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shame on alternative medicine quackery.
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Bob Officer
2017-05-23 03:51:52 UTC
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http://www.medicaldaily.com/baby-dies-malnutrition-after-parents-put-him-alternative-gluten-free-diet-417525

"A seven month-old baby in Belgium died from malnutrition after his parents
put him on an alternative gluten-free diet despite no actual medical
diagnosis or recommendation. The child weighed only 9 pounds, about half
the size of an average child his age, and was extremely dehydrated. The
story brings to light just how dangerous alternative diets can be for very
young children."
--
Dunning's work explained in clear, concise and simple terms.
John Cleese on Stupidity

Stephen Fry on Dunning Kruger examples:

Duncan
2017-06-04 23:33:09 UTC
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On Tue, 23 May 2017 03:51:52 +0000 (UTC), Bob Officer
Post by Bob Officer
http://www.medicaldaily.com/baby-dies-malnutrition-after-parents-put-him-alternative-gluten-free-diet-417525
"A seven month-old baby in Belgium died from malnutrition after his parents
put him on an alternative gluten-free diet despite no actual medical
diagnosis or recommendation. The child weighed only 9 pounds, about half
the size of an average child his age, and was extremely dehydrated. The
story brings to light just how dangerous alternative diets can be for very
young children."
And this happened where?
Notice how bob has to scan the world to find negative alt-med stories?


--
Duncan

"Consensus is not a scientific term. It is a political term." (Ed. The
Climate Skeptics (TCS) Blog)

"There are known knowns. These are things we know that we know. There
are known unknowns. That is to say, there are things that we know we
don't know. But there are also unknown unknowns. There are things we
don't know we don't know." -- Donald Rumsfeld
Post by Bob Officer
[BOB] "Beliefs are not opinions."
I think you will find that "belief" is a synonym for "opinion".
So WTF are you trying to say idiot?
[BOB] "I stand by what I said in context. A belief is
something held true with or without supporting
evidence or in the face of contradictory evidence.

An opinion is based on what one thinks and not what
one believes. Ones religion is what one believes.
Religion requires no thinking and in many cases
Religion forbids thinking.

While you might believe their are interchangeable
synonyms, I think if you asked an expert in the
English Language they might agree with me. The
words have different meanings and uses."
--------

">I didn't know there was a requirement to generate topics. Where did
Post by Bob Officer
you get that idiotic idea from. " -- Bob Officer
DK: Bob Officer is a member of the group I
DK; accurately describe as...
PSEUDO-SKEPTIC-FANATICS (PSF)
http://www.psicounsel.com/bobofficer.html

---
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Clay
2017-06-05 01:37:09 UTC
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Post by Duncan
On Tue, 23 May 2017 03:51:52 +0000 (UTC), Bob Officer
Post by Bob Officer
http://www.medicaldaily.com/baby-dies-malnutrition-after-parents-put-him-alternative-gluten-free-diet-417525
"A seven month-old baby in Belgium died from malnutrition after his parents
put him on an alternative gluten-free diet despite no actual medical
diagnosis or recommendation. The child weighed only 9 pounds, about half
the size of an average child his age, and was extremely dehydrated. The
story brings to light just how dangerous alternative diets can be for very
young children."
And this happened where?
Did you read the story?
Post by Duncan
Notice how bob has to scan the world to find negative alt-med stories?
And *that* discredits the story that an alterniative diet killed this
baby?
⊙_⊙
2017-06-05 23:10:50 UTC
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Jun 4Duncan
On Tue, 23 May 2017 03:51:52 +0000 (UTC), Bob Officer
Post by Bob Officer
http://www.medicaldaily.com/baby-dies-malnutrition-after-parents-put-him-alternative-gluten-free-diet-417525
"A seven month-old baby in Belgium died from malnutrition after his parents
put him on an alternative gluten-free diet despite no actual medical
diagnosis or recommendation. The child weighed only 9 pounds, about half
the size of an average child his age, and was extremely dehydrated. The
story brings to light just how dangerous alternative diets can be for very
young children."
And this happened where?
Notice how bob has to scan the world to find negative alt-med stories?
--
Duncan

"Consensus is not a scientific term. It is a political term." (Ed. The
Climate Skeptics (TCS) Blog)

"There are known knowns. These are things we know that we know. There
are known unknowns. That is to say, there are things that we know we
don't know. But there are also unknown unknowns. There are things we
don't know we don't know." -- Donald Rumsfeld
Post by Bob Officer
[BOB] "Beliefs are not opinions."
I think you will find that "belief" is a synonym for "opinion".
So WTF are you trying to say idiot?
[BOB] "I stand by what I said in context. A belief is
something held true with or without supporting
evidence or in the face of contradictory evidence.

An opinion is based on what one thinks and not what
one believes. Ones religion is what one believes.
Religion requires no thinking and in many cases
Religion forbids thinking.

While you might believe their are interchangeable
synonyms, I think if you asked an expert in the
English Language they might agree with me. The
words have different meanings and uses."
--------

">I didn't know there was a requirement to generate topics. Where did
Post by Bob Officer
you get that idiotic idea from. " -- Bob Officer
DK: Bob Officer is a member of the group I
DK; accurately describe as...
PSEUDO-SKEPTIC-FANATICS (PSF)
http://www.psicounsel.com/bobofficer.html

---
This email has been checked for viruses by AVG.
http://www.avg.com

*****

Jun 4Clay
Post by Bob Officer
On Tue, 23 May 2017 03:51:52 +0000 (UTC), Bob Officer
Post by Bob Officer
http://www.medicaldaily.com/baby-dies-malnutrition-after-parents-put-him-alternative-gluten-free-diet-417525
"A seven month-old baby in Belgium died from malnutrition after his parents
put him on an alternative gluten-free diet despite no actual medical
diagnosis or recommendation. The child weighed only 9 pounds, about half
the size of an average child his age, and was extremely dehydrated. The
story brings to light just how dangerous alternative diets can be for very
young children."
And this happened where?
Did you read the story?
Post by Bob Officer
Notice how bob has to scan the world to find negative alt-med stories?
And *that* discredits the story that an alterniative diet killed this
baby?


*****


There's little evidence to support much of what is now common practice in medicine ... "The problem is that we don't know what we are doing." ... "Medical Guesswork"

-----

Magazine
Healthy Discourse
June 18, 2006

When my May 29 Cover Story "Medical Guesswork" went to press, I had some trepidations. The story asserts that there's little evidence to support much of what is now common practice in medicine. It questions the value of high-risk procedures such as coronary bypass surgery for many people. As the story's central figure, Dr. David Eddy, bluntly observes: "The problem is that we don't know what we are doing." When Eddy began to push what he called "evidence-based" medicine in the 1980s, the response was mostly hostile. I was bracing for the same.

Sure enough, there are plenty of critics among the 100-plus letter writers and online commentators who have responded so far. "As a 12-year survivor of Stage IV colorectal cancer, I can attest to the fact that my [doctors] knew what they were doing," writes Dan Verdirame of Far Hills, N.J. "Your article does them a disservice and provides incentive for those looking to avoid uncomfortable, but necessary, medical treatment."

One common charge is that the whole "evidence-based" idea was cooked up by insurance companies. "It sounds like a ploy to lower patient access to the latest technologies," complains one online writer. More substantively, readers said that while evidence is lacking that treatments work, firm proof that the treatments are unnecessary is also lacking. Good point.

Other readers said I'd missed major issues. The threat of lawsuits forces doctors to treat patients aggressively, even when physicians know the treatment is dubious, several wrote. Others wished I had mentioned the importance of diet and lifestyle in keeping people healthy -- and the need for a health-care system that's primed to prevent diseases.

On the other hand, a great many readers applauded BusinessWeek's willingness to "print the truth about our current health-care system," as one online poster put it. The story won praise from doctors, economists, and patients. And readers provided us with some poignant glimpses of what happens when health care falls short of its promises. "Medical science is nowhere near as exact or insightful as many people have been led to believe," laments one online poster who lost his wife to breast cancer. "There are no magic bullets in medicine, and I am glad to see the story start to bring that idea to light. Perhaps now it will get people to think more realistically about treatments that cost a small fortune, have little or no curative effect, leave families drowning in debt, and have survivors wondering whether it was all worth it."

The responses show that this subject is far too large to encompass in one magazine story. Here is a sample of what readers said:"

Having been diagnosed with colon cancer less than three months ago, I have experienced the predicament posed by Dr. David Eddy, i.e., receiving contradictory opinions from physicians. Choosing the right doctor becomes an exercise in guessing and hoping for the best. Fortunately, the oncologist I am working with seems flexible and open to discussing options based on evidence. The glimmer of hope is that medicine is facing several forces that will provoke a change. Dr. Eddy is right on track, and many others will follow in his footsteps. - Carlos A. Valenzuela, Bethlehem, Pa.

