Your Body Is Awesome and Really Complicated; Please Don’t Trust It To Idiots and Charlatans. (No Poker Content)

(Seriously.. No poker content at all.)

The human body is unquestionably the most complicated machine that any person has ever encountered, and it’s likely to hold that title. Each of the about 6.8 billion people on Earth is composed of a unique set of roughly 100 trillion cells (Whenever you hear the word trillion, be amazed) of a huge variety of types. Each of these cells is way more complicated and elegant than your high school bio textbook said. The organelles in your cell exist in this terrifyingly confusing and surreal world in which incredibly weird objects of a huge variety of scales interact according to the bizarre laws of organic chemistry, three-dimensional geometry, and quantum mechanics. This is explained way better than I ever could by this insanely awesome video created for Harvard students:

(For more about this video, see this awesome TED talk.)

Everything you see happening in that video (except for the stuff at the beginning and the end that is clearly extracellular in a blood vessel) is a mundane occurrence from your cells’ perspective, and each is happening at least hundreds of billions of times over in your body at this moment. (Some are happening over ten sextillion times at once, like the walking thing, called a kinesin.) And, somehow, arising through all of this madness, is some lazy poker player who’s considering going to Chipotle, but he can’t quite sum up the energy, so he’s writing a blog post instead. My typing fingers, my beating heart, my hunger, my laziness, my terrible ideas for blog posts–All of these things are somehow wonderfully nuanced properties of one giant machine built out of an incomprehensible number of these weird tiny machines.

So how the hell do we study this thing? That video only shows a tiny fraction of the mundane activities that we’ve thoroughly researched, and we likely know only about one percent of what actually goes on in your cells. The organs in your body, weird and busy in their own right, are each composed of trillions of these trippy, poorly-understood, active worlds. Worse still, this machine wasn’t designed by anybody (sorry creationists…). Your laptop was designed in layers by humans for human use with the explicit goal of being easily understood by humans. It’s actually not that hard to understand how something gets written to RAM or how to write in assembly language or how to program in C, and you can understand all of these things individually without any knowledge of the others. There might even be a guy somewhere who understands how your computer works from the ground up.

In horrifying contrast, your body was designed by a bootstrap evolutionary process that didn’t partition it into such neat layers. In order to understand one aspect of the human body, it is often necessary to understand everything underlying it–from the interactions of molecules composed only of a few atoms to the mechanics of a large and complex organ. Your thoughts, for example, are influenced to a huge degree by the tiny details of the process by which billions of individual neurons release trace amounts of chemicals to interact with those around them. Indeed, it’s unlikely that any person will ever understand all of the workings of a single red blood cell, let alone the entire human body. So, to say that the human body is difficult to understand is an understatement of epic proportions.

But, we have to understand it. Our bodies are machines that were built to live miserable and short lives, and we would strongly prefer them to live much longer, happier lives with significantly less pain and significantly more happiness and pleasure along the way. So, for as long as man has been conscious, he has been attempting to rig the most complicated and intricate machine on Earth to do entirely new things. (And we’ve certainly made some serious progress. Most of us would not have made it past the age of five had it not been for modern medicine.)

The correct way to do this is to identify potential fixes that are plausible based on our (extremely limited) knowledge of how this machine works and try them out to see what happens. For extremely simple things, this process isn’t too hard at all. Broke a bone? Don’t move it for a while, and it’ll probably heal itself–If it’s really bad, we’ll line it up so it heals properly or mabe put some metal in there to help out. Cut yourself really bad? We’ll clean the wound and maybe sew it up if necessary. Baby not coming out right? We’ll cut you open and take her out ourselves (ewwwwwwww). All of these things are pretty obvious solutions, and they work so often in practice with so few consequences that it really doesn’t take much to establish their plausibility, test them, refine them, and conclude that they’re smart procedures.

