Why Do People Keep Falling For Things That Don't Work?
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- čas přidán 26. 07. 2024
- There’s one particular mental trap that seems to fool everyone, especially those WITH medical knowledge.
THANK YOU for your support in 2022. This Christmas I'm donating my sponsorship fee to charity via GiveWell because I know it'll help those in need. If you can join me in giving something, please do - anything helps. Have a wonderful festive season! www.givewell.org/medlife
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Watch this video free of ads at Nebula: nebula.tv/videos/medlifecrisi...
My video on vaccines and people’s reactions: • What Is The Future For...
My video on bias, which mentions other failed therapies (two parter): • How Medical Research G...
Kevin Klatt’s post / cb72yxvlcf3
Andrew Steele’s dissection of ‘Blueprint’ longevity plan • Can ‘Blueprint’ make y...
Writing: Rohin Francis
Editing: Tanmay Nandanikar and Rohin Francis
Thumbnail design: Simon Buckmaster
0:00 Intro
3:41 The demarcation problem
6:44 Pseudoscience
9:06 Homeopathy and chiropractic
11:20 It's nice to feel nice
13:37 Bioplausibility
16:39 The mechanistic bias
17:06 Hard vs soft; clean vs messy science
20:25 Mechanistic examples: COVID Rx and masks
24:40 Diets
28:12 Vitamin D supplements
36:36 The Big Pharma graveyard
45:33 Most therapies don't work
47:07 Influencers' love of sexy mechanisms
50:25 Closing summary
References:
Convalescent plasma doesn’t work www.thelancet.com/journals/la...
Meta-research: A comprehensive review of randomized clinical trials in three medical journals reveals 396 medical reversals elifesciences.org/articles/45183
Most healthcare interventions don’t work www.jclinepi.com/article/S089...
COVID experts give Thanksgiving tips www.statnews.com/2022/11/21/h...
VITAL study (vitamin D) www.nejm.org/doi/full/10.1056... www.nejm.org/doi/full/10.1056...
VITAL website www.vitalstudy.org/index.html
Vitamin D in kids jamanetwork.com/journals/jama...
MAST pants don’t work pubmed.ncbi.nlm.nih.gov/10796...
Nesiritide www.ahajournals.org/doi/10.11...
REDOX www.nejm.org/doi/10.1056/NEJM...
PANTHER IPF www.nejm.org/doi/10.1056/NEJM...
OSCILLATE www.nejm.org/doi/10.1056/NEJM...
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THANK YOU for your support in 2022. This Christmas I'm donating my sponsorship fee to charity via GiveWell because I know it'll help those in need. If you can join me in giving something, please do - anything helps. Have a wonderful festive season! www.givewell.org/medlife
Great video. I thought of so many funny responses while I watched this on nebula & by the time I noticed it on yt I'd forgotten them 💀
The problem with the C-19 shots is not the science behind the shots. Rather, it's the vehement distrust of the people behind it. That's all.
I'm not trying to be woker than necessary but why does a charity spend money on youtuber advertising? To me it doesn't inspire confidence they use their funds sensibly when they spend it on CZcams ads...
What a kind endorsement of a hyper-effective charity! Good for you!
All the most sick people have lower vitamin D levels because they usually most in bed in hospitals or home and most beds aren't under direct sunlight.
The Return of the King
The anti liver king
Liver King? May the sun ever shine on his scrotum and his testosterone forever swell
Cardiac King
King of hearts
@@spreekstem 🥇
When I was doing my biochemistry master's on the first day my work mentor asked me to guess how a particular biochemical mechanism works. I gave him one and he said that the explanation was very good, reasonable, and plausible. It was wrong tho because of factors I did not know or could have reasonably known. I learned then that no matter how smart you or your explanation are, reality does not really care.
Lol, yeah. The everyday reality of labwork is that biology doesn't care about your cool hypothesis.
I'd refuse reality and design a whole new biochemical pathway, with novel enzymes and mechanisms, proceed to build the genes related to their expression (and regulation nonetheless) and finally get a break together with a Nobel prize or two.
Same conclusion I reached after every chapter I read on molecular biology
So true really
I myself am constantly taught to create arguments that are reasonable and defendable even if flawed.
I am not educated in the military sector but even with my limited knowledge, I can make a plausible argument that all the problems in my life can be attribued down to the military because I one day mentioned a technology they are currently secretly working on and they want to silence me. Why don't they just kill me? Because if they do then it will be suspicious if I-saying they are working on a secret technology-suddenly die!
I can even bullshit my whole way to diagnosing a random person with adhd or autism even with my limited medical knowledge because I can create plausible arguements
@@gabrielsb3419 I'm more on the chemistry than the biology side, but biochem kicks my three letters six ways till sunday...
Pretty much any time I think I've gotten a (loose) handle on wtf is going on another bombshell gets dropped on my head and I realise how little I know.
There's like... two things I'm reasonably sure of? Fructose and seed oils are probably not great for humans to eat, but why exactly is this long, long, _long_ trip into biochemical pathways ;_;.
And that's like a teeny tiny slice of the ridiculous insane world of just human metabolism ;_;.
There's a joke I heard a while back that I really like that came up in a discussion about cognitive biases and increasing awareness about them: "The only critical thinkers left are people who know they are not critical thinkers". Knowing about a cognitive bias in large part is knowing how blind we are to them when they are our own.
Thiiiiiiiiiiiiis.
I don't suffer from cognitive biases. In fact, I quite enjoy them!
@tallskinnygeek BASED
Is that based or biased?@itsmyright2229
i know the phrase sounds cool but it doesnt make much sense
I was at Eli Lilly's launch of Xigris in my country. Champagne, fabulous food, and a popular singer giving a concert. Then about two weeks later I had a patient who I thought would benefit from this almost miraculous drug. She was in severe sepsis, and on 4 vasoactive drugs. Because of the high cost we needed special approval from the administration. The patient was a sibling of one of the administrators. We got approval immediately. She was weaned off the vasoactive drugs in less than a day and extubated 2 days after. The drug was a success. Afterwards we had no problem getting approval for its use. It was similarly useful in at least two more cases. We were believers, and when we saw that it wasn't universally effective, and caused some significant side effects, we were profoundly disillusioned. We bought into the hype, and were reassured by our own first experience with the drug. Lilly's explanation of the mechanism was completely bioplausible.
