Seth's Blog

• Bruce Handy (who wrote for Spy) on Newsweek. “The second biggest problem is the way each issue begins with a miles-long slog of columns by A-list writers eager to champion the incontrovertible and rehash the already thoroughly hashed. . . . Niall Ferguson has discovered that, thanks to technology, “the human race is interconnected as never before.””
• The Willat Effect in Venice, CA: side-by-side coffee comparisons at Intelligensia .
• Why is the headline 28 Unexpected TV Ratings Facts more attractive than Unexpected TV Ratings Facts?
• Engaging interview with Julia Schopick, creator of Honest Medicine. “After they [his surgeons] were done with him . . . “

Thorstein Veblen might have gloated that this 2011 article — about the uselessness of law schools and legal scholarship — so thoroughly supports what he wrote in a book published in 1899 (see the last chapter of The Theory of the Leisure Class). Why are law schools useless? Because law professors feel compelled to imitate the rest of academia, which glorifies uselessness:

“Law school has a kind of intellectual inferiority complex, and it’s built into the idea of law school itself,” says W. Bradley Wendel of the Cornell University Law School, a professor who has written about landing a law school teaching job. “People who teach at law school are part of a profession and part of a university. So we’re always worried that other parts of the academy are going to look down on us and say: ‘You’re just a trade school, like those schools that advertise on late-night TV. You don’t write dissertations. You don’t write articles that nobody reads.’ And the response of law school professors is to say: ‘That’s not true. We do all of that. We’re scholars [i.e., useless], just like you.’ ”

Yeah. As I’ve said, there’s a reason for the term ivory tower. And seemingly useless research has value. Glorifying useless research has the useful result of diversifying research, causing a wider range of research directions to be explored. Many of my highly-useful self-experimental findings started or received a big boost from apparently useless research.

The pendulum can swing too far, however, and it has. A large fraction of health researchers, especially medical school researchers, have spent their entire careers refusing to admit, at least in public, the uselessness of what they do. Biology professors have some justification for useless research; medical school professors have none, especially given all the public money they get. Like law professors, they prefer prestige and conformity. The rest of us pay an enormous price for their self-satisfaction (“I’m scientific!” they tell themselves) and peace of mind. The price we pay is stagnation in the understanding of health. Like clockwork, every year the Nobel Prize in Medicine is given to research that has done nothing or very close to nothing to improve our health. And every year, like clockwork, science journalists (all of them!) fail to notice this. If someone can write the article I just quoted about law schools, why can’t even one science journalist write the same thing about medical schools — where it matters far more? What’s their excuse?

In this interview, a doctor who does research on biofilms named Randall Wolcott makes the same point I made about Testing Treatments — that evidence-based medicine, as now practiced, suppresses innovation:

I take it you [meaning the interviewer] are familiar with evidence-based medicine? It’s the increasingly accepted approach for making clinical decisions about how to treat a patient. Basically, doctors are trained to make a decision based on the most current evidence derived from research. But what such thinking boils down to [in practice -- theory is different] is that I am supposed to do the same thing that has always been done – to treat my patient in the conventional manner – just because it’s become the most popular approach. However, when it comes to chronic wound biofilms, we are in the midst of a crisis – what has been done and is accepted as the standard treatment doesn’t work and doesn’t meet the needs of the patient.

Thus, evidence-based medicine totally regulates against innovation. Essentially doctors suffer if they step away from mainstream thinking. Sure, there are charlatans out there who are trying to sell us treatments that don’t work, but there are many good therapies that are not used because they are unconventional. It is only by considering new treatment options that we can progress.

Right on. He goes on to say that he is unwilling to do a double-blind clinical trial in which some patients do not receive his new therapy because “we know we’ve got the methods to save most of their limbs” from amputation.

Almost all scientific and intellectual history (and much serious journalism) is about how things begin. How ideas began and spread, how inventions are invented. If you write about Steve Jobs, for example, that’s your real subject. How things fail to begin — how good ideas are killed off — is at least as important, but much harder to write about. This is why Tyler Cowen’s The Great Stagnation is such an important book. It says nothing about the killing-off processes, but at least it describes the stagnation they have caused. Stagnation should scare us. As Jane Jacobs often said, if it lasts long enough, it causes collapse.

Thanks to Heidi.

In a previous post I criticized the book Testing Treatments. Two of the authors, Paul Glasziou and Iain Chalmers, have responded. I have replied to their response. They did not respond to the main point of my post, which is that the preferences and values of their book — called evidence-based medicine — hinder innovation.

Sure, care about evidence. Of course. But don’t be an evidence snob.

From this comment (thanks, Elizabeth Molin) I learned of a British book called Testing Treatments (pdf), whose second edition has just come out. Its goal is to make readers more sophisticated consumers of medical research. To help them distinguish “good” science from “bad” science. Ben Goldacre, the Bad Science columnist, fulsomely praises it (“I genuinely, truly, cannot recommend this awesome book highly enough for its clarity, depth, and humanity”). He wrote a foreword. The main text is by Imogen Evans (medical journalist), Hazel Thornton (writer),  Iain Chalmers (medical researcher), and Paul Glaziou (medical researcher, editor of Journal of Evidence-Based Medicine).

To me, as I’ve said, medical research is almost entirely bad. Almost all medical researchers accept two remarkable rules: (a) first, let them get sick and (b) no cheap remedies. These rules severely limit what is studied. In terms of useful progress, the price of these limits has been enormous: near total enfeeblement. For many years the Nobel Prize in Medicine has documented the continuing failure of medical researchers all over the world to make significant progress on all major health problems, including depression, heart disease, obesity, cancer, diabetes, stroke, and so on. It is consistent with their level of understanding that some people associated with medicine would write a book about how to do something (good science) the whole field manifestly can’t do. Testing Treatments isn’t just a fat person writing a book about how to lose weight, it’s the author failing to notice he’s fat. (more…)