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Friday, July 20, 2012

Why Our Medical "Science" is Doomed to Failure

(Spending on welfare - a large portion of which is "health care" - is at the point of exceeding what is spent on education.  Our way of life and health is literally collapsing under the weight of our own ignorance.)

So I have written here quite a bit about health care and doctors; quite often being critical of what's being done in the name of "heath care."

So, you might ask, what is the right thing?

First off I think there are probably only three "ingredients," if you will, that really matter in health care:

1) The placebo affect.

2) Accurate and unbiased double blind studies.

3) The lack of a systematic model for "debugging" health problems.

"The Placebo Effect" - These ingredients matter because they affect nearly every aspect of your health starting with what you believe about it, i.e., the placebo effect.  While most people thing of the "placebo effect" as getting better while being secretly given a "sugar pill" instead of some medication in fact I think the effect is far, far more important.

For example, you can convince yourself that you have a disease and even create the symptoms and you can be affected by the placebo effect even if you know you are receiving a useless sugar pill.

So clearly the placebo effect is a stand in for a huge mental aspect regarding health.

And yet no one understand this at a scientific level: why does it work, why is it so strong, how can the body do things it might otherwise seem impossible to do.

I think this "affect" extends to practitioners as well - I believe in the "science" hence it must be working even if the patient says it doesn't.

(This is also a common aspect of debugging large, complex software systems - separating the "facts" about what is wrong from "beliefs" that influence you  and often take you down the wrong path.)

The bottom line here is that we don't know how this works or why.

"Accurate and unbiased double blind studies." - This is the antithesis of the placebo effect - basically a process designed to eliminate it by ensuring that no one - neither practitioner nor patient - has knowledge about the real state of things so they cannot be influenced.

Of course, studies have to be unbiased or they are useless as well, i.e., I don't want drug manufacturers designing a testing protocol for a medication that ensures it will be a success - particularly if it really isn't.

Today the "greed" factor is strongly influencing science - greed for "success," for "funding," for recognition.

In some sense this is almost like a reverse placebo effect at the societal level - Society says "I want to believe that all this high tech medicine is good" and so people create positive results out of whole cloth to fill that need.

Imagine, for example, a topic like "climate science."

Does the placebo effect (or the reverse) affect those with strong opinions one way or another?

I think that it most certainly does.

And it helps that "climate science" is not amenable "double blind tests" of any sort.

So there is nothing to counterbalance the placebo effects by individuals or groups.  (Say as opposed to a sigma 5 signal in the Higgs Boson world at the Large Hadron Collider where everyone decides on the theory and the nature of what's being looked for in advance and then merely compares technically generated experimental results.  Though even this device, the LHC, is biased I think to some degree because only the most "powerful" or "influential" scientists guided its design.)

And don't forget that, as I have written here, as many as 1 in 20 medical "studies" are not reproducible.

"The lack of a systematic model for "debugging" health problems." - There is actually no science I am aware of regarding the process of "fixing" something broken.  Certainly it does not exist for software which is A) basically mathematical and B) subject by this nature to systematic analysis.

So if I have a large software system I cannot estimate, if its considered to be "broken" in some way, how long (or how much it will cost) to "fix it."

Software (and mathematics) itself is not subject directly to the placebo effect, i.e., the software, given the exact same initial conditions should do the exact same thing each time.  But those "debugging" it are - for example, I may believe there is a particular "symptom" or cause of that system for what amounts to basically an irrational reason.

But since I am doing that and not the software I will go off on what's called "a wild goose chase" trying to fix something based on faulty data.

Now imagine how this applies in the medical world: both the patient and the doctor are susceptible to the placebo effect.

There is not established protocol for how the biology of a human should work (yes I know there is at a "high level" - you're fasting blood glucose is X at point Y therefore you are diabetic - for example.  But this is complete nonsense when you consider whether or not other factors could have come into play - disease, deficiencies in other unrelated health areas, differences in human genetics, etc. etc.

Triage for heart attacks in the US is a good example of this.

But there is no consensus on why the Standard American Diet (SAD) is killing people: is it really cholesterol, or is it inflammation, is it diet, or exercise, is it A or B, etc.

So what path of science took the person from a supposedly healthy newborn to a terminally sick adult?

What's the process?

At the end of the day the process of modern medical science (and probably many other "sciences" like climate science) is terminally broken.

Until human's figure out how to take the "placebo effect" out of the process (funding, publishing, career, and so on) it will always be tainted.

Until human's can create accurate, unbiased and unambiguous tests for truly "complex" and open system the placebo effect will rule at the societal level (like phlogiston and ether).  (And yes, I understand the science got the bottom of ether - but its not the same as other things and I think there is significant "lacking" in our tools and techniques.)

Until we have a true science that deals with "debugging" things like the human body that's "free" of bias and the placebo effect we will continue to thrash.  For me "debugging" a human problem, say the reaction to an environmental change, must become a true science - with theory and a process and reliable outcomes.  (And of course fixing the root cause as opposed to papering over a symptom.)

Today most of humanity believes in a scientific process that is by and large a failure - a failure that's growing exponentially into a full blown, planet scale disaster (as the SAD proliferates around the world killing untold billions of inhabitants, for example).

I think we all need to "wake up" from this nightmare.

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