In mental illnesses it is very easy to show that medications can lessen psychosis or block depression and anxiety. But they create a multitude of metabolic problems and cognitive compromises. Just think about virtually every treatment guideline and algorithm issued by cost-conscious insurance companies, prestigious universities, and learned societies like the American Psychiatric Assn. In the name of evidence-based medicine, these academicians have flooded the field of psychiatry with shallow diagnostic manuals, irrelevant brain studies, and treatment guidelines. Instead of painstakingly going into the meaning of patients' symptoms, dreams, and intrapsychic conflicts, they teach how to ask a few rote questions, prescribe the algorithm-based medications, and get to the next patient within 15 minutes. - Surendra Kelwala, M.D., Livonia, Mich.

"First, do no harm" has been totally replaced by "just do any old thing and bill to the max." - Ron Tripp, Johnson City, N.Y.

Reevaluation of gold-standard treatments is a good start on the path to more effective and efficient health care. However, your Cover Story overlooked the key reason why we have costly, inefficient health care today: The system is designed for crisis management rather than for fostering optimal health. A top-to-bottom restructuring with changes in incentives is needed for every party, including insurers, health-care providers, employers, and patients. All other changes are like putting duct tape on a leaking pipe. - Candice M. Hughes, Hughes BioPharma Advisers, Darien, Conn.

Your story was right on the money. Until the "Art of Medicine" becomes the "Science of Medicine," we are doomed to suffer the consequences. - Subash Khadpe, Slatington, Pa.

John Carey's article blames the failures of medicine on financial self-interest three times. Adam Smith demonstrated that financial self-interest generates a creative-productive economic system. Drop the trite 16th century ideology of blaming self-interest, or you will rapidly watch your subscription base move to magazines that aren't stuck with outmoded ideology. - Michael Phillips, San Francisco

Regarding the suggestion that income clouds judgment, reimbursement is so poor for procedures that I am incentivized to be in the office rather than the operating room. - Daniel A. Spilman, M.D., Santa Cruz, Calif.

In your cover package, you say: "Surgery can cure early-stage colon cancer." This seems to advocate currently popular routine colonoscopies, which I'm personally biased against. According to my research, colorectal cancer occurs in 24 of every 100,000 people aged 40 to 49 and in 48 of every 100,000 people aged 50 to 54. Assuming that all of those would be discovered and cured by routine colonoscopy is a stretch. Moreover, we will never know how many benign polyps are precancerous unless someone follows untreated polyps in a large group of patients for a long time. In simple terms, if my local gastroenterologist performs three colonoscopies a day, or 1,000 per year, at $600 per exam (a reasonable assumption), he earns $600,000 a year. In 10 years, he will have prevented between 2.4 and 4.8 colon cancers. Mindful of the recognized procedural colon perforation rate of 0.2%, he will have perforated 20 colons, i.e., he will have seriously injured many more people than he will have helped. Many men will die of old age harboring prostate cancer. At least in the old days, they never knew they had it. Medicare has it partly right: They'll only pay for one colonoscopy every 10 years for average-risk individuals. - Jay G. Selle, M.D., Cornelius, N.C.

The true reduction in health-care costs will come from education and prevention. However, education and prevention will only work if getting and staying healthy is rewarded in a manner that will encourage such lifestyle changes. - Michael J. McKeown, M.D., Hillsboro, Ore.

One thing your article failed to mention was doctors' fear of litigation (especially in California) when expensive testing procedures are not provided. If a doctor provides all alternative-procedure information to a patient, and the patient then makes the decision on which treatment he should use, the doctor should not have to fear a lawsuit over the outcome. - Lance Becker, La Mesa, Calif.

Physical therapists know firsthand about physicians' "vested interests" as you stated in your Cover Story. [This is] a subject that has been causing physical therapists great concern for years. Today a physician can receive financial gains by having total or partial ownership of the physical therapy practice to which he or she refers. - Ben F. Massey, Jr., P.T., M.A., President, American Physical Therapy Assn.

Until high-quality evidence is produced, well-reasoned decision-making based on lower-quality evidence (e.g., tradition, experience, anecdotes) will still be needed. High-quality evidence is downright rare in terms of the series of lifelong care decisions often needed for chronic diseases where initial treatment (sometimes the topic of clinical trials) is followed by reevaluation, follow-on treatment (rarely the topic of clinical trials), more reevaluation, etc. - Mike Rethman, D.D.S., Honolulu

Dr. David Eddy's computer model makes perfect sense in an ideal world with ideal patients, but it may not be powered for "real world" medicine. Physicians practice in a very complicated world. They see patients with varying severities of sickness. And there are other characteristics such as economic, cultural, intellectual, and linguistic barriers and other social factors. Numerous studies with conflicting and contradictory conclusions cast doubt in the minds of clinicians as well as patients. There are many flaws in medical research, compared with other sciences. There will always be a divide between the analog life of the physicians and their patients and the digital age we are in. - Joseph K. Chemplavil, M.D., Hampton, Va.

"Medical Guesswork" convincingly portrays the potential of advanced computer-based technology to improve the diagnostic and treatment power of evidence-based medicine. Such technology has been underutilized because of conflicting incentives among physicians, hospitals, and payers. Fortunately, innovative ways of deploying computer-based technology are enabling the rapid, cost-effective, and highly accessible delivery of evidence-based best-practices information. In the course of a five-year clinical trial, a research team from the University of Vermont has been able to demonstrate the power of an advanced computer-based system to deliver health improvement to diabetic patients. - Benjamin Littenberg, M.D.; Charles D. MacLean, M.D.; Michael Gagnon, Vermont Clinical Decision Support, Burlington, Vt.

To view the May 29 Medical Guesswork Cover Story and scores of thoughtful reader comments, go to www.businessweek.com/go/medicalguesswork/

By John Carey

http://www.businessweek.com/stories/2006-06-18/healthy-discourse
⊙_⊙
2017-06-05 23:14:33 UTC
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"Half of what physicians do is wrong," or "Less than 20 percent of what physicians do has solid research to support it." > It would be political suicide for our public leaders to admit these truths > Most Americans wouldn't believe them anyway.


http://www.scientificamerican.com/article/demand-better-health-care-book/


-----


Health Care Myth Busters: Is There a High Degree of Scientific Certainty in Modern Medicine?
Two doctors take on the health care system in a new book that aims to arm people with information
March 25, 2011 |By Sanjaya Kumar and David B. Nash
**
Demand Better! Revive Our Broken Health Care System


Second River Healthcare Press
Editor's Note: The following is an excerpt from the new book Demand Better! Revive Our Broken Health Care System (Second River Healthcare Press, March 2011) by Sanjaya Kumar, chief medical officer at Quantros, and David B. Nash, dean of the Jefferson School of Population Health at Thomas Jefferson University. In the following chapter they explore the striking dearth of data and persistent uncertainty that clinicians often face when having to make decisions.


Myth: There is a high degree of scientific certainty in modern medicine

"In America, there is no guarantee that any individual will receive high-quality care for any particular health problem. The healthcare industry is plagued with overutilization of services, underutilization of services and errors in healthcare practice." - Elizabeth A. McGlynn, PhD, Rand Corporation researcher, and colleagues. (Elizabeth A. McGlynn, PhD; Steven M. Asch, MD, MPH; et al. "The Quality of Healthcare Delivered to Adults in the United States," New England Journal of Medicine 2003;348:2635-2645.)


Most of us are confident that the quality of our healthcare is the finest, the most technologically sophisticated and the most scientifically advanced in the world. And for good reason--thousands of clinical research studies are published every year that indicate such findings. Hospitals advertise the latest, most dazzling techniques to peer into the human body and perform amazing lifesaving surgeries with the aid of high-tech devices. There is no question that modern medical practices are remarkable, often effective and occasionally miraculous.

But there is a wrinkle in our confidence. We believe that the vast majority of what physicians do is backed by solid science. Their diagnostic and treatment decisions must reflect the latest and best research. Their clinical judgment must certainly be well beyond any reasonable doubt. To seriously question these assumptions would seem jaundiced and cynical.

But we must question them because these beliefs are based more on faith than on facts for at least three reasons, each of which we will explore in detail in this section. Only a fraction of what physicians do is based on solid evidence from Grade-A randomized, controlled trials; the rest is based instead on weak or no evidence and on subjective judgment. When scientific consensus exists on which clinical practices work effectively, physicians only sporadically follow that evidence correctly.

Medical decision-making itself is fraught with inherent subjectivity, some of it necessary and beneficial to patients, and some of it flawed and potentially dangerous. For these reasons, millions of Americans receive medications and treatments that have no proven clinical benefit, and millions fail to get care that is proven to be effective. Quality and safety suffer, and waste flourishes.

We know, for example, that when a patient goes to his primary-care physician with a very common problem like lower back pain, the physician will deliver the right treatment with real clinical benefit about half of the time. Patients with the same health problem who go to different physicians will get wildly different treatments. Those physicians can't all be right.

