Friday, 10 May 2013-Doctor Skeptic
“Recently, while debating a respected colleague regarding a shift in practice towards treatment X, despite a lack of evidence showing its superiority, my colleague said: “But we know that practice always runs ahead of the evidence”. He was implying that the evidence would one day catch up and justify the practice. I wondered if medical practice really was running ahead of the evidence, or whether it was running away from it.
When clinical practice does run away from the evidence, we tend to spend our time gathering evidence to support the current practice, instead of using an objective evaluation of the current evidence to inform future practice. This is known as putting the cart before the horse. It is also known as Confirmation Bias.
Like the ghosts in The Sixth Sense, many clinicians and researchers only see what they want to see. I am not referring to a conscious process, where a deliberately biased argument is created (case-building) such as in a debate. In medical practice it is usually subconscious, where the selection of patients, measurement tools, outcomes and time-points tends to favour the beliefs of the researcher, and the researcher’s biases are then confirmed.
Even if the evidence is not clearly supportive, some may interpret the results as confirming their pre-conceived beliefs. This is also confirmation bias.
Confirmation bias is seeking, interpreting or recalling evidence in a way that is favourable to existing beliefs, expectations or hypotheses. And it is one of the most problematic aspects of human reasoning.
The bottom line
Many clinicians are running their practice on confirmation bias, or less. I think trends (read: fashions) in current practice should slow down and wait until the evidence catches up. The two can then travel together, preferably with the evidence doing the driving.”
And this would be a self check against research that is invalid. As a Joe Blow citizen I can sack a theory much easier than someone whose job, grant or means of livelihood depends on a correct diagnosis.
In psychiatry this might mean a force fit of the person to the diagnosis-iatrogensis.
Diagno$i$ has a clearer meaning in terms of $takeholder$:
“The term “stakeholder”, as traditionally used in the English language in law and notably gambling, is a third party who temporarily holds money or property while its owner is still being determined.
* More recently a very different meaning of the term has become widely used in management. In a business context, a “stakeholder” is a person or organization that has a legitimate interest in a project or entity. The new use of the term arose together with and due to the spread of corporate social responsibility ideas, but there are also utilitarian and traditional business goals that are served by the new meaning of the term (see Stakeholder theory and below).
”==In law== The role of stakeholder is a very old concept in law. A stakeholder was originally a person who temporarily holds money or other property while its owner is being determined. This is, for example, the situation when two persons bet on the outcome of a future event and ask a third, disinterested, neutral person to hold the money (or “stake[s]”) that they have wagered (or “staked”)). After the event occurs, the stakeholder distributes the stakes to one or both of the original (or other) parties according to the outcome of the event and according to the previously decided conditions. Courts sometimes act as stakeholders, holding property while litigation between the possible owners resolves the issue in which one is entitled to the property. Trustees also often act as stakeholders, holding property until beneficiaries come of age, for example. An “escrow agent” is one kind of trustee who is a stakeholder, usually in a situation where part of the purchase price of property is being held until some condition is satisfied. In legal documents, the escrow agent is often referred to as a “mere stakeholder.” ”
Systemic cogs that grind out the finer points of our human-ness.