For even slightly more complicated things, stuff gets really messy really quickly because, again, the human body is a very complicated machine. Some stuff is just hard to figure out, even if the solution is simple and easily testable. For example, how the hell were we supposed to figure out that a tiny amount of iodine can prevent goiters and cretinism? And it only gets worse. For considering truly complex topics like heart disease, cancer, obesity, mental illness, etc., we have to drop the language of simple cause and effect and instead use the language of statistics–from causes and cures to risk factors and preventative therapies. This move brings with it all of the dangers of statistics that poker players are (or should be) quite familiar with–questions of sample size, variance, and correlation without causation. Are heart attacks actually made more likely because of high cholesterol or did random noise or a bias in our sample incorrectly suggest that? It also lends itself to misunderstanding. “My friend had cancer and survived when she changed her diet” is not sufficient evidence to suggest that a new diet cures cancer just like “My friend played 55/40 at 6-max and won five buy-ins” isn’t sufficient evidence that playing 55/40 at 6-max is a good idea. Your friend may be one of the few who happened to survive life-threatening cancer without treatment just like she may be one of the few who happened to win playing like a maniac. (Sorry for the poker analogy…)

And those two problems pale in comparison to the last; even if you find a statistically significant effect of a treatment and you’ve ruled out sample bias, and you’ve shown conclusively that you are witnessing true causation (not that anyone could actually do that in practice), you still can’t be sure that your treatment works. This is because of the great confounder of medical science: The placebo effect. This is a way bigger deal than you probably think; there are actually two sort of distinct placebo effects:

  1. “I think I feel better now.” This is what you probably think of when you think about the placebo effect. Some dude in some primitive tribe goes to his local witch doctor and tells him, “I feel funny.” The witch doctor kills a couple chickens and says a chant or two, maybe drinks some mescalin or whatever he’s got around for good measure, and goes, “Alright, I’ve cured you. That’ll be three goats.” The patient thinks about it for a while and decides “Hmmm.. I guess I do feel better. After all, you are a witch doctor…” He hands him four goats and goes home. (Tipping doctors is apparently standard in this culture.)
  2. “Hey… Where’d my Parkinson’s Go?” There’s still an active debate in the medical community about whether or not the placebo effect can actually cure real physical diseases. The consensus is that it actually does. In other words, paying the witch doctor four goats to slaughter a few chickens and tell you that you’re cured might actually cure you. For example, Parkinson’s disease–a very serious physical illness caused by the death of brain cells–responds remarkably well to placebo (1 2). People actually go from being bedridden to walking around after being treated with fake medicine. There’s some less compelling evidence that the same might be true for ulcers. And, indeed, there’s similar evidence about a long list of diseases.

If this actually happens and if so why are both still an open question. There are lots of different theories that essentially boil down to this one, which I won’t bother to attempt to summarize (1 2). There’s also a pretty wide body of literature (1 2) arguing that the placebo effect actually doesn’t cure much except for pain, nausea, and psychological disorders, and the rest is just caused by poor studies and the difference between how healthy people think they are and how healthy they actually are. (Radiolab has a really really awesome discussion of the placebo effect that I highly suggest you check out.)

So stuff is really really hard for medical scientists. It’s pretty easy to think that you’ve found a cure for something and later learn that the effect was statistical noise or that your patient would’ve been equally well cured by watching a tripping witch doctor behead a few chickens. To combat this problem, modern medicine has turned to the holy grail of studies: the large sample size, randomized, double-blind, placebo-controlled trial. The use of large sample sizes should be self-explanatory to poker players; you need to try out your cure on a lot of people to get statistically significant results. Instead of simply seeing how treated patients do on their own or how they fare compared to untreated patients, placebo-controlled studies look at how treated patients do compared to patients who receive fake treatment. (I.e. if you are testing the effect of a pill, you give your control group pills filled with sugar. Patients always consent to the chance of placebo.) This should in theory account for the placebo effect. In order to make sure that the two groups are treated equally, good experiments are typically done double blind, which means that both the patient and the doctor don’t know whether the treatment is real or fake (otherwise the doctor might appear more confident to one group or take one group less seriously). And, in order to minimize errors due to sample bias, patients from the sample are randomly chosen to be in either the placebo group or the group receiving real medicine. Even extremely subtle effects like the color of a pill can taint a study, so good studies have to be done extremely carefully.