Having limited clinical evidence for their decision-making is not the only gap in physicians' scientific certainty. Physician judgment--the "art" of medicine--inevitably comes into play, for better or for worse. Even physicians with the most advanced technical skills sometimes fail to achieve the highest quality outcomes for their patients. That's when resourcefulness--trying different and potentially better interventions--can bend the quality curve even further.

And, even the most experienced physicians make errors in diagnosing patients because of cognitive biases inherent to human thinking processes. These subjective, "nonscientific" features of physician judgment work in parallel with the relative scarcity of strong scientific backing when physicians make decisions about how to care for their patients.

We could accurately say, "Half of what physicians do is wrong," or "Less than 20 percent of what physicians do has solid research to support it." Although these claims sound absurd, they are solidly supported by research that is largely agreed upon by experts. Yet these claims are rarely discussed publicly. It would be political suicide for our public leaders to admit these truths and risk being branded as reactionary or radical. Most Americans wouldn't believe them anyway. Dozens of stakeholders are continuously jockeying to promote their vested interests, making it difficult for anyone to summarize a complex and nuanced body of research in a way that cuts through the partisan fog and satisfies everyone's agendas. That, too, is part of the problem.

Questioning the unquestionable
The problem is that physicians don't know what they're doing. That is how David Eddy, MD, PhD, a healthcare economist and senior advisor for health policy and management for Kaiser Permanente, put the problem in a Business Week cover story about how much of healthcare delivery is not based on science. Plenty of proof backs up Eddy's glib-sounding remark.

The plain fact is that many clinical decisions made by physicians appear to be arbitrary, uncertain and variable. Reams of research point to the same finding: physicians looking at the same thing will disagree with each other, or even with themselves, from 10 percent to 50 percent of the time during virtually every aspect of the medical-care process--from taking a medical history to doing a physical examination, reading a laboratory test, performing a pathological diagnosis and recommending a treatment. Physician judgment is highly variable.

Here is what Eddy has found in his research. Give a group of cardiologists high-quality coronary angiograms (a type of radiograph or x-ray) of typical patients and they will disagree about the diagnosis for about half of the patients. They will disagree with themselves on two successive readings of the same angiograms up to one-third of the time. Ask a group of experts to estimate the effect of colon-cancer screening on colon-cancer mortality and answers will range from five percent to 95 percent.

Ask fifty cardiovascular surgeons to estimate the probabilities of various risks associated with xenografts (animal-tissue transplant) versus mechanical heart valves and you'll get answers to the same question ranging from zero percent to about 50 percent. (Ask about the 10-year probability of valve failure with xenografts and you'll get a range of three percent to 95 percent.)

Give surgeons a written description of a surgical problem, and half of the group will recommend surgery, while the other half will not. Survey them again two years later and as many as 40 percent of the same surgeons will disagree with their previous opinions and change their recommendations. Research studies back up all of these findings, according to Eddy.

Because physician judgment varies so widely, so do treatment decisions; the same patient can go to different physicians, be told different things and receive different care. When so many physicians have such different beliefs and are doing such different things, it is impossible for every physician to be correct.

Why are so many physicians making inaccurate decisions in their medical practices? It is not because physicians lack competence, sincerity or diligence, but because they must make decisions about tremendously complex problems with very little solid evidence available to back them up. (That situation is gradually changing with the explosion in medical literature. Recent surveys by the Healthcare Information and Management Systems Society (HIMSS) reveal that an increasing number of hospitals and healthcare organizations are adopting technologies to keep up with the flow of research, such as robust, computerized physician-order-entry (CPOE) systems to ensure appropriate drug prescribing.)

Most physicians practice in a virtually data-free environment, devoid of feedback on the correctness of their practice. They know very little about the quality and outcomes of their diagnosis and treatment decisions. And without data indicating that they should change what they're doing, physicians continue doing what they've been doing all along.

Physicians rely heavily on the "art" of medicine, practicing not according to solid research evidence, but rather by how they were trained, by the culture of their own practice environment and by their own experiences with their patients.

For example, consider deep-vein-thrombosis (DVT) prophylaxis, that means therapy to prevent dangerous blood clots in vessels before and after operations in the hospital. Research offers solid, Grade-A evidence about how to prevent DVT in the hospital. But only half of America's hospitals follow these practices. That begs an important question: Why? We have the science for that particular sliver of care. How come we still can't get it right?

The core problem we would like to examine here is that a disturbingly large chunk of medical practice is still "craft" rather than science. As we've noted, relatively little actionable science is available to guide physicians and physicians often ignore proven evidence-based guidelines when they do exist. A guild-like approach to medicine--where every physician does it his or her way--can create inherent complexity, waste, proneness to error and danger for patients.

A great example comes from Peter Pronovost, MD, PhD, a patient-safety expert and a professor of anesthesiology, critical-care medicine and surgery at the Johns Hopkins University School of Medicine. He is co-author of Safe Patients, Smart Hospitals: How One Doctor's Checklist Can Help Us Change Health Care from Inside Out. In a televised interview about his book, Pronovost said that we (that is, physicians) knew that we were killing people with preventable central-line blood-stream infections in hospitals and we accepted it as a routine part, albeit a toxic side-effect, of practice. We were killing more people that way, probably, than those who died of breast cancer. We tolerated it because our practices didn't use available scientific evidence that showed us how to prevent such infections. We ignored the science and patients paid the price with their lives.

Cost is another toxic by-product of care delivery practices that are not based on solid science and the tremendous clinical variation that results from them.

Doing the right thing only half of the time
When we look at how well physicians are really doing, it's scary to see how off the mark they are. Anyone who feels self-assured about receiving the best medical care that science can offer is in for a shock, considering some eye-opening research that shows how misplaced that confidence is. Let's start with how well physicians do when they have available evidence to guide their practices.

The best answer comes from seminal research by the Rand Corporation, a respected research organization known for authoritative and unbiased analyses of complex topics. On average, Americans only receive about half of recommended medical care for common illnesses, according to research led by Elizabeth McGlynn, PhD, director of Rand's Center for Research on Quality in Health Care. That means the average American receives care that fails to meet professional evidence-based standards about half of the time.

McGlynn and her colleagues examined thousands of patient medical records from around the country for physician performance on 439 indicators of quality of care for thirty acute and chronic conditions as well as preventive care, making the Rand study one of the largest of its kind ever undertaken. The researchers examined medical conditions representing the leading causes of illness, death and healthcare service use across all age groups and types of patients. They reviewed national evidence-based practice guidelines that offer physicians specific and proven care processes for screening, diagnosis, treatment and follow-up care. Those guidelines were vetted by several multispecialty expert panels as scientifically grounded and clinically proven to improve patient care.

For example, when a patient walks into the doctor's office, the physician is supposed to ensure that when the patient shows up for hip surgery, he or she will receive drugs to prevent blood clots and then a preventive dose of antibiotics.

Even though clinical guidelines exist for practices like these, McGlynn and her colleagues found something shocking: physicians get it right about 55 percent of the time across all medical conditions. In other words, patients receive recommended care only about 55 percent of the time, on average. It doesn't matter whether that care is acute (to treat current illnesses), chronic (to treat and manage conditions that cause recurring illnesses, like diabetes and asthma) or preventive (to avert acute episodes like heart attack and stroke).

How well physicians did for any particular condition varied substantially, ranging from about 79 percent of recommended care delivered for early-stage cataracts to about 11 percent of recommended care for alcohol dependence. Physicians prescribe the recommended medication about 69 percent of the time, follow appropriate lab-testing recommendations about 62 percent of the time and follow appropriate surgical guidelines 57 percent of the time. Physicians adhere to recommended care guidelines 23 percent of the time for hip fracture, 25 percent of the time for atrial fibrillation, 39 percent for community-acquired pneumonia, 41 percent for urinary-tract infection and 45 percent for diabetes mellitus.

Underuse of recommended services was actually more common than overuse: about 46 percent of patients did not receive recommended care, while about 11 percent of participants received care that was not recommended and was potentially harmful.

Here is disturbing proof that physicians often fail to follow solid scientific evidence of what "quality care" is in providing common care that any of us might need:

* Only one-quarter of diabetes patients received essential blood-sugar tests.
* Patients with hypertension failed to receive one-third the recommended care.
* Coronary-artery-disease patients received only about two-thirds of the recommended care.
* Just under two-thirds of eligible heart-attack patients received aspirin, which is proven to reduce the risk of death and stroke.
* Only about two-thirds of elderly patients had received or been offered a pneumococcal vaccine (to help prevent them from developing pneumonia).
* Scarcely more than one-third of eligible patients had been screened for colorectal cancer.

These findings have shaped the conversation among experts on American healthcare quality by establishing a national baseline for the status quo. That baseline is jarring and disturbing. The gap between what is proven to work and what physicians actually do poses a serious threat to the health and well-being of all of us. That gap persists despite public- and private-sector initiatives to improve care. Physicians need either better access to existing information for clinical decision-making or stronger incentives to use that information.

Inappropriate use of medical services (both underuse and overuse) by physicians is rampant, affecting millions of patients. We know that because some of the nation's leading healthcare quality and safety experts reviewed several large-scale national studies and presented their findings to the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry, which was formed during President Bill Clinton's administration.

