The Dunning-Kruger Effect is Everywhere Now!

[Muse]

Good that the first doc didn't take a personal affront to the 2nd opinion. That's like a true professional.

Yes, he comes off as anything but arrogant. He doesn't seem at all excited with his job, however. First time I saw him was by video. He was ~45 minutes late and seemed harried to say the least. He's not going to cop an attitude with me, is my impression, which is a big plus for a doctor. Doesn't come off as a know-it-all!

 

[Torn Mind]

True Story: Medical Malpractice & Informed Consent | Patrick Malone Law

The doctor knew that there was an existing hole in the patient's skull. He didn't discuss it with him before the surgery. Drilled another hole and then tried to close it with surgical gelfoam, to contain the leakage of blood. And he didn't inform the patient of this surgical complication for obvious reasons. Patient developed short term memory loss and lost control of his temper because part of the brain that modulated emotions was affected. The doctor treated the patient nothing more than a sheep for his "experiment", even though he wasn't qualified for the particular procedure in this specific instance.

Just so happens this case occurred in my local county. I mean, I don't have time to research it now, but the records are in my backyard.

The appeal gets broadcasted to places like Findlaw. https://caselaw.findlaw.com/md-court-of-appeals/1240913.html

Billy Boone, there's a Sr. and Jr. The Sr. died in 2009, and I believe that's the one who had this case, as Jr. already had his own house by the time of the lawsuit.

The doc would close his practice but still get very nice jobs that would impress a neutral third party layperson(rife with ignorance) based on his linkedin. And the outcome of him paying off the debt, I'm not sure.

https://www.linkedin.com/in/sethgoldbergmd

 

[Muse]

Here’s an important question:

When a doctor has a hunch that his patient would receive better care elsewhere, should he inform the patient and send him to another provider?

I figure the answer is yes. I have asked at least 2 doctors that very question, including the doctor who proposed surgery on my finger around 10 weeks ago. I know it's a touchy question. Of course, 95+% of the time there's a doctor somewhere who's more qualified! But the logistics of getting finding and getting care from that doctor complicate the situation a lot most of the time. Getting into the details with the doctor who you are asking that question is something they are likely not anxious to engage in. Lots is unspoken, especially at my HMO where they seldom afford you the time and thoroughness you would hope for. My HMO (N. Calif. Kaiser Permanente) is very highly rated but they're a far cry from what is required to be great a great deal of the time.

 

[Torn Mind]

Here’s an important question:

When a doctor has a hunch that his patient would receive better care elsewhere, should he inform the patient and send him to another provider?

I figure the answer is yes. I have asked at least 2 doctors that very question, including the doctor who proposed surgery on my finger around 10 weeks ago. I know it's a touchy question. Of course, 95+% of the time there's a doctor somewhere who's more qualified! But the logistics of getting finding and getting care from that doctor complicate the situation a lot most of the time. Getting into the details with the doctor who you are asking that question is something they are likely not anxious to engage in. Lots is unspoken, especially at my HMO where they seldom afford you the time and thoroughness you would hope for. My HMO (N. Calif. Kaiser Permanente) is very highly rated but they're a far cry from what is required to be great a great deal of the time.

Well, it took an individual victimized, having to file suit in 2002, go through a trial, exhaust every appeal available under state law to get that final judgment that makes the principle legally mandatory until something else overturns it. . And that is only for the state of Maryland. So, for a few hundred years, no such rule was determined to be "the law".

That it had to become legally mandatory only hints that many in medicine might have done the same and gotten away with it.

 

[Torn Mind]

I have some recurring neck pain that could potentially be corrected with surgery but it's not serious enough to take the very real risk of making things worse per several doctors.

My ex-wife had carpal-tunnel surgery that was supposed to "fix" her hand and wrist issues and all it did long-term was trash her ability to lift heavy stuff with her wrists.

Surgery of any kind isn't something to go into lightly.

"Syndromes" like carpal tunnel usually have a muscular tightness component to it. If someone goes their entire life without addressing their muscles via DIY trigger point therapy, many aches will manifest and make life miserable; and it's all too common with the sedentary life.

I had a laceration and the intangible issues of the muscles seizing up was much more persistent than the wound itself. It's was a big yeouch when a therapist applied pressure on the forearm.

I've become quite adept at feeling out my own areas that could use some trigger point pressure.

 

[pmv]

If I have a medical issue I ain’t going to Joe Rogan.
Aaron Rogers is the perfect example of someone shopping for the answer they want vs the consensus of medical experts.

Tribalism when it comes to their health is just plain stupid

Not talking about tribalism.

The problem is there's a long history of cases of such a "consensus"among "experts" being entirely wrong for long periods of time.

And who do you count as being part of an "expert community" anyway?