Needless to say, this leaves a ton of room for error, confusion, and misinformation. In fact, there is an entire industry called alternative “medicine” that thrives off of this confusion. It exists entirely to sell “medicine” to people that has not been properly tested, or even “treatments” that have been repeatedly shown not to work. This is a gigantic business, with about $34 billion per year in revenue. People’s fundamental misunderstandings of the above concepts and the huge prevalence of misinformation coming from this industry (both from people who think that they are helping and from people who are intentionally lying to make money) cause the vast majority of people to believe in pseudoscientific fake medicine. Tragically, even many real doctors who went to legitimate medical schools and practice western scientific medicine are misinformed about many topics. And, the internet is full of misinformation (ughhhhh). I’m not just talking about forums and web sites that look like they were made in the 90s by obvious quacks, I’m talking about sources that reasonable, smart people trust like WebMD, which is full of pseudoscience.

This information spreads so readily because it’s so easy to believe. It gives people hope, makes them feel unique, and feeds into our fears of science, technology, government, and corporations. People don’t want to hear that an expensive pill made by a giant corporation and regulated by the government might make them better, but it comes with side effects; they want to hear that some ancient civilization knew of some wonderful natural cure that always works for all diseases with no side effects, and that stupid and/or evil corporations and governments have failed to provide this knowledge for various reasons. This rhetoric, combined with a general fear of insulting people’s “beliefs” causes the better-informed to fear speaking out, so very reputable sources like the NIH and the Mayo Clinic treat alternative “medicine” with guarded respect. And as a result, it can be extremely difficult to find good information anywhere.

This extreme prevalence of poorly combatted misinformation kills people. In fact, my uncle (with whom I wasn’t very close.. not looking for sympathy) would probably not be dead right now were it not for a crank who convinced him that the best way to cure his cancer was to take large amounts of vitamins and other crank cures. Rather than suffer through radiation and chemo and live, he chose to fly to Germany, where he was treated with a variety of “cures” that did nothing. It wasn’t until his cancer paralyzed him that he realized the The people who did this to him, and many others, don’t only charge money to lie to their patients, they charge them money to keep them away from doctors and ultimately kill them.

So, when you consider medical advice, follow NoahSD’s Official Guide to Interpreting Medical Advice(TM):