The commission released a report in March, 1998, that stated: "Exhaustive research documents the fact that today, in America, there is no guarantee that any individual will receive high-quality care for any particular health problem. The healthcare industry is plagued with overutilization of services, underutilization of services and errors in healthcare practice." The central problem, as the Rand study had revealed, is clinicians' failure to follow evidence-based best practice guidelines that exist and have been proven to enhance the quality of healthcare delivery.

The commission's report acknowledged that physicians may have difficulty keeping up with an explosive growth in medical research, noting that the number of published randomized, controlled trials had increased from an average of 509 annually between 1975 and 1980 to 8,636 annually from 1993 through 1997. That's just for randomized, controlled trials. Several other types of studies considerably increase the number of annual research articles that physicians must keep up with to be current on scientific research findings. Plus, that was more than ten years ago; the numbers grow more rapidly each year.

From these data, the report concluded that a troubling gap exists between best practices and actual practices and that the likelihood that any particular patient will get the best care possible varies considerably. Translation: physicians aren't following the evidence.

Hospitals are on the hook as well and show wide gaps in their delivery of recommended care. The Leapfrog Group is a consortium of large employers that reports and compares hospital quality-performance data to help companies make healthcare purchasing decisions. (Full disclosure: Sanjaya Kumar is president and CEO of Quantros, the company that hosts the Leapfrog Group's Hospital Safety Survey.) The group tracks more than 1,200 U.S. hospitals that voluntarily report how well they adhere to a variety of evidence-based quality measures that are endorsed by the National Quality Forum (NQF) or are consistent with those of The Joint Commission and the Federal Centers for Medicare & Medicaid Services.

Results from the Leapfrog Group's 2009 hospital survey show that just over half of hospitals meet Leapfrog's quality standard for heart-bypass surgery; under half meet its standard for heart angioplasty; and under half of hospitals meet Leapfrog's quality standards for six common procedures, including high-risk surgery, heart-valve replacement and high-risk deliveries, even though nationally accepted scientific guidelines for these procedures exist and have been proven to save lives.

It's disturbingly clear from these studies that too many physicians and hospitals are not applying known, evidence-based and available guidelines for quality practice. Physicians are either ignoring or unaware of much better ways to treat their patients.

Knowing the right thing only one-fifth of the time
Failing to follow existing guidelines is only part of what makes so much of medical practice "unscientific." Another key reason is that there are so few solid, actionable scientific guidelines to begin with, and those that are available cover a relatively small slice of clinical care.

Part of the problem is that science, technology and culture are all moving targets. Today's dogma is tomorrow's folly, and vice versa. Many examples show that what physicians once accepted as truth has been totally debunked. Twenty years ago, for instance, physicians believed that lytic therapy for post-myocardial infarction would prolong a heart attack. The therapy involves clot-busting medication given to heart-attack patients. Today it is standard practice. Angioplasty and intracoronarylysis of clots are other examples. Years ago, surgery for benign prostatic hypertrophy (enlarged prostate) was one of the top DRGs (illnesses billed by hospitals) under Medicare. Today, we do far fewer of these procedures because of new drugs.

The public has little idea that physicians are playing a sophisticated guessing game every single day. That is a scary thought. We hope that one day we'll look back, for example, on cancer chemotherapy the same way we look back at the use of leeches, cupping and bloodletting.

Another part of the problem is that clinical knowledge generated by randomized, controlled trials takes far longer to reach the front lines of medical care than most people realize. Turning basic scientific discoveries into innovative therapies--from "laboratory bench to bedside"--takes up to 17 years. Existing scientific literature is being added to and undergoing overhaul every two years, which adds to the knowledge gap at the bedside.

Time lag notwithstanding, thousands of research articles are published every year, which presents a different challenge to delivering care based on the strongest evidence. Physicians can't always keep up with the volume of knowledge to be reviewed and put into practice, and those who don't provide poorer quality care. Medical advances occur frequently, and detailed knowledge quickly goes out of date.

Here's a counterintuitive consequence: the more years of practice experience a physician has, the more out-of-date his or her practice patterns may be. Research has documented this phenomenon of decreasing quality of clinical performance with increasing years in practice. Although we generally assume that the knowledge and skills that physicians accumulate during years of practice lead to superior clinical abilities, those physicians may paradoxically be less likely to provide what the latest scientific evidence says is appropriate care! It's all about the evidence and keeping up with it.

But just how comprehensive is the available scientific evidence for effective clinical practices? It is slimmer than most people think. Slice a pie into five pieces, and remove one piece. That slice represents the roughly 20 percent of clinical-care practices for which solid randomized, controlled trial evidence exists. The remaining four-fifths represent medical care delivered based upon a combination of less reliable studies, unsystematic observation, informed guesswork and conformity to prevailing treatments and procedures used by most other clinicians in a local community.

To illustrate how little scientific evidence often exists to justify well-established medical treatments, David Eddy researched the scientific evidence underlying a standard and widely used glaucoma treatment designed to lower pressure in the eyeball. He searched published medical reports back to 1906 and could not find one randomized, controlled trial of the treatment. That was despite decade after decade of confident statements about it in textbooks and medical journals, statements which Eddy found had simply been handed down from generation to generation. The kicker was that the treatment was harmful to patients, actually causing more cases of blindness rather than fewer.

Similar evidence deficits exist for other common medical practices, including colorectal screening with regular fecal-occult-blood tests and sigmoidoscopy; annual chest x-rays; surgery for enlarged prostates; bone-marrow transplants for breast cancer; and common approaches to pain control, depression, immunizations, cancer screening, alcohol and drug abuse, smoking and functional disabilities. The problem is rampant across medicine; a huge amount of what physicians do lacks a solid base of scientific evidence.

In the past, many standard and accepted practices for clinical problems were simpler and more straightforward than those that today's clinicians face--and these practices seem to have worked, despite the paucity of good research evidence. Physicians simply made subjective, intuitive decisions about what worked based on what they observed. The problem today is that the growing complexity of medicine bombards clinicians with a chaotic array of clinical choices, ambiguities and uncertainties that exceeds the inherent limitations of the unaided human mind. As a result, many of today's standard clinical practices bear no relation to any evidence of effectiveness.

Instead, physicians frequently base their decisions on shortcuts, such as the actions of the average practitioner ("if everyone is doing it, the intervention must be appropriate"); the commonness of the disease ("if the disease is common, we have no choice but to use whatever treatment is available"); the seriousness of the outcome ("if the outcome without treatment is very bad, we have to assume the treatment will work"); the need to do something ("this intervention is all we have"); and the novelty or technical appeal of the intervention ("if the machine takes a pretty picture, it must have some use").

Drug prescribing is another blatant example of medical practice that is often evidence-free. Drugs that are known to be effective may work well for only 60 percent of people who take them. But about 21 percent of drug prescriptions in the United States are for "off-label" use, that is, to treat conditions for which they have not been approved by the U.S. Food and Drug Administration. That's more than 150 million prescriptions per year. Off-label use is most common among cardiac medications (46 percent) and anticonvulsants (46 percent). Here's the real punch line: in 73 percent of the cases where drugs are used in unapproved ways, there is little or no evidence that they work. Physicians prescribe drugs well over a million times a year with little or no scientific support.

These are fighting words, saying that such a big chunk of medical practice is not based on science. To illustrate just how provocative this topic is, look at what happened in the 1990s when the Federal Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality) released findings from a five-year investigation of the effectiveness of various treatments for low back pain--one of the leading reasons that Americans see physicians.

Between 1989 and 1994, an interdisciplinary Back Pain Patient Outcomes Assessment Team (BOAT) at the University of Washington Medical School in Seattle set out to determine what treatment strategies work best and for whom. Led by back expert Richard A. Deyo, MD, MPH, the team included orthopedic surgeons, primary-care physicians, physical therapists, epidemiologists and economists. Together, they examined the relative value of various diagnostic tests and surgical procedures.

They conducted a comprehensive review of clinical literature on back pain. They exhaustively examined variations in the rates at which different procedures were being used to diagnose and treat back pain. Their chief finding was deeply disturbing: what physicians thought worked well for treating low back pain doesn't. The implication was that a great many standard interventions for low back pain may not be justified. And that was immensely threatening to physicians, especially surgeons who perform back operations for a living.

Among the researchers' specific findings: no evidence shows that spinal-fusion surgery is superior to other surgical procedures for common spine problems, and such surgery leads to more complications, longer hospital stays and higher hospital charges than other types of back surgery.

Disgruntled orthopedic surgeons and neurosurgeons reacted vigorously to the researchers' conclusion that not enough scientific evidence exists to support commonly performed back operations. The surgeons joined with Congressional critics of the Clinton health plan to attack federal funding for such research and for the agency that sponsored it. Consequently, the Agency for Healthcare Policy and Research had its budget for evaluative research slashed drastically.

