top of page

Conflicts, Corruption, Medicine, and Me Part IV

It’s easier to fool people than to convince them that they have been fooled.

Mark Twain

 

It is fitting that my final installment of this series has its focus on the last word of my title. Me. Pointing out corruption, financial or political influence, and bias arising from self-interest of corporations, institutions, and journals is important and true. It’s also a safe distance from looking at myself – my own implicit bias. Ultimately, I am the final arbitrator of what I accept as truth. And I can no longer lay claim to a defense that I did not know such conflicts and corruptions exist.


“Follow the science” was the mantra incessantly repeated over media airwaves, in print, on the internet, and with interviews of select scientists, politicians, and journalists for the past four years. Some of us translated that phrase as demanding blind social obedience to lying bureaucrats who were making panic-inducing proclamations based on very little evidence. The entire concept of science was misunderstood and abused by this phrase.


At the heart of “follow the science” is the idea that science is free of researcher’s personal values, free of bias, and instructs us on which action we should take. None of these are true. These three misconceptions about science are important to clarify.

 

Misconception #1: Science tell us what to do.


Facts in a vacuum are not instructions for how to act. If you know that it is raining outside, this fact alone does not tell you whether to bring an umbrella, wear a raincoat, put on galoshes, all the above or none of the above.


Data alone informs us with respect to an issue but does not tell us what to do. People, not viruses and not research findings, make decisions. Those decisions are based on personal values and countless specifics to their own situation. Science makes no claims regarding morality. People do.


Science does not tell us what to do any more than a telephone tells us what is say.

 

Misconception #2: Science is value-free.


Social and ethical values play a role in the production and dissemination of science. Researchers are in control over what they study, how they study it, how the resultant data is collected and analyzed, and how the empirical results are reported. These choices reflect values, epistemic- knowledge, creation, or ethical – doing what they believe is right. Such choices also reflect the values and goals of those sponsoring the research.


A recent example is the exclusion of young children from Phase III Covid vaccine trials. Individuals under the age of 18 were excluded. Researchers had reason to believe that children would be at undue risk of harm were they included. The same reasoning was applied to the exclusion of pregnant and breast-feeding women, as well as immunocompromised individuals.


The ethical value of preventing harm was prioritized to the exclusion of the epistemic value of learning how efficacious the vaccine would be in that population. It left these groups with no scientific evidence, no data, on vaccine efficacy or safety, to guide their decisions on whether to vaccinate or not. Choices of researcher impacted choices of end users.


Values can also be seen in choice of endpoints in the vaccine trials. The primary endpoint, what the researchers were primarily concerned with understanding, was prevention of symptomatic infection. Importantly, transmission of the virus- from vaccinated to vaccinated, or unvaccinated to unvaccinated, vaccinated to unvaccinated, unvaccinated to vaccinated – was not studied in these trials.   The choice to study whether the vaccines prevent transmission, or death, or hospitalization, or acute infections is up to those running the trial and those decisions tend to be based on values.

 

Misconception #3: Science is unbiased.


The loudly expressed mantra “trust the science” struck me as odd considering the landscape of scientific literature was, and remains, remarkably divided. Which science am I supposed to wholeheartedly trust? Those who claim that “science is right” are wrong because they fundamentally misunderstand how science works. One study does not “prove” anything, and politicized science is not true in virtue of being sensationalized by those in power. All studies are not equal in quality.


If skepticism is the correct way to meet scientific evidence, then people should hardly be scolded for not “trusting the science” as that is the correct attitude to take.

 

Bringing it all back home.


But I promised to bring this home. To you and me. What about my own unconscious bias? How do I navigate the schism within the scientific community, academic institutions, and our culture on the polarizing topics of our time and come to their own understanding of what is true?  Truth is what most closely conforms to reality. Reality is that which, when you stop believing in it, doesn’t go away.


Does it not seem crazy out there? Why do smart people believe stupid things? From where does delusional thinking arise?


The prevailing view is that people adopt false beliefs because they're are too stupid or ignorant to grasp the truth. In fact, just as often, the opposite is true. Many delusions prey not on dim minds but on bright ones.


Yale law professor, Dan Kahan conducted experiments testing the effect of intelligence on ideological bias. He scored people on intelligence using the cognitive reflection test, a task to measure a person’s reasoning ability. He found that liberals and conservatives scored about equal on average – but the highest-scoring individuals in both groups were the most likely to display political bias.


Test subjects who scored highest in numeracy were better able to objectively evaluate statistical data when told it related to a skin rash treatment. But when the same data was presented as relating to a polarizing subject- gun control, those who scored highest on numeracy exhibited the greatest bias.


This correlation between intelligence and ideological bias is robust having been found in many other studies. These studies found stronger biases in clever people on both sides of the aisle. Since such biases are mutually contradictory, they can’t be the result of greater understanding.


What is it about intelligent people that make them prone to bias?


It starts with this understanding. An intelligent agent cannot just be intelligent. It must be intelligent at something. Rationality is intelligence in pursuit of objective truth. But intelligence can be used to pursue any number of goals.  Since how the goal is selected is distinct from how the goal is pursued, the intelligence with which an agent pursues its goal is not a guarantee that the goal itself is intelligent.


Human intelligence has evolved to become less a tool for pursuing objective truth than as a tool for pursuing personal well-being, tribal belonging, social status, and sex. And this often requires the adoption of fashionably irrational beliefs, or fibs, which the brain has come to excel at. Since we’re a social species, it is intelligent for us to convince ourselves of irrational beliefs, if holding those beliefs increases our status and wellbeing.


