Next edition I have some additions for you — may need to be 2 volumes!
My penultimate piece (so far) for the SAU Blog. This book greatly impressed me at the time, which is surely clear. Since I have learnt a lot about the philosophy of medicine and am perhaps a little more sceptical about the scientific pretensions of medicine (let alone the medical pretensions of psychiatry). Nevertheless Wootton’s arguments seem important and difficult for even the most critical theorist to fully evade. I came across references to Thomas McKeown lately, having nearly forgotten about him.
Bad Medicine: Doctors Doing Harm Since Hippocrates
by David Wootton
Pp. 304. Oxford: Oxford University Press, 2006
Not only were the Ancient Greeks influential, in many fields they are still directly influential today. Whitehead famously remarked that all Western philosophy is footnotes to Plato. Euclidean geometry is still central to mathematics. Aeschylus, Sophocles, Euripides and Aristophanes are still performed. While the practice of history today is…
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One thought on “Review of “Bad Medicine: Doctors Doing Harm Since Hippocrates” by David Wootton, Social Affairs Unit Blog, August 31st 2006”
Somehow this seems to harmonize Dr. Carl Phillips writes in his blog …..”With those lessons, we immunized grade-schoolers against being tricked by coincidence, teaching them to not over-conclude from one observation. We also teach young children “do not get into a car with a stranger”, which is good simple advice at the appropriate level for them. It guards against the worst possible mistake. But anyone who does not eventually learn that life is not so simplistic will have a rather hard time getting from the airport to their hotel.
Unfortunately, far too many people only get to the grade-school level in their understanding of scientific inference, but nevertheless think they are experts. People working in serious sciences get past that and learn the value of single observations (imagine: “The orbit of Mercury is not what Newtonian physics predicts. But who cares? That is just one anecdote. Ignore it.”). But a large portion of those pontificating about health science, particularly physicians, do not understand scientific inference any better than fifth grader. The worst problem is that they do not realize that.
Learning exactly how to tease the informational nuances out of any data, whether it be columns of numbers or a single personal testimonial, requires a lifetime of study and some decent intuition. But it is possible to teach a simple lesson to the “that is just an anecdote!!” crowd to make it obvious that their “never get in a car with a stranger”-level understanding is overly simplistic.
Consider a man who at 3:00 has no major injuries; shortly thereafter he gets into a car crash (and nothing else noteworthy occurs); upon talking to first-responders at 4:00 he say “I am basically ok, but I really hurt my wrist in the crash”; at 6:00 that evening, an x-ray shows he has a broken wrist. He tells us this anecdote, leading with the causal claim, “I broke my wrist in that car crash.” Do we believe his assertion of cause an effect? And, thus also conclude that (sometimes) car crashes cause broken wrists? It was, after all, just one story.
Of course we believe him. We are not idiots…..”
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