The "consensus" can be wrong, because such communities of accredited "experts" are a socio-political phenomenon. They exist for social and political reasons, and their membership is determined by political, economic, and social factors, and are influenced by he same biases that influence the rest of a society.

For example, look how long it took to realise autism presents differently in girls, or heart attacks can present differently in women. Yes, it's in a sense 'self-correcting' but that process of correction can take a very long time - decades or even centuries.

For example, right now, as i understand it (and I might be wrong, not being an 'expert' myself), there's a shift in the idea that Chagas disease is not domestically spread in the US, but is a disease largely of immigrants from areas where it's endemic. They've discovered (largely by accident due to blood-donation screening) that its present in Americans who have never been to Latin America, and indeed they've now found that it's present in the insect population of several states. Hence people may be contracting it from insect bites within US borders.

They didn't consider this before because they'd never bothered to systematically check. I find it hard to believe that that failure to notice the domestic nature of the disease and the insistence it was a disease purely of foreign migrants had nothing to do with systemic bias towards national pride.

That is the one argument of climate-change deniers that I took seriously from the start - the idea that a 'false consensus' can emerge. Because there are many historical examples of that happening. Particularly in small fields (am I obliged to to believe the 'consensus of experts' on race and IQ, for example? Most of those who go into that field have an ideological agenda for doing so. In very small fields 'peer review' can be just fellow-believers agreeing with each other).

As it happens with Climate Change it soon became clear, as each alternative argument fell by the wayside, not fitting the observed facts, and particularly as the deniers kept resurrecting already-debunked arguments, that the bias and motivated reasoning was entirely on the denialist side.

Also, if you are going to weight "experts" by how prestigious are their positions and qualifications, when it comes to Constitutional law, you'd have to conclude that the verdicts of Alito, Thomas, Barratt, and Roberts, holding the most "prestigious" positions in the subject, can't be challenged by mere laypeople.

And when it comes to doctors - I had medical issues for decades - kept going to the accredited 'experts' and they kept telling me there was nothing physically wrong and it was all psychological. When I argued that maybe they (individually and collectively) didn't know everything (as there have always been medical issues that doctors as a profession didn't know about so why should our era be any different) they'd dismiss the idea and insist that _now_ they wouldn't miss anything. Their 'expertise' over-rode my own direct experience of what my body was telling me, apparently.

Aftter 30 years of this they finally did the right test to find I did indeed have a chronic, life-long, medical issue, and it turns out to be something medical science has only just (in the last few years) started to acknowledge, and still barely understands. (Every paper on it I find in the literature stresses how poorly-understood it is and how little it has been studied - though what case-histories and studies there are report symptoms identical to some of those I've been looking for an explanation for most of my life).

Or how about all the 'financial experts' who failed to see the financial crash coming? The 'experts' at the credit-rating agencies that rated junk mortgages AAA?

I'm not a fan of 'experts' as a group. They're part of the Professional Managerial Class and like all classes they have a class-interest that they defend. (Or, as George Bernard-Shaw put it "all professions are conspiracies against the laity")


I know this all concedes something to anti-vaxxers and climate-change-deniers (neither of whom I have any time for) but I don't think it can be helped. You can't simply invoke "the concensus" and declare that solves everything. It's more complicated than that.

 

[pmv]

Another example of how the "expert consensus" can be wrong, because of imbalances of power in society.

This has been a big story recently, that those oximeters are not as reliable as the 'expert concensus' told us they were, because they didn't test them sufficiently on darker-skinned people.

Racial bias and reproducibility in pulse oximetry among medical and surgical inpatients in general care in the Veterans Health Administration 2013-19: multicenter, retrospective cohort study

Objectives To evaluate measurement discrepancies by race between pulse oximetry and arterial oxygen saturation (as measured in arterial blood gas) among inpatients not in intensive care. Design Multicenter, retrospective cohort study using electronic medical records from general care medical...

www.bmj.com

Pulse oximeters’ measurements vary across ethnic groups: An observational study in patients with Covid-19 infection

The pulse oximeter provides regular non-invasive measurements of blood oxygenation and is used in a wide range of clinical settings [1]. The light wave transmission that this technology uses is modified by skin pigmentation and thus may vary by skin colour. A recent study of paired measures of...

erj.ersjournals.com

Again, it's being corrected, "science" working as intended - but how many people suffered negative concequences in the meantime before that happened?

 

[PowerEngineer]

I'm not a fan of 'experts' as a group. They're part of the Professional Managerial Class and like all classes they have a class-interest that they defend. (Or, as George Bernard-Shaw put it "all professions are conspiracies against the laity")

I know this all concedes something to anti-vaxxers and climate-change-deniers (neither of whom I have any time for) but I don't think it can be helped. You can't simply invoke "the concensus" and declare that solves everything. It's more complicated than that.

