Doctors and experts - be wary of their opinions at times

[LongHaul]

Over the last 20 years, many times an expert has told me their opinion on what is effective or something else and then I research it and come to the opposite conclusion based on my research which is often studies that clearly show the opposite to be true.  I am usually looking for multiple studies that have the same conclusion.

This has happened with eyes, nutrition, heart disease risk factors, etc. 

 

I get the impression that many doctors stopped learning certain things after they exited medical school. 

 

My main point is that one must research serious issues themselves and keep their own council.  It is you or your family members health. 

 

And if you are intimidated by the research - just try - I don't usually understand all the data but there is a conclusion paragraph that is a quick summary.

[boilermaker75]

"Research has shown that, generally speaking, once a person reaches that level of “acceptable” performance and automaticity, the additional years of “practice” don’t lead to improvement. If anything, the doctor or the teacher or the driver who’s been at it for twenty years is likely to be a bit worse than the one who’s been doing it for only five, and the reason is that these automated abilities gradually deteriorate in the absence of deliberate efforts to improve."

 

Ericsson, Anders. Peak: Secrets from the New Science of Expertise (p. 13). Houghton Mifflin Harcourt. Kindle Edition.

[Cigarbutt]

Over the last 20 years, many times an expert has told me their opinion on what is effective or something else and then I research it and come to the opposite conclusion based on my research which is often studies that clearly show the opposite to be true.  I am usually looking for multiple studies that have the same conclusion.

This has happened with eyes, nutrition, heart disease risk factors, etc. 

 

I get the impression that many doctors stopped learning certain things after they exited medical school. 

 

My main point is that one must research serious issues themselves and keep their own council.  It is you or your family members health. 

 

And if you are intimidated by the research - just try - I don't usually understand all the data but there is a conclusion paragraph that is a quick summary.

 

My questions have to do with the research part.

In investing, isn't it the goal to become an "expert" about a company/industry and profit from the discrepancies, if any?

 

How do you go about the selection and triage of data?

If you don't evaluate the merits of the data, how do you appraise the conclusions?

 

[writser]

Also stop vaccinating your kids. I've read some interesting research. It causes autism.

[LongHaul]

"Research has shown that, generally speaking, once a person reaches that level of “acceptable” performance and automaticity, the additional years of “practice” don’t lead to improvement. If anything, the doctor or the teacher or the driver who’s been at it for twenty years is likely to be a bit worse than the one who’s been doing it for only five, and the reason is that these automated abilities gradually deteriorate in the absence of deliberate efforts to improve."

 

Ericsson, Anders. Peak: Secrets from the New Science of Expertise (p. 13). Houghton Mifflin Harcourt. Kindle Edition.

 

Very interesting Boilermaker.

 

Cigarbutt - for medical research I am looking for the obvious.  If 5+ studies come to the same conclusion and none or 1 against, then seems like a high probability that the 5+ studies are the one to bet on.  I am no experts in statistics, so lack there, but some data I can evaluate. It really depends.  I am trusting the scientists - which does leave open the wrong conclusion.  I look for conclusions that are generally clear in one direction though. 

 

For investing:  This is a really involved question on the research.  I usually try to disprove my thesis for the big drivers of value.

 

 

 

 

[lschmidt]

These are good points regarding the difficulty keeping up to date, the lack of diffusion of new information, and the difficulty changing one's opinion.

 

I would add a note of caution that a true medical expert has a more nuanced picture of the research. Seems studies are better done than others, some are more biased than others, some are more generalizable than others, some should care more weight than others, some should be discarded. It may be very, very hard for laypeople not immersed in a research field to be able to abstract a context from a set of research results.

[LC]

Also stop vaccinating your kids. I've read some interesting research. It causes autism.

Agreed. Have you seen the new AgTech research coming out? Could really turn the industry on its head:

[Cigarbutt]

"Research has shown that, generally speaking, once a person reaches that level of “acceptable” performance and automaticity, the additional years of “practice” don’t lead to improvement. If anything, the doctor or the teacher or the driver who’s been at it for twenty years is likely to be a bit worse than the one who’s been doing it for only five, and the reason is that these automated abilities gradually deteriorate in the absence of deliberate efforts to improve."

 

Ericsson, Anders. Peak: Secrets from the New Science of Expertise (p. 13). Houghton Mifflin Harcourt. Kindle Edition.

