE-BASED-HEALTH December 2004

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Subject:

Re: Epistemology and EBM

From:

"Simon, Steve, PhD" <[log in to unmask]>

Reply-To:

Simon, Steve, PhD

Date:

Wed, 1 Dec 2004 09:28:08 -0600

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (63 lines)

Adrian Roberts writes:

> I recently ran one of a series of workshops for general
> practitioner registrars, on aspects of EBM. They were intelligent and
> receptive and it appeared to have gone well. However, I was intrigued
> by a conversation at lunch when one of the participants was
> earnestly and seriously recommending that her friend should try a
> particular herbal remedy for her ailment. The justification was, "It
> cleared my problem up really quickly." It demonstrated that the
> messages of that day and of previous sessions had not really got
> through. There was still the uncritical acceptance of anecdote as a
> basis for decision making, the failure to distinguish Necessary
> from Sufficient evidence, not to mention the lack of awareness
> of the problem of uncommon serious adverse effects and the
> difficulty of knowing the probability of these.

I think it is just a fundamental characteristic of human nature to apply
critical thinking skills to everything except a core set of beliefs that
you hold near and dear to your heart. Martin Gardner wrote a book "Fads
and Fallacies in the Name of Science" that talked about bizarre beliefs
such as the earth being hollow, flying saucers, Velikovsky, etc. and how
passionately these beliefs are held by certain groups of people. He
reports that he got a lot of letters back complimenting him on the great
book and saying how he really outlined some very silly beliefs ...
except for the chapter on [whatever]. The person would then explain how
this belief really was obvious to anyone who had a bit of common sense.

One recent example springs to mind. A single study appeared showing a
temporary increase in IQ among students listening to Mozart. Classical
music lovers seized on this study and started lobbying for more music in
the schools and marketing music CDs to turn your children into geniuses.

Now I count myself among those who love classical music, but I am
surprised at how incautiously people embrace preliminary research that
really needs careful replication before you take any serious action on
these studies. There are lots of good reasons to encourage children to
listen to Mozart, but we can't pretend that raising their IQs is one of
them.

Perhaps the Mozart effect exists. Perhaps the herbal remedy really
works. But too many of us give a "free pass" to beliefs that are deeply
entrenched in our souls.

Rather than be disappointed, I would take this as an excellent teaching
example for future students. Tell this story and then ask them for other
examples of entrenched beliefs that people they know have that they
refuse to open to skeptical inquiry.

If you are interested in this tendency, there is a wonderful review
article by Robert MacCoun that has some very good examples of entrenched
beliefs and our unwillingness to critically examine them (as well as our
tendency to be overly critical of research that supports conclusions we
fundamentally dislike).

Biases in the interpretation and use of research results. RJ MacCoun.
Annu Rev Psychol 1998: 49259-87.
[Full text] http://socrates.berkeley.edu/~maccoun/ar_bias.html
[PDF]
http://ist-socrates.berkeley.edu/~maccoun/MacCoun_AnnualReview98.pdf

Steve Simon, [log in to unmask], Standard Disclaimer.
The STATS web page has moved to
http://www.childrens-mercy.org/stats.

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