The back panel's guidelines were published in 1994. Since then, even though there are still no rigorous, independently funded clinical trials showing that back surgery is superior to less invasive treatments, surgeons continue to perform a great many spinal fusions. The number increased from about100,000 in 1997 to 303,000 in 2006.

What are physicians to do? They need a great deal more reliable information than they have, especially when offering patients life-changing treatment options. Before recommending surgery or radiation treatment for prostate cancer, for example, physicians and their patients must compare the benefits, harms and costs of the two treatments and decide which is the more desirable.

One treatment might deliver a higher probability of survival but also have bad side effects and high costs, while the alternative treatment might deliver a lower probability of survival but have no side effects and lower costs. Without valid scientific evidence about those factors, the patient may receive unnecessary and ineffective care, or fail to receive effective care, because neither he nor his physician can reliably weigh the benefits, potential harm and costs of the decision.

Recognizing that the quality and reliability of clinical-research information vary greatly, entities like the U.S. Preventive Services Task Force (USPSTF) have devised rating systems to rank the strength of available evidence for certain treatments. The strongest evidence is the scarcest and comes from systematic review of studies (randomized, controlled trials) that are rigorously designed to factor out biases and extraneous influences on results. Weaker evidence comes from less rigorously designed studies that may let bias creep into the results (for example, trials without randomization or cohort or case-control analytic studies). The weakest evidence comes from anecdotal case reports or expert opinion that is not grounded in careful testing.

Raymond Gibbons, MD, a professor of medicine at the Mayo Clinic and past president of the American Heart Association, puts it well: "In simple terms, Class I recommendations are the 'do's'; Class III recommendations are the 'don'ts'; and Class II recommendations are the 'maybes.'" The point is this: even physicians who follow guidelines must deal with scientific uncertainty. There are a lot more "maybes" than "do's."

Even the "do's" require value judgments, and it is important to be clear about what evidence-based practice guidelines can and cannot do, regardless of the strength of their scientific evidence. Guidelines are not rigid mandates or "cookie-cutter" recommendations that tell physicians what to do. They are intended to be flexible tools to help physicians and their patients make informed decisions about their care.

Even guidelines that are rooted in randomized, controlled trial research do not make clinical decisions for physicians; rather, they must be applied to individual patients and clinical situations based on value judgments, both by physicians and their patients. Clinical decision-making must entail value judgments about the costs and benefits of available treatments. What strong guidelines do is to change the anchor point for the decision from beliefs about what works to evidence of what works. Actual value-based treatment decisions are a necessary second step.

For example, should a physician recommend an implantable cardioverter-defibrillator (ICD) to his or her patient when a randomized-control trial shows that it works? The device is a small, battery-powered electrical-impulse generator implanted in patients at risk of sudden cardiac death due to ventricular fibrillation (uncoordinated contraction of heart chamber muscle) and ventricular tachycardia (fast heart rhythm). A published randomized trial compared ICDs to management with drugs for heart-attack patients and found that ICDs reduced patients' probability of death at 20 months by about one-third.

Armed with such a guideline, the physician and patient must still make a value judgment: whether the estimated decrease in chance of death is worth the uncertainty, risk and cost of the procedure. The ultimate decision is not in the guideline, but it is better informed than a decision made without the evidence to help guide it. The guideline has lessened uncertainty but not removed it.

The lesson here is that there are huge gaps in the scientific evidence guiding physician decision-making, and it wasn't until healthcare-quality gadflies like David Eddy began to demand to see the evidence that we learned about those gaps. This revelation has had at least two beneficial effects: it informs us about the lack of evidence so that we can be more realistic in our expectations and more aware of the uncertainty in medical decision-making, and it exhorts the medical community to search for better evidence.

"Nothing should be affirmatively promoted unless there is good evidence of at least some benefit," writes Eddy. It is simply amazing that applying such a statement to modern medicine represents such a ground-breaking development. But it has literally changed the face of medicine.

Excerpted from Demand Better! Revive Our Broken Healthcare System by Sanjaya Kumar and David B. Nash. Copyright (c) 2011 by Sanjaya Kumar and David B. Nash. Excerpted with permission by Second River Healthcare Press.


http://www.scientificamerican.com/article/demand-better-health-care-book/
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2017-06-05 23:18:28 UTC
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THE BASIC LAWS OF HUMAN STUPIDITY
By Carlo M. Cipolla
illustrations by James Donnelly


http://harmful.cat-v.org/people/basic-laws-of-human-stupidity/


Table of contents
The first basic law of human stupidity
The second basic law
The third (and golden) basic law
Frequency distribution
The power of stupidity
The fourth basic law
The fifth basic law

The first basic law of human stupidity

The first basic law of human stupidity asserts without ambiguity that:

Always and inevitably everyone underestimates the number of stupid individuals in circulation.

At first, the statement sounds trivial, vague and horribly ungenerous. Closer scrutiny will however reveal its realistic veracity. No matter how high are one's estimates of human stupidity, one is repeatedly and recurrently startled by the fact that:


a) people whom one had once judged rational and intelligent turn out to be unashamedly stupid.

b) day after day, with unceasing monotony, one is harassed in one's activities by stupid individuals who appear suddenly and unexpectedly in the most inconvenient places and at the most improbable moments.

The First Basic Law prevents me from attributing a specific numerical value to the fraction of stupid people within the total population: any numerical estimate would turn out to be an underestimate. Thus in the following pages I will denote the fraction of stupid people within a population by the symbol σ.

The second basic law
Cultural trends now fashionable in the West favour an egalitarian approach to life. People like to think of human beings as the output of a perfectly engineered mass production machine. Geneticists and sociologists especially go out of their way to prove, with an impressive apparatus of scientific data and formulations that all men are naturally equal and if some are more equal than others, this is attributable to nurture and not to nature. I take an exception to this general view. It is my firm conviction, supported by years of observation and experimentation, that men are not equal, that some are stupid and others are not, and that the difference is determined by nature and not by cultural forces or factors. One is stupid in the same way one is red-haired; one belongs to the stupid set as one belongs to a blood group. A stupid man is born a stupid man by an act of Providence. Although convinced that fraction of human beings are stupid and that they are so because of genetic traits, I am not a reactionary trying to reintroduce surreptitiously class or race discrimination. I firmly believe that stupidity is an indiscriminate privilege of all human groups and is uniformly distributed according to a constant proportion. This fact is scientifically expressed by the Second Basic Law which states that

The probability that a certain person be stupid is independent of any other characteristic of that person.

In this regard, Nature seems indeed to have outdone herself. It is well known that Nature manages, rather mysteriously, to keep constant the relative frequency of certain natural phenomena. For instance, whether men proliferate at the Northern Pole or at the Equator, whether the matching couples are developed or underdeveloped, whether they are black, red, white or yellow the female to male ratio among the newly born is a constant, with a very slight prevalence of males. We do not know how Nature achieves this remarkable result but we know that in order to achieve it Nature must operate with large numbers. The most remarkable fact about the frequency of stupidity is that Nature succeeds in making this frequency equal to the probability quite independently from the size of the group.

Thus one finds the same percentage of stupid people whether one is considering very large groups or one is dealing with very small ones. No other set of observable phenomena offers such striking proof of the powers of Nature.

The evidence that education has nothing to do with the probability was provided by experiments carried on in a large number of universities all over the world. One may distinguish the composite population which constitutes a university in five major groups, namely the blue-collar workers, the white-collar employees, the students, the administrators and the professors.

Whenever I analyzed the blue-collar workers I found that the fraction σ of them were stupid. As σ's value was higher than I expected (First Law), paying my tribute to fashion I thought at first that segregation, poverty, lack of education were to be blamed. But moving up the social ladder I found that the same ratio was prevalent among the white-collar employees and among the students. More impressive still were the results among the professors. Whether I considered a large university or a small college, a famous institution or an obscure one, I found that the same fraction σ of the professors are stupid. So bewildered was I by the results, that I made a special point to extend my research to a specially selected group, to a real elite, the Nobel laureates. The result confirmed Nature's supreme powers: σ fraction of the Nobel laureates are stupid.

This idea was hard to accept and digest but too many experimental results proved its fundamental veracity. The Second Basic Law is an iron law, and it does not admit exceptions. The Women's Liberation Movement will support the Second Basic Law as it shows that stupid individuals are proportionately as numerous among men as among women. The underdeveloped of the Third World will probably take solace at the Second Basic Law as they can find in it the proof that after all the developed are not so developed. Whether the Second Basic Law is liked or not, however, its implications are frightening: the Law implies that whether you move in distinguished circles or you take refuge among the head-hunters of Polynesia, whether you lock yourself into a monastery or decide to spend the rest of your life in the company of beautiful and lascivious women, you always have to face the same percentage of stupid people - which percentage (in accordance with the First Law) will always surpass your expectations.

The third (and golden) basic law
The Third Basic Law assumes, although it does not state it explicitly, that human beings fall into four basic categories: the helpless, the intelligent, the bandit and the stupid. It will be easily recognized by the perspicacious reader that these four categories correspond to the four areas I, H, S, B, of the basic graph (see below).