 

Very interesting Boilermaker.

 

- for medical research I am looking for the obvious.  If 5+ studies come to the same conclusion and none or 1 against, then seems like a high probability that the 5+ studies are the one to bet on.  I am no experts in statistics, so lack there, but some data I can evaluate. It really depends.  I am trusting the scientists - which does leave open the wrong conclusion.  I look for conclusions that are generally clear in one direction though. 

 

For investing:  This is a really involved question on the research.  I usually try to disprove my thesis for the big drivers of value.

 

Interesting perspective. If I understand correctly, there is an element of « gut feeling » which apparently can be improved with deliberate practice.

 

Would add that one should be aware of what is described as the Bing Crosby methodology which has many meanings in research (and can be applied to investing decisions) but can be used to explain that the results that one “sees” may not reflect a sound process (from publication {selection bias} to the reader {confirmation bias}) and may simply reflect a form of cherry-picking.

 

But I see your point for health issues where the price of being wrong can be high and would tend to assess the price to abate the information asymmetry that exists and determine if the effort is worth it. What is great about investing is that one can simply walk away if the target does not go through the basic filters. Next.

 

Trust is often a key variable in those cost/benefit decisions when we meet the lawyer, doctor, car mechanic or whatever on a daily basis.

 

So, what makes an expert?

 

However benign or life-changing, we (consciously or not) should? go through the following steps:

 

1-level of relevant knowledge acquired from training and practice

2a-offered conclusions are based on a disclosed set of facts

2b-offered conclusions are based on sound and well delineated reasoning

3-opinion not offered as authority but as a basis to understand and solve a specific problem or question

 

The underlying problem often resides in the bridge that needs to be crossed from research (often uncertain and controversial) to policy that works well if simple and clear (without nuance), the same way that an investment recommendation may not convey the uncertainty of the outcomes for a specific security.

 

@LC

I liked the video. If I understood correctly, the leader had a hard time convincing his Congress until he started to use their own language. Experts come in different varieties.

 

[LC]

@LC

I liked the video. If I understood correctly, the leader had a hard time convincing his Congress until he started to use their own language. Experts come in different varieties.

 

Idiocracy is a pretty good movie especially in today's day and age, give it a watch some time!

[Dynamic]

Cigarbutt - for medical research I am looking for the obvious.  If 5+ studies come to the same conclusion and none or 1 against, then seems like a high probability that the 5+ studies are the one to bet on.  I am no experts in statistics, so lack there, but some data I can evaluate. It really depends.  I am trusting the scientists - which does leave open the wrong conclusion.  I look for conclusions that are generally clear in one direction though. 

 

This sounds like a sensible initial approach to look for a number of studies on one side outweighing the few that are probably spurious or based on wishful thinking.

 

A second or third opinion from a conventionally trained doctor or specialist can be valuable to weed out the fatal 'in my experience' phrase where such long experience is filtered badly by the statistically-poor human memory and it out-competes the body of reliable evidence based medicine in forming their clinical judgement.

 

It's very easy to find things online that contradict your qualified medical expert's judgement, but there's an awful lot of small studies with low clinical relevance or low statistical power that may be helpful to find avenues for further research but which should have no relevance to clinical decision making or what actually happens in a complex human body as opposed to a test tube.

 

There's also a lot of rampant pseudoscience and outright quackery online often from well meaning people taught bad science in colleges of 'natural medicine' (including herbal, homeopathy, acupuncture etc), 'traditional chinese medicine' (popularised in the 20th century when China couldn't afford enough conventional doctors), 'energy medicine' or 'chiropractic' (of which there is a wacky side that thinks chiropractic subluxations exist and are the cause of all diseases and a more sane side which only tries to treat back pain and the like in a slightly less safe way than massage and physiotherapy).

 

A good fun and inspiring book to read is "Bad Science" by Doctor Ben Goldacre, who is involved in the international Cochrane Collaboration (which is close to the gold standard in systematic review and meta-analysis of medical research to give and update best-practice advice). This is heavily in the field of Evidence Based Medicine. He's also trying to weed out the practice of leaving research that shows no effects unpublished, which distorts the statistical evidence base on which clinicians try to make sound clinical judgements about the best treatments to use. His book Bad Pharma addresses that and he was instrumental in getting the AllTrials campaign going as well as some great evidence-based government policy initiatives.

