Heroes Not Zombies

Iona Heath writes in the BMJ recently,  that

we have somehow lost our way in the management of chronic non-communicable diseases. In this arena the largely unexpressed sense of medical impotence seems to have led to the frequent exaggeration of treatment effects and to an excessive emphasis on unproved preventive interventions.

She picks out two issues to highlight

Wishful thinking seems to be encouraged by two serious structural impediments within medicine: firstly, a diagnostic taxonomy that manages to be both rigid and intensely inconsistent; and, secondly, the unjustifiable manipulation of statistical information, with or without intention.
Experience is fluid and continuous, while diagnoses are discrete and dichotomise the normal from the abnormal in a way that has proved useful but that is totally artificial. The insistence that medicine is able to make a clear distinction between these two categories is a major constituent of the pervasive wishful thinking—perhaps particularly in preventive interventions such as mammography, where overdiagnosis of the abnormal can lead to mutilating interventions that have a minimal effect on overall mortality.
In his 2010 Bradford Hill memorial lecture at the London School of Hygiene and Tropical Medicine, Sander Greenland described contemporary statistical practice as perpetuating hopelessly oversimplified biological and mathematical models and of promoting excessive certainty through the promulgation of a two valued logic that allows only complete certainty of truth or falsehood.

She concludes

It is surely time for medicine to reassert a standard of integrity that seeks out and actively curtails wishful thinking and acknowledges the degree of uncertainty at every level of practice, even at the expense of admitting impotence.

As so often seems to be the case, I agree completely with her. Our current fashion for “evidence based” approval labels is built on the merging scientism, which in turn has arisen from logical positivism. It’s continued default to two value thinking (it’s either this or that, right or wrong, good or bad, works or doesn’t) is a ridiculous abstraction that increasingly bears little connection to reality. We live in a highly complex world where human beings are complex adaptive organisms embedded in our unique and multiple environments and relationships.

The claims for “cures” and the claims for “certainty” and rightness of point of view of “experts” is not doing any of us any favours.

Again, I think this illustrates how helpful Ian McGilchrist’s analysis is – there are two world views clashing here and we’ll only make progress if we can integrate both of our cerebral hemispheres and stop believing that only left hemisphere function gets it “right”.