Dr. Paul Marik has used H.A.T. (hydrocortisone, ascorbic acid, thiamine) therapy to greatly reduce sepsis.
I looked this drug up and read its history.
A number of years ago the rules changed about drug companies giving sponsored dinners\parties and whether CMEs could be given for these presentations. Basically CMEs are not given for most of these type of presentations.
The health care system privilege money shot: "Because of the high cost we needed special approval from the administration. The patient was a sibling of one of the administrators. We got approval immediately."
I just watched the vasopressor trap video..
You started off your story with, "champagne, fabulous food, and a popular singer giving a concert. "
Those are all red flags.
Obviously they were trying to trick you..
That thumbnail is disgustingly good. Well done sir 👏
I outsourced it for the first time ever! So I’m glad it was worth it! I suck at thumbnails
@@MedlifeCrisis Definitely got me clicking straight away 👌
I thought it was an ad when it showed up on my feed 😂
Yep. Amazing
@@TommoCarroll Oh, I guess I need to check the thumbnail now, didn't even see it yet. I just see a Rohin video available, I watch it. =)
"When you know a bit about metabolic pathways or NTs or cells it's actually easier to concoct things that confirm your beliefs"
Every student of physiology felt this in their bones
Or you spend years getting to know how spectacularly little you know and getting the slightest sense of being sure stamped out.
Yes Sherman, or to look at it another way, "A little bit of knowledge is a dangerous thing."
your emphasis on human contact and concern being what is actually helpful in many pseudo-therapies is so accurate. we need each other as humans and when we feel lonely and depressed, that can manifest as physical symptoms. sometimes what we really need is touch and attention - someone to put their skin on our skin and listen to what's burdening us. the most helpful things my doctor has ever done to treat my chronic illness are to listen to my struggles, give me solid advice, and give me a hug. of course the medicine and lifestyle changes contribute to reducing the bad things but the social components of treatment help maximize the good things.
we need each other and we can save each other.
Very true!
I once had an interesting experience at the dentist: I had to get a root canal treatment and it was unpleasant and painful.
At some point, the dentist put his hand on the side of my face to stabilize my head and it made everything better. This warm pressure made me feel safe and comfortable and that altered my perception of the pain. It was easier to endure.
And we know that feeling cared for reduces the amount of stress hormones in your body and has other measurable physiological effects (on top of the psychological ones).
Modern medicine needs to take this knowledge into account. "Holistic approach" is not just a buzzword.
But of course all of that is being ruined by the profit motive of capitalism.
non sexual physical contact has pretty much become inexistant in our society, appart from parent/child, and that is really scary to me
It is one thing to say that this kind of pseudoscience placebo effect may help in some instances, it is a completely different story to market these practices to the mass
Here's my take on the subject of human decency and caring: When you're looking for a family doctor, NEVER get a doctor older than 45.
After that age, they've grown so used to death, and are so utterly numb to their patient's concerns that they are just counting the days until retirement. They've lost all passion for actually helping people, and are just going by muscle memory. The other day just to see if I was right, I asked my doctor for a random drug saying I heard it would help with weight loss. Without even looking up from his notepad, he said my pharmacist would have it shortly, and he didn't so much as ask me where I heard about it, or if I was experiencing any symptoms the drug was prescribed for.
Yyunko, friends do hug. Putting an arm around the shoulder of a friend is also pretty common. That's how it is here, at least
12 years into my self education of science in all it’s glory, and I was 100% unaware of my own mechanistic bias, in fact, i believed it to be a very promising indicator. Even though I was very much into evidence based medicine, I was stuck in a mentality of “it makes so much mechanistic sense, it’s clearly going to pan out in all the trials that are sure to come.” Thank you so much for helping me along in my journey, you may have saved my life or a loved one’s, because they or I will get very unwell eventually. Thank you sir
I agree.
Science is ultimately a process of becoming less wrong, so all of our theories are always at all times limited and will miss certain things. They are a basis from which to start an investigation or to try to understand something but always come with the caution that usually reality is much more complex. Also it's all dependent on how well evidenced the theory is, there are some theories that are so rock solid that you can dismiss things solely based on them but there are others that are much more limited in scope and sure-ness (not sure what to call it but like how clearly you can predict an effect from a cause).
science shouldn't see itself (ego) as right or wrong but proven or unproven. to help seperate the ego of the dr from facts. i would be hard pressed to find a dr. who would say "vitamin D" is not doing anything. but as a primative mammel it makes me feel better to go outside everyday. but a dr. can't make person go outside. these are the problems we need to tackle
I'm addicted to placebos. I'd give them up, but my doctor says there'd be no point.
😝🤣😝🤣😝🤣👍👍
Wow comment 😊
You just won the internet!❤
As someone in physics, I think the idea can be extended a bit further. The problem isn't just that people believe in things that are bioplausible (or just mechanistically plausible, in other fields). The problem is that we never truly have a perfect working model. If one actually has a perfect simulation or model of any system, then any mechanistic solution/therapy/fix that satisfies the model ought to work; however, we're never working in that perfect world, even in physics, and other fields just get harder and harder to model as we move away from physics.
In other words, the problem isn't that we believe in mechanisms, but that we mistake out intuition for actual perfect models of reality. A nice label that's not field-specific might be 'intuition bias'. I see this all the time in physics, and honestly, the longer I've been in research, the more I find that I have to fight this bias, because one develops more and more intuition around models that are not exact reflections of reality.
I think this is also quite related to the current state of science, and how in the past, a single smart bloke could indeed revolutionize three different fields with mechanistic insights, because something like Newton's law of gravitation or Darwin's evolution, figured out mechanistically, makes sense and works perfectly for the understanding of the time. These days, models are so insanely advanced and the boundaries of science pushed so far that it requires entire lifetimes to meaningfully expand a single niche. There is no way to directly intuit this stuff anymore, best you can do is make some good hypotheses to be tested. But many get stuck in the old way, after all, it worked for centuries before, didn't it? Everyone is taught that you could become the next Genius of our Time, rather than the reality of contributing your study to many huge groups set up to probe topics far too vast for any one person to fully plot out from cause to effect.
