A death in the curriculum

During my third year of med school, the deaths of my patients have been entirely mysterious to me. They are dispassionate words on the medical record or casual condolences passed in the workroom. Sometimes, they happened even without my knowing. “How could you not know?” A friend teased. I reached reflexively for excuses. I hadn’t known because the patient had passed away on a Sunday when I had not been on call. The next day, the death was old news and no one thought to tell me since she was not a patient who I had cared for on a regularly. It took me two days to notice that a new patient had settled into her old room.

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Influencing thought

My major underlying motivation for writing analytical blog and forum posts is simply to influence thought. I’m a dork destined to be an academic. I like to track the number of clicks on links, even those on facebook, just to get a sense of how many people are within this sphere of influence. I get gratification when people on SDN cite one of my posts, as if my amateur spreadsheet jockeying could confer some semblance of credibility to their arguments. Occasionally I come across an oddly familiar idea that I convince myself originated from me, and that idea has diffused so widely that it has become apocryphal and no longer deigns to be cited. Just wanted to share an example I read today:

Baylor is on probation with the LCME. On their webpage defending themselves (i.e. explaining to prospective students that they are still fully accredited and a good school), one key point is

Our curriculum enables students to exceed predicted outcomes. For example, MCAT scores are a strong predictor of student performance on the USMLE Step 1 exam, and Baylor students score  8-9 points higher than predicted by their MCAT total score at admission.

I wonder where that 8-9 figure comes from. Hmm. (Look at the first graph.) It’s a figure so specific to that year’s data and the specific schools used to generate the regression that it’s unlikely some other independent analysis produced it.

Alright, that’s enough self-indulgent thoughts for the day.

“Messing with nature”: a worldview

Dear Anti-Vaxxers: You Want Pure Nature? OK, Die Young“, opines Jeffrey Kluger in a scathing piece in Time published today.

The article quotes an interview in Mother Jones with Dr. Stacia Kenet Lansman, a Tufts-graduated MD pediatrician, homeopath, herbalist, energy healer, and anti-vaxxer sympathizer who fears that vaccines are somehow disturbing the balance of nature and contributing to the rise of diseases like autism:

“I think we’re just messing with nature, and we really don’t know what we’ve created. We’ve reduced or largely eliminated many infectious diseases. But in their place, we have an epidemic of chronic illnesses in children. The incidence of asthma, allergies, and autism spectrum disorders has dramatically increased since the 1990s. And the reason for this we don’t know. But my concern is that vaccines have played a role.”

She spins her support of lax vaccination policies as “open-minded.” I see the view as falling in a long tradition of close-minded conservatism.

There are two separate aspects to this kind of worldview.

The first is an “appeal to nature.” This rhetorical device implies that if something is natural, then it is good. If something is unnatural, then it is bad. The “logic” is pervasive and extends to a preference not just for nature, but for the status quo in human society. The “status quo bias” afflicts human decisions almost by default, perhaps, according to “system justification theory,” due to a psychological need for stability in ones experience of life.

An appeal to nature can be a useful rule of thumb to determining what is good or useful, until one starts dismissing or ignoring contrary evidence. To do so would committing a fallacy of sweeping generalization. To ignore evidence is to become an ideologue. The key issue that separate the reasonable people and the crazies is determining when the evidence is good enough for you to believe something.

That brings us to the second aspect of this worldview I’m trying to describe: noncredulity. Noncredulity is exemplified by the following quote from former Congressman Willard Duncan a century ago, which originated Missouri’s sobriquet of the “Show-Me state”:

“I come from a state that raises corn and cotton and cockleburs and Democrats, and frothy eloquence neither convinces nor satisfies me. I am from Missouri. You have got to show me.”

Subscribers to this worldview are reluctant to believe something in the absence of adequate evidence.

By itself, noncredulity does not point to either conservative or progressive thinking. Noncredulity without a bias towards or against the natural could manifest as agnosticism or ambivalence. Noncredulous people with an irrational predisposition against the status quo could include extremist demagogues, paranoid anarchists, or hipsters who disavow anything mainstream. In contrast, unshakable noncredulity combined with a strong preference for what is natural or the status quo creates the special kind of conservative worldview espoused by Dr. Kenet Lansman.

Noncredulity and a strong bias towards a certain ideology is Donald Rumsfeld proclaiming there are “unknown unknowns” so we should invade Iraq in the absence of any evidence for or against WMD, just in case, because that’s what all my neo-conservative advisors say is right.

Noncredulity and ideological bias is Ann Coulter asserting that there is no credible or definitive evidence for evolution all while depicting intelligence design as serious “science.”

Noncredulity and ideological bias is a G. W. Bush aide tampering with government climate reports to sprinkle in phrases like “significant and fundamental uncertainties” about global warming, resigning after being outed, and then promptly getting re-hired by the fossil fuel lobby that he came from.

The extremes of noncredulity is denialism, including such mind-boggling phenomena as Holocaust denialism, AIDS denialism, and tobacco industry advertisements sowing seeds of doubt against the link between smoking and lung cancer.

The don’t-mess-with-nature anti-vaxxers are not ideologues like most of these examples in the traditional, political sense of the term. But I do think they are subscribing to a similar kind of thinking, one that happens to over-value one’s fears and current subjective experience of the world against contrary evidence.

My bias is towards the opposite. I’m a transhumanist, an early adopter, and an agitator. A few examples will suffice.

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