  • Always be skeptical. This is self-explanatory. Remember that your body is complicated and that it’s easy for people to be misinformed about it. Just because someone tells you something doesn’t mean it’s true. Even very smart people (and even doctors) are frequently wrong about the human body.
  • Always assess plausibility. If someone tells you that sticking needles in your back will cure your asthma, you’re probably pretty safe ignoring their advice. If someone tells you that eating lots of spinach (or whatever) will cure your asthma, you should wonder how that could be true when so many people with access to spinach have asthma, and probably ignore the advice or maybe continue researching with a large dose of skepticism. If your pulmonary doctor tells you that a certain gas is FDA approved for asthma patients, and that inhaling it might help alleviate your symptoms, you’re probably okay taking it regardless, but you should still probably research it on your own to make sure.
  • Remember that you’re not special, and the placebo effect affects you too. This is depressing as hell, but just because something “worked” for you, doesn’t mean it actually worked. My dad takes vitamin C every time he gets a cold, and every time he says that after taking it he feels better. This is in spite of the fact that the evidence shows that vitamin C actually doesn’t help with colds more than placebo. (Or, you might have experienced a sugar high at some point in your life, except for the fact that sugar highs don’t exist.) To some extent, this is fine. My dad takes his vitamin C, and he gets some placebo effect (either by convincing himself he feels better than he feels or by an actual physical placebo effect lessening his symptoms). He pays a few bucks to go to a witch doctor, and he comes out happier. That’s fine. The danger in stuff like this is when similar logic is applied to more important things, e.g. eating an extreme diet because it seemed to make you “feel better” or attempting to cure seriously illnesses with false cures.
  • Two (or four) opinions are better than one. This stuff is complicated, and doctors get stuff wrong all the time. If you see a doctor for a serious medical condition, your next step should always be to see another one (and then another).
  • Wikipedia is your friend–seriously. Believe it or not, Wikipedia is a wonderful wonderful resource for medical advice. It is far far better than WebMD or anything else that I’ve discovered. One way that you can tell that Wikipedia is so good is because of how non-committal its claims are. For example, there is no evidence that colds are caused by cold weather (in spite of what my pediatrician told me), nor is there any evidence that cold weather hurts your immune system. (These are myths created to explain why colds occur so much more often in colder climates and during the winter. The real reason is that cold weather makes people stay indoors, where they breathe each other’s germs.) Wikipedia knows this, but it is beautifully open-minded in it’s discussion of the topic: “The experimental evidence for this effect is uneven: many experiments have failed to produce evidence that short-term exposure to cold weather or direct chilling increases susceptibility to infection, implying that the seasonal variation is instead due to a change in behaviors such as increased time spent indoors at close proximity to others.[10][23] However, other experiments do find such an effect for both body chilling and cold air exposure, and a number of mechanisms by which lower temperatures could compromise the immune system have been suggested,[17] while other experiments have shown that exposure to cold temperatures may instead stimulate the immune system.[74][75]” Plus, it lists it’s sources, so you can check the information yourself.
  • Large sample size, double blind, placebo controlled, randomized. If something is proven by a study that has all of those characteristics, it’s probably true. Any other evidence should probably be ignored, or at most, considered with a very healthy dose of skepticism. Remember that witch doctors “cured” people for millenia with ridiculous rituals. Don’t fall for that stuff. In particular, completely ignore anecdotal evidence.
  • Multiple studies are much better than one. Even if studies are double blind, placebo controlled, etc., it’s just so easy to make mistakes. This is why there’s a news story about once a week about how something causes or prevents cancer or heart disease or Alzheimer’s or whatever. (You often don’t hear about the follow-up studies that disagree with these findings.) Studies also have a natural selection bias in that negative studies often don’t get published; this is less true of larger studies (i.e. clinical trials) and follow-up studies to earlier-published positive results. So, lots and lots of bad treatments have one or two studies that were poorly designed or got lucky and showed positive results. Worse still, some people lie about results. (The autism vaccine controversy was a fraud that cost the world lives and money.)
  • Be very wary of anything that’s “alternative”. Food supplements, “natural healing”, “eastern medicine”, anything that mentions “flow of energy” or “your body’s natural frequency”, etc etc. All of these things are “alternative” because nobody’s shown that they work rigorously enough to satisfy conventional medicine’s standards.
  • Quackwatch is cool. http://quackwatch.org/ is a nice resource for researching fake medical claims. For example, if someone tells you that the acidity/alkalinity (i.e. pH level) of your blood influences your health, you can search “alkalinity” on Quackwatch and find a nice concise article explaining that that’s not true and debunking some related common misconceptions and tricks that cranks will use to sell you their products. (Compare that to searching google for alkaline diet.)
  • Sometimes you have to gamble with your health, but gamble responsibly. In a perfect world, every medication, diet, therapy, etc. would be tested on a sample of 10,000 clones of you in a perfectly done study before you even considered it. Unfortunately this isn’t happening (yet). Many potential treatments are poorly studied or not studied at all, but still might be effective. When considering such things, weigh the plausibility, potential pros, and potential cons, and make an informed decision. Doctors do this all the time when they prescribe drugs for off-label treatments, for example.
  • Remember that nobody knows what they’re talking about. I probably got some facts wrong in this article. (Sorry about that. Please call me out in the comments.) Doctors regularly misdiagnose patients. The FDA has approved many drugs that turned out to not do what they were supposed to do, sometimes in spite of clear evidence, and it will do so again. This is a complicated topic, and nobody understands it well. In fact, probably the single best way to judge someone’s medical advice is by how often they sound unsure. The more times someone says “maybe”, “the evidence is inconclusive”, or something similar, the more likely they are to be well-informed. (The fact that this post makes a lot of assertions without qualifiers is pretty good evidence that I am not a good medical researcher.)

Not-So-Brief Explanation for This Post

First of all, let me know if you’d like more non-poker stuff here. I’d love to rant about lots of fun (or maybe really boring?) stuff like politics, science, economics, my weird social theories, etc., but I have no clue if people are interested. So please let me know if that sounds appealing or boring or repulsive or whatever. (More variance-related poker stuff coming soon. I promise.)

This post was motivated by the fact that the poker community (like almost all communities) seems to be infected with pseudoscience. I originally intended to discuss the Poker Road show Life Smart with Thuy Doan, in which Thuy, a pro poker player with cancer whose name is pronounced “Twee”, talks about medicine, health care, etc. with her health advisor Kevin Meehan, whose web site describes him as “the Owner [sic] and founder of the Teton Health Clinic, serving Teton County, and nearby Idaho and Wyoming communities with alternative healing therapies that foster the body’s inherent ability to heal.” I wanted to explain why I think Poker Road should not have this type of stuff on their site and why I strongly disapprove of Meehan. But, after making an ass out of myself in an e-mail conversation with her, I’ve realized that I’m no where near tactful enough to handle a delicate issue like that without offending Thuy–who I believe has nothing but the best of intentions, and just generally seems to be really sweet and much more of a mench than I am–and just generally coming off as an ass.

