Monday, June 4, 2007

A Strawman fallacy

Evidence based medicine and cookie cutter treatments
The argument goes like this: Today’s medicine, in particular, those utilizing evidenced based treatments are not able to take into account many idiosyncrasies of a disease because no two individuals are alike and no two diseases are alike. The implication here is that science based medicine is basically a cookie cutter style enterprise and can’t possibly take into account a persons or an animals unique characteristics and needs.

This is an argument that goes around and around in the mind set of many who can not get out of the cycle of “lopsided” reasoning and “a priori” assumptions. The “you can’t treat the individual” canard seems to have the staying power of favorites such as conspiratorial thinking, pseudo-quantum reasoning, and “special” /ancient knowledge fallacies.

It is difficult to know where to begin with this faulty logic because its very utterance implies a significant amount of scientific illiteracy or at least false assumptions. This mild ad hominem basically exposes a certain ignorance of the very essence of what science does.

The fact that we are different individuals does not exempt us from the even bigger fact that we are part of a big mess of very similar human beings who have very close biological, physical, and genetic ties. There is a natural consensus of biological human function that, like everything else we are aware of, falls into classic statistical patterns of behavior. From the Schrodinger equation and the uncertainty principle to population dynamics and Bell curves the world has shown itself to be rather granular in nature- not black and white. How these phenomena behave is the very definition, fascination, and focus of science since man looked to the stars.

An individual human, animal, or other system is “obligated” to behave under the constraints of the physical laws we observe. When disease occurs, it does so under the same auspices and tendencies as all other phenomena. There is no misinterpreted quantum escape latch here. An illness for example will impact a window of the population due to a window of circumstance and result in a window of effects. The goal of science based medicine is to use all that we have at our disposal as accumulated scientific knowledge to understand these windows and find ways to effectively deal with them, their implications, and repercussions.

For instance here's a unique analogy: in the majority of today’s societies we wear shoes. The style, size, and shape will vary but they provide to all users a similar function and effect to your foot whether you live in Ohio or Tokyo. If you claim science only offers square wooden clogs in a size 4 for everybody; you are creating a straw man that is easily attacked.

Another analogy is smiling. Smiling is a very complex form of visual communication often utilized by us; being the social creatures we are. The point here is that the smile, no matter how nuanced, has a very obvious role that conveys very common meanings and effects to most of us. Disease impacts us in similar broad ways and science based therapies are an attempt to understand associations that counter act its broad negative effects.

To the extent possible treatments are investigated to determine a series of characteristics (mechanisms, effectiveness, duration, side effects, plausibility, specific conditions…) that sheds light on their utility as a therapy. A specific treatment is designed to impact a significant proportion of the populace-in other words as many as possible- it is as simple as that. In general, there will often be “shades of grey” in disease behavior and science and evidence based medicine provides coherent tools for fine tuning treatments in individuals in order to attain the most profound impact.

Because it is the result of a rational consensus of accepted science, evidence based medicine isn’t perfect and improvements and “tweaking” will likely always be a part of its make up, but its self correcting and skeptical nature helps insure flexibility and adaptability allowing it to stay in tune to reality as it is- a recipe for survival and effectiveness in the real world..

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