Figure 1 - The basic graph
If Tom takes an action and suffers a loss while producing a gain to Dick, Tom's mark will fall in field H: Tom acted helplessly. If Tom takes an action by which he makes a gain while yielding a gain also to Dick, Tom's mark will fall in area I: Tom acted intelligently. If Tom takes an action by which he makes a gain causing Dick a loss, Tom's mark will fall in area B: Tom acted as a bandit. Stupidity is related to area S and to all positions on axis Y below point O. As the Third Basic Law explicitly clarifies:

A stupid person is a person who causes losses to another person or to a group of persons while himself deriving no gain and even possibly incurring losses.

When confronted for the first time with the Third Basic Law, rational people instinctively react with feelings of skepticism and incredulity. The fact is that reasonable people have difficulty in conceiving and understanding unreasonable behaviour. But let us abandon the lofty plane of theory and let us look pragmatically at our daily life. We all recollect occasions in which a fellow took an action which resulted in his gain and our loss: we had to deal with a bandit. We also recollect cases in which a fellow took an action which resulted in his loss and our gain: we had to deal with a helpless person. We can recollect cases in which a fellow took an action by which both parties gained: he was intelligent. Such cases do indeed occur. But upon thoughtful reflection you must admit that these are not the events which punctuate most frequently our daily life. Our daily life is mostly, made of cases in which we lose money and/or time and/or energy and/or appetite, cheerfulness and good health because of the improbable action of some preposterous creature who has nothing to gain and indeed gains nothing from causing us embarrassment, difficulties or harm. Nobody knows, understands or can possibly explain why that preposterous creature does what he does. In fact there is no explanation - or better there is only one explanation: the person in question is stupid.

Frequency distribution
Most people do not act consistently. Under certain circumstances a given person acts intelligently and under different circumstances the same person will act helplessly. The only important exception to the rule is represented by the stupid people who normally show a strong proclivity toward perfect consistency in all fields of human endeavours.

From all that proceeds, it does not follow, that we can chart on the basic graph only stupid individuals. We can calculate for each person his weighted average position in the plane of figure 1 quite independently from his degree of inconsistency. A helpless person may occasionally behave intelligently and on occasion he may perform a bandit's action. But since the person in question is fundamentally helpless most of his action will have the characteristics of helplessness. Thus the overall weighted average position of all the actions of such a person will place him in the H quadrant of the basic graph.

The fact that it is possible to place on the graph individuals instead of their actions allows some digression about the frequency of the bandit and stupid types.

The perfect bandit is one who, with his actions, causes to other individuals losses equal to his gains. The crudest type of banditry is theft. A person who robs you of 100 pounds without causing you an extra loss or harm is a perfect bandit: you lose 100 pounds, he gains 100 pounds. In the basic graph the perfect bandits would appear on a 45-degree diagonal line that divides the area B into two perfectly symmetrical sub-areas (line OM of figure 2).

Figure 2
However the "perfect" bandits are relatively few. The line OM divides the area B into two sub-areas, B1, and B2, and by far the largest majority of the bandits falls somewhere in one of these two sub-areas.

The bandits who fall in area B1 are those individuals whose actions yield to them profits which are larger than the losses they cause to other people. All bandits who are entitled to a position in area B1 are bandits with overtones of intelligence and as they get closer to the right side of the X axis they share more and more the characteristics of the intelligent person.

Unfortunately the individuals entitled to a position in the B1 area are not very numerous. Most bandits actually fall in area B2. The individuals who fall in this area are those whose actions yield to them gains inferior to the losses inflicted to other people. If someone kills you in order to rob you of fifty pounds or if he murders you in order to spend a weekend with your wife at Monte Carlo, we can be sure that he is not a perfect bandit. Even by using his values to measure his gains (but still using your values to measure your losses) he falls in the B2 area very close to the border of sheer stupidity. Generals who cause vast destruction and innumerable casualties in return for a promotion or a medal fall in the same area.

The frequency distribution of the stupid people is totally different from that of the bandit. While bandits are mostly scattered over an area stupid people are heavily concentrated along one line, specifically on the Y axis below point O. The reason for this is that by far the majority of stupid people are basically and unwaveringly stupid - in other words they perseveringly insist in causing harm and losses to other people without deriving any gain, whether positive or negative.

There are however people who by their improbable actions not only cause damages to other people but in addition hurt themselves. They are a sort of super-stupid who, in our system of accounting, will appear somewhere in the area S to the left of the Y axis.

The power of stupidity
It is not difficult to understand how social, political and institutional power enhances the damaging potential of a stupid person. But one still has to explain and understand what essentially it is that makes a stupid person dangerous to other people - in other words what constitutes the power of stupidity.

Essentially stupid people are dangerous and damaging because reasonable people find it difficult to imagine and understand unreasonable behaviour. An intelligent person may understand the logic of a bandit. The bandit's actions follow a pattern of rationality: nasty rationality, if you like, but still rationality. The bandit wants a plus on his account. Since he is not intelligent enough to devise ways of obtaining the plus as well as providing you with a plus, he will produce his plus by causing a minus to appear on your account. All this is bad, but it is rational and if you are rational you can predict it. You can foresee a bandit's actions, his nasty manoeuvres and ugly aspirations and often can build up your defenses.

With a stupid person all this is absolutely impossible as explained by the Third Basic Law. A stupid creature will harass you for no reason, for no advantage, without any plan or scheme and at the most improbable times and places. You have no rational way of telling if and when and how and why the stupid creature attacks. When confronted with a stupid individual you are completely at his mercy. Because the stupid person's actions do not conform to the rules of rationality, it follows that:

a) one is generally caught by surprise by the attack; b) even when one becomes aware of the attack, one cannot organize a rational defense, because the attack itself lacks any rational structure.

The fact that the activity and movements of a stupid creature are absolutely erratic and irrational not only makes defense problematic but it also makes any counter-attack extremely difficult - like trying to shoot at an object which is capable of the most improbable and unimaginable movements. This is what both Dickens and Schiller had in mind when the former stated that "with stupidity and sound digestion man may front much" and the latter wrote that "against stupidity the very Gods fight in vain."

The fourth basic law
That helpless people, namely those who in our accounting system fall into the H area, do not normally recognize how dangerous stupid people are, is not at all surprising. Their failure is just another expression of their helplessness. The truly amazing fact, however, is that also intelligent people and bandits often fail to recognize the power to damage inherent in stupidity. It is extremely difficult to explain why this should happen and one can only remark that when confronted with stupid individuals often intelligent men as well as bandits make the mistake of indulging in feelings of self-complacency and contemptuousness instead of immediately secreting adequate quantities of adrenaline and building up defenses.

One is tempted to believe that a stupid man will only do harm to himself but this is confusing stupidity with helplessness. On occasion one is tempted to associate oneself with a stupid individual in order to use him for one's own schemes. Such a manoeuvre cannot but have disastrous effects because a) it is based on a complete misunderstanding of the essential nature of stupidity and b) it gives the stupid person added scope for the exercise of his gifts. One may hope to outmanoeuvre the stupid and, up to a point, one may actually do so. But because of the erratic behaviour of the stupid, one cannot foresee all the stupid's actions and reactions and before long one will be pulverized by the unpredictable moves of the stupid partner.

This is clearly summarized in the Fourth Basic Law which states that:

Non-stupid people always underestimate the damaging power of stupid individuals. In particular non-stupid people constantly forget that at all times and places and under any circumstances to deal and/or associate with stupid people always turns out to be a costly mistake.

Through centuries and millennia, in public as in private life, countless individuals have failed to take account of the Fourth Basic Law and the failure has caused mankind incalculable losses.

The fifth basic law
Instead of considering the welfare of the individual let us consider the welfare of the society, regarded in this context as the algebraic sum of the individual conditions. A full understanding of the Fifth Basic Law is essential to the analysis. It may be parenthetically added here that of the Five Basic Laws, the Fifth is certainly the best known and its corollary is quoted very frequently. The Fifth Basic Law states that:

A stupid person is the most dangerous type of person.

The corollary of the Law is that:

A stupid person is more dangerous than a bandit.

The result of the action of a perfect bandit (the person who falls on line OM of figure 2) is purely and simply a transfer of wealth and/or welfare. After the action of a perfect bandit, the bandit has a plus on his account which plus is exactly equivalent to the minus he has caused to another person. The society as a whole is neither better nor worse off. If all members of a society were perfect bandits the society would remain stagnant but there would be no major disaster. The whole business would amount to massive transfers of wealth and welfare in favour of those who would take action. If all members of the society would take action in regular turns, not only the society as a whole but also individuals would find themselves in a perfectly steady state of no change.

When stupid people are at work, the story is totally different. Stupid people cause losses to other people with no counterpart of gains on their own account. Thus the society as a whole is impoverished. The system of accounting which finds expression in the basic graphs shows that while all actions of individuals falling to the right of the line POM (see fig. 3) add to the welfare of a society; although in different degrees, the actions of all individuals falling to the left of the same line POM cause a deterioration.