So, I scrapped the project. But, after the appearance of a bunch of tweets from various poker pros like Prahlad Friedman and Jen Harman discussing their incorrect views on health and the memory of that horrible “balance bracelet” thing that fooled a bunch of poker players (See here. Their web site is now down, probably for legal reasons…), I got to writing. I feel a pretty strong need to combat misinformation about science in general, and medicine in particular, because I know that this sort of misinformation kills people, and I’m hoping that the fact that some people in the poker community are actually willing to listen to me will allow me to change a mind or two. Hopefully this post doesn’t make me come off like a total ass like I probably would have had I devoted the entire thing to calling out people for their perfectly reasonable incorrect beliefs.

21 Comments.

  1. Interesting post. I think throwing in an occasional opinion on off-topic subjects is a good thing. Keep ‘em coming!

  2. great post.
    this blog is quickly turning into my favorite read on the internet.

    more random non poker stuff would be great. especially something about your “weird social theories”

  3. I dig it, just keep writing what you feel passionate about. Good read.

  4. def more of this ! Thx

  5. nice piece. can you do one on placebo effect working even if you know it’s a placebo? what i mean is will i get better healing from a placebo i think is working or one i know is crap. if the first is true then eastern medicine, alternative, etc could be argued do have their uses. (not my opinion just curious)

  6. Noah, just stumbled upon your blog. Excellent work. I go by the rule of thumb of not reading any 2p2 posts not by you. Seems to be far and away the best strategy.

  7. Your entire post is invalidated by your endorsement of Quackbusters, whose head, Stephen Barrett, is a defrocked psychiatrist (he now holds no medical license whatsoever) who has been shown to have done NO valid research of his own in attacking myriads of techniques, some of which, granted, are quite shady, but many of which have helped millions of people.
    I appreciate your desire to have people examine treatments that have a weight of scientific evidence behind them, however, it is important to know that Lancet, a very prestigious British medical journal, stated emphatically that 99% of all medical treatments have no valid hard science behind them. People need to be aware that when you combine deaths from drugs properly prescribed and and properly taken, deaths from medical malpractice, deaths from diseases picked up in the hospital (nosocomials), and other medical-related deaths, that the medical profession is the #1 cause of death in the U.S.
    Also, it is important to understand that it is almost impossible to get research money to look seriously at alternative treatments, because no one stands to make enough money on the back end. If you think that thousands of years of acupuncture being used effectively for a wide variety of conditions does not constitute “proof”, that is your right (and no, I am not an acupuncturist). However, I think it’s a little short-sighted and somewhat xenophobic on your part.

  8. Jan,

    1) Were it true that I had cited one bad source, that would not invalidate my entire post, that would only invalidate the references I made to that one bad source.

    2) Were it true that he no longer had a medical license or had done none of his own research, that would not invalidate the writings of people who use the site that he hosts that link to peer-reviewed journals.

    3) He actually has a medical license. Here it is: http://www.licensepa.state.pa.us/Details.aspx?agency_id=1&license_id=528406& . He’s retired, but his license is still in tact, and indeed was renewed a month ago. He has no disciplinary actions listed either.

    4) Wherever you got that misinformation from is probably feeding you lots of other lies as well.

    5) I don’t believe the statement that you attribute to Lancet. Please provide a link. You probably misread a quote or took it out of context.

    6) When you say that the medical profession is the #1 cause of death in the US, you’re completely ignoring the ridiculous number of lives that the medical profession saves each year. You’d probably still be wrong if that weren’t the case, but it seems like a silly thing to debate.

    7) It is not true that it’s impossible to get research money to look into alternative
    “treatments”. It is true that it’s very hard to get money to look into implausible “treatments”.

