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incogn comments on MetaMed: Evidence-Based Healthcare - Less Wrong
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That's not exactly 100.00% true -- I once overheard a barber priding himself with the fact that someone once got laid the night after getting a haircut from him.
Jokes aside, barbering is evidence-based -- given that it works at all, then barbers either have knowledge of how to do that hard-coded in their DNA (unlikely) or have learned to do that -- using evidence (even though not in a systematized way). You can immediately see that if you use this cutting technique then your client's hair will look this way. OTOH, a practitioner of non-evidence-based medicine cannot immediately see that giving a patient this substance diluted in 10^20 times as much water or sticking a needle in this particular spot or whatever will help cure the patient. (Likewise, musicians are normally evidence-based musicians to some extent, but astrologists are not evidence-based astrologists; can you find more examples?)
If you interpret evidence-based in the widest sense possible, the phrase sort of loses its meaning. Note that the very post you quote explains the intended contrast between systematic and statistical use of evidence versus intuition and traditional experience based human learning.
Besides, would you not say that astrologers figure out both how to be optimally vague, avoiding being wrong while exciting their readers, much the same way musicians figure out what sounds good?
Yes, but “intuition and traditional experience based human learning” is probably much less reliable in medicine than it is in barbering, so the latter isn't a good example in a discussion about the former.
:-)
Something similar could be said about practitioners of alternative medicine, though.
The goal of barbering is to create haircuts that increase the attractiveness of the client to people besides the barber and the client.
A barber might think: "All my clients look really great", when in reality his haircuts reduce the attractiveness of the clients.
Surely, judging someone's attractiveness using your System 1 alone is less hard than judging someone's health using your System 1 alone, for most people in most situations?
A professional barber is likely to notice a lot of things about a haircut that the average person doesn't see. It could be that he creates haircuts that look impressive to other barbers but don't look good to the average person of the opposing sex who isn't a barber.
I do think that you can get a decent assessment of someone's backpain by asking them whether it has gotten better. Actually that's even how most scientific studies who measure pain do it. They let the person rate their pain subjectively and when the subjective rating gets better through the drug they see it as a win.
For a lot of serious health issues it's easy to see when a person gets better.
Most homeopathists spend more time interviewing their patients and getting a good understanding of their condition than the average mainstream doctor who takes 5 minutes per patient.
I think the barbering example is excellent - it illustrates that, while controlled experiments more or less is physics, and while physics is great, it is probably not going to bring a paradigm shift to barbering any time soon. One should not expect all domains to be equally well suited to a cut and dried scientific approach.
Where medicine lies on this continuum of suitedness is an open question - it is probably even a misleading question, with medicine being a collection of vastly different problems. However, it is not at all obvious that simply turning up the scientificness dial is going to make things better. It is for instance conceivable that there are already people treating medicine as a hard science, and that the current balance of intuition and evidence in medicine reflects how effective these two approaches are.
I am not trying to argue whether astrology is evidence-based or not. I am saying that the very inclusive definition of evidence-based which encompasses barbering is, (a) nearly useless because it includes every possible way of doing medicine and (b) probably not the one intended by the others using the term.
Huh? What evidence are homoeopathy and crystal healing and similar (assuming that's what Qiaochu_Yuan meant by “other kinds”) based on?
EDIT: Apparently not.
There are even dozens of scientific studies that support homeopathy. According to a report titled "Effectiveness, Safety and Cost-Effectiveness of Homeopathy in General Practice – Summarized Health Technology Assessment" commissioned by the Swiss government:
There are plenty people out there who can explain you why all those homeopathy studies are flawed, but on the other hand how many double blind controlled trials do you know that show that barbers can create haircuts that increase someone's chances with the opposing sex?
But in general people do buy homeopathic medicine not because they read the report of the Swiss government and belief it. They buy it based on anecdotal evidence. They hear that some friend had success with homeopathy and then the go out and buy it.
The fact that you are ideologically opposed to homeopathy and crystal healing working, doesn't mean that it fails to produce anecdotal evidence.
<nitpick>If that was the only point of barbers, then already-married people, prepubescent children, homosexuals, etc. would never go to the barber's.</nitpick>
"Other kinds" meant "whatever mainstream medicine does that doesn't fall under the evidence-based label," not alternative medicine. I should've been clearer.
Yes, I realized that later, while reading another branch of the thread (see my edit).
What do you mean with "mainstream medicine" in that context?
What ambiguity is there in what I mean by "mainstream medicine" here?
A lot of people use the term evidence-based medicine interchangeable with mainstream medicine. What's in your opinion medicine that counts as mainstream medicine but that doesn't count as evidence-based medicine?
That doesn't agree with my experience. Evidence-based medicine refers to a specific and recent movement within mainstream medicine, which is much older.