 

A great blog to read is Science Based Medicine (wiki). A number of world experts in various medical fields look into what works by adopting a Bayesian approach (incorporating prior plausibility as well as the strength of statistical evidence from new data, to find out what's most likely to be true. This is similar to Evidence Based Medicine but says there's little point contemplating wasting money on big studies in scientifically implausible techniques with a very weak evidence base, so it tells you where you get the best bang for your buck in research. Dr David Gorski is great, Dr Steve Novella too, and Dr Harriet Hall is another great one in that Science Based Medicine scene. All of them can be found on YouTube and podcasts giving great advice.

 

Dr Edzard Ernst is a German physician, taught conventional medicine alongside homeopathy at medical college. He found the research by fellow homeopaths was seriously flawed and sought to produce better research to back up what his experience of patients improving seemed to show worked. He found that it was actually usually effects such as the simple time course of the complaint developing and varying that made it look like the treatment worked after being given, fooling him by chance, so he changed his opinion and started researching alternative medicine with a careful, rational, scientifically skeptical approach - don't fool yourself is the mantra! His book with Simon Singh, called Trick or Treatment? is very good and was rationally sound enough for Singh to win a famous libel case brought by the British Chiropractic Association.

[petec]

This is a phenomenal article and relevant to this topic:

 

https://www.theatlantic.com/health/archive/2017/02/when-evidence-says-no-but-doctors-say-yes/517368/

[UNF2007]

I'm a physician/ surgeon and I totally agree with the sentiment in this thread. In fact through training I have always mentored the people under me to never take anything I or anyone else teaches without verifying it first. In training we even had a term for the info others tried to impart that was plain wrong or dangerous "black pearl of wisdom". Most physicians I have worked with are just as skeptical of the literature as anyone. If you adopt something into your practice that later turns out to be harmful, ethically that is a tough thing to deal with. In the surgical world for that reason change is glacial. In training we are used to having our judgement and opinion questioned relentlessly, that is what forces you to drill down to the facts. I will say this though, once a medical person forms an opinion about a topic, it's very tough to have them change their mind. I have been in charge of the journal club, this is an activity where we sit down as a department once a month a review relevant medical literature. I have noticed over time people really don't care what the literature says, if it contradicts what they are currently doing the literature is 'bad' if it supports them then they already knew that. Classic confirmation bias, that we are all susceptible to, hence my enthusiasm for always confirming advice or pearls that you are given.

[LongHaul]

Interesting perspectives from the doctors.  Docs can be irrational too.

 

Thanks Petec for the A+ article as it was loaded with insight.  I liked this part:

 

“There’s this cognitive dissonance, or almost professional depression,” Walker says. “You think, ‘Oh my gosh, I’m a doctor, I’m going to give all these drugs because they help people.’ But I’ve almost become more fatalistic, especially in emergency medicine.” If we really wanted to make a big impact on a large number of people, Walker says, “we’d be doing a lot more diet and exercise and lifestyle stuff. That was by far the hardest thing for me to conceptually appreciate before I really started looking at studies critically.”

 

I would recommend the book "Eat, Drink and be Healthy to everyone."  Walter Willett from Harvard seems like a very rational guy.

 

[boilermaker75]

Interesting perspectives from the doctors.  Docs can be irrational too.

 

Thanks Petec for the A+ article as it was loaded with insight.  I liked this part:

 

“There’s this cognitive dissonance, or almost professional depression,” Walker says. “You think, ‘Oh my gosh, I’m a doctor, I’m going to give all these drugs because they help people.’ But I’ve almost become more fatalistic, especially in emergency medicine.” If we really wanted to make a big impact on a large number of people, Walker says, “we’d be doing a lot more diet and exercise and lifestyle stuff. That was by far the hardest thing for me to conceptually appreciate before I really started looking at studies critically.”

 

I would recommend the book "Eat, Drink and be Healthy to everyone."  Walter Willett from Harvard seems like a very rational guy.

 

Which would result in a huge decrease in health care costs.

[Dynamic]

Thanks petec for that article.

 

UNF2007 - your input is fantastic. Applying critical thinking to such an uncertain world and trying to correctly incorporate new information into your decision making by way of the journal club is a mentally taxing thing to do right, overcoming human biases. Mind you, I think such ability can lend itself to investing.