    A lot of the more plausible alternative “treatments” have had tons of studies. Many dietary supplements, for example, have been studied extensively. Some, like vitamin C, have been shown repeatedly to have no effect (except on marathon runners for some reason..), but are still widely believed to be effect. Some, like fish oil, have actually shown to be beneficial in some areas and are thus actually part of the routine treatment of some diseases.

    However, many “alternative” treatments don’t pass a basic plausibility test. For example, it would be silly to test whether the “alkalinity” (i.e. pH) of your food can have effect the pH of your blood which can then have wide-ranging effects on your health because we know from basic biology (and from direct testing) that what food we eat has absolutely no effect on the pH levels of blood. So there’s no reason to test such things.

    8 ) I don’t believe that acupuncture works because it is not plausible. I don’t believe that sticking needles into different parts of my body can create a wide range of reactions that have no explanation based on modern science. My disbelief is confirmed by repeated studies that show acupuncture fails at everything except for nausea and pain. It is a well-known that inducing pain in one part of the body (i.e. sticking a needle into somebody) can lessen pain in another part of the body or nausea. That’s why soldiers used to bite bullets when they got amputated. However, soldiers no longer bite bullets when they get amputated because we have much more effective methods. Similarly, we no longer should use acupuncture as a cure for pain because we have much better methods.

    This isn’t xenophobic or short-sighted; it’s rational.

  9. You are further confirmation that poker players are one interesting group. Definitely enjoy your thinking on any topic. Thoughtful, articulate people are never boring.

  10. Hi Noah,

    great post. I just wanted to tell you that you shouldn’t write food supplements off completely in one fell stroke. I noticed you made a few caveats for fish oil, etc, and you’re absolutely right when it comes to wikipedia; you can find absolute droves of information, multiple studies from pubmed, etc that challenge/support the efficacy of multiple supplements. I am on a somewhat intense (by normal people standards) program of supplementation, both for my strength training and for longevity. I work in tandem with my doctor, who actually is listed as an integrative medicine specialist, but who I only use because she is willing to test specific genomic markers as well as well as a multitude of other factors which are either ignored by conventional doctors or are only tested when things start going horribly wrong (think: metabolic syndrome, type II diabetes, cancer, autoimmune diseases).

    So in short, I think that if you do aim to be more rational about your health and shoot for medium amounts of hassle while targeting a healthy, very long life, it is possible, and supplementation I think plays a vital role. As always, you need to, from time to time, reexamine the efficacy of new studies that emerge and reevaluate the program as you go along, but there are so many well done studies and plenty of information, if you are willing to do the work.

    Thanks, and keep up the good work.

  11. this blog is the absolute nizzle nuts, doesnt matter what u write about. ty

  12. Hi Noah. Wazz here. Just wanted to say that I think you’re my favourite poster on 2+2 and that my thoughts mirror yours in almost every way. I consider myself intelligent, educated and eloquent but you seem to take those qualities to the next level. Please do keep on writing non-poker blogs, please don’t be afraid to voice your opinion – even if people don’t outwardly want to hear it, they should.

  13. I just wanted to say that i greatly appreciate well written posts regardless of the topic, so please keep it up. I also think that science is well under-represented in blogs even tho there is so much to write about, lots and lots of interesting stuff.

  14. I’m always glad to see people speaking up about fraud

  15. You’re a smart guy that has well-written blog posts. MOAR!

  16. Noah,

    If the body is such a complex machine, and we don’t understand most of its internal functionality, how can we brush-off treatments that seem to work, knowing that 99% of accepted treatments do not have robust studies to back them up?

    I think that it’s important to keep the stated goal of the AMA in the forefront of our awareness. They are the only group that approves medical schools, and their goal is to increase the wages of medical doctors. Objectively speaking, what is the best way to increase the wages of doctors? As I see it, there are a few way, but the subject is so tainted with propaganda and morality that it is almost impossible to consider them in any even remotely objective manner.

    To make this more palatable, let us consider an analogy; imagine that patients are in fact automobiles, and doctors are auto-mechanics:

    1. Is it a good idea to accept only the treatments that work for all cars, in general? Or is it best to tailor repairs (treatments) to each individual type of car? A study that finds 5W-30 motor-oil as most effective for preventing engine wear would not apply to engines designed to accept a different grade, even if large studies show that the oil is effective for 75% of engines.