Well, perhaps I haven't made my thoughts completely clear (yet again). I never "simply" invoked reliance on the consensus of experts as a silver bullet solution to everything (or even any one thing). And I never suggested that the consensus of experts is always going to be correct (in fact I pointed out that an expert consensus changes with new facts). What I did (and still do) suggest is that generally the consensus of experts is far more likely to be true than an alternative you choose from a menu of unsupported alternatives. IMHO if you want to be right as often as possible then go with the consensus of the experts.

And I'm not an expert on this, but not being a "fan of experts" suggests that you might be suffering from a mild case of the general suspicion and distrust of experts that drives the madness of the anti-vaxers and climate-change-deniers. 😋

 

[igor_kavinski]

Aftter 30 years of this they finally did the right test to find I did indeed have a chronic, life-long, medical issue

If you don't mind, what is the medical term for it?

 

[pmv]

Well, perhaps I haven't made my thoughts completely clear (yet again). I never "simply" invoked reliance on the consensus of experts as a silver bullet solution to everything (or even any one thing). And I never suggested that the consensus of experts is always going to be correct (in fact I pointed out that an expert consensus changes with new facts). What I did (and still do) suggest is that generally the consensus of experts is far more likely to be true than an alternative you choose from a menu of unsupported alternatives. IMHO if you want to be right as often as possible then go with the consensus of the experts.

And I'm not an expert on this, but not being a "fan of experts" suggests that you might be suffering from a mild case of the general suspicion and distrust of experts that drives the madness of the anti-vaxers and climate-change-deniers. 😋

Well, I agree that accepting the "expert consensus" is usually by far the safer option.
The problem arises when that clashes with your personal direct experience of something. Often that's because the experts have a kind of demographic homogeneity and you're part of an 'out group'. An obvious example would be all the times a mostly-male medical profession ignored the experiences of women. I do think you still have to try your best to think critically about a subject for yourself. If honest one will usually end up deciding the expert consensus stands on its own merits.
(I mean, one can talk about appointments to the Supreme Court being a political process, but there's an element of politics and economics and sociology about access to every kind of elite 'expert' profession, Constitutional law being probably just the most extreme and obvious case).

I don't know what the answer is. Possibly there isn't one as long as power (and education, and access to knowledge and the means of acquiring it) is unevenly distributed in a society. In such a context "expert status" is never going to be exclusively and purely a matter of merit and knowledge, it's always going to be distorted by power imbalances.

I may have some of the same ailment (political ailment, not the physical one!) that anti-vaxxers and the others have - it seems to me there's a bit of class or race-based resentment behind much of that. Also in the US class-resentment tends to take a much more right-wing direction than it does elsewhere, possibly because of the salience of race.
(This is P&N stuff, but this thread was a political topic from the start, really)

 

[pmv]

If you don't mind, what is the medical term for it?

Really tempted to answer that, but I feel hesitant at giving too much such specific information.

Point is that it turned out to be something very rare, which apparently can present with a vast range of different symptoms. Have spent ages googling scientific papers about it, and most of them go on and on about how poorly-understood it is. One "pilot study" trying to establish the typical presenting symptoms of it was only published a year ago, but there are loads of case-histories of people with it suffering a huge range of different symptoms, including 'sudden death'.
The rarity and diversity of the symptoms is why it ends up only being diagnosed via a clinical test (or sometimes post-mortem), not from the presenting symptoms. And it took decades to actually get that test because the 'experts' thought they knew more than they did.

Someone did point out that this is a case where the US system might have done better - US doctors being so scared of being sued that they err on the side of caution and employ a barrage of expensive tests "just in case".
Thus I might have had the right test to diagnose this decades earlier. The NHS was set up to provide mass health-care as cheaply as possible, giving as many people as possible 'good enough' care, but I don't think it's that great at dealing with 'outliers', like very rare conditions.

On the other hand, had I been in the US I would probably have gone bankrupt while looking for a diagnosis, and paying for the eventual treatment. I had a lot of NHS money spent on me doing the wrong tests over many years.

 

[Torn Mind]

Another example of how the "expert consensus" can be wrong, because of imbalances of power in society.

This has been a big story recently, that those oximeters are not as reliable as the 'expert concensus' told us they were, because they didn't test them sufficiently on darker-skinned people.

Racial bias and reproducibility in pulse oximetry among medical and surgical inpatients in general care in the Veterans Health Administration 2013-19: multicenter, retrospective cohort study

Objectives To evaluate measurement discrepancies by race between pulse oximetry and arterial oxygen saturation (as measured in arterial blood gas) among inpatients not in intensive care. Design Multicenter, retrospective cohort study using electronic medical records from general care medical...

www.bmj.com

Pulse oximeters’ measurements vary across ethnic groups: An observational study in patients with Covid-19 infection

The pulse oximeter provides regular non-invasive measurements of blood oxygenation and is used in a wide range of clinical settings [1]. The light wave transmission that this technology uses is modified by skin pigmentation and thus may vary by skin colour. A recent study of paired measures of...

erj.ersjournals.com

Again, it's being corrected, "science" working as intended - but how many people suffered negative concequences in the meantime before that happened?

