Hacker News Reader

Comment by dekhn | Hacker News Reader

Are we all experts who are capable of thinking for ourselves ("thinking for ourselves" seems to equal: inspecting the primary literature, or review literature, and coming to a conclusion)? No, we're not.

Thinking for yourself is untenable- we need scientists who are experts in analyzing data to provide specific suggestions, and disseminate those in the media. Unfortunately, there is little consequence to reporting false conclusions, or inaccurate health data, so I don't see any change forthcoming.

View on HN

Out of curiosity, do you realize that the same thing can be said about religion? You don't know enough about it - definitely not as much as the people who specialize in it - so you should listen to your priest on the subject. Or politics: just pick a party and follow its lead, politics is a complex subject and you can't know as much as the professionals.

It definitely is so. What authority do I have to talk about economics or law? Shouldn't I leave that to the people who do know what they are talking about?

Kind of a central problem in democracy, if you think about it.

Protestants, at least, have the idea of the "priesthood of all believers", meaning roughly that each person can have authority in doctrinal matters. So you should listen to your priest, but you don't have to accept that he's correct if God is telling you something different. Thus the billion different protestant denominations.

Protestants if you go back to their roots actually expected you to become an expert in scripture in order to recognize when your "priest" is wrong. But they didn't promote anything goes. It's more that you should learn and be able to apply scripture correctly. This didn't prevent the proliferation of denominations because of course different people would interpret a piece of scripture differently and get really worked up about it.

This is in contrast with Catholicism, where pretty much everything was conducted in Latin rather than local languages; the emphasis on layperson understanding of theology was a direct response to the trend of most followers having zero understanding or ability to understand the scriptures and sermons they were expected to follow.

Of course, this also resulted in the more decentralized power structure relative to Catholicism's. Quite a bit of Protestant philosophy and tendency stems from immediate responses to a perceived-to-be corrupt and exclusive Catholic Church.

I'm sure you're right, but what domain of knowledge is religion expert in?

I would say that nutrition falls somewhere between religion - where the facts are all made up - and, say, math or physics where we're pretty damn sure the scientists aren't making all the facts up. But it definitely leans towards the scientific side where real facts can be known and people who devoted decades of their life to it have a tangible advantage over the layman when evaluating claims about it.

I respect a theological scholar or priest's mastery of their religion in the same was as I would respect an ardent nerd's mastery of Tolkein's universe, which is to say it is real respect for studying at length a somewhat internally consistent system of mythology. But no matter how much more that nerd knows about mythology I wouldn't trust his word about how Middle Earth actually existed at some point in the earth's history.

As for politics...well that's a huge can of worms isn't it? I would mention that it's not a politician's job to know about politics, but it's their job to get elected and accrue power. A better analogy for you to make might have been political scientist, in which case I would indeed trust their judgement over my own gut feel when it comes to questions about politics like why so-and-so won the election.

Publishing misleading health studies wouldn't be so risk-free if your average American could easily distinguish a legitimate expert opinion from a media/commercial one.

Unfortunately most Americans don't have access to a quality health education necessary to make that distinction.

I disagree. We have ample evidence that legitimate experts came to the wrong conclusion (for example, studies of the relationship of cholesterol to heart health).

What we need to systematic meta-studies that are analyzed and published by geniuses (see the Cochrane Collaboration).

> "Thinking for yourself is untenable"

Well, that's the best thing I've read all day.

It might hurt to read that because it pinches on the untouchable tenets, I mean, who dares to admit not being a individual free-thinker?

However, if you look behind the "smokes, you'll see he has a point. I proudly admit that I wouldn't think for myself on situations such as choosing a complex therapy. I know nothing about it; what would I do? Trust the Internet?

Well the research has shown [too lazy to come up with a citation for that] that it is very beneficial for patients to be well informed and involved in the therapy process - with healthcare professional as an equal partner, not as a "god" in the matters of health. It's called "patient empowerment" and it's a big thing since 1994. And one of the best ways to inform the patient is a decision aid (which is ranging from fliers to IT systems with semantic webs with auto-updating medical evidence sources). This works, because you don't have to an expert on athletes' foot to manage your diabetes well, you just have to be an "expert" of your own case. And that, my friend, is the definition of individual free-thinker.

> Well the research has shown [too lazy to come up with a citation for that] that it is very beneficial for patients to be well informed and involved in the therapy process

That's an irrelevant point: You won't see me advocating against having the patients fully informed and making decisions, after being given "alternatives" and respective pros&cons by their physicians. But what I was discussing was the knee-jerk reaction to the "thinking for yourself is untenable" argument.