    We make a fundamental error in assuming that all human bodies are the same machine. They could easily be as different (and similar) as the myriad makes and models of modern cars. Because we are all “human” does not, per se, make us the same, any more than all “cars” require the same replacement parts.

    2. If mechanics were somehow able to garner a monopoly on the education of auto-mechanics, with their only goal being to (immorally) increase their wages, do you imagine that they would train mechanics to teach their customers to avoid riding their brakes? Would they train them to change their oil regularly? Would they train mechanics to instruct their customers to fuel their cars with high-quality gasoline of the correct octane level? I think not–I think, were their goal to make money, they would focus only on repairs necessary, and ignore any and all preventative measures. New mechanics would come to see their jobs as repair specialists, only, with no obligation to inquire as to why some customers’ brake-pads wore out prematurely. Instead they would blame it on genetics, or manufacturing defects (make and model).

    Additionally, if consumers began experimenting on their own, and anecdotally discovered that using 10W-40 as the engine became older helped to prevent engine-death, would mechanics listen, or would they tell customers that such evidence is not valid unless millions of old cars are tested? And would there be any encouragement or support from professional mechanics to test this theory? Why would there be? Keeping engines alive longer with a simple solution lowers the income of auto mechanics–they won’t be repairing and replacing as many engines.

    The error here is twofold:

    1. There is an assumption that all people are (mostly) identical. The truth may well be that we are widely divergent (just like cars) and huge studies do indeed identify workable cures, but do not find the best cure. They only find cures that work for all makes and models, ignoring repairs specific to individuals.

    2. Assuming that the AMA’s stated goal (increasing wages for doctors) is not a reality; assuming that morality comes first in setting the course for future doctors.

    3. Assuming that any attention will be paid to cheap solutions, or preventative measures.

  17. Additionally, the analogy to poker is not appropriate, because the edge enjoyed by a drug in changing the outcome of the experiment is many magnitudes greater than a professional poker player.

    A good poker player may enjoy a 3% edge in affecting the outcome of a single hand; a good drug (or treatment) may enjoy a 90% chance in successfully affecting the health or mood of a random human body.

    In this way, we can see that even a single person, experimenting with a huge edge can arrive at statistically significant results. And the confounding variable involved in self-experimentation can be mitigated to a very large degree. Generally, when one thinks about natural remedies and self-medication with herbs or supplements, we imagine that the experimenter expects the remedies to work. That is not necessarily the case.

    Most often, I think, we don’t really expect herbs and supplements to work, and are surprised when they do. (This has been my experience; most don’t work). In this way we can see that the placebo effect should not be expected to confound results at all; if anything we should see a nocebo effect, where the efficacy of treatments is negatively impacted, because natural cures are generally expected to be ineffective.

  18. “Large sample size, double blind, placebo controlled, randomized. If something is proven by a study that has all of those characteristics, it’s probably true.”

    If you took a random sample of one million cars that all suffered from the same problem; perhaps they all have wheels that have fallen off unexpectedly, and tried to cure the problem with a new drug, a certain type of improved lug nut, what do you imagine we would be able to determine from this study?

    Even if the mechanics installing the new lug nuts don’t know which are the new type and which are standard, control lug nuts, and if the cars are sufficiently randomized into two statistically identical groups, we should expect to find that the treatment is effective for some percentage of cars–they no longer experience the original problem (wheels falling off).

    But for the remainder of cars, they will be no better off than before. Perhaps their wheels will fall off even more often, because the new lugs fit normal cars but not Ferraris and BMWs.

    We could end up finding a treatment that improves the problem for say, 60% of cars (patients), but will have failed to understand the problem. And this is what we see, today, with many treatments used in modern medicine. If one antibiotic doesn’t work, try another, and another, and another, until the infection goes away. If it doesn’t go away, we can’t help you. Same for antidepressant drugs, which are foisted upon patients in a very similar manner.

    This is a bit like throwing lug nuts at automobiles with loose wheels. It may eventually work, but it is much less effective than examining the wheels, determining which size they require, and installing the proper hardware.

    Large scale studies are doing us a disservice in this way, by moving away from personalized solutions, moving away from truly understanding the problem, and moving away from innovative solutions that are custom tailored to individuals. The situation is further complicated if the best lug nuts for are standard issue and available ubiquitously, and the improved lugs are titanium or rare earth metals that are patented and cost much more.