This just reinforces my notion that the vast majority of science has probabilistic conclusions than absolute ones.
Because we can't isolate, let alone IMAGINE, every variable contributing to the experimental outcome. But the effort can still be useful/important to build upon w/ more inquiry (go from a state of incredible messiness to something more organized). To attempt to make our models (and interpretations) more comprehensive, despite the impossibility of perfection.
AKA "The map is not the territory".
A good example are the TNF inhibitor class of drugs, Humira, for example. TNF is an important cytokine that modulates immune responses. However, in some autoimmune inflammatory diseases, too much TNF is produced which leads to damage to healthy cells. TNF inhibitors were designed to bind TNF and thus prevent some autoimmune diseases. But it became clear in clinical trials that these drugs rarely cause or worsten heart failure. This is unexpected since, mechanistically, there is no reason to suppose that this should be the case. Still, it happens, and indicates an incomplete understanding of the role of TNF.
Totally different context, but it's actually a kind of bias that the arts struggle with constantly as well, especially visual arts. In order to recreate a believable model of reality you have to back engineer from all the automatic image correction and manipulation the brain performs, while still understanding that either you can know things that your eyes tell you are false (relative colour issues for example) or that would be devastating to your other functions in life to truly undermine and break. Thinking especially about where crafts intersect here, where over time experienced workers build up incredibly sophisticated internal models of physical understanding that may entirely bypass the concious thought parts of the brain, being encoded somehow as some sort of artificial instinct almost. It can be a very structural issue, at least to my knowledge, but my perspective from the arts actually gives me a lot of hope for compensating for this problem in science, once the awareness of the distortion is there, the opportunity to change it exists
Omg, what a great video. I'm a med student and I could never make sense of why anyone ever said "stenting is effectively useless" when I knew it is a life-saving procedure for ACS. I didn't realize people used to just stent random people on the street just because they wanted to.
His friend thinks he’s hip but it’s all in his head
Oh, the Journal of Infrared Scrotal Science. JISS. I love JISS. JISS is my favourite medical journal of all time.
Goddamnit, Rohin.
It was originally an offshoot of the Proceedings of the National Academy of Sciences
@@aelolul Right. First you have PNAS, then comes JISS.
As a philosophy major - I may not entirely agree with Popper, but it's incredibly refreshing to see some philosophy of science brought into this kind of convo, very useful and great job
I'm satisfied with the note that there are criticism and like 100 years of philosophy of science after Popper.
A lot of philosophy inclined scientist often take Popper criteria as the end all of the demarcation problem
@@gregdesouza17 so what are the most important first next steps we should take?
@@gregdesouza17 My problem with the Popper critics is that their supposed star argument is "Poppers theory means it takes hundreds of years to consolidate scientific knowledge". (which means you can never use recent science for stupid polemics)
Uhm yeah? So what? A philosophical theory that describes reality as it is? Well that could tarnish the reputation of philosophy forever.... Oh noes. Have to keep that dilettante egg head image.
Of course there are valid concerns with Popper - falsfication is just a PART of science and reliable knowledge otherwise it would be paradoxical anyway.
"As a philosophy major"
lol
It's interesting how little the philosophy of science is taught in scientific degrees. I'm aware of Popper, but only through reading some Wikipedia articles after I finished my physics degree. You would have thought at least some discussion about what it was we were actually studying would have been worthwhile!
Thank you, Rohin, for your time and work invested in this type of content. As a med student, I can still remember, when learning the basic sciences (physio, biochem), I thought that I knew so much and would eagerly await the time, when I become a physician and would be able to explain my patients their diseases and treat them based on my mechanistic understanding. Now when finishing my studies I am much more aware of the limitations of investigating such complex subjects as humans in health and disease with all kinds of variables possibly playing a role. Now my wish is not to be mechanistic know-it-all, but to be a prolific "reader" of research. In words of Siddhartha Mukherjee: "But most doctors don’t really hunt diseases these days. The greatest clinicians I know seem to have a sixth sense for biases. They understand, almost instinctively, when prior bits of scattered knowledge apply to their patients - but, more important, when they don’t apply to their patients. They understand the importance of data and trials and randomized studies, but are thoughtful enough to resist their seductions. What doctors really hunt is bias."
damn this was actually a really important video to make... as a junior-level chemistry undergrad student I certainly have a tendency to see myself as an "expert" among my friends and family who have no formal science background at all, and it wasnt until this video that i was really able to finally formulate the thought that maybe my ability to reason out potential mechanisms of cetain phenomena isnt actually as valuable as i thought? and in some cases may actually be way less valuable than my friends' and family's approach of just reading news articles about studies on things? i can't imagine that im the only person who's like this and who needed to see this video, so thank ronin
I think it's easy to fall into that trap and when you learn about science you'll keep falling into it and pull yourself out, not because you're arrogant but simply because you're hyped about suddenly understanding a new thing and being able to describe it precisely and make predictions. And of course you want to share that knowledge both because it's really cool but also because it might be able to help those around you. And it's really scary because you know that those around you will likely see you as an expert simply because you can recite things they haven't heard about and take your word for things. There probably isn't any surefire solution here, like you can't always stop yourself from getting excited so you just have to live with the fact that you will make mistakes and say things that are wrong, and try to always stick with the evidence.
I was once by a patient's hospital bed when the doctor came by. We asked if a certain treatment could be tried, which would have made the patient more comfortable. The doctor gave an answer, which I thought weak at the time, but I now realise showed high training and courage: "there's no evidence that it works."
Depends on the treatment, if there's llittle cost and risk, there's no reason to deny it.
Not to mention, for new treatments to be found they have to be tried first, and if there's no interest in a treatment there'll be no funding for studies either.
Placebo effect though
Meh. Sometimes you get desperate.
I second Stee; it's not about whether there's evidence that it works. The question is whether the potential benefits outweigh the potential cost. No risk interventions should be tried willy-nilly, especially if the patient wants to try it. The only caveat is that the risks include opportunity costs, so make sure you're not forgoing treatments that do actually have evidence behind them.
If there's no benefit, any cost would be unnecessary.
