THE END OF HEALTH CARE: Part 2

David Hume the Philosopher noted that even if we observed millions of white swans, we cannot assume all swans are white. But if we only get one black swan, that is sufficient to disprove that not all swan is white. Scientific knowledge advances as the delicate interplay between theories which are clever guesses and eliminating errors in observation or practice. These small advances, when solved, take us toward larger problems, and in this way, we create real progress.

The iconoclastic Dr. Ben Goldacre noted how inaccuracies in articles are amplified simply by getting initial prominence from being quoted. We need contrarian views; the worst thing is the early consensus without questioning. Science must be messy; knowledge is difficult to generate and develop into wisdom. We must avoid early consensus trying to appear like we do not want to rock the boat. I am paying homage to the real power of science to debunk myths, how it teaches us about the limit of our knowledge and the vastness of our ignorance. I consider it a big success if all I propose is proved is wrong in practice. I have no interest in being quoted in journals and being a well-known scientist. It is the people in the field getting things done that matter.

I am always puzzled by a pattern that I notice that emerges when reading scientific journals and papers. Most authors will research some authoritative sources-which we never question- and the more sources we cite the better. If you can quote a hundred sources, the better, the more thorough, even if the reality is that so many people do not read all the papers, through and through and even then leave out those that do not fit in. We build on the shaky foundations of others. Progress yes is made on standing not just on the shoulder of giants but also in facing down these giants. Collecting data to retrofit into previous studies and build a nice-sounding theory or model. This just seems wrong. As a doctor, I was a victim of this approach. We are trained never to treat a patient we have not seen or examined. However, we accept the expert opinions, and experiences of others simply because we read them in a scientific journal even if it is called Lancet.

Sadly, some of the greatest recognized thinkers were armchair theorists, many were brilliant thinkers, and almost perfect in expressing their ideas in writing or speaking. We value elegance more than the dogged rough edges of uncertainty. What works well initially rarely looks nice. In hindsight, when we look back and retrofit, and discuss the past we can make it look well dressed. Theory always seems to follow practice. This is the big reason why many universities rarely contribute to innovative ways to get things done. What they do very well is in explaining things after the fact. What we call research is usually history warmed over and made to sound clever in writing. We are biased because we want our experts to be gods, confident, and supreme in the correctness of what they propose. We dislike those that are uncertain or self-critical. It is the confident expert brimming with unknown ignorance that is the most dangerous. We must allow doubt to creep into everything that we do, we must say no to the false gods of certainty.

Excerpt from Health Praxis: Public Health In Complex Times to be self published in 2021

#Public Health #Covid-19