Saturday 7 September 2013

An evidence-free world


In the 1990s there was a movement for 'evidence-based medicine' which was actually a movement for evidence-free medicine - since the assertion was that the only admissible 'evidence' for effectiveness of any treatment was restricted to large randomized controlled trials.

But large RCTs are funded only by large corporations and bureaucracies, and therefore medicine was reconfigured as a coalition of the Big Pharmaceutical Companies and the Health Service Administration who both conducted and 'officialy' interpreted RCTs.

So evidence-based medicine was in fact evidence-free medicine - since nothing could count as evidence against the official pronouncements of the bureaucrats.

No amount of personal experience, nothing that happened in the world, not even a pile of dead bodies, could count as evidence against 'the guidelines'.


But this phenomenon is general in the modern world.

Evidence does not merely count for little, it counts for nothing at all.

If the ruling media and bureaucrats want something to happen, then they need no evidence for it (beyond somebody's assertion that it is good, or a made-up anecdote or two about the suffering it may prevent); but if they don't want something to be true, then no amount of evidence is ever enough to change their minds.


In an evidence-free world, there is a complete, utter and absolute disconnection between what people believe and do - and what happens as a consequence.

Indeed, it is exactly consequence-iality which is denied - since the basis of being liberated from evidence is that we can never be sure about consequences therefore everything (and I mean everything) about what we do, depends on where we bestow the benefit of the doubt.   


The evidence-free rulers always give themselves the benefit of the doubt.

If they want to do something, their opponents have to prove that no good can possibly come of it; if they don't want to do something, opponents have to prove that unless they did this precise things the result must necessarily be instant catastrophe.

If they want to assert a fact, opponents have to prove that it cannot be true under any possible combination of circumstances; if they don't want to acknowledge a fact, their opponents have to prove that there is no other possible explanation that could be devised.  

In sum, there is always doubt about causality, and doubt about lack of causality, therefore the conclusion depends upon the side where that doubt is bestowed as being most significant.


When doubt is defined such as to be universal, and everything depends on which side gets the benefit of that doubt - then there is not room for evidence to play any role in decisions: we have an evidence-free world.


The lesson for opponents to Leftism is to forget about evidence in relation to public discourse - because in an evidence-free world the only admissible evidence is evidence against you; and the benefit of the doubt is bestowed on your enemies.

In an evidence-free world where plausibility and common sense count for nothing whatsoever, enemies of the Left are called upon to prove their innocence, prove that they are stating the only conceivable truth and nothing but the state: and prove these beyond any possible, imaginable shadow of doubt.



The Crow said...

This is part of the modern mindset, or disease, promoted by leftism. Experience counts for nothing.
Online forums are a good place to study the phenomenon.

If I state knowledge, gained from experience, I am called upon to 'quote sources' and 'provide proof'.
Because, experience, and the lessons learned from such experience, mean nothing to one who has not experienced anything.
Indeed, many people actually don't experience anything. Whatever they think they know, comes from YouTube and Wikipedia, along with their most recent high school lessons, and the quoted words of long-dead people that everyone has heard of.

Time was, the individual's experience of life could be added to the sum of general knowledge about the nature of life. But now, it is scorned and wasted, derided as being only one person's 'subjective' experience.

So be it.

Thursday said...

Yes, but . . . up until the last 100 years or so medical professionals were mostly distinguished by killing their patients. Not much has changed in their character, so far as I can see. For example, people in all rich countries get way to much medical care, and doctors aren't exactly going to lead the charge against that.

So, we're stuck between bureaucratic and corporate corruption and corruption of the profession.

Bruce Charlton said...

@Th - The golden age for medical progress was about 1935-65, since when progress first slowed up and now has probably reversed (overall)

But the level of dishonesty in doing and reporting medical research is now so extreme, that really nobody in the world knows what is going-on anymore.

Nicholas Fulford said...

In an evidence-free world, there is a complete, utter and absolute disconnection between what people believe and do - and what happens as a consequence.

Indeed, it is exactly consequence-iality which is denied - since the basis of being liberated from evidence is that we can never be sure about consequences therefore everything (and I mean everything) about what we do, depends on where we bestow the benefit of the doubt.
-- Bruce Charlton

The strength of belief or attachment to belief can and does influence behaviour. But, the degree to which belief is up against something more primal, (such as instinct), attenuates it. For example, fear of falling is deeply instinctive--as walking to the edge of a cliff will make abundantly clear. However, if I attach you to a hang-glider, and tell you to run off that cliff you will feel a very strong aversion to doing so, (until you have done it enough times in safe conditions to override the instinctive aversion.) Of course this is not an evidence-free situation, as each successful launch demonstrates, as does what happens to things I throw off the cliff.

This brings up the question: Do we live in an evidence-free world?

As my hang-gliding example makes clear, the evidence of the effect of gravity is demonstrated in such a way that we don't even have to think about it. The evidence has instilled itself at a deep level. However, the reciprocal relationship between a belief and instinct in the example can shift towards or away from belief or instinct based upon experience.

Consequences serve to strengthen or undermine belief. However, it is possible to compartmentalise or be in a state of cognitive dissonance, and this does happen as well. (Witness oncologists who smoke.)

To address your second point: Consequences which are proximate to an event are more strongly bound to the event as causal. Stepping off the cliff and falling is an obvious example. But the more removed a future state is from an event, the more tenuous is the connection. The first is necessary and sufficient, and the second may be necessary and is seldom sufficient due to the complex interactions which contribute to the consequence, (i.e. Butterfly Effect.) In other words there is a horizon for an actor to the effects of action, and much like the weather the further out the predicted effect lies, the less accurate the predicted consequence.

It is not the actions do not have consequences, it is just that the consequences may not be foreseeable at the time of the action.

Anonymous said...

One big problem in medicine is that the consequences of treatment are often diagnosed as new disease, creating a feedback loop in which treatment causes more "disease" which - instead of backing down on the treatment that is causing the problem - results in more and different treatment.

So by the time someone is elderly he is on sometimes tens of different medications, each causing the "need" for others - a very profitable though parasitical situation for doctors and pharma, precisely because the destruction of the life and productivity of the patient is disconnected from payment for his medical care.

I'd bet that, in a macroeconomic sense, medical care has long past reached the point of destroying more productivity in aggregate than it preserves.

Bruce Charlton said...

@ZC - very true.

Bill said...

It's kind of fun to ask "evidence-based medicine" clowns if there are any RCTs demonstrating the superiority of "evidence-based medicine."

Bruce Charlton said...

@Bill - I wasted about a decade of my life asking variations of that question in numerous articles, speeches and book chapters - crickets...