Monday, July 03, 2006

Real-Life Experience Versus Studies from Afar

I listened to a very intriguing lecture by Jessica Stern, who interviewed dozens of terrorists and tried to understand what makes them tick.

This lecture is part of the "Big Ideas" show on TV Ontario, also distributed as a podcast. Click here for more info.

Anyway, Jessica told several stories about the terrorists she met and the detailed insights she gained while on this trek of "curiosity," as she called it. This was obviously very dangerous for her to do, but we can be glad she had the courage to do it and we should pay close attention to the observations she's made about terrorism.

But, about half way through the speech, she began to lapse into quoting various statistics about "why terrorism happens." These statistics were not based on her work, but instead were collected by various academics who did not go through the experiences that Jessica did with the up-close-and-personal interviews.

I was struck by the irony of a woman who obviously had such detailed knowledge of this subject deferring to these academic studies as to what the cause of terrorism was. The studies looked at the impact of poverty, gross domestic product, male-to-female ratio, level of education, etc. and tried to correlate these to terrorism levels.

I wanted to hear what Jessica thought! But, instead, here she was, quoting statistics from people with LESS KNOWLEDGE THAN HERSELF! The Big Ideas podcast often cuts the speeches off at the end, so I'm not sure if she ever did explain her views about what causes terrorism.

Then, I reflected on how similar this was to Western medicine.

Medical doctors routinely ignore the findings of their own practices to defer to what the "clinical studies" say, however ridiculous or obviously wrong those conclusions are.

Even worse is the trend of doctors using techniques unproven by clinical studies OR hands-on experience, as reported in BusinessWeek magazine a few weeks ago in their cover story "Medical Guesswork."

But that aside, why would a perfectly competent doctor toss aside his own observations in favor of clinical studies? My only answer is that it is the product of a culture in medicine that has gone astray, that has told doctors they must do this seemingly unintuitive thing in their own practices, with their own patients.

Perhaps it is the fear of malpractice suits, or even hearings in front of the state medical boards, that causes doctors to fall in line with whatever the "common wisdom" is.

I heard Dr. Andrew Weil speak a few years ago, when he said that, in a debate with a conventional MD, he was shouted down every time he himself used the phrase " my experience..." because doctors weren't supposed to rely on their own experience, they were supposed to follow the results of clinical studies. Doesn't that seem backwards??

In any event, it is a truly dangerous phenomenon for us patients that this is occuring so regularly. I wish all doctors would pay attention to their own empirical evidence unfolding in front of them.

And, Jessica, if you're reading this, please tell us what YOU think causes terrorism!

And thanks for taking the risks you did to bring us new information from the front lines of terror.

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