Figure 3
In other words the helpless with overtones of intelligence (area H1), the bandits with overtones of intelligence (area B1) and above all the intelligent (area I) all contribute, though in different degrees, to accrue to the welfare of a society. On the other hand the bandits with overtones of stupidity (area B2) and the helpless with overtones of stupidity (area H2) manage to add losses to those caused by stupid people thus enhancing the nefarious destructive power of the latter group.

All this suggests some reflection on the performance of societies. According to the Second Basic Law, the fraction of stupid people is a constant σ which is not affected by time, space, race, class or any other sociocultural or historical variable. It would be a profound mistake to believe the number of stupid people in a declining society is greater than in a developing society. Both such societies are plagued by the same percentage of stupid people. The difference between the two societies is that in the society which performs poorly:

a) the stupid members of the society are allowed by the other members to become more active and take more actions; b) there is a change in the composition of the non-stupid section with a relative decline of populations of areas I, H1 and B1 and a proportionate increase of populations H2 and B2.

This theoretical presumption is abundantly confirmed by an exhaustive analysis of historical cases. In fact the historical analysis allows us to reformulate the theoretical conclusions in a more factual way and with more realistic detail.

Whether one considers classical, or medieval, or modern or contemporary times one is impressed by the fact that any country moving uphill has its unavoidable σ fraction of stupid people. However the country moving uphill also has an unusually high fraction of intelligent people who manage to keep the σ fraction at bay and at the same time produce enough gains for themselves and the other members of the community to make progress a certainty.

In a country which is moving downhill, the fraction of stupid people is still equal to σ; however in the remaining population one notices among those in power an alarming proliferation of the bandits with overtones of stupidity (sub-area B2 of quadrant B in figure 3) and among those not in power an equally alarming growth in the number of helpless individuals (area H in basic graph, fig.1). Such change in the composition of the non-stupid population inevitably strengthens the destructive power of the σ fraction and makes decline a certainty. And the country goes to Hell.

There is genius at work in this thesis. It came round about by way of reader Sam Keen, who sent to the UK a thin gray monograph printed anonimously in mid-1986 in Bologna, Italy. The trail eventually led to Carlo M. Cipolla, the author, who was Professor of Economics at UC Berkeley but, alas died in 2000 and left behind a bunch of (half-american) offsprings... who promptly tried to scrap money out of everything he had written, even if -as in the case of this small text- clearly earmarked and STATED by the Author in its 1986 version as intended for the public domain (and yes, stated again in 1992, despite having re-published this text in 1988, slightly modified, in his "Allegro ma non troppo" copyrighted collection).

This copy comes from Whole Earth Review (Spring 1987 pp 2 - 7) and is anyway easy to find all over the web and/or on any webarchive facility à la "wayback machine".

There isn't of course, nor cannot be, any valid patent or bogus "copyright" on this work that Professor Cipolla personally WANTED to have in the public domain and incidentally BECAUSE OF ITS VERY OPEN SPREADING is the only one that has made -and still makes- him famous all over the web.

We firmly believe that this belongs into any reality cracker's quiver, and that the best onor to the Author and the best chance that anyone will "buy" his other texts (frankly also equally easy to find in many "grey" areas of Internet, but waay less interesting) is to allow this nice little essay to be spread around as originally clearly intended by Professor Cipolla himself.

@&@&@&@&@

cat-v.org footnote: This is a mirror of an article that was originally found at http://www.zoon.cc/stupid/ and subsequently mirrored at http://www.searchlores.org/realicra/basiclawsofhumanstupidity.htm
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http://harmful.cat-v.org/people/basic-laws-of-human-stupidity/
Bob Officer
2017-06-06 01:24:19 UTC
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Post by Clay
Post by Duncan
On Tue, 23 May 2017 03:51:52 +0000 (UTC), Bob Officer
Post by Bob Officer
http://www.medicaldaily.com/baby-dies-malnutrition-after-parents-put-him-alternative-gluten-free-diet-417525
"A seven month-old baby in Belgium died from malnutrition after his parents
put him on an alternative gluten-free diet despite no actual medical
diagnosis or recommendation. The child weighed only 9 pounds, about half
the size of an average child his age, and was extremely dehydrated. The
story brings to light just how dangerous alternative diets can be for very
young children."
And this happened where?
Did you read the story?
No she doesn't read anything and if she did read it she doesn't know how to
apply or use what she has read. She is functionally illiterate.
Post by Clay
Post by Duncan
Notice how bob has to scan the world to find negative alt-med stories?
And *that* discredits the story that an alterniative diet killed this
baby?
Actually I have a news clipping service. I just post the most disgusting
news and worst examples.

I found a person playing doctor that lives in Wales. He touting hot
lemonade as a treatment for COPD.
Lemonade will not have any effect on a person which has COPD.
--
Dunning's work explained in clear, concise and simple terms.
John Cleese on Stupidity
http://youtu.be/wvVPdyYeaQU
Stephen Fry on Dunning Kruger examples:
http://youtu.be/rW9R6jgE7SQ
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2017-06-09 17:48:08 UTC
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as close as stink on shit
(as) close as stink on shit
phr. very close; intimate; inseparable. In love? He’s as close to her as stink on shit.
See also: close, on, shit, stink

http://idioms.thefreedictionary.com/as+close+as+stink+on+shit



Birds of a feather flock together
Peeps with similar likes, appearance, or behavior hang together, as in a clique.


http://www.urbandictionary.com/define.php?term=Birds%20of%20a%20feather%20flock%20together&amp=true&defid=961047
Post by Clay
Post by Duncan
On Tue, 23 May 2017 03:51:52 +0000 (UTC), Bob Officer
Post by Bob Officer
http://www.medicaldaily.com/baby-dies-malnutrition-after-parents-put-him-alternative-gluten-free-diet-417525
"A seven month-old baby in Belgium died from malnutrition after his parents
put him on an alternative gluten-free diet despite no actual medical
diagnosis or recommendation. The child weighed only 9 pounds, about half
the size of an average child his age, and was extremely dehydrated. The
story brings to light just how dangerous alternative diets can be for very
young children."
And this happened where?
Did you read the story?
Post by Duncan
Notice how bob has to scan the world to find negative alt-med stories?
And *that* discredits the story that an alterniative diet killed this
baby?
⊙_⊙
2017-06-14 06:44:25 UTC
Reply
Permalink
Raw Message
Post by Clay
Post by Duncan
On Tue, 23 May 2017 03:51:52 +0000 (UTC), Bob Officer
Post by Bob Officer
http://www.medicaldaily.com/baby-dies-malnutrition-after-parents-put-him-alternative-gluten-free-diet-417525
"A seven month-old baby in Belgium died from malnutrition after his parents
put him on an alternative gluten-free diet despite no actual medical
diagnosis or recommendation. The child weighed only 9 pounds, about half
the size of an average child his age, and was extremely dehydrated. The
story brings to light just how dangerous alternative diets can be for very
young children."
And this happened where?
Did you read the story?
Post by Duncan
Notice how bob has to scan the world to find negative alt-med stories?
And *that* discredits the story that an alterniative diet killed this
baby?
I cannot even begin to express the honor and pride I feel just being near you and all the great work you do.”

*****

‘I Am Just So Privileged’: Watch Morning Joe Troll Trump’s ‘Sick’ Cabinet Meeting
by Jon Levine | 6:37 am, June 13th, 2017


Morning Joe kicked off their Tuesday show with a none-too-subtle note of mockery toward Donald Trump and the bizarre cabinet meeting he held yesterday in which his senior staff bent over backwards in offering him their praises.

Perennially embattled Chief of Staff, Reince Priebus sounded almost prayerful.

“Your hair looks great today, Joe,” offered show regular Mike Barnicle. “I’m so proud to be here with you.”

Ex-Congressman Harold Ford Jr. got in as well.

“Thank you again Joe and Mika for having us here. I cannot even begin to express the honor and pride I feel just being near you and all the great work you do.”

Even notoriously late-to-the-joke Steve Rattner had a go.

“I am just so privileged. So privileged.” He said.

“Blessed? Are you blessed” Scarborough offered.

“I am blessed. And you are fantastic. There has never been anyone in this job better than you are.”

Very funny kids — Of course, Scarborough quickly reverted back to form, explaining a unique dilemma he and Mika found themselves in.


“Mika and I right now are in a bit of a quandary,” he said. “We decided this weekend that we thought we had been a little too rough and a little too snarky. It got too personal and we needed to report more news and offer less harsh biting criticism.”

He continued.

“And with that in mind, and with that as a backdrop let me just say that was the most sick, shameful, pathetic, unamerican, autocratic display. I will tell you if I were ever in meeting and people did that to me, I would say shut up and I would fire you.”