What a wonderful overview. The mechanism fallacy is a great little label for it. My Christmas wish would be for my "independent researcher" parents to watch this and absorb its message, but perhaps as a direct result of growing up in a household filled with magical thinking, I no longer believe in miracles. But you were so even-handed and cool headed in your handling of the subject Rohin, I hope it does reach a few people who need to hear this message!
Thanks mate. Weirdly enough I was talking about you at a party today as a friend who is prone to flights of fancy has decided to write a book about typefaces 😂
Here's something that bothers me about the "independent researcher" archetype, though- it's often used by medical professionals to paint any patient who contests their way of doing things as similarly deluded by quackery.
I'd been failed in my tendinopathies by GPs, surgeons & PTs who all pushed treatments not supported by science, before eventually solving the issue through simple load management and a single heavy load exercise.
I'd been failed as a transgender individual by a specialized clinic that still operates on myths like that spironolactone lowers testosterone & woefully under-prescribes estrogen for proper androgen suppression despite minimally elevated risks with higher doses through non-oral RoAs.
As a person with ADHD, I'd been failed by psychiatrists who prescribe the expensive 'Vyvanse', a simple rebrand of 'Dexedrine' that is functionally identical save for an attached-protein making it only able to be used via oral RoA, and makes me feel just as depressed when it wears off, as Takeda Pharma pushed that it was safer while conveniently collecting billions on a new patent. Similar was true of Adderall, a drug brought to market under a new patent through the inclusion of levoamphetamine- a chemical that had been indicated as *not* of therapeutic value decades prior due to its actions on norepinephrine making it bad for both the heart and anxiety. Meanwhile, mentioning the medication Desoxyn- known under a more popular name that might get this comment censored- has been met with shocked looks and abandoning me as a patient, despite how its lowered action on norepinephrine makes it more heart-healthy and its greater specificity for ADHD symptoms makes it have few side effects at the therapeutic dose. Stigma dating back to World War 2 dictated these doctors behavior more than the actual science of the chemical.
And yet- whenever I've brought any of this up to providers- I'm seen as the deluded "independent researcher", despite how I sourced all of my information from a variety of journals & Science-based Medicine journalists, all in response to a medical system that was failing me.
@@made.online2149 Holy shit, are you me? Literally everything you just said is exactly part of my own experience dealing with the medical community, topic for topic.
@@made.online2149 holy shit you might have just saved me $300 a month😊
@@MedlifeCrisis 07:40 Yes they are testable! a lot of work but they can be! Nobody will bother as we know theres no point it doesnt work! If they do dance with music near the plant it might make it grow better! :)
I really appreciate your discussion of ICU patients. My mother was admitted thru ER to the hospital after being told her high blood sugar (diabetic for perhaps 20 years) was alarming on a cardiologist's blood panel. That night before going, she also had an issue of clear fluid weeping from her legs, fluid retention from congestive heart failure. The next morning we visited her in her ordinary hospital room where she complained about the taste of a potassium supplement she ended up not being able to finish. Later that night, she had a cardiac event and was found in the bathroom un responsive. She was taken to ICU and spent almost three weeks there while the doctors monitored and assessed every detail. By the end, after she had aspirated and was too tired from being constrained from bed, she made the decision for a DNR and halted treatment. An irony, her legs had fully healed in that time, so if one's observations were blinded to the liquid food and other sources of pneumonia that ultimately ended her life in hospice, her fluid retention and leg wounds had been completely addressed.
Thank you for your work, and sharing your voice here on YT. As a math student in college, I have huge appreciation for science, and often tell my nurses "I can tolerate anything for science" such as blood tests, nasal swabs, and throat scrapings. That month of being in hospital with my mother, I was angry and disappointed that science didn't have a perfect solution for her, but I still appreciate that having a way of telling that we're capable of wrong is the best part of science.
Ultimately, the human connection that her doctors had with us helped us come to decisions, and while I subscribe to a Diet-Zen "life is suffering" and agnostic approach to the afterlife which I don't think I could make the same decision my mother did, I am gracious to compassionate medical staff willing to talk to us and answer our questions.
Since it is tangentially related to a couple of things you mentioned, I thought I'd go off about a pet peeve of mine: RCTs in social science. While they are the gold standard in medicine for good reason, I feel like we have imported them without realising that some of the key assumptions aren't satisifed. Firstly, double blinding is basically impossible: you can't not inform people they've been enrolled in a school, for example. Secondly, the external validity is much more of an issue because of huge differences in social context. Thirdly, there are bigger issues with dropout and substitution because it's just harder to keep people in social trials than medical trials. I could use this to say something about givewell and effective altruism, since they rely so heavily on these RCTs, but I'd need to look into it more. (Full disclosure: I also use Givewell but I need to investigate it further.)
Nice to see you here, love your videos 😎👍
Does research around diet fall into this category of not being able to be blinded?
@@le13579 I'm no expert but I guess it varies on a case by case basis. Some foods could be 'hidden' or made to look the same while others couldn't.
Another issue, of which you're very certainly aware, is how many social science research trial subjects are affluent, western university attendees, which is a very narrow subset of people who generally inhabit a shallow demographic pool...because universities are where research is being done (so I get it--I was a part of that machine). That leads to hugely imbalanced/skewed results that are not necessarily applicable to the outside/"real" world!
What does RCT stand for in this context?
While I watched this (commercial-free on Nebula, so thanks for that), I kept thinking of all of the folks I know who really need this information. As a retired scientist, my love of evidence is, well, evident. It drives my friends a bit crazy, but when they doubt the veracity of anything "sciency" or medical, they always ask for my assistance in researching the facts.
I want to thank you for finding the time to make these humorous and educational videos. You truly are one of a kind and have a unique perspective. I wish you had time to produce more, but I do understand your time constraints. Have a lovely holiday and joyous New Year.
Did you take the Covid vaccine and boosters ?
@@edcarson3113 All of them. I got the Moderna about 6 weeks after it was released and and have had 4 more, all without a single side-effect. Not even soreness at the injection site . I have not had covid, nor have I had a cold or flu since December 2010. Good hand hygiene and strong immune system 😀.
@@stephaniehyatt309You don't know how lucky you are that you didn't have a single side effect!
