5 ms·

I appreciate the appeal to reason and evidence, but these arguments miss the root: trust. Many people don't trust the medical establishment. If more people did

I appreciate the appeal to reason and evidence, but these arguments miss the root: trust. Many people don't trust the medical establishment. If more people did trust the medical establishment to consistently provide optimal treatments and self-correct in case of error, the whole nonsense over vaccines would never have happened. And if someone doesn't trust you, look in the mirror. I mean, look hard. The authors of TFA look in the mirror, love what they see, and ask the reader, "how can you not love me too?"

tokenadult 13y ago
And if someone doesn't trust you, look in the mirror. What do you do to gain trust if someone is continually spreading rumors about you behind your back? http://briandeer.com/mmr/lancet-summary.htm http://briandeer.com/mmr/lancet-summary.htm
- msandford 13y ago
  Well, certainly you don't let things like this happen: http://scienceblogs.com/insolence/2013/09/20/patients-endangered-by-failure-of-medical-boards/ http://scienceblogs.com/insolence/2013/09/20/patients-endang...
  - tokenadult 13y ago
    The author of that thoughtful blog post is, of course, one of the editors at Science-Based Medicine. http://www.sciencebasedmedicine.org/editorial-staff/david-h-gorski-md-phd-managing-editor/ http://www.sciencebasedmedicine.org/editorial-staff/david-h-... On his personal blog he uses the screen name "Orac," but he is the same person.
    - msandford 13y ago
      I guess the problem is that on the one hand he's imploring people to trust the science and those performing it, and on the other hand he's showing that those performing it aren't necessarily trustworthy. It's hard for me to look at those two articles and reconcile the information from one of them with the information from the other. Furthermore I have HUGE problems with people saying "LOOK SCIENCE!!" with anything other than physics or chemistry. In those areas where the interactions take place incredibly quickly and there are few compounding variables I love me some science just as much as the next guy. When you start talking about organisms where everything is potentially a confounding variable it's a lot harder for me to excited about things being "proven" via science. For example, fat used to be fine, then in the 80s and 90s it wasn't, now in the aughts and teens it might be again depending on which doctors you talk to. I mean, right now you can't even tell if it's better to get small infrequent doses of no-sunscreen daylight (for the vitamin D) or not. The doctors and scientists are split on this one and there's no real discernable pattern as to which goes on which side. http://www.skincancer.org/healthy-lifestyle/vitamin-d/the-d-dilemma http://www.skincancer.org/healthy-lifestyle/vitamin-d/the-d-... Given that 10 years ago there was no debate whatsoever and now there's a huge debate raging it makes a person a bit circumspect when taking the advice of those who purport to "know" something.
- pradocchia 13y ago
  The issue has been looked at by various think tanks. The question of trust is relevant to public health policy of course, but also to other areas of governance. If the response is simply "better messaging", that will backfire eventually. Then again, there may be systemic constraints on a more substantive response. A major breakthrough in obesity, chronic disease and/or aging would reset public sentiment.
logicchains 13y ago
Statistically speaking, people have reasons to distrust the competence of doctors. From the article here http://online.wsj.com/article/SB10001424127887323423804579023113596120826.html http://online.wsj.com/article/SB1000142412788732342380457902..., for instance: "Both studies also found that about 25% of the time antibiotics were being prescribed for conditions in which they have no use, such as viral infections." Anybody who's studied even high school level microbiology (or spent a minute on the Wikipedia article on antibiotics) knows that antibiotics only work on bacteria, not viruses. I imagine it's hard for people to trust doctors when they make basic mistakes like that. Even the CDC (http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-...) has stated that: "Up to half of antibiotic use in humans and much of antibiotic use in animals is unnecessary and inappropriate and makes everyone less safe". So if doctors can't even be trusted to not prescribe antibiotics as treatment for viral infections, why would people trust them regarding other more complex matters?
- tokenadult 13y ago
  The issue you bring up is the topic of the recent Science-Based Medicine post, "The Overuse of Antibiotics for Viral Infections in Children" (2 August 2013), http://www.sciencebasedmedicine.org/the-overuse-of-antibiotics-for-viral-infections-in-children/ http://www.sciencebasedmedicine.org/the-overuse-of-antibioti... and that is far from the first time that the site has brought up that issue. Some doctors are rolling up their sleeves and taking personal time after work to inform other doctors about this issue and other issues for improving patient care.
  - logicchains 13y ago
    Well then maybe if there was some kind of register of the doctors that did in fact practice science based medicine, public trust would be improved, although I imagine there's probably some legal or political obstacle standing in the way of that.
- 3am 13y ago
  Doctors are overwhelmingly not the reason that this happens. Some are being risk averse (heading off unlikely 2ary bacterial infections to prevent lawsuites) and some are taking the path of least resistance with patients (who will doctor shop until they get some medicine). This is just my firsthand experience with doctors and anecdotes. _Every single doctor_ is aware know the (lack of) efficacy of antibiotics against viral infections. I'm am completely comfortable with the blanket assertion, and I'm pretty sure you are wrong if you think otherwise.