People bind their intelligence to these evolutionary impulses, leveraging their logic and learning not to correct illusions but to justify them. What this means is that while less intelligent people are more easily misled by other people, intelligent people are more easily misled by themselves.


They are better at convincing themselves of things they want to believe, rather than things that are true. Being better at reasoning makes them better at rationalizing.  While this tendency is troubling in individuals, in groups it can prove disastrous, affecting the very structure and trajectory of society.


An example is wokeism, an identitarian ideology combining elements of conspiracy theory and moral panic, which became fashionable in academia toward the end of the 20th century. This spread to the mainstream with the advent of smartphones and social media.


Wokeism reduces the world down to simplistic oppressor - victim relations in which people who are white, straight, slim, or male are the oppressors, while those who are nonwhite LGBT, fat or females are victims. Wokes typically reject claims of objectivity as a weapon created by straight white men to enforce the dominant CIS heteronormative patriarchal white supremacist worldview.


The purpose of this scholarship is not to determine truth but to promote social justice – or as they call it diversity, equity, and inclusion. To this end, they will use their intelligence to persuade people of arguments that are logically unsound, but which are perceived to contribute to a more equitable world. These are some examples:


UCLA Medical School students are required to learn weight loss is a useless hopeless endeavor as part of their health equity curriculum. The argument is that anti-obesity attitudes are a health risk because they can cause obese people anxiety and stress.  It is further argued focusing on body size is rooted in racism.


This intention is not to develop methods or medications to lower obesity, but irrational arguments to normalize obesity in the interest of social justice. What is ignored is decades of medical research showing that obesity is a serious health risk.


Gender studies were created to normalize transgenderism and gender nonconformity through similarly dubious arguments. One such argument, that sex is a spectrum, is justified on the basis that there is no single thing that distinguishes all men from all women. This illustrates the univariant fallacy.  It is true that no single thing distinguishes all men from all women, but no single thing distinguishes all cats from all monkeys either. Is this proof of a cat monkey spectrum?


Even though fibs, like sex is a spectrum, and obesity is healthy, are objectively false, woke academics have made the mainstream through a combination of crafty arguments and idea laundering – the practice of coughing opinions in academic jargon and placing them in academic journals to disguise ideology as knowledge.


Despite being irrational, wokeism is an intelligent worldview. Intelligent, but not rational, because its goal is not objective truth, or even social justice, but social signaling. These actions often end up hurting rather than helping those in need, but they make some people feel good for a while and they increase their own social status.


This is not new behavior. In the 1800s, the dominant racial ideology in America really was white supremacy. As a result, the master debaters of that age often used their intelligence and reasoning to justify discrimination against blacks.

So, how does an intelligent person avoid a disorder that preys specifically on intelligence?


It is not by learning about cognitive biases and logical fallacies – this can be counterproductive. Research shows that teaching people about misinformation often just causes them to dismiss facts they don’t like as misinformation - while teaching them logic results in them applying that logic selectively to justify whatever they want to believe. If knowledge and reasoning are the tools by which intelligent people fool themselves, then giving them more knowledge and reasoning only makes them better at fooling themselves.


This very blog, speaking of cognitive bias and logical fallacy, will be interpreted by leftist claiming it explains rightest beliefs, and by rightist claiming it explains leftist beliefs. In no case will someone claim it explains their own beliefs.


The problem then is not our reasoning but our goals. Most goals are not to meet objective truth but to justify what we wish to believe. Motivated reasoning occurs when we place our intelligence in the service of irrational goals.


Learning can help to limit motivated reasoning only if it is accompanied by a deeper kind of development – that of one’s character. Two character traits critical to this process are curiosity and humility.


One of the strongest countermeasures against bias is curiosity. Curiosity occurs not when you know nothing about something, or think you know everything, but when you know a bit about it and genuinely want to know more, rather than confirm what is comfortable.  


Humility is critical because the source of our strongest biases is our ego. We base our self-worth on being intelligent and being right.  This makes us not want to acknowledge when we get things wrong. Or to change our mind. So, to protect our chosen identity, we stay wrong.


Character requires that instead of defining ourselves by our ability to reason or debate – we define ourselves by our willingness to learn. Then admitting we are wrong – instead of feeling like an attack - will become an opportunity for growth.


In the end, rationality is not about intelligence but about character. It requires constant honest interrogation of my own motives Humility and curiosity are essential if the goal is truth. And by seeking one, we also seek the other.  Being curious makes us humble. I have found the practice of medicine to be humbling if I am paying attention.


Without such character, more information will not make us a master of our biases. It will only make us a better servant of them.

 

Tim Powell MD

Recent Posts

See All

Conflicts, Corruption, Medicine, and Me Part III

It’s called “the green journal.” When I was in medical school in the 1970’s, it was the source most frequently quoted by faculty at OHSU. The American Journal of Medicine is the official journal of th

Conflicts, Corruption, Medicine, and Me Part II

Do you think the health care system in the United States is better than it was 40 years ago? A simple way to gauge the health of a country, and to compare the health of that country to others, is to l

Conflicts, Corruption, Medicine, and Me Part 1

At my age, it’s humbling to recognize how easily I can be manipulated. It is small comfort to know I am neither the first nor is it rare among my profession.  Still, as a physician in my 44th year of

Comments


bottom of page