eSkeptic: October 24, 2007

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                eSkeptic

          the email newsletter
         of the Skeptics Society

      Wednesday, October 24th, 2007
             ISSN 1556-5696

       ---------------------------

To view this newsletter with graphics and formatting,
visit the permanent url:
   http://www.skeptic.com/eskeptic/07-10-24.html

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In this week's eSkeptic:

- feature article: How The Medical Mind Works - media appearance:
Shermer on CNN's Glenn Beck show - debate on video: Michael Shermer
v. Dinesh D'Souza - Shop Skeptic: Why Darwin Matters in paperback

       ---------------------------

In this week's eSkeptic feature, Harriet Hall, M.D. reviews Jerome
Groopman's book How Doctors Think (Houghton Mifflin, 2007, ISBN
0618610030). Dr. Hall, the SkeptDoc, is Skeptic magazine's resident
expert on all matters medical.

       ---------------------------

   HOW THE MEDICAL MIND WORKS

     a book review by Harriet Hall, M.D.


Jerome Groopman's book How Doctors Think is a superb commentary on
the intersection between medical science, compassionate personal
interactions, and critical thinking. My only caveat is that it may
be exploited by "doctor-bashers" because it shows how doctors make
mistakes; but the overall impact of the book is very positive. It is
a good lesson in critical thinking about any subject, not just about
medicine. It shows how people make up their minds and then resist
changing them, twisting or disregarding subsequent evidence to make
it fit their first hypothesis. It covers a number of other common
mental foibles, illustrating them with memorable clinical vignettes.
Groopman cites a recent study of 100 incorrect diagnoses: only four
of them were due to inadequate medical knowledge; in the rest of the
cases the doctors fell into cognitive traps. He targets errors that
are particularly hazardous to doctors, such as poor communication
with patients, buying into fad diagnoses, bowing to economic
pressures, and succumbing to pharmaceutical company influences.

Doctors may be well education, but they are no less subject to the
various cognitive biases that plague the rest of humanity, educated
or not. Thus, Groopman offers several guidelines to improve
performance: don't stop thinking after you reach a diagnosis; keep
an open mind so you can reconsider if new data suggest another
possibility; don't skip steps in a misguided attempt to spare your
patient discomfort; guard against treating patients differently
because of your own emotions or prejudices; listen to the patient's
own story and make up your own mind rather than accepting the
diagnosis of a previous doctor.

Groopman also gives practical advice to patients so they can help
their doctors think better. They can offer to tell their story again
from scratch to allow a fresh reassessment. They can ask, "What else
could it be? Is there anything that doesn't fit? Is it possible I
have more than one problem?" If they have their own ideas about what
might be wrong, or if they are worried about something the doctor
hasn't mentioned, they should speak up.

In the push towards evidence-based medicine, we encounter pitfalls.
The evidence may have been derived from a group our patient doesn't
belong to. The Women's Health Initiative showed that hormone
replacement therapy did more harm than good, but it studied an older
population: a later study on younger women showed that it did offer
some benefits when used earlier in menopause. A treatment that is
right for the "average" patient may not apply to the individual who
falls on the end of the bell curve and has other co-existing health
problems. This doesn't mean we can disregard the evidence-based
consensus. It means we should take the patient's risk factors,
concomitant illnesses, physiologic variants, current medications,
allergies, life situation, personal preferences, etc. into account
when choosing the best evidence-based option for that individual --
not that we should exit the evidence-based playing field and try to
invent a unique treatment for a unique patient using guesswork or
intuition. Medicine is not an art, it's an applied science; we need
to make sure we're applying it appropriately.

There is a place for clinical intuition. In an emergency, we don't
have the leisure to go through a lengthy process of weighing all the
information -- we have to make snap decisions to save lives. An
experienced clinician may pick up on subtle clues he is not even
conscious of. Of course, intuition can be misleading. Plus, medical
science is messy. One clinical study is followed by another with a
different conclusion. No test is 100% accurate. No treatment is
guaranteed to work for every individual. Uncertainties abound.