tokenadult 13y ago

And if someone doesn't trust you, look in the mirror. What do you do to gain trust if someone is continually spreading rumors about you behind your back? http://briandeer.com/mmr/lancet-summary.htm http://briandeer.com/mmr/lancet-summary.htm

msandford 13y ago
Well, certainly you don't let things like this happen: http://scienceblogs.com/insolence/2013/09/20/patients-endangered-by-failure-of-medical-boards/ http://scienceblogs.com/insolence/2013/09/20/patients-endang...
- tokenadult 13y ago
  The author of that thoughtful blog post is, of course, one of the editors at Science-Based Medicine. http://www.sciencebasedmedicine.org/editorial-staff/david-h-gorski-md-phd-managing-editor/ http://www.sciencebasedmedicine.org/editorial-staff/david-h-... On his personal blog he uses the screen name "Orac," but he is the same person.
  - msandford 13y ago
    I guess the problem is that on the one hand he's imploring people to trust the science and those performing it, and on the other hand he's showing that those performing it aren't necessarily trustworthy. It's hard for me to look at those two articles and reconcile the information from one of them with the information from the other. Furthermore I have HUGE problems with people saying "LOOK SCIENCE!!" with anything other than physics or chemistry. In those areas where the interactions take place incredibly quickly and there are few compounding variables I love me some science just as much as the next guy. When you start talking about organisms where everything is potentially a confounding variable it's a lot harder for me to excited about things being "proven" via science. For example, fat used to be fine, then in the 80s and 90s it wasn't, now in the aughts and teens it might be again depending on which doctors you talk to. I mean, right now you can't even tell if it's better to get small infrequent doses of no-sunscreen daylight (for the vitamin D) or not. The doctors and scientists are split on this one and there's no real discernable pattern as to which goes on which side. http://www.skincancer.org/healthy-lifestyle/vitamin-d/the-d-dilemma http://www.skincancer.org/healthy-lifestyle/vitamin-d/the-d-... Given that 10 years ago there was no debate whatsoever and now there's a huge debate raging it makes a person a bit circumspect when taking the advice of those who purport to "know" something.
pradocchia 13y ago
The issue has been looked at by various think tanks. The question of trust is relevant to public health policy of course, but also to other areas of governance. If the response is simply "better messaging", that will backfire eventually. Then again, there may be systemic constraints on a more substantive response. A major breakthrough in obesity, chronic disease and/or aging would reset public sentiment.

logicchains 13y ago

Statistically speaking, people have reasons to distrust the competence of doctors. From the article here http://online.wsj.com/article/SB10001424127887323423804579023113596120826.html http://online.wsj.com/article/SB1000142412788732342380457902..., for instance: "Both studies also found that about 25% of the time antibiotics were being prescribed for conditions in which they have no use, such as viral infections." Anybody who's studied even high school level microbiology (or spent a minute on the Wikipedia article on antibiotics) knows that antibiotics only work on bacteria, not viruses. I imagine it's hard for people to trust doctors when they make basic mistakes like that. Even the CDC (http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-...) has stated that: "Up to half of antibiotic use in humans and much of antibiotic use in animals is unnecessary and inappropriate and makes everyone less safe". So if doctors can't even be trusted to not prescribe antibiotics as treatment for viral infections, why would people trust them regarding other more complex matters?

tokenadult 13y ago
The issue you bring up is the topic of the recent Science-Based Medicine post, "The Overuse of Antibiotics for Viral Infections in Children" (2 August 2013), http://www.sciencebasedmedicine.org/the-overuse-of-antibiotics-for-viral-infections-in-children/ http://www.sciencebasedmedicine.org/the-overuse-of-antibioti... and that is far from the first time that the site has brought up that issue. Some doctors are rolling up their sleeves and taking personal time after work to inform other doctors about this issue and other issues for improving patient care.
- logicchains 13y ago
  Well then maybe if there was some kind of register of the doctors that did in fact practice science based medicine, public trust would be improved, although I imagine there's probably some legal or political obstacle standing in the way of that.
3am 13y ago
Doctors are overwhelmingly not the reason that this happens. Some are being risk averse (heading off unlikely 2ary bacterial infections to prevent lawsuites) and some are taking the path of least resistance with patients (who will doctor shop until they get some medicine). This is just my firsthand experience with doctors and anecdotes. _Every single doctor_ is aware know the (lack of) efficacy of antibiotics against viral infections. I'm am completely comfortable with the blanket assertion, and I'm pretty sure you are wrong if you think otherwise.