Sometimes I wish … http://www.nature.com/nature/journal/v489/n7414/full/489170a.html
I’m afraid to say, you’re not allowed science any more :)
Comment by Kamran Agayev A. — September 7, 2012 @ 12:56 pm GMT Sep 7,2012
It’s a cute story and the case for vaccination is pretty clear-cut, but science and risk analysis are not as simple as the story would like to portray. Today science is changing so fast it’s even hard for scientists to keep up. Are eggs good for you or bad for you? What about Salmon; healthy or not? Omega-3 oils are good, Mercury in the fish not so much. Protein good, cholesterol bad, wait two, no three types of cholesterol, some good, some bad… Everyone must agree that smoking is bad for you… yeh, it’s not a stick full of vitamins but it shortens life spans from an average of 83 years old to 75 years old. Why does society feel compelled to force everyone to live as long as possible. Am I devoid of science if I smoke?
We modern people make thousands of decisions a day, very few are consciously performed and fewer still do we put thoughtful time in prior to acting.
I once heard that, and it makes sense to me but it may not have science behind it, that evolution has programmed us to jump when the bush rattles. Even if most of the time it’s just the wind, if we didn’t jump and it was a predator our genes would be removed from the pool. That’s why when confronted with even perceived danger our two choices are fight or flight, and not rationalize for a while whether or not there’s a real danger. It takes years of repetitious drills to teach people, pilots for instance, to not panic in dangerous situations, assess all options with the outer edges of the brain and not with the primitive core, and decisively arrive at the decision with the greatest chance of success.
The story also sends a very mixed message. I wonder what women were told who took Thalidomide? Were they reassured by their doctors that it was completely safe? I bet you a nickel that at that time, no one even asked their doctor if it was. We’re seeing messages from ‘authorities’ that we need to be more involved in our health care. That asking questions of our doctors is good. But this story either wants the mother to do what she’s told or to spend a lot of time and effort researching a singular decision. Or is the message, listen to science because we always know best? So why do we constantly read stories of approved drugs being pulled from shelves due to catastrophic side-effects. We’re to believe that those drugs didn’t get really scienced-up when they were approved but this shot of vaccine did?
I’m a person of reason to be sure, but I’m getting a little suspect of the “Science as the new Infallible Pontiff” cult.
Comment by Mark Brady — September 7, 2012 @ 4:44 pm GMT Sep 7,2012
Thank you for taking the time to comment.
“But this story either wants the mother to do what she’s told or to spend a lot of time and effort researching a singular decision.
If your re-read the first four lines of the story you will see that (a) the woman wants the doctor to make a yes/no decision for her; and (b) the time and effort she’s being asked to expend is the time and effort needed to read a leaflet that (apparently) gives some indication of how to assess the risk levels. On a cost/benefit analysis of how much time to spend considering which risks, I think that reading the pamphlet is a good bet if you’re worried about the risk to your children. (Parenthetically, I sometimes end up in the position where I say “Based on what you have told me, this change will be beneficial and will cause no problems” and get the response “Will you sign this piece of paper to guarantee that absolutely nothing will go wrong?”)
So why do we constantly read stories of approved drugs being pulled from shelves due to catastrophic side-effects
Maybe it’s because bad news sells better than good news. A few years ago there was a big news story in the UK about a (small group) drug trial that went badly wrong because of unexpected side effects – but strangely none of the media reports suggested that it’s necessary to have tests, and that sometimes tests are going two identify problems, and that we do small tests to reduce the risk of finding the problems only when it’s too late and many more people will be affected. Here’s a thought about testing – I don’t plan to have laser surgery on my eyes until a few people have had it done at age 20 and shown no side effects for 55 years … does that sound like a sensible strategy ?
“Why does society feel compelled to force everyone to live as long as possible.”
In the UK it seems to be the influence of the church on political life. I believe public opinion polls show something like 70% to 80% of the population in favour of assisted dying, but any changes to the law somehow end up being blocked by people arguing the religious case for the sanctity of life.
Comment by Jonathan Lewis — September 7, 2012 @ 6:17 pm GMT Sep 7,2012
By asking what the story wants I meant the moral of the story, not the text. The story is allegorical, not historical so I’m reading more into it than what’s actually written. Even if the mother had read the pamphlet the implicit assumption is that then she would be transformed into someone who can accurately measure risks. The pamphlet would have accurately described the actual risk of having the shot versus the potential risk of getting the disease. And what if after reading the pamphlet and understanding the risk she still decided to forego the injections? My gut feeling is that the author would still deny her science. Agree? For you and me that’s easy to understand, but for most people, that assessment isn’t simple. The here and now will outweigh the potential and future irrespective of facts almost every time, in most people’s lives.