The public believes x-rays and biopsies give clear yes-or-no
answers, but that is not the case. They depend on human perception,
pattern-recognition, and interpretation. Pathologists and
radiologists often disagree with each other and even with themselves
(in repeat readings). A radiologist who has recently missed a breast
cancer is likely to over-read future mammograms in compensation.
Computer-aided diagnosis may improve cancer detection but in one
study it persuaded radiologists to change 10% of their correct
readings to incorrect ones!

Groopman criticizes the current batch of medical students for
relying too heavily on algorithms. "Clinical algorithms can be
useful for run-of-the-mill diagnosis and treatment -- distinguishing
strep throat from viral pharyngitis, for example. But they quickly
fall apart when a doctor needs to think outside their boxes, when
symptoms are vague, or multiple and confusing, or when test results
are inexact." On the other hand, he shows how doctors can make
mistakes by not following appropriate algorithms because they think
their patient is unique and they can do better.

All too often there is no algorithm, no clear evidence-based
guidance, and the doctor must make a difficult decision based on
inadequate knowledge. Groopman illustrates the soul-searching,
self-doubting worries that all good clinicians struggle with. How
can we know we did the "right" thing if there is no "right" thing?

Groopman says, "Statistics embody averages, not individuals." The
average benefit of mammography may be less than the benefit to a
woman with previous breast biopsies, a family history of breast
cancer, and several other risk factors. In cancer, the evidence may
show that chemotherapy improves survival on average; but it's a
gamble because it doesn't help everyone and may shorten survival for
a few. There are other considerations such as side effects, quality
of life, and limitations on lifestyle. Given the same information,
one patient may choose chemotherapy while another chooses no
treatment, and a good doctor tries to understand and support either
choice.

I was so impressed by How Doctors Think that I went on to read
Groopman's previous book, The Anatomy of Hope. I was even more
impressed by that one. He describes his experiences as an
oncologist, showing how false hope can be damaging but how there can
always be real hope based on coping with reality. He tells the
stories of patients who refused chemotherapy and about one who
demanded even more chemo than his doctors recommended; and he helps
the reader understand the thought processes involved. One woman
refused treatment because she thought the cancer was her punishment
for sins she had committed, one man had watched a friend die of
another cancer and mistakenly thought his own (curable) cancer was
the same thing. He shows how patients can live worthwhile lives
"with" cancer, even when it can't be cured. If there isn't hope of
cure, there is always hope of a better life while life lasts. I wish
everyone who treats cancer, has cancer, or knows someone who has
cancer could read this book.

One of the stories in The Anatomy of Hope is Groopman's own story.
He had a ruptured disc, failed surgery, and chronic back pain that
limited his activities severely for 19 years. Finally he ran into a
rehabilitation specialist who convinced him that the pain didn't
mean what he thought it meant. He had been avoiding any
pain-inducing activities on the assumption that it was telling him
his body would be harmed by those activities. He re-conceptualized
the pain as meaning that he was so de-conditioned that his body had
been trained to irrationally protest at normal, safe activities.
With an intensive training program, he was able to build up his
muscle strength and mobility again and he now leads a normal life
and is pain-free.

This is a great example of how the mind influences recovery. Not
woo-woo thought transfer or mind-over-matter, but proper
reality-based thinking about symptoms that can facilitate
appropriate treatment.

Groopman is a wise old soul. If every evidence-based medical doctor
applied real science with his kind of judgment and compassion,
alternative medicine might curl up and die.

       ---------------------------

SHERMER ON CNN'S GLENN BECK SHOW
ON 9/11 CONSPIRACY THEORIES

Last Friday night Bill Maher's HBO series was disrupted by a gaggle
of obnoxiously loud 9/11 conspiracy theory "truthers" (as they like
to call themselves), resulting in Bill charging up the aisle himself
to throw them out of the studio. Last night I appeared on CNN's
Glenn Beck show to discuss and debunk.

