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How on earth do you separate causation from correlation in such cases? To actually know this you'd need a group of random patients to "give up the fight" and c

How on earth do you separate causation from correlation in such cases? To actually know this you'd need a group of random patients to "give up the fight" and compare them to a control group. And you'd need the caregivers to not know which group is which. A coach tells the team: "you lost because you gave up" -- to which they respond, "we gave up because we lost."

diminoten 8y ago
The point is the team didn't lose until the game was over, but they stopped trying before the game was over, and perceived the outcome as inevitable. The coach is trying to tell the team that giving up before the outcome is actually certain is what caused the loss, and the team is incorrect to claim that they had lost before they actually had.
gowld 8y ago
You can tease it apart by carefull measuring the order in which events occur. In medicine, you can measure various biological entities as well as psychological profile, and see to what extent psychologcal changes can affect biological changes. (Of course, psychology itself is in large part its own biological process.) But you can do experiments like psychological interventions (counseling, inspirational/depressing media content) and see if some tend to cause statistically significant biological changes. There are some obvious cases like if you hurt yourself and don't care enough to clean up or seek care, you risk infection or permanent injury.
deleted 8y ago
[deleted]
tonyedgecombe 8y ago
Atul Gawande's book mentions a study that showed people who received hospice care lived longer than those who got chemotherapy.
- cyberpunk0 8y ago
  Well yeah... Chemo is incredibly difficult on the body, not surprising it would significantly shorten your lifespan.
- vkou 8y ago
  Was hospice vs chemotherapy randomly distributed to the control group, with no patient or doctor choice on the matter? Because otherwise, there's a million statistical biases that can creep into that outcome.
  - tonyedgecombe 8y ago
    I can't remember the exact details now but that was how I interpreted it at the time I read it.
    - vkou 8y ago
      How on earth did they get ethical approval to run this study? "So, do you want to enter into a 50/50 lottery, where we will either try to treat you, or let you die in peace? You don't get a choice of which, by the way." Even if I was a cancer patient with an extremely poor outlook, I would probably have some pretty strong preference in the question of whether I wanted chemo, or end-of-life care.
      - olliej 8y ago
        I agree, it seems unlikely that you could get an IRB sign off any study that wasn't simply post-death statistic study. You /could/ try to control that by try to separate the groups into "type of cancer" and "stage", so that you're comparing like-to-like when looking at mortality. But even then there are problems ("stages" are subjective, and there's evidence that they're slowly shifting so that old stage three would now be considered stage four), different Drs may be more aggressive at directing people to chemo, etc. I think there's also basic issues of what we're comparing, e.g. are you undergoing chemo in an attempt to live a bit longer, or as an attempt to not die. Because at the "you're going to die within 3-6 weeks" you're going to get radically different survival rates for chemo than "you're going to die in 3-6 years". Which makes me wonder how you would deal with "EoL" chemo that does cause the cancer to die back? I'm having trouble wording it, but what I'm curious about is what happens when you have a patient that 1. Is dying, and given 3 months to live. Can choose between chemo and hospice 2. Chemo successfully pushes the cancer back 3. Cancer comes back 5 years later 4. Patient chooses hospice 5. Patient "dies in hospice" 3 months later. Which group should the patient be placed in? This is why I'm glad nothing I do impacts peoples health/safety/etc
phkahler 8y ago
>> How on earth do you separate causation from correlation in such cases? The other responses are better, but I think the stories of the prisoners should be enough to believe it. They watched people around them go through the progression with no apparent illness or other causes of decline. They didn't mention but I don't think they were just talking about old people where life may have just run its course. "This sucks, I'm done" seems to fit better than anything.
coldtea 8y ago
>How on earth do you separate causation from correlation in such cases? You don't always need (or can afford to have) a full control group and 100% separation causation from correlation. Sometimes you can just draw the obvious conclusions from the events you see and only rationally eliminate other causes.

diminoten 8y ago

The point is the team didn't lose until the game was over, but they stopped trying before the game was over, and perceived the outcome as inevitable. The coach is trying to tell the team that giving up before the outcome is actually certain is what caused the loss, and the team is incorrect to claim that they had lost before they actually had.

gowld 8y ago

You can tease it apart by carefull measuring the order in which events occur. In medicine, you can measure various biological entities as well as psychological profile, and see to what extent psychologcal changes can affect biological changes. (Of course, psychology itself is in large part its own biological process.) But you can do experiments like psychological interventions (counseling, inspirational/depressing media content) and see if some tend to cause statistically significant biological changes. There are some obvious cases like if you hurt yourself and don't care enough to clean up or seek care, you risk infection or permanent injury.

deleted 8y ago

[deleted]

tonyedgecombe 8y ago

Atul Gawande's book mentions a study that showed people who received hospice care lived longer than those who got chemotherapy.

cyberpunk0 8y ago
Well yeah... Chemo is incredibly difficult on the body, not surprising it would significantly shorten your lifespan.
vkou 8y ago
Was hospice vs chemotherapy randomly distributed to the control group, with no patient or doctor choice on the matter? Because otherwise, there's a million statistical biases that can creep into that outcome.
- tonyedgecombe 8y ago
  I can't remember the exact details now but that was how I interpreted it at the time I read it.
  - vkou 8y ago
    How on earth did they get ethical approval to run this study? "So, do you want to enter into a 50/50 lottery, where we will either try to treat you, or let you die in peace? You don't get a choice of which, by the way." Even if I was a cancer patient with an extremely poor outlook, I would probably have some pretty strong preference in the question of whether I wanted chemo, or end-of-life care.
    - olliej 8y ago
      I agree, it seems unlikely that you could get an IRB sign off any study that wasn't simply post-death statistic study. You /could/ try to control that by try to separate the groups into "type of cancer" and "stage", so that you're comparing like-to-like when looking at mortality. But even then there are problems ("stages" are subjective, and there's evidence that they're slowly shifting so that old stage three would now be considered stage four), different Drs may be more aggressive at directing people to chemo, etc. I think there's also basic issues of what we're comparing, e.g. are you undergoing chemo in an attempt to live a bit longer, or as an attempt to not die. Because at the "you're going to die within 3-6 weeks" you're going to get radically different survival rates for chemo than "you're going to die in 3-6 years". Which makes me wonder how you would deal with "EoL" chemo that does cause the cancer to die back? I'm having trouble wording it, but what I'm curious about is what happens when you have a patient that 1. Is dying, and given 3 months to live. Can choose between chemo and hospice 2. Chemo successfully pushes the cancer back 3. Cancer comes back 5 years later 4. Patient chooses hospice 5. Patient "dies in hospice" 3 months later. Which group should the patient be placed in? This is why I'm glad nothing I do impacts peoples health/safety/etc

phkahler 8y ago

>> How on earth do you separate causation from correlation in such cases? The other responses are better, but I think the stories of the prisoners should be enough to believe it. They watched people around them go through the progression with no apparent illness or other causes of decline. They didn't mention but I don't think they were just talking about old people where life may have just run its course. "This sucks, I'm done" seems to fit better than anything.

coldtea 8y ago

>How on earth do you separate causation from correlation in such cases? You don't always need (or can afford to have) a full control group and 100% separation causation from correlation. Sometimes you can just draw the obvious conclusions from the events you see and only rationally eliminate other causes.