I had a longer post but edited it out, so thanks for making my point. Bad news does sell; and the more a tabloid over-exaggerates the risks the better. This has a large impact of the risk assessment capability of the vast majority of Americans (I won’t speak for others). The one, grieving mother who claims her child has been damaged by a vaccine make the evening news night after night. Whereas It’s impossible to show millions of kids who didn’t die of whooping cough or measles. That forms a level of conditioning, of inculcating, that one doctor with one pamphlet cannot overcome. I hold those accountable (not the right word) who do not watch news coverage with a jaundice eye and a grain of salt. But I also believe that they are not ignoring science, they are just having well deserved confusion distinguishing the hype from the reality.
As to the comment about wanting people to live as long as possible. I was more referring to anti-smoking crusaders and the Mayor of NYC banning large sodas and large popcorns. One dimension of the parable in the story is, if you choose to ignore science when it helps you live longer, you’re no longer allowed to make decisions – “no longer have a say”. My point is why do I have to live longer? I know lots of very intelligent smokers, in fact I know doctors who smoke. They aren’t ignoring the science; they’re simply making a choice to live with the consequences of their actions. I do not exercise as much as science says I should to prolong my life. I’ve seen scientific studies which show doing crossword puzzles delays Alzheimer’s. If people don’t do crosswords should they “no longer have a say”? What if, hypothetically, there was a choice, and the scientific literature to back it up, to have unbelievable sex every day and die at 70 or never have sex again and die at 120
Outside the topic of the story, I think that testing is a tricky business. Releasing a drug too soon could harm people. But so could testing it for too long. Everyday a cure isn’t delivered for disease X means more people die from it. I don’t know that there’s a perfect answer.
Comment by Mark Brady — September 7, 2012 @ 7:04 pm GMT Sep 7,2012
As I said to Mladen, I posted the link because of my reaction to the line: “you’re not allowed science any more”; and while I think the discussion we’re having is one that everyone should be involved with somewhere, blog comments are probably not the best place to do it. Nevertheless I’m happy to bounce a few ideas around.
The story is allegorical, not historical so I’m reading more into it than what’s actually written.
I think that’s perfectly reasonable, and I agree – but I think there’s a point where you can read in so much that the author didn’t write that your interpretation moves away from the allegory. The author COULD have written the story to say the woman read the pamhplet and either responded with (a) “it’s too difficult to choose”, or (b) “you’re trying to blind me with science” or (c) “I can now make an informed decision” – any of these options would allow for a different allegory; but the author stopped at “I don’t want to try.”
I was more referring to anti-smoking crusaders and the Mayor of NYC banning large sodas and large popcorns.
I couldn’t work out quite why those comments fitted in earlier on, but I now understand – if someone wants to follow a lifestyle that shortens their life you have to address a lot of ethical questions before you claim the right to stop them. The point didn’t connect for me – even though I now remember seeing it – because it was probably a two-line note on page 27 under “in other international news”.
In the UK, of course, with the background of the National Health Service, one of the ethical arguments that comes into play is that a person who eats fourteen “pie, beans and chips” per day and weighs 450 pounds as a consequence is going to deny NHS resources to other people. Should the group explicitly remove rights/privileges (and where’s the line between rights and privileges) from the individual, or should the individual implicitly be allowed to take advantage of the group ? (Your “sex until 70” comment, of course, is just another example of the same – is the group allowed to question how many people you are depriving of what resource when you make your choice.)
Comment by Jonathan Lewis — September 8, 2012 @ 10:05 am GMT Sep 8,2012
Are you sure the smokers are making such a choice? They may have decided to smoke, but the science behind addiction shows quite a change in free will (if there is such a thing) once they are snared. People will go to great lengths to rationalize that away, too.
It is difficult for people to analyze their own risk, and it is difficult to apply group risk to societal decisions. Science has a particular set of methodologies, and even scientists can’t always agree on those or apply their own favored methodology correctly. Science does have the advantage of saying that replication and explication is good. However, there is information degradation when applying science to society, not the least of which is lag time.
When you try to apply formulaic solutions to societal problems, you are going to have a real issue with problem definition. Some would say engineers were among the worst US presidents (Hoover and Carter, though I think both more simply were not strong leaders when necessary). Eventually, you have to decide on what moral and ethical basis to make decisions that affect groups. Religions are about that (which can be quite counterproductive at times, since many tend to be absolutist, and relativistic morals have issues too). Complete anarchy certainly isn’t the answer, tragedy of the commons. What is needed is some level of specialization (like the CDC in the US for vaccinations), some level of trust (believe what the scientific consensus says and understand the limitations of media reports), and some manner of global feedback to adjust those correctly (uh-oh, now we’re in politics). The current trend towards self-circumscribing information channels is working against that – birds of feathers flocking together are reinforcing their own biases. It was a lot easier to be patriotic and know what is “right” when propaganda was more standardized, eh?
Comment by jgarry — September 7, 2012 @ 11:22 pm GMT Sep 7,2012
Hopefully, this is not a reaction to my recent jovial reference to Richard Dawkins on C.D.O.S?
Comment by Mladen Gogala — September 7, 2012 @ 9:31 pm GMT Sep 7,2012
No, I haven’t been following CDOS closely enough. It was the stunning simplicity of the line “I’m afraid to say, you’re not allowed science any more” that caught my eye.