Watch Above

[Image via screengrab]


http://www.mediaite.com/online/i-am-just-so-privileged-watch-morning-joe-troll-trumps-sick-cabinet-meeting/
Lu
2017-06-05 02:11:54 UTC
Reply
Permalink
Raw Message
Post by Duncan
On Tue, 23 May 2017 03:51:52 +0000 (UTC), Bob Officer
Post by Bob Officer
http://www.medicaldaily.com/baby-dies-malnutrition-after-parents-put-him-alt
ernative-gluten-free-diet-417525
"A seven month-old baby in Belgium died from malnutrition after his parents
put him on an alternative gluten-free diet despite no actual medical
diagnosis or recommendation. The child weighed only 9 pounds, about half
the size of an average child his age, and was extremely dehydrated. The
story brings to light just how dangerous alternative diets can be for very
young children."
And this happened where?
Notice how bob has to scan the world to find negative alt-med stories?
Copyright c/o Medical Daily120 Wall Street, 5th FloorNew York NY 10005Fax:
(646) 224 8146E-mail:info[at]medicaldaily.com (mailto:***@medicaldaily.com)
Bob Officer
2017-06-05 20:57:19 UTC
Reply
Permalink
Raw Message
Post by Duncan
On Tue, 23 May 2017 03:51:52 +0000 (UTC), Bob Officer
Post by Bob Officer
http://www.medicaldaily.com/baby-dies-malnutrition-after-parents-put-him-alt
ernative-gluten-free-diet-417525
"A seven month-old baby in Belgium died from malnutrition after his parents
put him on an alternative gluten-free diet despite no actual medical
diagnosis or recommendation. The child weighed only 9 pounds, about half
the size of an average child his age, and was extremely dehydrated. The
story brings to light just how dangerous alternative diets can be for very
young children."
And this happened where?
Notice how bob has to scan the world to find negative alt-med stories?
Does anyone recall the old compuserve (CIS) service called "news clipper".
It would scan the AP And other news wire services looking for stories by
key words. The CIS service was way before Google and the internet was
available to individuals.

Such clipping services are still available today. Some are better than
others. The best ones will get you get a brief summary and URL to the
stories. Nice way to keep up with things. Or just use a key word and Google
it under news.
--
Dunning's work explained in clear, concise and simple terms.
John Cleese on Stupidity
http://youtu.be/wvVPdyYeaQU
Stephen Fry on Dunning Kruger examples:
http://youtu.be/rW9R6jgE7SQ
Lu
2017-06-06 23:05:33 UTC
Reply
Permalink
Raw Message
Post by Bob Officer
Post by Duncan
On Tue, 23 May 2017 03:51:52 +0000 (UTC), Bob Officer
Post by Bob Officer
http://www.medicaldaily.com/baby-dies-malnutrition-after-parents-put-him-a
lt
ernative-gluten-free-diet-417525
"A seven month-old baby in Belgium died from malnutrition after his parents
put him on an alternative gluten-free diet despite no actual medical
diagnosis or recommendation. The child weighed only 9 pounds, about half
the size of an average child his age, and was extremely dehydrated. The
story brings to light just how dangerous alternative diets can be for very
young children."
And this happened where?
Notice how bob has to scan the world to find negative alt-med stories?
Does anyone recall the old compuserve (CIS) service called "news clipper".
It would scan the AP And other news wire services looking for stories by
key words. The CIS service was way before Google and the internet was
available to individuals.
I recall something about a job sitting there reading and clipping articles in
the papers for an insurance company. No, I did not do it. Too boring.
Post by Bob Officer
Such clipping services are still available today. Some are better than
others. The best ones will get you get a brief summary and URL to the
stories. Nice way to keep up with things. Or just use a key word and Google
it under news.
Bob Officer
2017-06-07 03:24:42 UTC
Reply
Permalink
Raw Message
Post by Lu
Post by Bob Officer
Post by Duncan
On Tue, 23 May 2017 03:51:52 +0000 (UTC), Bob Officer
Post by Bob Officer
http://www.medicaldaily.com/baby-dies-malnutrition-after-parents-put-him-a
lt
ernative-gluten-free-diet-417525
"A seven month-old baby in Belgium died from malnutrition after his parents
put him on an alternative gluten-free diet despite no actual medical
diagnosis or recommendation. The child weighed only 9 pounds, about half
the size of an average child his age, and was extremely dehydrated. The
story brings to light just how dangerous alternative diets can be for very
young children."
And this happened where?
Notice how bob has to scan the world to find negative alt-med stories?
Does anyone recall the old compuserve (CIS) service called "news clipper".
It would scan the AP And other news wire services looking for stories by
key words. The CIS service was way before Google and the internet was
available to individuals.
I recall something about a job sitting there reading and clipping articles in
the papers for an insurance company. No, I did not do it. Too boring.
Yep that the way it used to work. Once computers started becoming more
common, the clipping services improvement greatly.

I get a selection emails coving a dozen different subjects I am following.
Daily.
Post by Lu
Post by Bob Officer
Such clipping services are still available today. Some are better than
others. The best ones will get you get a brief summary and URL to the
stories. Nice way to keep up with things. Or just use a key word and Google
it under news.
--
Dunning's work explained in clear, concise and simple terms.
John Cleese on Stupidity
http://youtu.be/wvVPdyYeaQU
Stephen Fry on Dunning Kruger examples:
http://youtu.be/rW9R6jgE7SQ
Lu
2017-06-07 13:26:58 UTC
Reply
Permalink
Raw Message
Post by Bob Officer
Post by Lu
Post by Bob Officer
Post by Lu
Post by Duncan
On Tue, 23 May 2017 03:51:52 +0000 (UTC), Bob Officer
Post by Bob Officer
http://www.medicaldaily.com/baby-dies-malnutrition-after-parents-put-him
-a
lt
ernative-gluten-free-diet-417525
"A seven month-old baby in Belgium died from malnutrition after his
parents
put him on an alternative gluten-free diet despite no actual medical
diagnosis or recommendation. The child weighed only 9 pounds, about half
the size of an average child his age, and was extremely dehydrated. The
story brings to light just how dangerous alternative diets can be for
very
young children."
And this happened where?
Notice how bob has to scan the world to find negative alt-med stories?
(646) 224 8146E-mail:info[at]medicaldaily.com
Does anyone recall the old compuserve (CIS) service called "news clipper".
It would scan the AP And other news wire services looking for stories by
key words. The CIS service was way before Google and the internet was
available to individuals.
I recall something about a job sitting there reading and clipping articles in
the papers for an insurance company. No, I did not do it. Too boring.
Yep that the way it used to work. Once computers started becoming more
common, the clipping services improvement greatly.
I get a selection emails coving a dozen different subjects I am following.
Daily.
Post by Lu
Post by Bob Officer
Such clipping services are still available today. Some are better than
others. The best ones will get you get a brief summary and URL to the
stories. Nice way to keep up with things. Or just use a key word and Google
it under news.
A good way to do it. Guess the idiot was wrong when she stated that you had
to scan the world to find negative alternative med. stories. But then, they
are easy to find because alternative medicine is negative.
Bob Officer
2017-06-07 19:52:16 UTC
Reply
Permalink
Raw Message
Post by Lu
Post by Bob Officer
Post by Lu
Post by Bob Officer
Post by Lu
Post by Duncan
On Tue, 23 May 2017 03:51:52 +0000 (UTC), Bob Officer
Post by Bob Officer
http://www.medicaldaily.com/baby-dies-malnutrition-after-parents-put-him
-a
lt
ernative-gluten-free-diet-417525
"A seven month-old baby in Belgium died from malnutrition after his parents
put him on an alternative gluten-free diet despite no actual medical
diagnosis or recommendation. The child weighed only 9 pounds, about half
the size of an average child his age, and was extremely dehydrated. The
story brings to light just how dangerous alternative diets can be for very
young children."
And this happened where?
Notice how bob has to scan the world to find negative alt-med stories?
(646) 224 8146E-mail:info[at]medicaldaily.com
Does anyone recall the old compuserve (CIS) service called "news clipper".
It would scan the AP And other news wire services looking for stories by
key words. The CIS service was way before Google and the internet was
available to individuals.
I recall something about a job sitting there reading and clipping articles in
the papers for an insurance company. No, I did not do it. Too boring.
Yep that the way it used to work. Once computers started becoming more
common, the clipping services improvement greatly.
I get a selection emails coving a dozen different subjects I am following.
Daily.
Post by Lu
Post by Bob Officer
Such clipping services are still available today. Some are better than
others. The best ones will get you get a brief summary and URL to the
stories. Nice way to keep up with things. Or just use a key word and Google
it under news.
A good way to do it. Guess the idiot was wrong when she stated that you had
to scan the world to find negative alternative med. stories. But then, they
are easy to find because alternative medicine is negative.
Dead children make the news more often than dead adults.
--
Dunning's work explained in clear, concise and simple terms.
John Cleese on Stupidity
http://youtu.be/wvVPdyYeaQU
Stephen Fry on Dunning Kruger examples:
http://youtu.be/rW9R6jgE7SQ
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