@@vivianloney None of my friends or family had side-effects, and only one co-worker did (out of dozens). So I don't consider "normal" to be lucky. Lucky is when most people have side-effects but you don't. Just sayin'... BTW, to avoid a sore arm, get injection in dominant arm, massage immediately after injection, then use arm as much as possible. Learned this about 15 years ago from a nurse giving me my annual flu shot. This year, I got both at the same time!
@@stephaniehyatt309 What a weird way to define the idea of luck- I don't think the concept of "good outcome of a situation of chance" has anything to do with normalcy. And side effects weren't abnormal. Something like 30% of people got side effects other than a sore injection arm after the vaccine.
In charity too, interventions with plausible sounding mechanisms often turn out to have basically no effect. The economist Michael Kremer found that additional textbooks, flip charts and even teachers donated to poorer schools in Kenya had basically no effect on test scores when put through an RCT. However, de-worming drugs (to cure intestinal worms) had an enormous effect.
GiveWell tries to find interventions backed by solid evidence rather than just plausible sounding mechanisms.
For more on effective charities etc., I recommend the book "Doing Good Better".
Charity usually takes place from the perspective of the giver, not of the recipient. The idea of children being too sick with worm diseases to absorb education seems too disgusting for Western people.
"She's got a thing for Indian guys," OMG lol 🤣
From my background, it's interesting to note that the mechanistic bias also shows up in realms that you'd consider very pure and logical! In software, if you want to optimize the speed of your code, it's really vital to have good measurement tools. If you just follow rules of thumb about what "should" make things faster, you might "solve" something that wasn't the bottleneck in the first place, or even make things worse. Especially when you get down on the really low level of machine instructions, it gets really really hard to predict what's going to ACTUALLY be faster without just trying multiple approaches and measuring what works best in practice. You'll have people insist things like "but my code aligns data on cache lines!" as if the performance gods are obligated to reward your rain dances, when a hundred other little factors like inter-core contention might make your code slower.
Ultimately, there's no proof except proof, and you have to be kinda stubborn about it. Rules and models can be very alluring sirens for the unwary.
The law of "Unintended Consequences" comes to mind with code along with "Well, it worked on my machine". :)
It was bad enough back in the days of "single function computers" running one program at a time. Today it's hard to guarantee that Microsoft won't release an "upgrade" (and your IT department roll out) that breaks/degrades you code without warning. I got hit by a couple of those.
And I mean we do actually know for certain how computers work because we built them, so this isn't even like medicine where a lot of the time there's something we didn't know that messes things up. It just goes to show how quickly a system can evolve to become so complex that we have trouble truly understanding it.
@@hedgehog3180knowing how each part works and knowing exactly how the will behave when put together and then used in a very specific way are two very different tho.let alone how a piece of hardware should work and how exactly it will work aren't always the same, especially as manufacturing isn't completely perfect.
An extreme example I like to make is that "Smoking is healthy, because it helps manage stress" - sure, many people certainly feel eased when they can finally smoke after a stressful situation. But that doesn't induce that we should smoke or even that smokers are less stressful
(I'm similarly skeptical about the alleged benefits of modest alcohol intake)
Great video, enjoyed a lot!
Ah, but tobacco has been tested in RCTs. It does work, and if you're dying anyway, it might be worth the damage it'll do. (Don't mind me, that's my depression talking.)
But in all seriousness, it's worth testing. Consider chemotherapy, which by all means is terrible for you. Or even surgery, the application of wounding a patient and exposing them to dangerous pathogens to help them feel better. As much as I try to keep primum non nocere (yeah, that's probably spelled wrong) close to my heart, it cannot be the only guiding principle.
Hmm, ah I missed that. I need to find another example then. Thanks for pointing out.
(My other point with smoking is that there are various other ways to reduce stress, and maybe tobacco can also be consumed in other ways that aren't that harmful. But still, if it indeed shows effect in RCTs then the key point with my example is invalid)
To my understanding, a lot, if not all, of the benefits of alcohol disappear when you correct for income (especially the supposed benefits of wine-it turns out the people who can afford to drink it regularly can afford better health care in general) and that a sizable portion of non-drinkers are abstaining because they previously abused alcohol.
@@er00ic Or abstain because of pre-existing physical or mental health issues. Yup. This was my immediate thought on hearing about that result. It doesn't mean it is correct though of course, for exactly the topic of the video.
I guess I have another mantra to add to my logical toolset: A plausible mechanism can only ever expand the solution space, never shrink it.
@@marenjones6665 if smoking is helpful because it reduces stress, you'd need to prove it reduced stress better than the gazillion things that reduce stress without causing lung cancer or other types of cancer
Also, afaik, if a stimulant is reducing your stress, either you have ADHD or the stimulant isn't reducing the stress at all, it's just reducing your craving and getting you back to the baseline you were at before you took up smoking
Rohin, thanks for another great discussion! Worth the wait. My new favorite saying: The road to Hell is paved with bioplausibility.
EDIT: To say the ads that played during this video were ironic would an understatement.
Another legend appears!
This is the crossover I’ve been waiting for
I’d buy a shirt with that saying ! Hint hint
This is absolutely first class work. I have to say this is one of best pieces of content I've ever consumed on this platform. Thank you for the thorough work to produce this
So I watched this when it first came out. I just re-watched this and this time it really hit home. I think I am ready to "hear" this now because I just got so tired of chasing my mechanistic wellness tail. I just want to live as well as possible yet realize that eat well, sleep well, get a bit of exercise are the "real" secrets. The only thing I would add to that would be to have at least one good interpersonal relationships, because we are social creatures.
the thumbnail is so convincing that I kept ignoring this, thinking it was an ad
same, until I realized I'd said it to myself. On a closer look those parts look dangerous unless used in clock assembly or something similar.
See and this dovetails into everything else:
-I really like you know, "healthier" foods, but access to them isn't amazing where I live(I tend to subsist on frozen broccoli and green beans a lot)
-I can't walk safely in my neighborhood, there's no sidewalks and people go down roads at 65mph
-I try to sleep enough and prioritize my sleep, but I've had jobs call me in or schedule me for awful shifts over and over, messing up my sleep schedule.