Comment by Jonathan Lewis — September 8, 2012 @ 9:21 am GMT Sep 8,2012
Actually, the woman is not asking the doctor to make any decisions for her. Rather, she is asking for assurance in a one-word answer from the doctor – yes or no. Clearly, she would keep her right to decide.
By asking the question, she is doing what any good mother would do – ask her doctor. It is reasonable to expect that one’s doctor should be able to explain the options available and the risks involved in choosing one over another, and to do so more clearly and efficiently than some pamphlet. I believe that’s part of a doctor’s job.
In a Twilight Zone/1984-ish way, the author shows how insane it could be – but then we’re not far from that situation today. How much say do we have when it comes to things like vaccinations? Sometimes the only ‘card’ we have to play is the ‘yes or no’, and if that choice is taken away, well, 1984 here we come.
The author may also be pointing out how many people tend to take an ‘all or nothing’ approach to some pretty broad topics – science being one. “Are you WITH us, or AGAINST us?” A Redneck approach to life, that’s all. Some might feel that if you say no to any small part of science, it should then be forced upon you anyway. Others may say you should then be banished and not be allowed to benefit from science. But science is not ‘all or nothing’. People can embrace as much or as little of science as they like. Part of Freedom is being free to disagree.
Comment by Cliff Sterling — September 10, 2012 @ 8:13 pm GMT Sep 10,2012
Thanks for the comment:
Actually, the woman is not asking the doctor to make any decisions for her. Rather, she is asking for assurance in a one-word answer from the doctor – yes or no.
Technically, of course, you could argue that case – after all, the doctor could have said Yes (i.e. assurance that the injection would do no harm), and she could still have said that she wasn’t having it done. But notice that the doctor says No (albeit in five words: “Well, there’s always some risk”) and she repeats the question.
…expect that one’s doctor should be able to explain the options available and the risks involved in choosing one over another, and to do so more clearly and efficiently than some pamphlet
Personally, when making an important decision, I would rather have a printed copy of the arguments so that I can crosscheck the pros and cons, look for errors and omissions, and check for contradictions. However, you might note that (a) Ms. Melham was apparently unable to extract a “No” from “Well, there’s always some risk” and (b) when the doctor did try to explain “… this is less than the probability of…” she cut him off.
Part of Freedom is being free to disagree.
True, although there are some limitations: you can’t disagree with reality (technically you could disagree, I suppose, but disagreeing with the laws of physics might prove fatal); and one of the principles of democracy is that the majority is allowed to over-rule the minority – and we just have to hope that enough of the people have a solid grounding in ethics and moral philosophy.
Comment by Jonathan Lewis — September 11, 2012 @ 8:45 am GMT Sep 11,2012
Anyway, didn’t mean to get carried away about it. Thank you for your replies, Cheers.
Comment by Cliff Sterling — September 11, 2012 @ 10:05 pm GMT Sep 11,2012
Hi Jonathan, thanks for the reply,
Yes the doctor could have said yes or no but said neither – it’s possible she repeated the question and later cut him off for that very reason. It’s a yes or no question. Answer yes, or no. By all means provide further explanation to the yes or no, but at least start with a yes or no. Sometimes I ask my doctor yes or no type questions, he recognizes them as such, and provides the yes or no answer, usually followed by a brief explanation. Also according to the story we don’t know what Ms Melham may have decided if she had received a yes or a no answer.
We also don’t know if she may have already read the pamphlet, in any case its contents are unknown to us. I agree a printed copy can help, but what if that printed copy is nothing more than marketing hogwash designed to herd you into deciding in favor of whatever they’re selling? At the risk of sounding cynical, that seems to be the case more often these days.
Reality is a personal thing, and sorry, but people disagree with reality every day. Some do it just to cope with a bad situation or whatever is troubling them. I know what you’re saying though – one cannot just deny or ‘disagree’ with gravity or electromagnetic radiation.
Comment by Cliff Sterling — September 11, 2012 @ 9:54 am GMT Sep 11,2012
In your earlier comment you said: “By asking the question, she is doing what any good mother would do.” – but you don’t score points for questions if you’re not prepared to pay attention to the answer – even if it’s not the one word answer you wanted.
We also don’t know if she may have already …
I think the comment I made in response to Mark’s “The story is allegorical..” covers that.
what if that printed copy is nothing more than marketing hogwash …
The problem of extending the allegory too far comes up again. In a tale where the doctor is trying to get the woman to think about the alternatives and understand the facts, and and where declines to tell her what decision to make, you’re now suggesting that the pamphlet could have been designed to obscure the facts and push the decision the way the doctor wanted it made.
Comment by Jonathan Lewis — September 11, 2012 @ 6:07 pm GMT Sep 11,2012
the pamphlet reference was only in response to your speculation about her possible response to his possible answers, which may also be extending the allegory too far.
Comment by Cliff Sterling — September 11, 2012 @ 9:38 pm GMT Sep 11,2012
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