WATCH the video:
http://screwloosechange.blogspot.com/20 ... klers.html

       ---------------------------

DEBATE: MICHAEL SHERMER V. DINESH D'SOUZA
OREGON STATE UNIVERSITY, OCTOBER 15, 2007

   After watching my debate with Dinesh D'Souza last week I would
   be interested in your comments and constructive criticisms
   because Dinesh and I will be debating a similar but broader
   topic in December at Caltech ("Is Religion a Force for Good or
   Evil? & Can you be Good without God?" December 9, Beckman
   Auditorium, tickets available at the Caltech Public Events
   Office at 626-395-4652 or toll free at 888-222-5832).

   Please email your comments to me at mshermer@skeptic.com.

   Below are a few of my notes used during the debate. Most of the
   studies I reference about how atheists are just as moral as
   theists come from my book The Science of Good and Evil. The more
   recent studies are reported in either Skeptic magazine or in my
   Skeptic column in Scientific American. I had 25 minutes to cover
   five points.

       --Michael Shermer

WATCH the debate video:
http://www.oregonstate.edu/groups/socratic/archive.html

---------------------------

   IS CHRISTIANITY GOOD FOR THE WORLD?

     notes from Michael Shermer


1. WHAT ARE WE DEBATING?

"Is Christianity Good for the World?" The answer is obvious: It
Depends!

Religion is so complex, so all-encompassing, so sweeping and
culturally enveloping that it would be absurdly simplistic to offer
a simple "yes" or "no" answer, comparable to asking "Is government
good for the world?"

Religion is good when it does good, and bad when it does bad.

Christianity reminds me of Winston Churchill's comment about
Americans: "You can always count on Americans to do the right
thing... after they've tried everything else." Well, you can always
count on Christians to do the right thing...after they have tried
everything else."


2. WHICH CHRISTIANITY? GOOD FOR WHOM?

Which Christianity? (Catholic, Protestant, Evangelical, Mormon,
Episcopalian, Pentecostal?) 33,800 different Christian denominations
worldwide. Which is the right one? Good for whom? Individuals,
communities, society?

 - Protestant Christians determined to murder Catholic Christians
   over turf in Northern Ireland? Not good.

 - Mormon Christians who belong to the fundamentalist Church of
   Jesus Christ of Latter Day Saints who believe that is acceptable
   to force 13-year old girls to have sex with men five times their
   age? Not Good.

 - Pentecostal Christians who indoctrinate young children at
   Jesus camps into becoming warriors for Christ who are willing to
   kill for their lord? Not good.

 - Evangelical Christians who believe so strongly in the sanctity
   of life that they blow up abortion clinics and kill doctors? Not
   good.

 - Catholic Christians whose Priestly pedophile program of, in
   the words of Christopher Hitchens, "No Child's Behind Left"? Not
   good.


3. GAY MARRIAGE & HOMOSEXUALITY AS A CASE STUDY

The issue of Gay marriage in particular and homosexuality in general
is a case study in what is wrong with religion, especially
Christianity.

The overwhelming evidence from science shows that gender preference
is primarily determined by our genetics and prenatal biochemistry,
especially embryological hormone balance. Almost everyone is born
attracted to members of the opposite sex. A tiny percentage --
perhaps as few as one to two percent -- are attracted to members of
the same sex.

Asking a homosexual when he or she chose to become gay is like
asking a heterosexual when he or she chose to become straight.

Nevertheless, on this particular issue Christianity remains mired in
pre-civil rights, pre-enlightenment, even pre-scientific thinking,
basing their beliefs on a single biblical passage (Leviticus 18:22:
"Thou shalt not lie with mankind, as with womankind: it is
abomination") that itself is tucked in between other passages that
instruct parents to kill their disobedient children and to execute
adulterous wives and nonvirgin brides. That's right, the death
penalty for adultery, which would immediately eliminate a good
number of Christian Congressmen and Senators, preachers and
televangelists.