I think within this is the part where we created an environment where none of these things a prioritized, and then we're having like, solutions sold back to us in marketing schemes because like you said "Eat a healthy variety of foods, Go Outside, and Get Enough Sleep" isn't much of a marketing plan.
Drew Gooden even came to this conclusion with his video on his Sports Guy Diet--that the food was good and helped him feel better, it's just not easy to market "you'll feel less like crap all the time".
Having watched you for years now you have earned my complete trust. Other CZcams videos I watch skeptically realizing that most of them are just commercials for something. But with you I take everything you say at face value and never give it a second thought. Thanks!
Myers Briggs personality test is basically astrology for science majors. Yeah, it is not scientific but it appeals to my love of giving tests and filling surveys.
Four minutes and six seconds short of a golden hour! The statistic that 90% of interventions are not evidence supported is stunning!
As someone with a fairly rare condition (Meniere’s Disease) the Cochrane reviews are universally depressing. Nothing reliably works.
Thanks for the shout-out, doc! And great video! All the mechanism fallacy needs for ultimate podcast success is an expensive epigenetic test for it…
I... please don't, even in Jest.
@@marenjones6665 An epigenetic jest?
…sorry.
Please keep making these long form video essays, they're incredibly interesting!
Excellently written and presented.
Thank you. This really made me realize some problems with my own thinking and question advice I had previously given to others with, what turns out to be, way too much confidence.
All while believing myself to be smart and well-informed. It's really easy to overestimate yourself
For a succinct description of our cognitive biases, I recommend the book "You Are Not So Smart" by David McRaney. There's also the classics by Ben Goldacre: "Bad Pharma", "Bad Science", and "I Think You'll Find It's A Bit More Complicated Than That".
I was just looking for books like this. Thanks for the recommendations!
Goldacre's stuff is great. Informative, while still an entertaining read. Will try McRaney, thanks for the hint.
Ben Goldacre is an entertaining read, up till the point when you realise that the bad science he is exposing has killed people. Then you realise it is serious.
Ought to be required reading.
@@andrewharrison8436 Ah, don't be such a downer. Hasn't killed you or me yet, nor is there a shortage of people ;) Just my joke there...
My point is that it's a good thing that Goldacre presents the absurdities in a half-joking way. It's hard to get people interested in serious stuff, their lifes are usually full of that sort of thing already. If you want to raise awareness for a problem, providing a bit of entertainment while you do is a good thing. It helps the cause by bringing entities on board whose only interest in the problem is to make some money out of it (meaning publishers and the like).
@@andrewharrison8436 Phil Plait's 'Bad Astronomy' is along a similar vein. It killed people too, albeit usually for the science being perceived as heresy against the Catholic church!
From Australia the "black swan" example seems really silly. For us it's white swans that are rare... which probably shows something about selection bias or cultural relativity or something.
I’ve got the same thing with the “when you hear hoofbeats think horses not zebras.
I’m South African, I’m about equally as likely to see a zebra as I am to see a horse 😅
You've made at least one biochemistry PhD rethink his biases, and for that I thank you deeply!
Only criticism is I would consider having longer breaks between the sections as it is quite a lot to take in 😅
Fortunately the sections are time stamped. I sympathise with the long length with such information density being a bit much
Truly delightful to listen to your well collected thoughts on these subjects. You have a broad audience. I watch every single video. Thank you.
Thank you Rohin for once again providing content that bucks the algorithm by being both rigorous *and* entertaining. You're providing a service to society well beyond giving us all something to fill our evenings (but also that too!).
You apologised for the first mention of epistemology, as if it might prompt people to leave the video, but that was the scentence that made me think "oh I'm definately watching all of this".
Wooo you talked about ORBITA!
Thanks for making such a great video. I've needed this exact video on the mechanistic bias for years when speaking to people. Now it'll be so easy to just link to this.
Another great video. If only everyone had the capacity to listen and understand the meaning of this, the world would be a better place.
I love it when I forget who I am subbed too and then they spring back to life with an hour long video that sucks me in.
This video is fantastic! Loving the deep dive and thorough explanations.
Thanks for all your great videos and look forward to seeing more in 2023!
Thanks for the intelligent middle ground you provide.
I think lots of people find "community" in either extremes, but hopefully more folks start realizing there's a pretty big community here in the middle, and we're very welcoming.
It's harder to hit a moving target though, so I can understand the trouble with finding the middle ground too
An hour of Medlife Crisis before Christmas? Best Christmas gift I've received today!
No but seriously, thank you for all your videos both this year and before, you're honestly one of my absolute favourite channels and I always learn something new and get another view on your topics. You make me think from different perspectives and are a great teacher, and funny, entertaining and interesting to listen to!
This was great, really opened my eyes to the mistakes I was making. I have major depressive disorder, and I and my providers have hit that point where we're throwing stuff around to see what sticks. Since brain science is equal parts poorly developed and deeply complicated, it's been a ride. Recently went down the folate wormhole and did not come out unscathed. I think I'll go back to looking at treatments that improved mood in RTC with no clue as to why. Also still working the basics.
Give carnivore a try, do your research and you will find that it helped a lot of people, while my depression wasn't severe it worked for me.
He's practically saying nothing works and if it works for you - you must be a biased fool. So I don't see what you heard (into) this absolutely ridiculous rant.
In my own travels on that patjway, I found that a classically balanced diet was having a profoundly negative effect on not only mood, but the effects of medications. Abandoning that and just making sure I get a reasonable amount of various nutrient groups in rotation over the course of a month or so, restored function to my medications and some sanity to my life.
Go figure. Not everything works for everyone, but I do know that going overboard for any one thing is generally a poor idea.
Good luck; suggest going back to basics, and work with what successes you can find to light your way.
@@chickenlover657 I saw your other comments and you seem to be kind of defective
@@autoteleology Well, I'm responsible for what I say, not for what you (mis)understand.
Givewell seems like the organisation I have been hunting for for years- thanks so much for introducing me to it. Great video, really good for grounding the ever so excitable mind back to EBM. Also now you've nicely condensed into words why I dislike medical influencers so I can feel smug when they appear on my screen- thanks Rohin!
Thank you so much for your voice of reason and sanity; there's so little of either in the world!