> This works, because you don't have to an expert on athletes' foot to manage your diabetes well, you just have to be an "expert" of your own case.

I would say it's very oblivious to think you're an expert on your case. It means your emotions are way too much present: the fact that something is terribly relevant to you doesn't imply that you're an "expert" in it.

> And that, my friend, is the definition of individual free-thinker.

Quite a strange definition. But OK: if that's a very important point for you to make, great.

Just don't say that this is "thinking by yourself". You may have made the decision yourself, but the "thinking" part was on the physician all the time. He had the knowledge, he presented it to you, alongside the pros&cons, and he was there to warn you if you by chance made a wrong/worst decision.

>I would say it's very oblivious to think you're an expert on your case. It means your emotions are way too much present: the fact that something is terribly relevant to you doesn't imply that you're an "expert" in it.

I wouldn't discount emotions as being irrelevant for health. Patient involvement is very important in the empowerment process, and the patient is the expert in the ways that physician can never be: [s]he, not the physician, knows that drug A causes his/her skin itch; he, not the physician, cares for the quality of life, etc. And, sadly, you miss the point completely: experts have broad knowledge of the situation, while the "expert" patient knows (with the help of experts, of course, of course, of course) his exact case. And the "thinking" part is not done by physician all the time. Empowered patient does the majority of "thinking", the physician is there for support and information. Physician is the expert systems' knowledge base, while the empowered patient is the expert system doing the "thinking" and making informed/educated decisions.

Edit: e.g. http://www.sciencedirect.com/science/article/pii/S0738399109... (emphasis mine)

>Conclusion

>Unlike the traditional approach, empowerment is not something one does to patients. Rather, empowerment begins when HCPs acknowledge that patient are in control of their daily diabetes care.

>Empowerment occurs when the HCPs goal is to increase the capacity of patients to think critically and make autonomous, informed decisions. Empowerment also occurs when patients are actually making autonomous, informed decisions about their diabetes self-management.

And this is not a new thing in heathcare either, there is a plethora of articles saying the same since 1994.

There's a strong push to get patients to be more involved in their own care and to make decisions about their health and to be experts in their own health condition.

There are expert patient programmes http://www.nhs.uk/NHSEngland/AboutNHSservices/doctors/Pages/...

There are expert patiet groups.

Patient choice is (in the UK) written into law and into Department of Health, and NHS, and Clinical Commisioning Groups, and Trust guidance documentation.

You might want to learn what people mean when they talk about expert patients because it's not going away and you seem to have some misunderstanding about it.

> Just don't say that this is "thinking by yourself". You may have made the decision yourself, but the "thinking" part was on the physician all the time. He had the knowledge, he presented it to you, alongside the pros&cons, and he was there to warn you if you by chance made a wrong/worst decision.

This assumes that doctors are not subject to the same cognitive biases that patients are. But doctors clearly are subject to those same biases. The RCT for knee arthroscopy shows us that.

I think your reply is generally misguided and straw man-like fallacious. I never advocated against having patients involved and making decisions (which I pointed explicitly above), nor said anything which justified you prompting me with something like "Patient choice is (in the UK) written into law" (where have I questioned that?). It seems you're replying to someone else, probably a straw man.

> This assumes that doctors are not subject to the same cognitive biases that patients are.

I really can't tell how could you reach such conclusion. I just said that the doctors are the ones which hold and present the knowledge, as well as supervise your decision. No mentions. at all, to "patients are biased; doctors are 100% objective".

Again, what I was discussing was the knee-jerk reaction to the "thinking for yourself is untenable" argument.

Quoting out of context like that it sure seems pretty absurd. But I'm going to trust you understood GP's point?

Any sane person wouldn't presume to thing for themselves on the best course of action in treating their cancer, for instance. The same thing goes for nutrition and health.

Of course, I understand the parent post's point & the hazards of quoting out of context, it's just an amusing fragment.

Talking of context though, I think any individual is capable of thinking for themselves when it comes to how much water a day to drink.

As the GP you're referring to: I'm a PhD scientist with deep knowledge in biology. I still wouldn't try to decide for myself on how to treat my own cancer; I can use my knowledge to evaluate what the experts tell me, but there are limits that even a knowledgeable scientist is susceptible to.

Many people think otherwise: they second guess medical experts using their own engineering or scientific knowledge. Sometimes this "seems to work" but it's not clear that it does so in anything but an anecdotal way. Carefully controlled trials and meta-studies are much more effective.

Reply on news.ycombinator.com