Why I care about science and evidence

I caught myself wondering in the last few days about why I am so keen to pursue science and evidence-based approaches to health care.  I’m definitely consistent about wanting to know why something works, and equally consistent about knowing that it works – at the same time I meet people every day who don’t believe in science, but do want to believe in alternative health practices.

An excerpt from a great website that I refer to often might help to explain why I appeal to science when I am working in health care:

When you have something important at stake you demand truth. … whenever it matters to you, you already know enough to demand truth, and to understand what’s going on (i.e., to be “scientific”).
Suppose that you and I were going to bet $100.00 on the outcome of a coin toss. I flip; you call heads while it is in the air; it lands, I cover it, sneak a look, call it tails, and quickly put it in my pocket.
You would not pay. You would demand that you see an outcome before believing it or you would require that trustworthy people see an outcome and report it to you.

If you are uncertain about something that is personally important, you appeal to direct observation [my emphasis – adiemus] as your final arbiter.

It is what you can experience for yourself that ultimately determines what you accept as truth. If someone tells you something,

  1. whether there are several lines of evidence supporting it;
  2. whether the information is consistent with information from several other sources which are generally reliable or
  3. whether the information is consistent with what you already know.

When this informal notion of appealing to direct observation is used in an explicit, open, and consistent fashion, it is called the scientific method.

The website is Research Methods Lecture Notes written by William L. Palya, Jacksonville State University, 2000.
Palya gives a wonderful, logical rationale for why psychologists should follow a scientific path – and I’ll quote chunks of it and paraphrase bits of it for you here (but go and read it for yourself, in full – it’s worth it!)

The onus:
The first step in building a logical foundation for your practice of psychology is to decide what is at the heart of your system of wants, beliefs or values. An onus is the most primitive or most basic demand a person feels obliged to meet, even if it is not fun and even if it is not easy.
Here are some onuses that people in general accept:
a. Treat others in the way you would expect/hope to be treated
You would want to go to a maximally competent therapist who understands what is really going on and how to fix it.
b. Greatest Good for Greatest Number
Where things are complex, and there is no ‘completely right’ or ‘completely wrong’ decision, it makes sense to make decisions that maximise the results for most people.
What is the best answer for the big picture out of the possible alternatives? What will most positively affect the greatest number?
c. Others’ Interest Before Self Interest
If you have to assess more to understand a problem; work harder to get the job done; or give up a position to which you are emotionally committed but is actually wrong, then so be it. Decisions should be based on the truth rather than self interest.
d. Efficiently Eliminate Ignorance or Relieve Suffering
If you do therapy you must know how to help people and help them in the best possible way. The best solution requires a clear understanding of the actual factors involved.
e. Deal With Your Limitations Honestly
Know what you can or cannot do. Solve the problem when you can, but refer to others when appropriate. Stop seeing someone if you are not helping, even if it means a loss of income. Your decisions must be based on your ability to understand the requirements of the task.

These onuses are usually called ‘Ethics’ or ‘Ethical behaviour’

Now although this is written directly for students of psychology, I don’t see any difference between these requirements for psychologists to be ‘ethical’ than for anyone else to be ethical, whether it be a tradesperson fixing something, a physiotherapist helping someone recover the ability to walk, an occupational therapist helping someone to organise their daily activities, or a nurse helping someone return to health.

As a health consumer I really want to be assured that:
– the person I’m seeing is being honest about their ability to help me
– that by receiving my treatment, no-one else is being truly disadvantaged (no, I don’t want a kidney ‘donated’ by a starving person selling their body to make money)
– that my health care provider will put his or her own self interest to one side and not milk money from me because I’m a captive audience (how much money do they make from the products they sell?), after all I’m paying for their expertise already
– that they don’t spend a long time working out ‘what to do with me’ and in so doing make me spend hours there, just because they’re not efficient
– that when they don’t know what to do because it’s outside their expertise, they let me know and refer me elsewhere

Does any of this sound unreasonable? I don’t think so… you could replace ‘therapy’ or ‘healthcare’ with ‘plumber’ or ‘lawyer’ or ‘librarian’!

More tomorrow from this site – on being pragmatic, and how this affects why I use science to justify the therapies I use.

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