Easily held my attention the whole way through. Would love to watch more of your 'deep dives'.
An hour long!?
Hooray!!
i've basically got to listen to every one of medlife's videos more than once to glean what i'm meant to be gleaning, but like. gosh am i glad the videos are being made
Welcome back and thank you for the work that went into this.
Top notch. So valuable to get a contemporaneous medical perspective from an experienced, ethical medical practitioner; this also pairs nicely with the TedTalk. I remember listening to Huberman and Sinclair and thinking, "These guys are making huge leaps of logic", but doubting myself since they are both associated with some very respected educational institutions. I do like the NIH lectures and UCSF Mini Medical lectures. I will take a look at your recommendations as well. Happy New Year! I see your assistant has had some craniosacral therapy.
Didn't help, as you see; I think he needs a chiropractor. 😝
An absolute tour de force. Great job summarising that in an hour. I suspect it took longer than an hour to research! Very much looking forward to your next one on cardiology.
...and what a great magnum-opus it is. Thank you for the amazing overview, and highlighting how important critical thinking and healthy scrutiny is. I hope you have a great New Year's eve, and all the best for 2023.
Fantastic video, thanks for putting it out there.
Thanks so much for this long video.
I know there's dinner virtue to editing down to Tom Scott sized single topic videos, but I'm very happy to listen to you talk for an hour
Terrific video as always Rohin! I seldom comment, but as a student of social sciences I actually had some thoughts about both the demarcation problem, and the marketing-lingo of modern pseudoscience. So I thought I would put my two cents in.
First, while I think it is very good that you put in the distinction between clear vs. messy sciences in the sidenote to delineate between sciences that benefit from mechanistic modeling versus other sciences, I think it is also important to reflect on what we mean by "science". Because the demarcation between science and non-science is often (as you mentioned) murky and unclear, but it is also littered with questions of institutional politics, _scientific_ methodology, and ideology to maintain a sense of objectivity that defines science for both scientists and the public. This is not to say that science is doomed of course, only that every time we speak of science and its pseudoscientific counterpart we reenforce certain narratives about science and scientific objectivity (the jargon term for interested parties is boundary-work). This is actually vital to the creation of new science and scientific fields.
Second, I think that the argument made towards the conclusion of your video about sexiness of sciencey-explanations could be understood as a part of larger cultural trends. Specifically that the sexiness is precisely the problem we are seeing in large aspects of society. From social media spectacles that turn out to be marketing ploys, to images of bodies that are heavily edited, to these bio-plausible but pseudoscientific arguments. Instead of wading into the often complicated endeavors to accumulate new knowledge, we get a simulacrum of a scientific argument. A watered down, but effective marketing argument for a certain treatment or diet. It would make sense that the larger societal shift in mass-media, economics, and politics would also trickle through to areas in academia and medicine. The problem you are describing in medicine or science in general is also a cultural and political one, I think. But those are just some inputs from my social science perspective which could make some sense to stuff like this.
I didn't expect to watch it until the end, but hey, it was just too compelling! You got a like from me today, pls do more of these.
Often a long wait for your videos, but always worth it.
You are an extremely intelligent human being. You and your channel are one of the reasons I still watch CZcams. Thank You for making this platform better. Merry Christmas to you and your loved ones.
Congrats on a new subscriber, and thanks for the hours of immensely entertaining and wellmade content! Thank you, cant wait to see more things!
getting outside, getting some sun, he said...
*sighs in nordic darkness*
I have ectopic beats and they can be really horrible. It’s scary to think that if I was diagnosed 10 years earlier, I could have been put on a medication that was possibly life threatening.
Just for clarification, it was in patients who’d had heart attacks. But your point remains, people had strange ideas about ectopic beats even quite recently.
This is your best video so far. Very watchable - barely noticed it was almost an hour long.
I saw the duration and thought "hmmm.... bit too long" but after that intro, I think it's going to be worth it.
THANK YOU FOR COMING BACK YOUR ALIVE!!! YOU ARE THE FREAKIN BEST BROTHER :D THANK YOU FOR DOING YOUR PART AND THENN SOME ❤️❤️✌️
Modern conventional medicine in the UK normally does the exact of opposite of giving you a nice human interaction, you normally just rudely get told to go away...
The segment on Vitamin D reminds me of Goodhart's Law: "When a measure becomes a target, it ceases to be a good measure".
I really liked this video. I nearly passed on it due to the length, but so glad I gave it a go.
Made me realize my own mechanical bias and hopefully will make me more skeptical.
Ta very much!
I forget who it was attributed to, but there's a quote that summarizes this mechanistic bias nicely: "In theory, there's no difference between theory and practice. In practice, there is."
Biases? Affecting me? Hogwash. *snorts Paxlovid and prays to Ba'al Hammon*
Amazing video. Really just amazing and well thought-out. Keep up the good work :)
“Somebody offering you attention, listening, saying something soothing…”
Indeed in psychology and the behavioral health field we call this “the therapist effect” and it’s our interpersonal version of a placebo effect, against which any research evaluation of a specific intervention or psychotherapeutic technique must be compared to claim increased efficacy versus “treatment-as-usual”. Because we know that really does help most people at least a little bit, no matter what else may or may not be going on.
When the nurse at the psychiatric hospital I was at was recommending vitamin-D for my depression, I just wanted to scream.
What was worse was after when she ordered bloodtests for my serum vitamin-D level, apart from regular tests; and my results came with high levels of Vit-D, she buried her head in the sand and told me I should take more of it.
To be fair, giving people big pills that do nothing is probably one of the more effective treatments for depression, but only if the patient thinks it helps. I hope you found something that works for you!
@@armadillito Well in terms of medication yes. In terms of treatment 30 minutes physical exercise iirc dwarfs everything else we've tried for most people.
My cat lost a bunch of his teeth due to "tooth resorpotion"...nobody knows what causes it, but one of the leading theories is too much vitimin D in commercial cat food. (There is no upper limit for vitimin D in pet foods.) (Edit: Getting a friendly cat (or dog) is almost certainly a better treatment than vitamins!)