As a consequence of this embarrassing lapse of Christian charity,
Christian preachers, writers, and theologians think nothing of
tormenting gays by telling them that their desire to love another
person of the same sex is an "abomination," by telling them that
they have a disease that can be "cured" through "treatment" (such as
forcing gay guys to watch football games), and by telling them that
promiscuity is evil but that the single best prophylactic against it
-- marriage -- is legally banned from them.

Christians actually believe they are being charitable by proclaiming
that they "hate the sin, not the sinner," which is not dissimilar to
what Christians declared just before torching women for allegedly
practicing witchcraft in order to save their souls, or when
Christians called for pogroms against Jews for being Christ-killers.
(May I point out that if Jesus had to die for our sins, that means
someone had to kill him, and therefore that someone should be
thanked, not persecuted and murdered.)

Mark my words. Here is what is going to happen. Within a decade,
maybe two or three, Christians will come around to treating gays no
differently than they now treat other groups whom they previously
persecuted -- women, Jews, blacks -- but not because of some new
interpretation of a biblical passage, or because of a new revelation
from God. These changes will come about the same way that they
always do: by the oppressed minority fighting for the right to be
treated equally, and by a few enlightened members of the oppressing
majority supporting their cause.

Then what will happen is that Christians will take credit for the
civil liberation of gays, dig through the historical record and fine
a few Christian bloggers or preachers who had the courage and the
character to stand up for Gay rights when their fellow Christians
would not, and then cite those as evidence that were it not for
Christianity gays would not be equal.


4. RELIGION AND SOCIETAL MORALITY

In a 2005 study published in the Journal of Religion and Society,
independent scholar Gregory S. Paul found an inverse correlation
between religiosity (measured by belief in God, biblical literalism,
and frequency of prayer and service attendance) and societal health
(measured by rates of homicide, suicide, childhood mortality, life
expectancy, sexually transmitted diseases, abortion, and teen
pregnancy) in 18 developed democracies. "In general, higher rates of
belief in and worship of a creator correlate with higher rates of
homicide, juvenile and early adult mortality, STD infection rates,
teen pregnancy, and abortion in the prosperous democracies," Paul
found. "The United States is almost always the most dysfunctional of
the developed democracies, sometimes spectacularly so." Indeed, the
U.S. scores the highest in religiosity and the highest (by far) in
homicides, STDs, abortions, and teen pregnancies. Conservative
Christians, of course, will blame secular liberals for all these
societal ills, but with over 90 percent of Americans proclaiming
themselves to be Christians, and the country roughly split 50/50
between conservatives and liberals, this does not add up.


5. RELIGION AND INDIVIDUAL MORALITY

In 1934, Abraham Franzblau found a negative correlation between
acceptance of religious beliefs and three different measures of
honesty. As religiosity increased, honesty decreased.

In 1950, Murray Ross conducted a survey among 2,000 associates of
the YMCA and discovered that agnostics and atheists were more likely
to express their willingness to aid the poor than those who rated
themselves as deeply religious.

In 1969, sociologists Travis Hirschi and Rodney Stark reported no
difference in the self-reported likelihood to commit crimes between
children who attended church regularly and those who did not.

In 1975, Ronald Smith, Gregory Wheeler, and Edward Diener discovered
that college-aged students in religious schools were no less likely
to cheat on a test than their atheist and agnostic counterparts in
nonreligious schools.