I believe the field of nutrition science has a pretty egregious example of "accepting the advice" that wound up harming the acceptors more than the rejecters. Those who stopped consuming saturated fats in favor of unsaturated "trans" fats.

Why it took the FDA nearly 40 years to ban trans fats

Science on the health hazards of trans fats was already piling up by the 1970s.

www.vox.com

Even the article writer remains "protective" of science rather than calling out that the "mainstream science" of the past was in error.

The lag between science and policy on trans fats is a fascinating case study in the weird world of health policy-making — and how scientists and industry lobbyists can inadvertently collude to cause unnecessary disease and death.

The collusion was not inadvertent, and the rest of the article even point out the corruption and power of "industry scientists". It's that industry established the mainstream of the time. Here, we can infer the slant and bias of the journalist and mark this paragraph as present for the sole purpose of being a mental opiate. .


As i have some educational background in economics, the most prominent thing that about "nutrition science" is that "variable disambiguation" is something that is avoided when communicating "solutions" to the lay public, and even in the process of studying things.

Even a basic, well-established fact is usually not parroted at all, such as high insulin levels stops fat metabolism.


The process of "science" does create a sort of immunity and a defense of legal privilege that protects "science" from liability. Damages occur but to hold someone or a group of people for those damages is probably not possible, or very difficult to argue for.

The usual means to legally obtain compensation from damages is a tort action, usually predicated on a count of negligence. Meaning, someone breached their legal duty of care.

The humans executing science are still subject human tendencies like money and advocating an agenda...just that their domain happens to have some sort of robust correction mechanism, but it's not a perfect system and certainly not "self-correcting". A contrarian has to dig their heels in and many only get their points revived after they are long dead.

For the knowledge of trans fats being dangerous, it took a at least few hundred thousand people to take one for the team and screw up their own bodies. A de facto sacrifice of sorts.

 

[PowerEngineer]

Well, I agree that accepting the "expert consensus" is usually by far the safer option.
The problem arises when that clashes with your personal direct experience of something. Often that's because the experts have a kind of demographic homogeneity and you're part of an 'out group'. An obvious example would be all the times a mostly-male medical profession ignored the experiences of women. I do think you still have to try your best to think critically about a subject for yourself. If honest one will usually end up deciding the expert consensus stands on its own merits.
(I mean, one can talk about appointments to the Supreme Court being a political process, but there's an element of politics and economics and sociology about access to every kind of elite 'expert' profession, Constitutional law being probably just the most extreme and obvious case).

I don't know what the answer is. Possibly there isn't one as long as power (and education, and access to knowledge and the means of acquiring it) is unevenly distributed in a society. In such a context "expert status" is never going to be exclusively and purely a matter of merit and knowledge, it's always going to be distorted by power imbalances.

I may have some of the same ailment (political ailment, not the physical one!) that anti-vaxxers and the others have - it seems to me there's a bit of class or race-based resentment behind much of that. Also in the US class-resentment tends to take a much more right-wing direction than it does elsewhere, possibly because of the salience of race.
(This is P&N stuff, but this thread was a political topic from the start, really)

You make a valid point about expert consensus in medicine usually reflecting studies and experience with only portions (hopefully large ones) of the general population. It makes sense for individuals who have reason to think they are abnormal (in the sense of being significantly different from the normal population in an important way) to be careful when accepting the medical consensus for the general population. IMHO we need to be cautious when judging just how abnormal we really are (medically and otherwise). The unavoidable truth is that most of us are average by definition. 😊

I also agree that there is no clearly established or foolproof method for identifying experts or measuring their consensus, but maybe that's a good thing? Anyway, I think it still makes sense to do our best to seek out the expert consensus and give it a heavy weight in our decision making when making a personal choice.

And I appreciate the thoughtful discourse. 👍🏻

 

[pmv]

If you don't mind, what is the medical term for it?

Not going into such stuff here, but (having just tried and failed again) I do want to add the gripe that I've looked for forums specific to this condition, and not only are there almost none out there, but the couple I found have only had a handful of posts in the last 20 years (mostly saying "does anyone know anything about this?" and getting no replies).

It is incredibly frustrating trying to find information or 'support group' type things for rare conditions. And it's dispiriting finding peer-reviewed papers that all say things like "the paucity of literature on this topic is shocking" or that were only published a year ago and describe a "pilot study" that concludes "more research is needed".