Some people are known to give placebo because they think it would help. Just like some people pray all the time, as if any of those wishes will be answered. If you believe the Vit-D nonsense, the placebo effect might work on you. Even if it does not, taking extra Vit-D does not pose any harm. That is the rationale for some docs. It may not necessarily come from pure incompetence.
@@frankxu4795 a nurse is not a doctor with diagnostic training. And if a blood test comes back reporting high vitamin D levels yet said nurse still recommends taking more vitamin D, that's incompetence.
Spent 2 minutes trying to pause at 02:28 and was not disappointed.
Thanks for the time stamp!
We have hotkeys for that, next time use "," and "."
I hope my doctors will think as clearly as you. Thank you for this video!
I like your title for the mechanism fallacy. It’s so easy to feel certain about things we already agree with; it’s comforting. Until it fails us.
As editor of Infrared Scrotal Studies, color me flabbergasted
In the VITAL study, the treatment group was given 2000 UI daily but the placebo group was allowed to take 800 UI, plus most of the participants already had sufficient vitamin D levels to begin with, so it's unclear if this actually *says* (as you state) that vitamin D is just a bystander. The primary endpoint was about cancer, but they only followed up people for 5 years, which is a very short time. There are several limitations in this study, but the fact that it didn't focus on people with vitamin D deficiency is even properly acknowledged in the conclusions of the ancillary study to VITAL that focused on frailty ("Effect of Vitamin D3 and Omega-3 Fatty Acid Supplementation on Risk of Frailty - An Ancillary Study of a Randomized Clinical Trial"): "These results do not support routine use of either vitamin D3 or omega-3 fatty acid supplementation for frailty prevention in generally healthy community-dwelling older adults not selected for vitamin D3 deficiency."
I generally agree that low vitamin D association with many diseases is not a cause but more likely a consequence (if your health is bad, you end up spending little time outdoors, less sun exposure, less vitamin D). But going from that to saying that having low vitamin D levels is not that important (is not really a vitamin!) is really a stretch.
Exactly, surely having a normal level of vitamin D is better than an insufficient level? Does it really matter how you obtain it then?
This is one of your best Rohin - thanks :-) You have put in a lot of hard work in abstract thought for this (although this is also probably the result of your continuous thought about these matters over decades). I have made the same mistake over the years of embracing plausible mechanism over data and of course misled myself. Great work!
I've just set up a monthly donation to Give Well.
Thank you for your suggestion.
And thank you for your informative, entertaining videos. My favourites are still the ones with your darling baby boys.
I couldn't take my eyes off the skeleton with the pelvis and cranium juxtaposed. Very apt! Thanks for the insight on Give Well.
At a low enough video quality the face looks right side up, cheekbones as eyes, and the pelvis forms another cartoon like face. It isn't there; do you see it too?
Just wanted to say that the thumbnail for this video is 10/10 A+ premium certified.
Bravo, Rohin ‼️‼️One of your best videos, to date...
YESSSSS what a lovely Christmas gift for us!! We love meandering video essays :D!!
This was a wonderful video, I'll be sending it to a few people!
Thanks buddy!
“The clothes of science” that sweater looks like it could be on a wax statue dedicated to the House of Tudor
Thank you for all you do. That conclusion clip should be added to the front of every one of the YT sciencey health vids
Your videos are simply the best (and most entertaining) presentation of health and medical information and debunking of myth and misinformation currently available. Thank you thank you for your contribution to evidence-based living.
Really happy to see you mention Popper when you talk about epistemology. For an even more modern take which further develops Popper's, I highly recommend "The Beginning of Infinity" by David Deutsch; it's a remarkably rational and insightful presentation of how and why progress in knowledge is possible. He also has a paper, "The Logic of Experimental Tests, Particularly of Everettian Quantum Theory" which is freely available from a link on his webpage. You can skip over the quantum mechanics stuff and just read the bit about experimental testing. In my opinion, David has the most brilliant theory of the philosophy of science to date, compared to a lot of other stuff you might find (Bayesianism etc.)
A lot of people seems to think science is about "right" and "wrong" - so that one party can go say "hah! I was right - told you so! (and by that I also imply you are an idiot)".
The whole idea is prediction. We do not need to "prove the earth is a sphere" so flat earthers can be mocked. But using a globe model of the earth lets us make useful predictions - that helps us in anything from metrology to navigation.
@@jarls5890 That science is only about prediction is actually one of the misconceptions David corrects in his book. In short, what science is about is seeking "good" explanations; an explanation that is hard to vary (changing the elements of the explanation) while still accounting for the phenomenon it purports to explain. What is and isn't a "good" explanation also depends on the totality of our knowledge at any point in time. The "flat earth" theory is a "bad" explanation because it conflicts with many other things we know of. For example, we know from physics that the gravitational force is spherically symmetric, which would pull stuff into a ball, not a flat disk. David also talks about how science is problem driven and conjectural; it always starts with a conflict of ideas, something you didn't expect or expected to be otherwise, and solutions to these problems are guesses, bold hypotheses which can be criticized and altered until a tentative solution is reached. He also has a TED talk on youtube that is worth watching.
@@Daniel-vu7pi I see no conflict here. Deutsch's "A bad explanation is easy to vary" is perfect for scientists and those who "believe" science.
The problem with it is when talking to the less scientifically inclined - or the ones who straight up distrust science - and especially distrusts scientists (and very much so if a scientist gets to define "good" and "bad").
I can't believe my layman attempts to understand (what I now know can be conceived as) the Everettian interpretation and experiments, testability and our subjective experience work in that framework without stumbling into anthropocentric Deepak Chopra territory has been spurred yet again by a CZcams comment.
Why is Bayesianism not as good?
The confirmation biases that I selected from your video essay made me feel really good. ;)
Excellent video, and I would donate to your chosen charity if I could afford it. I do, however, always make a Christmas donation to the BHF.
I hope that cause is close to your heart too... Ba dum tss!
Also big up to the whole NHS demanding a proper pay rise. !!!
Love this video subject so much, my favourite topics combined. I literally shouted when you said your caveat
I could have listened to this topic for hours. Please do a deep dive into more.
Sir, your philosophy of science is refreshing, cheers and thank you!
Ironically, I clicked away from the video but at the last second I heard epistemology and philosophy of science, so I came back.