In 1996 George Barna, a born-again Evangelical Christian, in his
Index of Leading Spiritual Indicators, based on interviews with
nearly 4,000 adult Americans, revealed: "Born again Christians
continue to have a higher likelihood of getting divorced than do
non-Christians." And: "Atheists are less likely to get divorced than
are born-again Christians." Barna found that the current divorce
rate for born-again Christians is 27 percent, while it is only 24
percent for non-Christians. In addition, the Baby Boomers -- that
generation often criticized for sexual indulgence and moral
relativism -- has a lower rate of divorce (34 percent) than the
preceding generation (portrayed in popular culture as the idealized
1950's Ozzie and Harriet family), who hover at 37 percent.

Five years later, in a 2001 survey, Barna found that "33 percent of
all born again individuals who have been married have gone through a
divorce, which is statistically identical to the 34 percent
incidence among non-born again adults."

The July/August 2007 issue of the Annals of Family Medicine
published the results of a study conducted by researchers from the
University of Chicago and Yale New Haven Hospital that religious
doctors were no more likely (and even slightly less likely) to
employ their craft among underserved patients than were physicians
with no religious affiliation. Specifically, Farr Curlin, MD, an
assistant professor of medicine at the University of Chicago and his
colleagues surveyed 1,820 practicing physicians from all
specialties: 31% of physicians who were more religious practiced
medicine among the underserved, compared to 35% of atheist,
agnostic, and nonreligious doctors. Religiosity was measured by
religious service attendance and self-reported "intrinsic
religiosity" questions that measured the extent to which individuals
embrace their religion as the "master motive that guides and gives
meaning to their life." Curlin noted his own response to the data:
"This came as both a surprise and a disappointment. The Christian,
Jewish, Muslim, Hindu and Buddhist scriptures all urge physicians to
care for the poor, and the great majority of religious physicians
describe their practice of medicine as a calling. Yet we found that
religious physicians were not more likely to report practice among
the underserved than their secular colleagues."

The key to understanding who helps the needy the most was
spirituality, not religiosity. According to Curlin, those who
identified themselves as very spiritual, whether or not they were
religious, were roughly twice as likely to care for the underserved
as those who described their spirituality as low. "Part of this
divergence between religion and spirituality can be traced to a rift
between Christian denominations in the late-19th and early-20th
centuries," Curlin concluded. About a century ago, he noted, many of
the mainline and liberal Protestant churches began "to emphasize
efforts to right social injustices, while the more conservative
churches tended to stress doctrinal orthodoxy. Research indicates
that those who consider themselves spiritual but not so religious
are more likely to be formed in the more liberal denominations."
Curlin added that he is an orthodox Christian in the Protestant
tradition.


CONCLUSION

Absolute morality leads logically to absolute intolerance. Once you
believe that you have the absolute and final answers to moral
questions, why be tolerant of those who refuse to accept your Truth?
Religiously based moral systems apply this principle in spades. From
the medieval Crusades and the Spanish Inquisition to the Holocaust
and Bosnia, history is rife with examples of intolerance. In the
name of their religion, people have lighted faggots to burn women
accused of witchcraft. In the name of God, religious people have
sanctioned slavery, anti-Semitism, racism, homophobia, torture,
genocide, ethnic cleansing, and war. Not only does religion not
necessarily make one more moral, it can lead to greater intolerance,
racism, sexism, and the erosion of other values cherished in a free
and democratic society.

       ---------------------------

WHY DARWIN MATTERS IN PAPERBACK
NOW AVAILABLE AT SHOP SKEPTIC

Evolution happened, and the theory describing it is one of the most
well founded in all of science. Then why do half of all Americans
reject it? In Why Darwin Matters, historian of science and
bestselling author Michael Shermer diffuses these fears by examining
what evolution really is, how we know it happened, and how to test
it. Shermer then discusses what science is through a brief history
of the evolution-creation controversy from the Scopes "Monkey" trial
of 1925, through the U.S. Supreme Court case of 1987, to the ongoing
trials today, demonstrating clearly how and why creationism and
Intelligent Design theory are not science.

READ more and order the book:=20
   http://www.skeptic.com/productlink/b111PB

       ---------------------------

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